Open Collections

UBC Faculty Research and Publications

Physical activity behaviours of Culturally and Linguistically Diverse (CALD) women living in Australia:… Caperchione, Cristina M; Kolt, Gregory S; Tennent, Rebeka; Mummery, W K Jan 11, 2011

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata


52383-12889_2010_Article_2746.pdf [ 244.11kB ]
JSON: 52383-1.0223981.json
JSON-LD: 52383-1.0223981-ld.json
RDF/XML (Pretty): 52383-1.0223981-rdf.xml
RDF/JSON: 52383-1.0223981-rdf.json
Turtle: 52383-1.0223981-turtle.txt
N-Triples: 52383-1.0223981-rdf-ntriples.txt
Original Record: 52383-1.0223981-source.json
Full Text

Full Text

RESEARCH ARTICLE Open AccessPhysical activity behaviours of Culturallyand Linguistically Diverse (CALD) womenliving in Australia: A qualitative study ofsocio-cultural influencesCristina M Caperchione1, Gregory S Kolt2*, Rebeka Tennent3, W Kerry Mummery4AbstractBackground: Australia continues to witness rising levels of immigration by individuals from Culturally andLinguistically Diverse (CALD) origins. With this rapidly growing diverse population, Australia faces a number ofpopulation health challenges. In particular, CALD women have been shown to be at an increased risk of chronicdiseases such as cardiovascular disease, diabetes, and poor mental health. Despite the high risk of these diseases,women from CALD groups are less likely to be proactive in accessing health care or undertaking preventativebehaviours, such as physical activity participation. The purpose of this study was to examine the socio-culturalinfluences on the physical activity behaviours of CALD women living in Australia by identifing the barriers,constraints and possible enablers to physical activity participation for this population.Methods: Twelve focus group sessions were undertaken with CALD women (N = 110) from Bosnian, Arabicspeaking, Filipino and Sudanese communities in three regions: New South Wales, Victoria, and Queensland. In asemi-structured, open table discussion, participants were encouraged to share their opinions, perceptions andbeliefs regarding socio-cultural influences on their physical activity behaviours. Common and ethnic-specific themesemerged from the discussions.Results: Common themes included: knowledge of physical activity, differing physical activity levels, and the effects ofpsychological and socio-cultural factors, environmental factors, and perceptions of ill-health and injury, on physical activitybehaviours. Ethnic-specific themes indicated that post-war trauma, religious beliefs and obligations, socio-economicstatus, social isolation and the acceptance of traditional cultural activities, greatly influenced the physical activitybehaviours of Bosnian, Arabic speaking, Filipino and Sudanese women living in communities throughout Australia.Conclusions: This study demonstrates that attitudes and understandings of health and wellbeing are complex, andhave a strong socio-cultural influence. The findings of the present study can be used not only to inform furtherhealth promotion initiatives, but also as a platform for further research with consumers of these services and withthose who deliver such services.BackgroundAustralia has witnessed a rapid increase in migration overthe past 10 years, with annual migrant numbers doublingas a proportion of the total population [1]. With thediversity of this growing population Australia faces anumber of population health challenges. Close examina-tion of epidemiological data reveals particular burdens ofdisease in women from Culturally and LinguisticallyDiverse (CALD) communities now living throughoutAustralia [2]. Moreover, there is a consensus among wes-tern countries, including Australia, New Zealand, UnitedKingdom, United States and Canada, that significantracial and ethnic disparities exist with regard to preva-lence, mortality, and morbidity, highlighting higher rates* Correspondence: of Biomedical and Health Sciences, University of Western Sydney,Sydney, AustraliaFull list of author information is available at the end of the articleCaperchione et al. BMC Public Health 2011, 11:26© 2011 Caperchione et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (, which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.of risk factors for a number of chronic diseases in thesewomen [3,4]. Of particular concern is the greater risk ofhypertension, diabetes, and overweight/obesity, all ofwhich are predominant risk factors to cardiovascular dis-ease (CVD) [4,5].Despite the high risk of these non-communicable dis-eases, women from CALD groups are less likely to beproactive in accessing health care or undertaking preven-tative measures to reduce risk of chronic disease [6,7]and ensure optimal health outcomes [8,9]. Physical activ-ity, which is operationally defined as any bodily move-ment produced by skeletal muscles that results in energyexpenditure [10], is a particular preventative measure inwhich women from CALD backgrounds are less likely toundertake then other non-CALD women [11,12]. Forinstance, CALD women born outside of Australia havereported a 20% less participation rate in sport and physi-cal activity in Australia compared to Australian bornwomen (46.3% in CALD women compared to 66.5% inAustralian born women) [12].For many CALD individuals there are several constraintson activity participation beyond personal motivation. Cul-tural barriers, socioeconomic factors, psychological traumarelating to migration, perceptions of ill health and injury,and alternate health seeking behaviours are just a few ofthe constraints that are likely to have a detrimental impacton health in these populations [13-16]. In an attempt tolimit these constraints and positively influence the physicalactivity behaviours of CALD women, it is necessaryto carefully consider cultural diversity whilst developingand planning health promotion (e.g., physical activity)resources and programs. The limited nature of research inthis area is evident [2,17,18]. Despite the significance ofthe work outlined above, there are a number of gaps inthe literature. Thus, the purpose of this study was to buildupon existing, yet limited research, and examine the socio-cultural influences on the physical activity behaviours ofCALD women living in Australia by identifing the barriers,constraints and possible enablers to physical activity parti-cipation for this population. Such information will supportthe development of culturally appropriate programsdesigned to positively influence the physical activity beha-viours of women from CALD populations [14,19].MethodsStudy ParticipantsThis study was conducted with CALD women living inthree Australian cities with the highest proportion ofCALD migrants: Sydney, New South Wales; Brisbane,Queensland; and Melbourne, Victoria [20]. Four distinctCALD groups were chosen as they were identified asbeing interested in participating, and were accessible tothe research team due to prior research linkages theresearchers had with organisations that providedservices for these groups. These included Bosnian,Arabic speaking (including women from Eygpt, Iraq,Syria, Jordan, Palestine, and Lebanon), Fillipino, andSudanense adult women (18 years+). A total of 110women participated in one of 12 focus group sessions,separated by CALD group. Mean age was 46.2 (SD ±11.6) years, with an age range of 18-87 years. Themajority of the women were married and had children.All participants were born outside of Australia and hadlived in Australia for an average of 12.4 years. Partici-pant characteristics are detailed in Table 1.Study Design and ProceduresThe proposed project is exploratory in nature and aims toexplore perceptions, attitudes, opinions, and beliefs con-cerning the physical activity behaviours of CALD women.With this intention, the researchers chose to utilise focusgroup research as a method of data collection. Focusgroup research is recognised as an exploratory researchTable 1 Demographic Characteristics of StudyParticipantsVariable Participants (N = 110)Age of each group (Mean ± SD)Filipino 55.7 (15.3)Sudanese 26.8 (7.0)Bosnian 63.0 (13.1)Arabic Speaking 39.1 (10.4)Cultural group (%)Filipino 28.2Sudanese 22.7Bosnian 22.7Arabic Speaking 26.4Years living in Australia (Mean ± SD)Filipino 18.2 (9.1)Sudanese 5.0 (2.4)Bosnian 14.8 (10.2)Arabic Speaking 11.6 (9.8)Marital Status (%)Married 81.0Divorced 2.0Widowed 7.0Not married 10.0Total those with children (%) 86.0Children per woman (Mean ± SD)Filipino 3.1 (1.7)Sudanese 1.7 (1.1)Bosnian 2.5 (1.1)Arabic Speaking 3.1 (1.4)Caperchione et al. BMC Public Health 2011, 11:26 2 of 10method that best draws upon respondents’ attitudes, feel-ings, beliefs, experiences and reactions in a way in whichwould not be feasible using other methods, for example,one-to-one interviewing [21]. These attitudes, feelings andbeliefs may be partially independent of a group or its socialsetting, but are more likely to be revealed via the socialgathering and the interaction which being in a focus groupentails.With assistance from community partners in each ofthe three cities, CALD women were recruited to takepart in focus group sessions between April and July,2009. CALD women who were clients, accessed services,or who were somehow associated with each communitypartner organisation were contacted by phone, email orin person by a community health worker or project offi-cer from each partner organisation. These partnershipswere a crucial aspect of the overall project as each part-ner provided comprehensive knowledge and advice per-taining to the different CALD groups, as well as playinga lead role in recruiting participants. Each of these com-munity partners are not-for-profit organisations fundedby different arms of their own state government ( services, immigration services). These communitypartners represent the interests of the many CALDgroups throughout New South Wales, Queensland, andVictoria, particularly focusing on such matters as healthpromotion, cultural diversity and health, cultural compe-tence, language services, cross cultural communication,health assessment and consumer participation.A total of 125 potential participants were contactedand invited to participate in the focus group sessions.Initially, all 125 invited participants agreed to take partin the project, however only 110 participants attendedeach of their CALD specific focus groups. Participantswho did not attend the groups (N = 15) indicated thatthey had either forgotten about the focus group sessionor had an unplanned matter that they had to attend to.Researchers from the project team undertook four focusgroup sessions (one representing each of the four CALDgroups) in each of the three cities (total of 12 focusgroups). These included Bosnian (N = 25), Arabicspeaking (N = 29), Fillipino (N = 31), and (4) Sudanense(N = 25) women. Participation was voluntary, howeverall participants were given a $40 honorarium to assistwith transport and childcare costs for the duration oftheir focus group session.The principal researcher (CC) acted as the moderator,guiding the discussion and providing assistance whereneeded, whilst a second researcher (RT) took notes andwas responsible for the audio recording of each session.A translator/interpreter was used during four focusgroup sessions (one Arabic group and all three Bosniangroups) to accommodate CALD group participants whospoke minimal or no English. Although these sessionsdid take longer to complete, the researchers felt thatthese sessions flowed well and were not disrupted bythe language barrier. All other sessions were held inEnglish at the request of the group members. Focusgroups were held at a central location convenient forparticipants and ranged from 45-90 minutes in duration.During this time participants were encouraged to sharetheir opinions, perceptions and beliefs regarding the bar-riers and enablers to women’s physical activity, in asemi-structured, open table discussion.Questions in the focus group schedule were guided bythe objectives of the project and based on previous lit-erature concerning the physical activity and health beha-viours of women [7] and CALD populations [9]. As well,the focus group schedule was informed by questionsused in previous studies by members of the researchteam [22-24]. Questions were open-ended in order toencourage a range of responses, and probes and clarify-ing questions were used to stimulate further discussion.For example, to uncover some of the barriers andmotives to physical activity participation in CALDgroups, participants were asked ‘Can you tell me someof the reasons why you and other people from yourcommunity might not participate in physical activity?’and ‘What are some of the things and/or reasons thatwould motivate you to regularly participate in physicalactivity?’.Data Management and AnalysisFollowing each of the sessions the data were profession-ally transcribed verbatim. QSR NVivo qualitative analy-sis software (QSR International Pty Ltd, Melbourne,Australia) was used to organise and manage the data.Using an inductive approach, data analysis focused oneliciting themes concerning barriers and enablers towomen’s physical activity participation. Research teammembers systematically read the transcripts multipletimes, highlighted segments of interest and made anno-tated comments on the transcripts to identify potentialthemes. Emerging themes were summarised and cate-gorised during the process of reading and rereading.Structural corroboration, where segments of data vali-dated each other, was performed by noting emergingdescriptors, issues and concerns in each transcript [25].Members of the research team reached consensus con-cerning emerging themes and categories through a pro-cess of ongoing discussion to mutually resolve anydiscrepancies or concerns with analysis. Final themesand categories were identified by the researchers andare summarised in the results section below.Ethical approval was obtained from the CentralQueensland University’s Human Research Ethics Com-mittee. The standard university guidelines of informedconsent, voluntary participation, confidentiality, andCaperchione et al. BMC Public Health 2011, 11:26 3 of 10anonymity were rigorously followed. All participantsgave written and verbal informed consent prior to eachfocus group session.ResultsThe themes identified are reported in two ways: first,the themes common to all CALD groups are reported,and second, those relevant to specific CALD groups arediscussed.Common themesKnowledge and Awareness of Physical ActivityThe responses from most participants indicated that theysaw physical activity in the broad context that covered arange of activities usually aligned with Western interpre-tation of physical activity. Participants were also able todistinguish between moderate and vigorous physicalactivity. This is demonstrated by, physical activities suchas walking, gardening and stretching being suggested byparticipants as examples of ‘moderate physical activity’,whilst participants tended to refer to ‘sport’ as vigorousexercise (defined as a subset of physical activity that isplanned, structured, and repetitive and has a final orintermediate objective, the improvement or maintenanceof physical fitness [10]). This included activities such asjogging and swimming. Most participants described dailyactivities such as sweeping, vacuuming and washingclothes as physical activities, however a small number ofparticipants were unsure whether such incidental activ-ities were considered as physical activities. These partici-pants suggested that such home duties were traditionallyjust part of the normal day, indicating thatHousework is just working everyday, I would not sayit is sport or exercise, I feel we have to make specialexercises for our bodies. (Filipino participant)Although some of the participants engaged in leisure orrecreational type physical activity, most of the physicalactivity undertaken by participants originated from dailyincidental activity or walking for transport. Furthermore,when discussing physical activity the majority of partici-pants used the terms physical activity and exercise inter-changeably, suggesting that they were not clear on howeach differed from one another.Levels of Physical Activity Change Upon MigrationIn general, participants were more active in their coun-try of origin than in Australia due to the more physicalnature of everyday life. For example, many suggestedthat in their birth country there was less reliance oncars; water was derived through water pumps locatedsome distance from the home; homes had bare floorsthat required sweeping daily; and there was less accessto labour saving devices such as vacuum cleaners andwashing machines. One respondent summarised thewords of many:In Egypt it was completely different. What I saw isthat they all live in apartments, so they all take thestairs up and down. There’s barely any lifts. And ifthere are lifts they don’t normally work. They walk tothe markets. Not many people have cars so they walkeverywhere. Even if they take the bus, they walkaround the shopping centres cause most of them arenot malls. They’re outside shopping centres and youwalk from store to store. (Arabic speaking participant)Psychological and Socio-cultural FactorsThe vast majority of participants indicated that familycommitments frequently prevented them from under-taking physical activity. Most undertook the bulk of thedomestic duties; this was suggested to be the culturalnorm for each of the groups. The following quote reso-nates with the majority of responses:Everyone has different lives. Sometimes I have to startwork at 8:30. I leave so early for the traffic. Then Ifinish 3:30, 4:00, and when I reach home I have tocook for my family. After dinner we have to clean up,get ready for bed, for the next day. Tell me when Iam going to do exercise. (Bosnian respondent)While several participants indicated that having youngchildren led them to undertake more physical activity,such as dancing and walking, no participants linked phy-sical activity to their own health or the health of theirfamily. Participants understood that being physicallyactive was beneficial for health and wellbeing, yet theydid not recognise it as a important daily necessity, butrather a luxury.Environmental FactorsSafety was a key concern for the women as many livedin areas with higher than average crime rates and thusfound it difficult to feel safe and at ease in their newcountry. In most cases, women would only undertakephysical activity outside of the home during daylighthours. In a couple of cases, women reported havingbeen followed by strangers:I always set aside the time for me to walk in themorning but then one time I was walking, there wassomebody who stopped his car near me and followedme. I didn’t go walking any more after that. (Filipinorespondent)Most participants acknowledged that physical activitycould be undertaken in and around the home for free;however they were less likely to be motivated withoutthe support of a group.Caperchione et al. BMC Public Health 2011, 11:26 4 of 10A further problem was in knowing where to accessinformation about community activities, assuming thatprograms did exist. Many of the participants were una-ware if any physical activity initiatives actually existed intheir local community, and if they were aware of them,many did not know where or how to access such pro-grams or initiatives.Perceptions of Ill-Health and InjuryThe health concerns of participants were both a motivatorand a limitation to participating in physical activity. Someparticipants commenced new and different physical activ-ities due to medical concerns. In this regard, health“scares” was often a motivating factor for increasing physi-cal activity. Conversely, participants indicated that toomuch physical activity could create perceived health con-cerns such as injury, tiredness and soreness. As onerespondent said, “My mother told me, remember youruterus will drop if you do physical activity” (Filipinorespondent). Yet others were limited in the physical activ-ity they could undertake due to illnesses. For example:I have problems in my cervix, so I feel restricted tothe kind of exercise I can handle... I used to love toswim but I started to get cramps so now I panicwhen I am swimming. (Arabic speaking respondent)Many of the participants were unclear as to what con-stitutes health, and/or had different understandings ofthe association between health and physical activity. Forexample, one respondent explained that weight lossassociated with being physically active was considerednegative; it was understood that being overweight was asign of health, prosperity and happiness.In Africa we have this belief, the bigger you are thebetter. You are rich, you are happy and healthy. Youare skinny they think you are sick. I think someoneskinny in Africa has AIDS. (Sudanese respondent)Different understandings of health and the associationbetween health and physical activity were commonamongst the majority of the CALD groups.Ethnic-specific themesBosnianMost of the women in this group were suffering frompost-war trauma, and suggested that in general, theywere not coping with life well in Australia. This had ledto lack of motivation for physical activity, as well asexperiences of depression, stress and overeating. In thewords of one respondent:I just think one of the main points is that we haveabnormal circumstances (due to post-war stress andpost-war trauma). We are not coping good now. Even ifwe are the same age, a 50 year old woman in Bosniaand a 50 year old woman in Australia is not the same.Our circumstances have made us more depressed [thanAustralian women]. If you are depressed you are notable to socialise. If you are not able to socialise you areeating more. (Bosnian respondent)Nonetheless, for several participants trauma wasreported to be a motivator for physical activity, on thebasis that they believed physical activity to promotepsychological wellbeing.By comparison to the Arabic speaking group, whichsimilarly comprised a majority of Muslim women, theBosnian participants suggested that being physicallyactive was a religious obligation, although all concededthat they needed to do more physical activity. Religiousadherence was not considered to bring about any bar-riers to physical activity. In fact, this group consideredprayer to be a form of physical activity.Arabic-speakingA key theme for Arabic-speaking women was findingthe time to be physically active. This group suggestedthey had less time for physical activity due to largerthan average family sizes and cultural norms thatrequired the bulk of normal domestic duties, includingcooking, cleaning and child care, to be undertaken bywomen. This was assumed regardless of externalemployment. One respondent summarised the experi-ences of many:In our culture men usually do nothing at home.Women do the cooking and the cleaning, even if theywork. If they want to do something they don’t havethe chance. (Arabic speaking respondent)The need for public modesty for women was alsoidentified as a barrier to physical activity outside of thehome. For this reason, the group stipulated the need forformal indoor facilities where activities such as swim-ming and gym activities could be undertaken in the pre-sence of women only:If we would like to go to the gym then we have tomention the person there, there is no men to goinside. That’s a bit of problem for us. You have totrust the people there, because it’s our religion. It’svery hard.Many women suggested that local indoor pools withwomen-only times would be useful. With a strong cul-tural emphasis on family, the ideal facility for this groupwas an internally-segregated centre where men, womenand children could attend at the same time. It wasCaperchione et al. BMC Public Health 2011, 11:26 5 of 10thought that this type of facility would be beneficial inpromoting increased physical activity.FilipinoSocio-economic status played an important role in deter-mining changes in physical activity upon migration forthose born in the Philippines. Those with government orother office jobs in the Philippines were more likely tohave similar levels of physical activity before and aftermigration. For example, these participants tended to useprivate transport in the Philippines, visit a gym for physi-cal activity and have less-laborious domestic duties.Other Filipino women suggested that migration resultedin significantly different lifestyles, undertaking less physi-cal activity due to increased reliance on private transport,domestic labour saving devices and in-house access towater. Participants also suggested that those who lived inrural areas tended to be more active than those living incities; this impacted upon changes in physical activityafter migration to Australia. A small number of partici-pants said they were more physically active in Australiathan they were in the Philippines because they walkedmore in Australia. Similar to other CALD groups, a keyissue was lack of time to partake in physical activities.One respondent highlighted this problem:In Australia, we don’t have any help at all. In ourcountry, we have our relatives, like brother or sisteror nephews or nieces to look after the kids while wecan have time a little bit to ourselves to relax. But inhere you tend to do everything and as they said, it’smore kind of a stressful way financially and physi-cally. (Filipino respondent)SudaneseSudanese women in this study reported childcare andother home duties as significant barriers to undertakingmore physical activity. Many lacked support of familyand friends in Australia, and suggested they weresocially isolated.A lack of understanding within Australia of Sudanesecultural norms also played a role in preventing Sudanesewomen from being active. The women mentioned thatthey were reluctant to undertake common forms of phy-sical activity, due to these misunderstandings. For exam-ple, these women outlined how they would normallycarry their children tied onto their backs (as a physicalactivity) to help maintain their strength, but had beenprevented from doing so in Australia. Specifically, onewoman recalled a time where a friend was questionedby local police officers while undertaking such an activ-ity in her own neighbourhood.In Sudan we used to carry our child [on our back].Every woman have a child, put child [on the back]and run... But my friend [here in Australia], she tiedher kid on with a rock pile and she got in troublewith the cops. They thought she was trying to stealher child. Now we don’t have this way to carry. Soless exercise. (Sudanese respondent)Similar to the Bosnian women, barriers to physicalactivity were also psychological in nature; many partici-pants had migrated to Australia as the result of war inSudan, and this led to stress and a lack of motivationfor physical activity. As one respondent highlighted:Such things are traumatic... it helps with issues ofstress but when you’re tired and stressed, you’re lazy.I know that when you run, you release that stress...DiscussionThis study revealed a number of common and ethnic-specific themes concerning the physical activitybehaviours of Bosnian, Arabic speaking, Filipino andSudanese women. With regards to common themes,most participants described what physical activity waswithin a broad context (and in line with a Westerninterpretation), and were able to distinguish betweenmoderate and vigorous intensity physical activity. This islargely inconsistent with previous research which hasindicated that the use of these modifiers (moderate, vig-orous) are commonly misunderstood by the mainstreamwhite culture and further complicated when culture andlanguage translations are considered [26]. A clear under-standing of what physical activity is and how much isgood for you may be influenced by the increase in pub-lic health messages regarding recommended levels andintensities of physical activity.When discussing physical activity levels at the pre-sent time and prior to migration to Australia, themajority of participants indicated that they were muchmore active in their country of origin due to the morelabour-intensive nature of daily life. These responseswere consistent with what researchers have labelledthe ‘healthy immigrant effect’. A ‘healthy immigranteffect’ exists where migrants are in generally very goodhealth on arrival to a western country, however, thiscondition changes with increased time since migration,and is associated with acculturation, defined aschanges in cultural patterns when groups of individualsfrom different cultures come into first-hand continu-ous contact with each other [27-29]. Acculturation isoften associated with detrimental behaviours such asthe consumption of high fat, calorie dense diets andphysical inactivity [30]. It has been suggested that aneducational component should be a major part of anyhealth promotion initiative, paying close attention tocultural differences pertaining to the interpretation,and benefits of, physical activity [31].Caperchione et al. BMC Public Health 2011, 11:26 6 of 10The majority of participants indicated that familycommitments, in particular childcare and domestichome duties, such as preparing meals and cleaning thehome, prevented them from being physically active.This is a common theme between both CALD womenand Australian born women who have indicated thatfinding time to be active outside of their family duties isa major barrier [31,32]. It has been suggested that com-peting demands may only be constraints for organisedactivities that require women to attend activity sessionsat a specific time and place [33,34]. Encouragingwomen to engage in physical activities that fit into thecontext of their daily lives may help to overcome thisbarrier [31].Environmental factors such as safety concerns andaccess to programs and facilities were reported as com-mon barriers to physical activity for CALD women.Structural environmental changes (e.g. improved lighting,well maintained footpaths, access to indoor facilities, etc.)have been reported as a way to overcome safety issues aswell as assist with facility accessibility. In addition, offer-ing programs and facilities in the heart of these localneighbourhoods will increase program awareness andallow for these facilities to be easily accessed. This hasbecome a common practice in the United Kingdom inwhich local health organisations and centres have set up‘health action zones’ in deprived communities wheremany CALD communities reside [35]. These ‘healthaction zones’ provide health care resources and differenthealth promotion initiatives in an area of the communityin which the majority of community members can walkto. Similar zones should be considered in specific suburbsof Sydney, Melbourne and Brisbane, and other areaswhich are heavily populated by CALD communities.Ill health and injury was both a motivator and barrierto participants’ physical activity engagement. Consistentwith the Health Belief Model [36], some participantsperceived their ill health to be at a level of severity thatrequired action, while others were fearful of being sus-ceptible to disease due to an unhealthy lifestyle. Whenthe risk of disease, and possibly death, is described as aconsequence of physical inactivity and an unhealthy life-style, women in particular are motivated to change theirlifestyle behaviours when they realise the benefits ofdoing so [37]. This is synonymous with the findings ofthe current study, with a number of older participantsmaking changes to their lifestyle behaviours by attempt-ing to be more physically active and making healthierdiet choices.Ill health and injury also acted as a barrier to physicalactivity for many participants. Specific to CALD popula-tions, perceptions of ill health and injury associated withbeing physically inactive may be related to differentunderstandings and/or misunderstandings of physicalactivity and its’ benefits. For instance, previous researchhas reported that many Arabic speaking groups per-ceived sweating, increased heart rate, and breathlessnessas illness states rather than ‘normal’ by-products of phy-sical activity [14]. Similarly, many of the participants inour study also associated physical activity with healthconcerns such as injury, tiredness and soreness.Although these different understandings may be con-flicting with the health and physical activity messagestraditionally promoted in Australia, they are not neces-sarily incorrect or inappropriate. It is essential thathealth professionals are sensitive to the different under-standings and perceptions that some CALD groups mayhave regarding health and physical activity, as manyCALD groups believe that their understanding of physi-cal activity and health is both culturally appropriate andlegitimate.In addition to the common themes outlined above,there were also a number of ethnic specific themesrevealed by each of the four groups. For example,Bosnian women highlighted the detrimental effect of theexperiences of war, indicating that depression and stressare common symptoms of post-war trauma, and thatthese psychological states limit their motivation to beactive. Post-war trauma and the effect it has on health,has commonly been associated with migrant populationsand those entering a new country as a refugee [38,39]. Incontrast, some women felt that being active promotedtheir psychological well-being. Cultural competence andsensitivity is essential in these circumstances, however, itis necessary that health professionals establish the linkbetween trauma and health and wellbeing for these popu-lations, and clearly outline the psychological and physicalbenefits associated with preventive health measures suchas physical activity. Additionally, Bosnian women alsorecognised prayer as a form of physical activity due tothe up and down movements and rising and lowering ofarms during each visit to temple. It may be useful to alsobuild awareness around the physical benefits that may beassociated with this religious practice.Arabic speaking participants indicated that publicmodesty was a barrier to engaging in physical activityoutside of their home due to their religious beliefs andpractices. Many women of Muslim faith interpret scrip-tures of the Qur’an as prohibiting physical activity parti-cipation [40], as this is seen to conflict with their familyresponsibilities [14]. These women feel underpinned bytheir ‘ethic of care’ to their children and other familymembers and believe that taking time out for them-selves to engage in physical activities would signify thatthey were neglecting their role of mother and familycaregiver [41,42]. Developing programs in an environ-ment that is mother-child friendly, where motherscan participate in activities with their children, wouldCaperchione et al. BMC Public Health 2011, 11:26 7 of 10provide mothers with the opportunity to benefitfrom physical activity while still upholding their ‘ethic ofcare’ [41].Furthermore, cultural modesty in the form of accepta-ble dress was also a barrier for these women. Thus,appropriate adjustments may need to be made to activ-ities, activity facilities and activity session times, creatingsuitable alternatives for these women that will allowthem to either participate in their cultural dress or in anenvironment which is appropriate if they are not intheir traditional dress. Recommendations such as hold-ing women-only classes and maintaining closed off sec-tions of the gym or facility for women only should beconsidered as ways to address these barriers. However,these are only short term solutions. For long termeffects, health professionals must work towards empow-ering these women by placing them at the centre of pro-gram development and encouraging them to take leadroles in development and implementation throughouttheir own communities so they can make changes,develop programs and embark on new initiatives thatare meaningful and suitable to them and other membersof their CALD group [18,43].Surprisingly, the Filipino women were the only partici-pants that indicated that changes in socioeconomic statusupon migration to Australia limited them from being asactive as they were when living in the Philippines. Theydescribe how in the Philippines many of them had rela-tives to help with childminding as well as housekeepersto deal with domestic duties such as cleaning and prepar-ing meals. Now living in Australia, these women havegreater financial restrictions and no longer have theluxury of this type of support. However, many of thewomen indicated that they had close relationships withother Filipino women in their community, thus it may beworthwhile exploring the possibility of shared childmind-ing and alternate participation times amongst thewomen. It may also be worthwhile to explore alternativemodes of physical activity such as occupational physicalactivity [44] for these women, given that many of themwork fulltime. Research has revealed a numbers of waysin which physical activity can be incorporated into aworking day, including lunchtime walks, using the stairsinstead of the lifts, and organising physical activity teamchallenges with other workmates [42,45,46].Lack of social support and social isolation were speci-fically reported by the Sudanese women. Commonlyrevealed as a barrier in many CALD groups [31],researchers have reiterated the importance of developinga social network both within the same culture, and withthose from other cultures [47,48]. Furthermore, under-taking group physical activity with others from yoursocial network, or joining a physical activity group withnew members, has been reported to positively influencephysical activity behaviours, while providing motiva-tional and emotional support and addressing social iso-lation [49,50]. This strategy may be particularly useful inthe initial stages of migration and resettlement, wheresocial isolation is most evident [51].The Sudanese women also indicated that due to a lackof understanding within Australia of specific Sudanesecultural activities, they were reluctant to engage in suchtraditional activities. This resonates with previousresearch suggesting that a lack of self-efficacy can restrictwomen from being physically active [33,52], and high-lights the importance in promoting and encouragingactivities in which CALD communities have mastered,enjoy undertaking and feel comfortable performing.Adapting new and unique strategies and initiatives is anasset to promoting physical activity amongst CALDpopulations. Again, this highlights the importance of cul-tural competence, sensitivity and the acknowledgementof cultural diversity [18,43]. Additionally, Sudanesewomen and health professionals should work together todevelop new initiatives which include undertaking physi-cal activity with their children. These activities couldincorporate the traditional activities they once undertookwith their children in Sudan and new initiatives theyhave learnt since migrating to Australia. This may alsoopen the door to an integrated mother-child programwhich would include Sudanese participants as well aswomen and children from different cultures, includingAustralian-born participants. This type of program wouldpromote physical activity for mothers and their childrenas well as provide an outlet for social engagement.Strengths and LimitationsA major strength of this study is the sample size anddiversity, which included women from four differentCALD groups. More importantly, our study includedthree focus groups for each of the four CALD groups(Bosnian, Arabic speaking, Filipino, Sudanese), allowingfor a more in-depth examination of the topic or area ofstudy. As a standard protocol for focus group research,it is recommended that three focus groups for eachgroup represented is conducted in order to reach datasaturatation and provide a deeper understanding of theissues or topic [13,53]. However, it is important to notethat the participants in this study are not consideredrepresentative of all adults in their CALD group.Although this study has made a significant contributionto the literature pertaining to physical activity in CALDgroups throughout Australia, the inclusion of only fourdifferent CALD groups also becomes a limitation as thereare a significant number of other CALD groups inAustralia. Given that CALD groups vary in many respects(e.g. culture, religion, language, socioeconomic status, edu-cation, employment, etc.) future research should extend toCaperchione et al. BMC Public Health 2011, 11:26 8 of 10other CALD groups. Furthermore, the sample was limitedto CALD women living in Sydney, Melbourne, andBrisbane. Although, it has been documented that the capi-tal cities and surrounding areas of these states have thegreatest porportion of CALD populations [20], there areother areas in South Australia, Western Australia and par-ticular rural areas of Australia which are witnessing arapid growth in CALD populations through internationaland inter-state migration [20]. Future research shouldfocus on large representative sampling, throughout allstates in Australia to clearly establish a national profileregarding the physical activity behaviours of CALD popu-lations, as well as provide a comparison of similarities anddifferences across multiple sites and multiple CALDgroups. This sampling should include more of the existinggroups used in this study (Bosnian, Arabic speaking,Filipino, Sudanese), a variety of other CALD groups,groups including both CALD men and women, andgroups including CALD individuals from varying agegroups. This sampling could also be extended to CALDgroups from other countries, providing camparative dataon an international level.ConclusionsThe over-arching purpose of this study was to examinethe socio-cultural influences on the physical activitybehaviours of CALD women living in Australia by iden-tifing the barriers, constraints and possible enablers tophysical activity participation for this population. Com-mon themes emerged from the data, however it is theethnic-specific themes that have made a significant con-tribution to the research literature. Ethnic-specificthemes indicated that post-war trauma, religious beliefsand obligations, socio-economic status, social isolationand the acceptance of traditional cultural activities,greatly influenced the physical activity behaviours ofBosnian, Arabic speaking, Filipino and Sudanese womenliving in communities throughout Australia. Implicationsfor future research and practice can be drawn fromthese findings.AcknowledgementsThis study was funded by a CQ University Merit Grant. The authors wouldlike to thank the CALD women who contributed their time and commentsto this research study.Author details1Faculty of Health and Social Development, University of British Columbia,Kelowna, Canada. 2School of Biomedical and Health Sciences, University ofWestern Sydney, Sydney, Australia. 3Research School of Social Sciences, TheAustralian National University, Canberra, Australia. 4Faculty of PhysicalEducation and Recreation, University of Alberta, Edmonton, Canada.Authors’ contributionsCMC was a Chief Investigator on the study. She designed the study,collected and analysed data, wrote the first draft of the paper and lead thecritical review and revision of the paper. GSK was a Chief Investigator on thestudy. He contributed to the study design, interpretation of the data, andreview of the paper. RT was the study researcher. She assisted with thecollection and analysis of data, and contributed to the drafting and criticalreviewing of the paper. WKM was also a Chief Investigator on the study. Hecontributed to the study design, interpretation of data, and review of thepaper. All authors have read and approved the final manuscript.Declaration of Competing interestsThe authors declare that they have no competing interests.Received: 31 August 2010 Accepted: 11 January 2011Published: 11 January 2011References1. Australian Department of Immigration and Citizenship: AustralianImmigration Fact Sheet 2. Key Facts in Immigration Canberra, ACT:Department of Immigration and Citizenship; 2009.2. Adily A, Ward J: Improving health among culturally diverse subgroups:an exploration of trade-offs and viewpoints among a regionalpopulation health workforce. Health Promot J Austr 2005, 16:207-212.3. Davidson PM, Daly J, Hancock K, Jackson D: Australian women and heartdisease: trends, epidemiological perspectives and the need for aculturally competent research agenda. Contemp Nurse 2003, 16:62-73.4. Johnson PA, Fulp RS: Racial and ethnic disparities in coronary heartdisease in women: prevention, treatment, and needed interventions.Womens Health Issues 2002, 12:252-271.5. Torpy JM, Lynm C, Glass RM: JAMA patient page. Risk factors for heartdisease. JAMA 2003, 290:980.6. Bauman AE: Updating the evidence that physical activity is good forhealth: an epidemiological review 2000-2003. J Sci Med Sport 2004, 7(1Suppl):6-19.7. Brown WJ, Burton NW, Rowan PJ: Updating the evidence on physicalactivity and health in women. Am J Prev Med 2007, 33:404-411.8. Gettleman L, Winkleby MA: Using focus groups to develop a heartdisease prevention program for ethnically diverse, low-income women. JCommunity Health 2000, 25:439-453.9. Caperchione CM, Kolt GS, Mummery WK: Physical activity in culturally andlinguistically diverse migrant groups to Western society: a review ofbarriers, enablers and experiences. Sports Med 2009, 39:167-177.10. Caspersen CJ, Powell KE, Christenson GM: Physical activity, exercise, andphysical fitness: definitions and distinctions for health-related research.Public Health Rep 1985, 100:126-131.11. Walseth K, Fasting K: Islam’s view on physical activity and sport: Egyptianwomen interpreting Islam. Int Rev Soc Sport 2003, 38:45-60.12. Australian Bureau of Statistics: Migrants and participation in sport andphysical activity 2006 Canberra, ACT: National Centre for Culture andRecreation Statistics; 2006.13. Belza B, Walwick J, Shiu-Thornton S, Schwartz S, Taylor M, LoGerfo J: Olderadult perspectives on physical activity and exercise: voices frommultiple cultures. Prev Chronic Dis 2004, 1:A09.14. Lawton J, Ahmad N, Hanna L, Douglas M, Hallowell N: ’I can’t do anyserious exercise’: barriers to physical activity amongst people ofPakistani and Indian origin with Type 2 diabetes. Health Educ Res 2006,21:43-54.15. Bird SR, Radermacher H, Sims J, Feldman S, Browning C, Thomas S: Factorsaffecting walking activity of older people from culturally diverse groups:an Australian experience. J Sci Med Sport 13:417-423.16. Bird S, Kurowski W, Feldman S, Browning C, Lau R, Radermacher H,Thomas S, Sims J: The influence of the built environment and otherfactors on the physical activity of older women from different ethniccommunities. J Women Aging 2009, 21:33-47.17. Kreuter MW, Lukwago S, Bucholtz D: Achieving cultural appropriateness inhealth promotion programs: Targeted and tailored approaches. HealthEduc Behav 2002, 30:133-146.18. Rogerson M, Emes C: Physical activity, older immigrants and culturalcompetence: A guide to fitness practitioners. Activ Adapt Aging 2006,30:15-28.19. Dawson AJ, Sundquist J, Johansson SE: The influence of ethnicity andlength of time since immigration on physical activity. Ethn Health 2005,10:293-309.Caperchione et al. BMC Public Health 2011, 11:26 9 of 1020. Australian Bureau of Statistics: 2006 Census of Population and Housing.Canberra:ACT; 2006.21. Krueger RA: Focus groups: a practical guide for applied research London:Sage; 1988.22. Kalavar JM, Kolt GS, Giles LC, Driver RP: Physical activity in older AsianIndians living in the United States: Barriers and motives. Activ AdaptAging 2005, 29:47-67.23. Kolt GS, Paterson JE, Cheung VYM: Barriers to physical activityparticipation in older Tongan adults living in New Zealand. Australas JAgeing 2006, 25:119-125.24. Kolt GS, Chadha NK: Barriers to physical activity participation in olderadults: a cross-cultural study. In New Approaches to Exercise and SportPsychology: XIth European Congress of Sport Psychology (CD-ROM): 2003;Copenhagen, Denmark, University of Copenhagen Edited by: Stelter R 2003.25. Eisner E: On the difference between scientific and artistic approaches toqualitative research. Educ Res 1981, 10:5-9.26. Tudor-Locke C, Henderson KA, Wilcox S, Cooper RS, Durstine JL,Ainsworth BE: In their own voices: definitions and interpretations ofphysical activity. Womens Health Issues 2003, 13:194-199.27. Tremblay MS, Bryan SN, Perez CE, Ardern CI, Katzmarzyk PT: Physicalactivity and immigrant status: evidence from the Canadian CommunityHealth Survey. Can J Public Health 2006, 97:277-282.28. Carrington K, McIntosh A, Walmsley J: The social costs and benefits ofmigration into Australia. Canberra: Commonwealth of Australia; 2007.29. Evenson KR, Sarmiento OL, Ayala GX: Acculturation and physical activityamong North Carolina Latina immigrants. Soc Sci Med 2004, 59:2509-2522.30. Hosper K, Nierkens V, Nicolaou M, Stronks K: Behavioural risk factors intwo generations of non-Western migrants: do trends converge towardsthe host population? EurJ Epidemiol 2007, 22:163-172.31. Caperchione CM, Mummery WK, Joyner K: Addressing the challenges,barriers and enablers to physical activity participation in prioritywomen’s groups: Findings from the WALK Program. J Phys Act Health2009, 6:589-596.32. Miller Y, Brown WJ: Determinants of active leisure women with youngchildren-an “Ethic of Care” prevails. Leisure Sciences 2005, 27:405-420.33. Eyler AE, Wilcox S, Matson-Koffman D, Evenson KR, Sanderson B,Thompson J, Wilbur J, Rohm-Young D: Correlates of physical activityamong women from diverse racial/ethnic groups. J Womens Health GenBased Med 2002, 11:239-253.34. Sternfeld B, Ainsworth BE, Quesenberry CP: Physical activity patterns in adiverse population of women. Prev Med 1999, 28:313-323.35. Barnes M, Bauld L, Benzeval M: Health Action Zones: Partnerships for HealthEquity London: Routledge; 2005.36. Janz NK, Becker MH: The Health Belief Model: a decade later. Health EducQuart 1984, 11:1-47.37. Gatewood JG, Litchfield RE, Ryan SJ, Geadelmann JD, Pendergast JF,Ullom KK: Perceived barriers to community-based health promotionprogram participation. Am J Health Behav 2008, 32:260-271.38. Choudhry UK: Uprooting and resettlement experiences of South Asianimmigrant women. Western J Nurs Res 2001, 23:376-393.39. Richardson S, Miller-Lewis L, Ngo P: The settlement experiences of newmigrants: A comparison of wave one of LSIA1 and LSIA2 Canberra: DIMIA;2002.40. De Knop P, Theeboom M, Wittock H: Implications of Islam on Muslim girlssport participation in western Europe: Literature review and policyrecommendations for sport promotion. Sport Educ Society 1996, 1:147-164.41. Lewis B, Ridge D: Mothers reframing physical activity: family orientedpoliticism, transgression and contested expertise in Australia. Soc SciMed 2005, 60:2295-2306.42. Lo Cascio M, Thomas M, Conolly A: Busy Mums Wanted: A qualitative studyof mothers and physical activity Sydney: Social Health Research Unit, NewSouth Wales Health and Central Sydney Area Health Service; 1999.43. Morioka-Douglas N, Sacks T, Yeo G: Issues in caring for Afghan Americanelders: insights from literature and a focus group. J Cross Cult Gerontoly2004, 19:27-40.44. Wolin KY, Colditz G, Stoddard AM, Emmons KM, Sorensen G: Acculturationand physical activity in a working class multiethnic population. Prev Med2006, 42:266-272.45. Behrens TK, Domina L, Fletcher GM: Evaluation of an employer-sponsoredpedometer-based physical activity program. Percept Mot Skills 2007,105:968-976.46. Gilson ND, Puig-Ribera A, McKenna J, Brown WJ, Burton NW, Cooke CB: Dowalking strategies to increase physical activity reduce reported sitting inworkplaces: a randomized control trial. Int J Behav Nutr Phys Act 2009,6:43.47. Estabrooks PA, Carron AV: Group cohesion in older adult exercisers:prediction and intervention effects. J Behav Med 1999, 22:575-588.48. Barnes DM, Almasy N: Refugees’ perceptions of healthy behaviors. JImmimg Health 2005, 7:185-193.49. Burgoyne LN, Woods C, Coleman R, Perry IJ: Neighbourhood perceptionsof physical activity: a qualitative study. BMC Public Health 2008, 8:101.50. Caperchione CM, Mummery WK: Psychosocial mediators of groupcohesion on physical activity intention of older adults. Psych Health Med2007, 12:81-93.51. Bhugra D, Becker MA: Migration, cultural bereavement and culturalidentity. World Psychiatry 2005, 4:18-24.52. Sharpe PA, Granner ML, Hutto BE, Wilcox S, Peck L, Addy CL: Correlates ofphysical activity among African American and white women. Am JHealth Behav 2008, 32:701-713.53. Morgan DL, Krueger RA, King JA: In The focus group kit. Volume 1-6.Thousand Oaks:CA: Sage Publications; 1998.Pre-publication historyThe pre-publication history for this paper can be accessed here: this article as: Caperchione et al.: Physical activity behaviours ofCulturally and Linguistically Diverse (CALD) women living in Australia: Aqualitative study of socio-cultural influences. BMC Public Health 201111:26.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color figure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at et al. BMC Public Health 2011, 11:26 10 of 10


Citation Scheme:


Citations by CSL (citeproc-js)

Usage Statistics



Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            async >
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:


Related Items