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. Author manuscript; available in PMC: 2020 Dec 1.
Published in final edited form as: Eval Program Plann. 2019 Sep 10;77:101718. doi: 10.1016/j.evalprogplan.2019.101718

A Qualitative Study to Examine How Differences in Motivation Can Inform the Development of Targeted Physical Activity Interventions for African American Women

Allison M Sweeney 1, Dawn K Wilson 2, Asia Brown 3
PMCID: PMC6900870  NIHMSID: NIHMS1542891  PMID: 31539644

Abstract

Self-Determination Theory proposes that some people are motivated to initiate physical activity by externally-controlled reasons (e.g., physical appearance, approval from others), whereas others feel compelled by more autonomous sources of motivation (e.g., enjoyment, personal importance). This study used qualitative methods to examine whether individual differences in autonomous motivation offers a useful framework for developing targeted intervention programs for African American women. Focus groups (k = 6) were conducted to examine how different levels of autonomous motivation for physical activity related to differences in physical activity barriers and facilitators among African American women (N = 31). Sessions were audiotaped, transcribed, and coded by independent raters (r = .70). QSR NVivo 11 was used to analyze data, and themes were identified separately for women with low, medium, or high autonomous motivation. Those with high autonomous motivation focused on themes of wanting novelty, excitement, and competition, whereas those with low autonomous motivation focused on themes of wanting instrumental support and financial incentives for increasing engagement in physical activity. Implications for developing physical activity intervention programs for African American women that are targeted toward differences in autonomous motivation are discussed.

Keywords: Motivation, Physical Activity, Intervention Development, Qualitative Methods

Introduction

Although the health benefits of engaging in regular physical activity (PA) are substantial and well-documented (Lee et al., 2012), the majority of U.S. adults fail to meet national PA guidelines (Clarke, Norris, & Schiller, 2017). Underserved groups, defined as members of racial or ethnic minority groups or those of low income, have the highest rates of physical inactivity, and are at a significantly higher risk for morbidity and mortality (Benjamin et al., 2018; Ford et al., 1991; Ward, Clark, Nugent, & Schiller, 2016). Lower rates of PA have been consistently reported in African Americans adults compared to Whites in the United States (Benjamin et al., 2018; Carlson, Fulton, Schoenborn, & Loustalot, 2010; Clarke et al., 2017). PA tends to be lower among women than men, placing African American women at an even higher risk for a range of chronic diseases (Benjamin et al., 2018; Ward et al., 2016).

Group-based interventions that target changes in diet and PA remain one of the most effective approaches for improving health outcomes, including weight loss and diabetes self-management (Borek, Abraham, Greaves, & Tarrant, 2018; Steinsbekk, Rygg, Lisulo, Rise, & Fretheim, 2012). This approach may be effective, in part, because the group context provides opportunities for increasing group social support and sharing strategies for effectively improving health behaviors (Greaves & Campbell, 2006). Group-based interventions may be particularly effective for African American women, as lack of social support is one of the most frequently cited interpersonal barriers to PA among African American women (Joseph, Ainsworth, Keller, & Dodgson, 2015). Although some advances have been made in recent years to engage minority populations in group-based intervention programs (Nicholson, Schwirian, & Groner, 2015), systematic reviews of behavioral interventions with African American populations have revealed that regular attendance and sustainability of outcomes remain critical issues (Fitzgibbon et al., 2012; Lemacks, Wells, Ilich, & Ralston, 2013). Low levels of engagement in PA intervention programs among African Americans may be due, in part, to a reliance on interventions that adopt a “one-size-fits-all” approach, with relatively fewer studies examining whether certain individuals are more responsive to an intervention than others.

Increasingly researchers are recognizing that intervention effectiveness can be maximized by clarifying how individual differences and specific program components relate to overall treatment effects (Collins, Murphy, Nair, & Strecher, 2005; Lei, Nahum-Shani, Lynch, Oslin, & Murphy, 2012). For example, several trials have demonstrated that developing interventions that are targeted (at the group level) around differences in cultural beliefs, race, and ethnicity are effective approaches for increasing program engagement among African Americans (Barrera, Castro, Strycker, & Toobert, 2013; Feathers et al., 2007; Spencer et al., 2011). Targeted interventions are theorized to be effective because they increase the personal relevance of health promotion strategies for behavior change, which, in turn, enhances engagement in PA. Specifically, cultural targeting has been an effective intervention approach when embedded within the broader cultural or social values of groups (Kreuter & Haughton, 2006; Resnicow, Baranowski, Ahluwalia, & Braithwaite, 1999), including addressing topics of socio-cultural importance (e.g., hairstyle concerns for PA), framing information in terms of personal or cultural values (e.g., spirituality, racial pride), and featuring role models or testimonials from members of a target community (Parra-Medina et al., 2011; Wilbur et al., 2008)

Although there is growing evidence for the importance of targeting interventions around culture, relatively little research has integrated a theory-driven approach to investigate other types of between-person differences that can be used to develop novel interventions strategies. Several systematic reviews have revealed that although theory is often proposed as the foundation for behavioral interventions, the majority of previous PA intervention programs have not explicitly linked intervention components to a theory, or relevant constructs of health behavior change (Mama et al., 2015; Prestwich et al., 2014). Such findings highlight the importance of integrating theory more extensively in the early stages of intervention development.

One source of between-person variability that may impact how individuals respond to a group-based intervention program is their motivation for wanting to initiate PA. Systematic reviews of qualitative studies with African American women have shown that low motivation is a major barrier to PA (Joseph et al., 2015; Siddiqi, Tiro, & Shuval, 2011). Previous work on motivation for PA has focused on individuals’ readiness to change their behavior, specifying distinct stages of change including pre-contemplative, contemplative, determination, action, relapse, and maintenance (Prochaska, Taylor, & Hill, 1999). However, systematic reviews of efforts to adapt interventions to individuals’ stage of motivational readiness have yielded mixed results (Bridle et al., 2005; Hutchison, Breckon, & Johnston, 2009). Rather than focusing on the quantity of motivation or stages of change, an alternative approach to evaluating the role of motivation in PA is to examine the quality of motivation; that is, the extent to which motivation is internally versus externally driven.

Self-Determination Theory (SDT) ( Ryan & Deci, 2000; Ryan, Williams, Patrick, & Deci, 2009) posits that people’s motivation for engaging in PA ranges on a continuum from externally-controlled to completely internally-driven forms of behavioral regulation. Some people feel compelled by reasons that are controlled by external rewards and contingencies, including engaging in PA to improve one’s physical appearance or gain approval from others. Although this type of motivation, known as controlled motivation, has been associated with physical activity initiation, both experimental and correlational studies have shown that it does not promote PA engagement in the long-term (Kwan, Hooper, Magnan, & Bryan, 2011; Rodgers, Hall, Duncan, Pearson, & Milne, 2010; Teixeira, Carraça, Markland, Silva, & Ryan, 2012). Alternatively, others may feel compelled to engage in PA by reasons that are guided by internal rewards, including engaging in PA because it is enjoyable, personally important, and consistent with one’s personal values and identity. This type of motivation, known as autonomous motivation, has been shown to be a critical predictor of long-term maintenance of PA (Hagger, Chatzisarantis, & Harris, 2006; Kwan et al., 2011; Silva et al., 2011).

Numerous qualitative studies have focused on African American women’s overall low levels of motivation (Joseph et al., 2015; Siddiqi et al., 2011); however, to date, no previous study has examined how individual differences along the self-determination continuum (ranging from low to high autonomous motivation) relate to distinct PA needs and interests. Although individuals low in autonomous motivation are not likely to maintain long-term PA, there may be a benefit to using externally-focused intervention strategies in order to maximize initial engagement among those with low autonomous motivation. For example, there is increasing evidence that at least in the short-term, financial incentives have a positive impact on PA (Finkelstein, Brown, Brown, & Buchner, 2008; Mitchell et al., 2013; Patel et al., 2016). Researchers have argued that the use of financial incentives may reduce autonomous motivation (Deci, Koestner, & Ryan, 1999) or “crowd-out” intrinsic motivation (Frey & Jegen, 2001). However, for those low in autonomous motivation, for whom PA is otherwise viewed as unenjoyable, financial incentives may be a useful strategy for maximizing initial engagement. We propose that SDT may offer a useful framework for developing motivationally-targeted PA intervention programs for African American women, but that more qualitative research is needed to clarify how PA barriers and facilitators vary as a function of between-person differences in autonomous motivation.

To further investigate how barriers and facilitators vary depending upon differences in autonomous motivation, the present study adopts an ecological framework. Ecological models of health behavior change propose that behavior is shaped by multiple levels of influence, including at the individual, social environmental, and physical environmental levels (McLeroy, Bibeau, Steckler, & Glanz, 1988; Sallis, Owen, & Fisher, 2015). Supporting the use of this framework, systematic reviews have shown that some of the most frequently cited barriers to PA among African American women span across individual, interpersonal, and environmental levels, including lack of motivation, caregiver responsibilities, lack of social support, neighborhood safety, and lack of access to facilities (Joseph et al., 2015; Siddiqi et al., 2011). Thus, the present study adopts an ecological framework in addition to a SDT framework to evaluate how barriers and facilitators vary at the individual, interpersonal, and environmental levels among African American women with different levels of autonomous motivation to inform targeted intervention development.

The primary purpose of the present study was to evaluate 1) the different sources of autonomous versus controlled motivation that drive African American women’s PA engagement; and 2) the extent to which differences in autonomous motivation relate to different PA needs and interests at individual, interpersonal, and environmental levels that could be used to inform intervention development. The focus groups reported in this article were undertaken as an assessment in an early phase of working with a community center to develop PA intervention programs for African American women that are targeted toward differences in autonomous motivation. We propose that multi-level needs and interests in regards to a PA intervention program will vary as a function of women’s degree of autonomous motivation for initiating greater PA.

Method

Participants

All participants (N = 31) in this study were African American females (see Table 1). Participants were included in the study if they were 21 years of age or older and self-identified as African American. Participants ranged from 24 to 69 years of age and had a median household income of between ~ $25,000-$39,000. The majority of participants were not meeting national recommendations for weekly PA, with only two participant reporting engaging in at least 30 minutes of moderate to vigorous PA 5 or more days per week.

Table 1.

Participant Demographics.

Low Autonomous Motivation (n = 9) Medium Autonomous Motivation (n = 10) High Autonomous Motivation (n = 12)
Female, % 100% 100% 100%
African American, % 100% 100% 100%
Age, M(SD) 46.2 (12.1) 41.1 (6.7) 43.2 (14.0)
Married, % 56% 50.00% 41.70%
Days of > = 10 min. MVPA, M(SD) 1.78 (2.28) 1.2 (1.8) 0.67 (.99)
Children in household, M(SD) 2.6 (1.3) 2.7 (.95) 2.2 (1.3)
Household Income, Median $25-$40 k $25-$40 k $25-$40 k
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Note. MVPA = Moderate to Vigorous Activity (self-reported)

Procedures

Prior to recruiting participants, the study protocol was submitted to the University of South Carolina Institutional Review Board, and was determined to be exempt from approval, given the minimal risks. Participants were recruited to take part in one of six focus groups with the help of a local church-based community center in a suburban southeastern community. The community center director advertised the focus groups by distributing fliers and through a word-of-mouth to recruit a convenience sample of local community members. Participants were offered a $15 incentive to participate. At the beginning of each focus group, participants completed a 10-minute questionnaire, which included measures of PA in the last 7 days, level of autonomous motivation for PA, and demographic items. The discussion guide for the focus groups were developed based on SDT (Ryan & Deci, 2000) and an ecological framework (Bronfenbrenner, 2005; McLeroy et al., 1988; Sallis et al., 2015) (see Figure 1 for focus group questions). Questions were open ended to capture novel PA facilitators and barriers. Overall questions were designed to: 1) identify different sources of autonomous versus controlled motivation for PA; and to 2) assess PA barriers, facilitators, and resources at individual, interpersonal and environmental levels for intervention development to increase engagement in greater PA. To better understand participants’ experiences with PA and to make participants feel comfortable, broad questions (e.g., “What types of physical activities have you enjoyed in the past?”) were asked at the beginning of each focus group session. Next, questions were asked regarding motivation for increasing PA, barriers, facilitators, and PA resources.

Figure 1.

Figure 1.

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Focus Group Questions and Probes

All focus groups were held at a local community center in the early evening. Sessions ranged between 4 to 6 participants per group and lasted between 30 to 45 minutes. The moderator followed a standard protocol, including: introducing the focus group purpose, facilitating introductions, encouraging confidentiality of issues discussed, and asking the core questions and probes in an open ended manner. All sessions were audio recorded and transcribed by an independent transcription company.

Measures

Self-Reported Physical Activity.

The short-version of the International Physical Activity Questionnaire (IPAQ; Craig et al., 2003) was used to assess participants’ PA in the last week, including time spent engaging in walking and moderate to vigorous PA. Past research has found moderate levels of agreement between the IPAQ and accelerometry-estimated PA (α =0.65-0.88) (Craig et al., 2003).

Motivation for PA.

Motivation for PA was assessed using the Behavioral Regulation of Exercise Questionnaire (BREQ-3) (Markland & Tobin, 2004), which measures the degree to which motivation for engaging in PA is autonomous. The 24-item scale, which demonstrated good reliability (α = 0.89), consists of subscales indexing controlled motivation (introjected, external), and autonomous motivation (intrinsic, integrated, identified). An example of a controlled motivation item from the external subscale is, “I feel under pressure from my family to exercise.” An example of an autonomous motivation item from the integrated subscale is, “Exercise is consistent with my life goals.” An autonomy index score was computed to assess the degree to which participants felt self-determined by applying a weight to each subscale and then summing the weighted scores. The controlled motivation subscales were weighed with negative values and the autonomous subscales were weighted with positive values, with higher scores indicated greater autonomous motivation (Wilson, Rodgers, Loitz, & Scime, 2007).

Analysis

Given that SDT posits that motivation exists on a continuum, we reasoned that it would be advantageous to evaluate different levels of autonomous motivation. The autonomy index scores, which index the degree to which motivation is autonomous, were divided into three quantiles, with low autonomous motivation ranging from −6.08 to 8.5 (n = 9), medium autonomous motivation ranging from 9.25 to 13.67 (n = 10), and high scores ranging from 16.42 to 24.17 (n = 12). Importantly, analyses revealed that at least one member with low, medium, and high autonomous motivation was present for each of the six focus group discussions. Each participant was assigned an ID number linking her name to her motivation score. The IDs were then added to the focus group transcriptions prior to conducting the qualitative coding to distinguish the different speakers in a de-identified manner.1

Focus Group Coding

Guided by SDT and an ecological framework, a preliminary coding book was developed using a deductive approach (Kyngäs & Elo, 2008). Specifically, drawing from SDT, codes were developed to evaluate different aspects of self-determined motivation for PA, including intrinsic sources (e.g., interest/enjoyment, importance/value) and extrinsic sources (e.g., physical appearance, approval from others). An ecological framework was used to develop codes to evaluate barriers at the individual, home, and neighborhood levels. Importantly, the ecological codes were informed by previous qualitative studies on PA among AA women (Joseph et al., 2015; Siddiqi et al., 2011), including the importance of safety, access to facilities, social support, caregiver responsibilities, and lack of time.

Additionally, the transcripts were reviewed using an inductive approach to look for other codes not captured through the preliminary theory-driven codes (Fereday, Adelaide, Australia, & Eimear Muir-Cochrane, 2006). This approach allowed for the identification of additional sources of motivation (including health and social reasons), barriers (including the role of the social environment, tangible results/appearance concerns, weather/seasonal effects), resources needed to be active (including opportunities to involve family members or participate in a team, age-appropriate activities, opportunities to engage in events/activities that are fun/enjoyable/exciting, educational resources for healthy eating), and other types of incentives (including social opportunities). The first three transcripts were used to develop the codebook. Importantly, we allowed for new themes to emerge in the later transcripts but found that saturation had been reached as no new themes emerged in the later transcripts.

Codes were used to separate participant responses into “themes,” and themes were defined as concepts discussed by at least two participants across at least two focus groups. Two evaluators coded the transcripts. Interrater reliability between coders indicated acceptable level of agreement (r = .70), and any coding disagreements were settled through discussion until 100% agreement was reached. The qualitative software QSR NVivo 11 was used to perform a content analysis of the themes and for stratifying coded participant responses by level of autonomous motivation (low, medium, or high).

Results

Table 2 provides a summary of themes, including information on frequency of themes (number of participants who endorsed each theme) and the number of sources (focus groups) in which each theme was identified. Qualitative results are summarized by autonomous motivation group (defined as participants with low, medium, or high autonomous motivation) into the following topic areas: Past PA Engagement, Sources of Motivation for PA, PA Barriers, Resources Needed to Increase PA, Role of Family or Friends, and Incentives for PA. As noted in Table 2, “Did Not Meet Criteria” refers to themes that were mentioned by a handful of participants, but did not reach saturation, such as weather/season concerns and role modeling for children.

Table 2.

Summary of Themes by Autonomous Motivation Group

Themes Low Autonomous Motivation (n = 9) Medium Autonomous Motivation (n = 10) High Autonomous Motivation (n = 12) Total Comments Total Sources
Past Physical Activity Engagement
Light activities 9 10 12 31 5
Moderate to vigorous activities 8 6 11 25 5
Alone 1 1 5 7 2
With a group or partner 4 4 3 11 4
Motivation for Increasing Physical Activity
Interest or enjoyment 2 1 4 7 2
Improved physical or mental well-being 3 13 4 20 4
Having a friend, partner or group 5 1 0 6 2
Socializing with friends, family, or others 5 2 3 10 3
Role modeling for children Did not meet criteria Did not meet criteria Did not meet criteria 0
Physical Activity Barriers
Safety concerns 0 6 1 7 2
Caregiver duties 5 4 2 11 4
Support from spouse or family 1 1 4 6 2
Lack of time 8 12 6 26 6
Lack of energy or enjoyment 6 6 5 17 5
Lack of competency/health limitation 5 1 6 12 3
Social Environment Did not meet criteria Did not meet criteria Did not meet criteria 0
Transportation or convenience Did not meet criteria Did not meet criteria Did not meet criteria 1
Tangible results/appearance concerns Did not meet criteria Did not meet criteria Did not meet criteria 1
Weather or seasonal concerns Did not meet criteria Did not meet criteria Did not meet criteria 0
Resources Needed to increase Physical Activity
Access to facilities/resources for PA 1 6 8 15 2
Affordability 3 2 2 7 2
Opportunities to involve family or participate in team 5 2 7 14 3
Greater social support 11 5 12 28 6
Age appropriate activities 3 1 2 6 2
Greater opportunities to engage in fun, exciting, or competitive events 2 2 8 12 2
Educational resources about healthy eating 3 0 6 9 2
Role of Family and Friends
Instrumental Social Support 8 4 4 16 3
Emotional Support 3 2 6 11 3
Material and Non-Material Incentives for PA
Financial 7 4 5 16 5
Social opportunities or events 3 1 5 9 4
PA goods or merchandise Did not meet criteria Did not meet criteria Did not meet criteria 1
Access to facilities or gym Did not meet criteria Did not meet criteria Did not meet criteria 0
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Note. Did not meet criteria: themes that did not meet the saturation criteria of being discussed by at least two participants across at least two sessions.

Past PA Engagement.

Across autonomous motivation groups (low, medium, and high), there was frequent discussion of engaging in light PAs defined as activities that require little exertion, e.g., easy walking and stretching). Alternatively, the high autonomous group made more comments about engaging in moderate to vigorous PAs, defined as activities that require one to breathe harder than normal (e.g., swimming, weight lifting, and sports), than the low or medium autonomous motivation groups. Those with high autonomous motivation reported engaging in PAs by themselves more frequently than the other autonomous motivational groups; however, all three groups reported previously engaging in some PA with a group or partner (e.g. “I would meet my fiend to walk at the park.”)

Sources of Motivation for PA.

Improved physical and/or mental well-being was the most frequently discussed motivator, with participants in the medium autonomous motivation group making the greatest number of comments about physical and/or mental well-being (e.g., “For me, when I see more family members getting on different types of medications, that’s motivation for me because I’m not on any and I do not wish to be on any. ”) The high autonomous motivation group made more comments about engaging in PA for personal interest or enjoyment than the other autonomous motivation groups. For example, regarding personal enjoyment and interest, one participant described how she enjoys dancing, “We have a radio and we‘ll be dancing, and we just do Zumba. The 90s music was real good. I think music’s really entertaining, like, for us, makes us dedicated and keep going” Conversely, those with low autonomous motivation made more comments about engaging in PA because they had a friend, partner, or group to work out with. One participant explained that in the past she was more likely to be active if her husband was also being active, “He was out there, so that put me out there too.” Similarly, another participant explained how walking with her neighbor helped her to build a walking routine, “When my next door neighbor, she was like, “Come on. Let’s go walk,” and let’s do this. So I did that. When me and her did it, it was fun, because she was like, “Okay. You my age. We going to do this together.“ ” The low autonomous motivation group also made a greater number of comments about engaging in PA in order to socialize with friends or family relative to the other autonomous motivation groups. One participant described spending quality time with her family by getting together to play softball, “We get together and play softball, and that’s a lot of fun. A lot of exercise. A lot of fussing, too, but, um, I enjoy that.”

PA Barriers.

Overall participants focused primarily on interpersonal and individual barriers. Lack of time, lack of energy or enjoyment, and lack of competency and/or health limitations were the three most frequently discussed barriers. For example, regarding lack of time, one participant commented that, “I work two jobs. I teach, and then, after school, I work a part-time job, so by the time I finish that, the only thing I wanna do is go home.” Regarding lack of energy and/or enjoyment, participants made comments about their low energy levels, (e.g., “I just don’t have the energy now”), as well as their low levels of enjoyment, (e.g., “I didn’t enjoy exercising. I never have. I know I should, but I’m gonna be honest, I just never enjoyed it”). When describing concerns about lack of competency, one participant shared that, “And then sometimes, I mean, the people that go and do the walking, they’re very fast walkers. So, I mean, I don’t feel, I guess I’m kinda feeling I won’t be able to keep up with them and stuff.” Lack of time was more frequently discussed among those with low to medium autonomous motivation than those with high autonomous motivation. Lack of enjoyment/energy was brought up at similar levels of frequency across all three autonomous motivation groups, whereas lack of competency and/or health limitations was brought up more frequently among those with low and high autonomous motivation (versus medium autonomous motivation). Additionally, participants also brought up concerns about safety (e.g., crime, stray dogs), caregiver duties, and insufficient support from their spouse or family.

Resources Needed for PA.

The need for greater social support, access to places/facilities for being active, and opportunities to involve family or participate as a team were the three most frequently discussed resources. The need for social support and the need to involve family members were discussed more frequently among those with low and high autonomous motivation (versus medium motivation). For example, regarding the importance of involving family members in PA, one participant explained, “And for a lot of people actually, you know, want to do things as a family. So do something like family night, then we incorporate fun and exercise altogether.” Issues of access were discussed primarily by those with medium to high autonomous motivation. Some participants indicated they wanted more home-based options (e.g., “I just think my barrier, for me personally, is I need an at-home outlet. Something I can do at home versus always going out to [have] that easier access”), whereas other participants indicated they wanted more resources in their communities (e.g., “Open up a park, you know, to motivate other older people, you know, that get out in the community.”) Affordability of PA, and the need for age-appropriate activities were brought up at similar frequencies across all three autonomous motivation groups.

One key difference between the autonomous motivation groups was that those high in autonomous motivation made a greater number of comments about opportunities to engage in PA events that are fun, exciting, or competitive. For example, one participant suggested that “You take something like the Amazing Race and scale it down. Or something like a family game night. Something that people would want to do and want to participate in, and so it’s not necessarily exercise but it is. You know what I mean? ‘Cause for some people they, like you said, you just don’t really care for exercising but I think most people are competitive.” Similarly, another participant noted that she would enjoy more opportunities to be involved in competitive events, “I think something like drills. Obstacle course things. That would be fun. Seeing who can get through it the fastest, and that’s a real workout, too.” Finally, those with high autonomous motivation made a greater number of comments that, in addition to PA resources, they would also be interested in learning more about strategies for implementing a healthy diet.

Role of Family and Friends.

As described above, both the low and high autonomous motivation groups indicated that social support was an important resource for PA. However, when asked more specifically about the role of family and friends, those with low autonomous motivation made a greater number of comments on the importance of instrumental social support, defined as actions that promote being active together, including having a partner who helps to provide an exercise routine or structure. For example, one participated explained that, “Okay. If she and I connect and I know that she can only work out on Tuesday at a certain time, I’m going to call her. You wanna know why? She say, “Yeah, “I’m there. You know what I’m saying? So you have to find things andfind you a compatible partner that you know that you can depend on.” Conversely, those with high autonomous motivation made a greater number of comments about the importance of emotional support, defined as words of support that facilitate a sense of belonging, comradery, or enhanced motivation. For example, one participant explained that, “It just feels better when you have that person beside, you know, somebody beside you saying, “Come on. We can do this together. “ So I think that’s kinda like, you know, how this support system goes. It’s just better with somebody else there.”

Material and Non-Material Incentives for PA.

When asked about what types of rewards or incentives would motivate them to engage in greater PA, the topic of financial incentives was frequently discussed (e.g., gift cards, cash, grocery vouchers), with participants low in autonomous motivation making a greater number of comments. Alternatively, those with high autonomous motivation made a greater number of comments about non-material incentives, including opportunities to engage in social events, such as, “Well, we could have a culminating activity. I mean, as you said, if you lose weight, why not go out and show it? So we could go out together. You know, that could be one of the things we do as a group, you know. And also, it could be an exploratory thing. Going somewhere different, you know, out of the regular, same old, same old. Just having things tied to it, you know?”

Discussion

The present study used qualitative methods to evaluate how between-person differences in level of autonomous motivation among African American women map on to different PA barriers and facilitators at the individual, interpersonal, and environmental levels. Across all levels of autonomous motivation, participants commented frequently on the importance of social support as a critical resource for engaging in greater PA. However, when asked more specifically about the role of family and friends, women low in autonomous motivation made a greater number of comments about the importance of having someone to be active with. Relatedly, those low in autonomous motivation also indicated that engaging in PA because they had a friend, partner, or group to work out with was an important source of motivation (more so than those with medium to high autonomous motivation). Conversely, those high in autonomous motivation indicated that emotional support was important for engaging in regular PA. These results suggest that across participants with all levels of autonomous motivation, social support is central to engagement in PA, but that the type of social support needed may vary.

Another important distinction across the different levels of autonomous motivation was that those high in autonomous motivation focused more on the importance of engaging in opportunities that are novel, exciting, or competitive, commenting frequently on activities, such as relay races or obstacle courses. Furthermore, those lowest in autonomous motivation made the greatest number of comments about financial incentives. Alternatively, those high in autonomous motivation made a greater number of comments about non-material incentives (e.g., social opportunities). By identifying areas in which needs and interests vary, these findings provide preliminary support for the usefulness of developing interventions targeted towards between-person differences in autonomous motivation.

In addition to these key differences, several other barriers and facilitators were discussed across one or more of the autonomous motivation groups, including lack of time, lack of energy/enjoyment, lack of competency/health limitations, caregiver responsibilities, access to facilities/resources for PA, affordability of PA, opportunities to involve family or participate in a team, the importance of age-appropriate activities, and an interest in educational resources for healthy eating. These findings corroborate previous qualitative studies with African American women, which have found that lack of time, physical disability/health limitations, lack of knowledge, affordability of PA, and fatigue are among the most frequently cited individual barriers, whereas family demands/caregiver responsibilities is one of the most frequently cited interpersonal barriers to PA (Joseph et al., 2015; Siddiqi et al., 2011). Taken together, these findings confirm that these barriers and facilitators are important to African American women, and may need to be universally addressed in PA intervention programs, regardless of differences in autonomous motivation.

These findings have several important implications for developing future targeted intervention programs. As described above, social support was one of the most frequently discussed themes, with those with low autonomous motivation expressing a greater need for instrumental forms of social support. Having a partner to be active with may be especially important for women low in autonomous motivation given that controlled motivation is characterized by a greater interest in approval from others (Ryan & Deci, 2000). Previous interventions targeting partner-based support have included a variety of strategies such as the creation of buddy systems, behavior contracts between participants and program leaders, and the formation of walking groups (Brownson et al., 2004; Heath et al., 2012; Kahn et al., 2002; King, Taylor, Haskell, & Debusk, 1988; Lombard, Lombard, & Winett, 1995; Wilson et al., 2015). The results from the focus group suggest that in order to engage women low in autonomous motivation in greater PA, it may be important for future intervention programs to integrate program elements that promote enhanced partner-based support systems.

Although the high autonomous motivation group also indicated an interest in social support, they focused less on the importance of a PA partner and more so on social opportunities to engage in activities that are novel, competitive, or exciting, suggesting a greater interest in social support in the form of stimulating group activities. Consistent with this finding, there is converging evidence that intergroup competition, or competing as a team to achieve a common goal, poses an exciting challenge, increases an individual’s drive to perform well, and offers an opportunity for relatedness, all of which should facilitate enhanced autonomous motivation (Reeve & Deci, 1996; Tauer & Harackiewicz, 1999). Relative to individual competition, intergroup competition promotes a greater sense of competitive excitement, enhanced performance, and more positive emotions (Tauer & Harackiewicz, 2004; Wittchen, Krimmel, Kohler, & Hertel, 2013). Among both expert and recreational exercisers, people with higher levels of sports competitiveness tend to have higher levels of PA enjoyment and autonomous motivation for PA (Frederick-Recascino & Schuster-Smith, 2003). Thus, in designing a targeted intervention program for women with relatively high autonomous motivation for PA, it may be important to incorporate opportunities to engage in exciting, competitive intergroup activities in order to capitalize on these women’s drive for relatedness, competition, and excitement.

Another important distinction between the autonomous motivation groups was that the low autonomous motivation group expressed a greater interest in financial incentives. Consistent with SDT, to the extent that people low in autonomous motivation do not experience intrinsic rewards from PA (e.g., personal enjoyment or satisfaction), financial rewards may help to overcome resistance to an otherwise unrewarding activity. Conversely, among individuals who are motivated to initiate PA for more autonomous reasons, the use of traditional financial incentives may be less effective. Importantly, the majority of past PA interventions with financial incentives have drawn primarily from samples of middle-class White adults (Finkelstein et al., 2008; Kullgren et al., 2013; Mitchell et al., 2013; Patel et al., 2016). Relatively little is known about the extent to which financial incentives have a positive impact on PA initiation among underserved racial minority communities.

Participating in a health behavior change intervention primarily for the financial incentives can have a detrimental impact on maintaining changes in health behaviors (Moller, McFadden, Hedeker, & Spring, 2012). Such findings suggest that the framing of incentives is important, especially when targeting low income communities. In the focus groups many of the women’s comments about financial incentives in the low autonomous motivation group highlighted an interest in using the incentives as resources for supporting a healthy lifestyle (e.g., gift cards for healthy groceries). Furthermore, those high in autonomous motivation indicated that they would enjoy non-material incentives in the form of social opportunities. Taken together, these findings suggest that framing incentives as connecting to individuals’ broader values or aspirations (e.g., to live a healthy lifestyle, to spend quality time with family or friends) may be a universally beneficial strategy for promoting PA engagement across autonomous motivational groups. This conclusion is consistent with recent work by Kullgren et al. (2016) who proposed that tailoring financial incentives towards an individual’s goals, values, and aspirations should be more effective than standard incentives for sustaining long-term health behavior change.

A few limitations of this study should be noted, including the small sample size and the use of a convenience sample of volunteers. Not all themes reached saturation, and in some cases the difference in the number of comments between autonomous motivation groups was relatively small. Thus, future research may benefit from incorporating larger samples to further understand how PA barriers and facilitators vary as a function of autonomous motivation. Efforts were made to make an environment of respect and openness; however, participants may have been somewhat inhibited in sharing their perceptions about certain topics. Furthermore, the use of focus groups, as opposed to individual interviews, may have limited the depth of information provided by each participant. Given that participants were recruited from a community center that provides some free PA services (including free boot camp-style classes), they may have provided different responses from women in communities without these services. Another limitation is that due to feasibility and recruitment constraints, it was not possible to stratify the groups in advance by motivation, which may have impacted the type of issues that were raised during the discussions. Despite these limitations, the qualitative data obtained in this study yielded novel insights into the commonalities and differences between women guided by different levels of autonomous motivation for PA.

Conclusions

This study contributes to the literature in several important ways, including comparing the unique perspectives of African American women with different levels of autonomous motivation. By making both theory and community feedback central from the early stages of program development, the findings from this qualitative study provide an initial framework for developing targeted intervention programs for engaging African American women in greater PA that are theoretically-grounded and more likely to be feasible and acceptable. Drawing from Wight et al.’s Six Steps for Quality Intervention Development (6SQulD) framework (Wight, Wimbush, Jepson, & Doi, 2016), the focus groups helped to identify some potential contributing factors to low levels of PA among AA women across different levels of autonomous motivation. Findings suggest that partner-based instrumental support may be uniquely beneficial for African American women low in autonomous motivation, whereas fun intergroup competition may be more helpful for motivating women with relatively higher autonomous motivation. Figure 2 shows how these factors, along with other insights gained from the focus groups, were used to guide the next two steps of the 6SQulD framework: identifying which factors are modifiable and deciding on mechanisms of change. Two group-based motivationally-targeted intervention programs for African American women are currently being evaluated for feasibility, acceptability, and proof-of concept through a community-based pilot intervention study. Efforts to better understand the multi-level barriers, needs, and interests of racial minority communities are essential for developing effective interventions to increase PA and reduce chronic diseases. The results from these focus groups provided important and novel insights, which are now being implemented in a community-based randomized pilot study

Figure 2.

Figure 2.

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Process of translating focus group themes two motivationally-tailored intervention programs

Highlights.

  • Among African American women physical activity needs vary by autonomous motivation

  • Women with high autonomous motivation focused on excitement and competition

  • Women with low autonomous motivation focused on instrumental support and incentives

Acknowledgements.

The authors wish to thank Mr. Barney Gadson from the Newton Family Life Community Center for his invaluable support with recruitment and community engagement.

Funding. This work was supported by the National Heart, Lung, and Blood Institute at the National Institutes of Health [grant number F32 HL138928-01A1]; and the University of South Carolina, ASPIRE Program, Office of the Provost.

Author Biographies

Allison M. Sweeney (Ph.D.) is a postdoctoral fellow in the Department of Psychology at the University of South Carolina. Her research has focused on the role of the social environment in developing community-based interventions for engaging underserved communities in long-term health behavior changes. Her approach to developing community-based interventions is guided by the use of community-based participatory strategies, a bioecological framework, and social-cognitive theories of health behavior change.

Dawn K. Wilson (Ph.D.) is a Professor of Psychology and Director of the Behavioral Medicine Research Group at the University of South Carolina. Her work has primarily focused on developing innovative, theoretically-based motivational interventions for health promotion in underserved adolescents and their families. Dr. Wilson has conducted numerous large-scale intervention studies on improving youth health behaviors in low-income, high crime communities including the Active Choice Today (ACT) trial (R01HD045693), the Positive Action for Today’s Health (PATH) trial (R01DK067615), and the Families Improving Together for Weight Loss (FIT) trial (R01 HD072153).

Asia Brown is a doctoral graduate student in the Clinical-Community Psychology program at the University of South Carolina. Her research interests include the role of motivation and genetics on obesity-related outcomes.

Footnotes

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1

To track participants’ comments, we used a two-part system. First, participants wore name tags during the group discussion, which the moderator used to facilitate discussion. Second, a research assistant took detailed notes during the group discussions about the comments that were raised. Within 24 hours of completing each focus group, the moderator reviewed the notes and matched each comments with an ID code. After the recordings were transcribed, these notes were used to link coimnents to IDs.

Contributor Information

Allison M. Sweeney, Department of Psychology, University of South Carolina, Columbia, SC, 29201

Dawn K. Wilson, Department of Psychology, University of South Carolina, Columbia, SC, 29201

Asia Brown, Department of Psychology, University of South Carolina, Columbia, SC, 29201

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