Individual, social and environmental barriers to and facilitators of physical activity among Latinas living in San Diego County: Focus group results

Abstract

Objective:

To examine the barriers to and facilitators of physical activity (PA) relevant to a faith-based community living in a border region.

Methods:

Two focus groups were conducted with 25 Latina churchgoers.

Results:

Latinas identified barriers to PA that included individual (e.g., lack of motivation and time, language, economics, social support, family/household responsibilities), socio-cultural (e.g., fear of border patrol, machismo, and neighborhood safety), and environmental barriers (e.g., traffic-related and dogs). Facilitators of PA were PA knowledge, childcare, time management and advocacy skills.

Conclusion:

A church-based multi-level intervention targeting Latinas may be ideal for promoting PA and facilitating environmental changes.

INTRODUCTION

The benefits of a physically active lifestyle, such as chronic disease prevention, are well documented.¹ The CDC recommends accumulating 30 minutes of moderate-intensity PA at least 5 days per week, or a minimum of 20 minutes of vigorous-intensity at least 3 days of the week.² Despite the CDC recommendations for moderate to vigorous-intensity physical activity (MVPA), national surveillance data indicate a high prevalence of physical inactivity during leisure time, especially among women and ethnic minorities.³ Furthermore, Latinos report the lowest prevalence of PA during leisure time compared to other ethnic groups placing them at greater risk for obesity and chronic diseases.^{4, 5}

Latinos are the largest ethnic group in the U.S. and, by the year 2050, one in four persons will be Latino.^{3, 6} Given these statistics, understanding factors that inhibit or facilitate Latinas’ PA is warranted. Moreover, reports show that Latinas engage in less overall PA than Latino men;^{4, 5} therefore, it is likely that Latinas face unique barriers to PA. The vast majority of studies have focused on the individual level correlates of PA, yet emerging research shows that the social and physical environment also play an important role in physical inactivity.⁷ Indeed, the use of a social ecological framework in understanding correlates of PA will yield for more comprehensive and effective interventions aimed to reduce Latinas’ lack of PA.^{8, 9} The few studies that have included Latinos suggest that lack of English language skills, household responsibilities, lack of childcare, insufficient free time, poor social support from family, and lack of transportation are barriers to PA.^10–12 Socio-cultural barriers noted are social norms pertaining to gender roles, such as sports being male-oriented.¹¹ Environmental barriers noted include living in unsafe neighborhoods and inaccessibility to exercise facilities.^{10, 12} To date, a modest amount of research evaluates the impact of the physical environment on Latinas’ PA. Because Latinos living in different regions (e.g., border communities) may experience unique challenges (e.g., cultural barriers to PA) to engaging in PA, research is needed to explore ethno regional factors that may contribute to the low levels of PA in Latinas living in border communities. In California, which has one of the largest U.S. Latino populations (and is projected to more than double by 2050), research is needed to better understand some of the unique multi-level challenges to engaging in PA. Social ecological theory may be most appropriate for developing innovative programs in settings that may be effective for promoting PA among Latinos. In addition, a social ecological perspective may be effective in identifying environmental factors that can be modified through social interaction such as advocacy.⁷ The majority of theories applied to PA assume that individual factors influence behavior;¹³ therefore, advocacy may be overlooked and underdeveloped as a means of mobilizing environmental changes for PA promotion. Studies that include advocacy for PA in faith-based settings are warranted given that it may be a promising approach for modifying the built environment.^{7, 14}

For Latinos, churches play an important role in guiding lifestyle choices and social interactions. The majority of the U.S. Latino population (70%) identify as Catholic, and indeed, more than 90% of Latinas actively practice Catholism.¹⁵ Among Latinos, important cultural traditions that are practiced in the church include sacramental events, prayers groups, posadas, and quinciñeras.¹⁶ Churches also promote bodily and spiritual well-being which is in line with aims of health promotion programs. Furthermore, churches are a prestigious and credible source in local communities, and religious figures (e.g., priest and sisters) have influence that can be used to help advocate for social and physical environmental changes that promote PA. Given the importance and the credibility of the Catholic Church within Latino communities, churches are a suitable channel for promoting healthy behaviors. In addition, faith-based settings such as churches may be an effective place for mobilizing advocacy for PA promotion.

The goals of the current qualitative study were: 1) to identify individual, social and physical environmental barriers to Latinas’ physical activity; and 2) to explore the feasibility of implementing a faith-based multi-level intervention promoting physical activity among churchgoing Latinas living in a border region (San Diego, U.S.-Tijuana, Mexico border). Currently, to our knowledge there are no known published studies examining the multi-level influences (e.g., advocacy and environmental changes) on the PA of churchgoing Latinas in a faith-based setting. The unique nature of this study is that focus group findings were used to inform the development of a multi-level intervention targeting barriers to and facilitators of PA involving promotoras to mobilize advocacy for modifying the built environment surrounding the church parish.

METHODS

Setting and participants

The majority of Latinos live in urban areas (91%), with California (mainly Southern California) and Texas being home to over half of all U.S. Latinos.¹⁷ San Diego has a diverse population of approximately 2.9 million, of which 60% are white (non-Latino), 27% are Latino, 14% are Asian and other Pacific Islanders, and 8% are African American. The target area for this study comprised two Major Statistical Areas (MSA) with the largest concentration of Latinos within south suburban and central counties (of which Latinos comprise 53% and 36% respectively) of San Diego.¹⁸ Walking is often the focus of health promotion programs that aim to increase levels of PA among low active communities,¹⁹ however, it is important to consider physical environmental barriers to walking and the risk of injury pedestrians encounter in different regions in the nation. In San Diego, pedestrian injuries and fatalities have increased almost 10% since 1994.²⁰ The current rate of fatal pedestrian injuries is 22.5% which makes San Diego the third most dangerous place to walk in the nation behind New York and Miami.²⁰

Recruitment of church and participants

In 2005, approximately 29 million Latino Catholics lived in the U.S.²¹ Given that Southern California is home to many U.S. Latinos, Catholic Churches were selected as a setting for focus groups with Latinas. The selection criteria for churches included having a medium size parish (3000 members), and having at least one Spanish service. A convenience sample of Latina church members were recruited to participate in focus groups from two churches in San Diego County. Invitations to participate were made during and after Spanish language services. To be eligible, women had to be between the ages of 18 and 65 and attend church services at least 2 times per month. Two focus groups were facilitated in Spanish by two bilingual/bicultural researchers (who held a PhD or MPH) and lasted approximately 90 minutes. At the beginning of each session, the group leaders read the consent form out loud and asked permission to audio-tape the focus group discussions. An ecological framework was used to structure the focus groups guide that included open-ended questions regarding barriers and facilitators to physical activity.^{8, 9} Examples of questions included:

• “What barriers to walking are there in the neighborhood surrounding the church?”

• “How can the environment/neighborhood surrounding the church promote you to do PA or exercise?”

• “What could you do to advocate for environmental changes in the neighborhood [in reference to trash, graffiti and stray dogs]?”

• “What obstacles do you think could prevent you from participating in these types of activities [in reference to activities to improve the church environment]?”

The Social Ecological Model was used to identify themes that were individual, social and environmental. Major themes that evolved included individual level barriers (e.g., economics, time, motivation, childcare), socio-cultural barriers (e.g., social norms, lack of safety), and environmental barriers (e.g., broken sidewalks). The guide also assessed questions about the feasibility of implementing a multi-level intervention promoting physical activity and advocating for environmental changes in a faith-based setting. At the end of the group discussion, participants’ demographic characteristics were also collected. Participants were given refreshments, were thanked for their participation and given a $20 incentive for attending the session.

Qualitative data analysis

Focus groups were transcribed verbatim in Spanish to maintain the integrity of the participants’ responses. Transcripts were not back-translated into English, only the quotes included in this paper. The research team systematically reviewed and identified emerging themes. Transcripts were coded for major themes by the second and fourth author. Codes were entered into the qualitative data analysis software, Ethnograph (V5). All identifiers were removed to protect anonymity of participants and summaries were generated for Spanish speaking Latinas. Descriptive analyses were performed using SPSS version 15.0.

RESULTS

Demographic characteristics are shown in Table 1. A total of 25 women participated in two focus groups at two churches in San Diego County. Female participants were church members who attended church services on a regular basis (e.g. at least two times per month). Nearly all of the women were Mexican born (97%) and 19 women had lived in the U.S. for more than 12 years. Using country of birth as a proxy of acculturation, nearly all women demonstrated a low level of acculturation. Language preference is another measure of acculturation, and given that the focus groups were conducted in Spanish suggests that participants were of lower acculturation backgrounds. The average age of the participants was 40 years of age and a little more than half of the women were married or living as married (56%). Most women were employed (80%) and had less than a high school education (84%). The monthly household income for almost half of the participants was less than $1500. Slightly more women from church A were married and employed compared to participants from church B.

Table 1.

Focus group participants (N=25)

Demographics	%(Freq)
Country of birth
Mexico	96(24)
Marital status
Total married/partnered	56(14)
from Church 1	75(9)
from Church 2	38.5(5)
Employment status
Full-/Part-time	80(20)
from Church 1	83(10)
from Church 2	77(20)
Formal education
<High school	84(16)
from Church 1	75(9)
from Church 2	38.5(5)
Race/ethnicity
Latino/Hispanic	100
Average monthly income (SD)
≤$1500	48(12)
Average age (SD)	40(14)
Average yrs in the U.S. (SD)	17(11)

In the focus groups conducted at the churches, women participants were asked to describe a range of individual, social, and environmental factors that enabled them or prevented them from engaging in physical activity (summarized in Table 2). Participants also discussed the feasibility for promoting physical activity in a faith-based (e.g., church) setting. In addition, focus group participants provided their opinion on the feasibility of advocating for environmental changes in the church neighborhood.

Table 2.

Focus group multi-level outcomes

Barriers	Facilitators
Individual	Individual
• Economic limitations	• Knowledge about PA and nutrition
• Time constraints	• Encouraging social support
• Lack of motivation	• Building organizational/advocacy skills
	• Providing child-care
Socio-cultural	Socio-cultural
• Homelessness, crime, gangs	• Safer neighborhoods
• Fear of immigration
• Mexican cultural norms (e.g. gender roles, body size image)
Environmental	Environmental
• Poor lighting	• Aesthetics/Plants
• Lack of sidewalks	• Clean streets
• Speeding traffic	• Play grounds for children
• Unleashed/unattended dogs
• Vandalism

Individual barriers and facilitators of physical activity

Focus group participants mentioned numerous personal factors that impacted their physical activity in their neighborhood. They identified barriers to physical activity that included economic limitations, time constraints, lack of time management, and lack of motivation. Conversely, focus group participants also identified individual level facilitators to engaging in physical activity. These facilitators included creating an exercise program, learning more about the benefits of nutrition and physical activity, encouraging social support, building organizational and time management skills, and providing child-care.

Themes.

A total of thirteen focus groups participants stated that they faced economic barriers to physical activity. Two women acknowledged the availability of local physical activity programs in the church vicinity, but agreed that they were too costly. Several other women expressed that they had too many other expenses and could not afford exercise program fees. One woman stated that, “even if [she] had extra money to invest in a gym membership [for herself],” she would “rather buy something for [her] children.” When it was suggested that a more cost-efficient physical activity program could be organized at the church, requiring women to pay minimal fees, several women warned that some participants would not be willing to pay a fee. Specifically, one woman noted, “I think the principal thing is that it is free because in reality some people don’t even have money for the bus.”

A total of thirteen participants agreed that family, work, and housework responsibilities limited their time for engaging in physical activity. Many women described their hectic daily routine which consisted of caring for their children and husband, cooking, cleaning, and working outside their home on weekdays and weekends. One woman described how she had limited time to exercise because she was busy “preparing her children for school in the mornings, then going to work, and coming back home in the afternoons to pick-up and clean the house.” Two women mentioned walking their children to school as a means of exercise; however running late to school in the morning was a barrier. Also, two women said that they did not have the time to exercise because of work. Nevertheless, several focus group participants acknowledged that they could potentially allot time for physical activity, but they lacked the organizational and time management skills. One woman explained that her problem was “disorganization…that [she] wasn’t organized like Americans who had their agenda.” She stated that she spent her spare time watching television when she “could be walking instead.” In reference to physical activity, one woman stated, “Everything is possible…when one wants to, at whatever time, it’s possible…” Furthermore, three participants expressed that family responsibilities, such as taking care of children, was a barrier because it hindered their engagement in exercise programs. Ten participants understood the need of organizational and time management skills to facilitate physical activity in the church. Women suggested scheduling physical activity programs at the best possible time for most people such as the evenings and/or weekends. They believed that setting a schedule for the program would enable more people to reserve that time specifically for exercise. As one woman noted, “It’s easier to say I’m going somewhere to exercise than to exercise where I live, where it’s more dangerous to walk. It’s better to say, ‘I’ll go to a place [e.g. church], exercise, and come back.’ ” Furthermore, focus group participants indicated that any physical activity program should avoid interfering with family obligations like preparing meals or doing chores.

A total of sixteen participants expressed that lack of motivation hampered them from engaging in physical activity. One woman’s statement expressed the thoughts of many other women when she said, “well for me… it’s the hesitance and the laziness…we can make some time, but it’s the laziness…” Another focus group member believed the lack of motivation to exercise came from the perception that exercise was difficult to do. She commented, “It’s really hard to exercise…at the beginning it’s hard and the next day you don’t even want to stand up and you say, ‘no more.’ ”

Many women in the focus groups were knowledgeable about the physical and psychological benefits of physical activity. As one woman noted, “With exercise you become more active, and you can be healthier and in a better mood.” One woman mentioned that it was important to know about the benefits of physical activity from chronic diseases given the high prevalence of diabetes among Latinos, especially during pregnancy. Indeed, focus group participants were enthusiastic about a faith-based exercise and health program since they recognized that some of their children were overweight and unhealthy. The women viewed such a program at the church as a way to facilitate healthy family lifestyle changes.

A total of eight focus group participants agreed that the leadership of a knowledgeable and experienced exercise and/or nutritional guide would motivate them to attend a physical activity program at the church. When it was suggested by focus group leaders that church members themselves could be trained as exercise leaders, six women demonstrated enthusiasm. Six other focus group participants, however, believed that an outsider, perhaps a professional trainer or nutritionist, would garner more credibility among exercise group participants. According to focus group participants, the PA leaders should also have the capacity to incorporate nutrition and health education classes into a physical activity program. Indeed, several women wanted “an activity that brought together a group of women to teach them about food and cooking,” and other health matters. For example, one woman suggested “cooking for one hour and running for another.” Furthermore, two women were interested in gaining knowledge about the benefits of PA and chronic disease prevention.

A total of four women participants expressed that a program that offered childcare would allow them to participate in an exercise program. One woman said, “Well, a lot of the people who have children can’t come…they would like to go those types of classes, but not with the children.” Furthermore, most women supported having childcare on site and possibly taking turns caring for each others children. Other women envisioned a concurrent exercise and/or nutrition program for their children. One woman suggested a program that taught their children “what to eat, or what not to eat…or to be more active.” Indeed, women in the focus groups expressed that providing an exercise and/or nutrition program for their children would facilitate and motivate them to engage in physical activity.

A total of seven women in the focus groups expressed the importance of social support in their effort to become physically active. More specifically, one woman expressed that physical activity could be facilitated by “the motivation to go together, of doing it in [a] community.” Similarly, another focus group participant stated: “For me [walking] is easier and less tiresome when I go with another person because we chat, talk and walk…and I take my baby in her carriage so time goes by [faster].” Other women suggested that it was important to obtain family support when beginning an exercise program. For other women, social support was defined as being considerate of each other’s different skill and fitness levels, and avoiding ridicule from each other during physical activity sessions.

Socio-cultural barriers and facilitators of physical activity

Focus group participants described socio-cultural factors that either hindered or facilitated their physical activity. Lack of neighborhood safety was the most common social barrier. Other barriers were cultural, such as fear of immigration and social norms that are well engrained in Latino culture. Indeed, the most pronounced social facilitator of physical activity was increasing safety in the community.

Themes.

A total of nineteen focus group participants identified the lack of safety in the neighborhoods around the church as a social barrier for engaging in physical activity. They described encounters with gang members, drug addicts, and drunk persons at the parks and on the streets. One woman noted that, “there are places that one does not know very well, that are not safe enough to go walking.” Focus group participants especially noted the lack of safety in the neighborhood parks due to gang activity combined with the presence of homeless persons. Reported rapes in the community discouraged one woman from visiting a park where she used to walk. She stated, “my husband tells me ‘go take a walk,’ and I tell him, ‘no, I am afraid, after all that happened [the rapes].’ ” Seven focus group participants expressed that safer neighborhoods would motivate them to engage in physical activity. Several women mentioned increasing safety patrol and wished the police would remove drug addicts, drunk and homeless persons from the church vicinity. Another woman suggested, “remov[ing] all the gang members,” in the parks and streets.

Several women noted that they feared being apprehended by the Border Patrol and being turned over to the U.S. Citizenship and Immigration Services (formerly knows as INS). In particular, one woman said that “Latinos don’t usually use that park. We don’t come to visit the park because they [other people] say that immigration goes there.” Another woman stated, “If we don’t have papers, they’ll take us, and the kids, they just stay there.”

Focus group participants described other socio-cultural barriers of physical activity. Three women described how some Latinos discourage weight loss because it is viewed as a sign of poor health. As one participant stated, “In one’s family they think that because one is losing weight, one is sick and instead of lifting your spirits they lower them and ask you what’s going on? You were so pretty and look how you are looking.” Also, husband’s jealousy was a barrier to engaging in physical activity. Five women shared that their husbands disapproved of them wearing exercise apparel because other men would look at them. The women described these ideas as “long engrained” in Latino culture and so unavoidable.

Physical environmental factors of physical activity

Women in the focus groups discussed physical environmental barriers and facilitators that impacted their physical activity. Moreover, women concluded that constructing playgrounds for children and exercise areas for adults, increasing public transportation to physical activity parks/facilities, and clean, lush neighborhoods would facilitate physical activity.

Themes.

Given that none of the participants stated that physical environmental factors impacted their physical activity, focus group leaders probed whether aspects in the physical environment inhibited participant’s physical activity. In response, eight women commented on the poor lighting in the streets and parks. One woman explained how the lack of light frightened her when “bringing [her] children to catechism classes every day…but there is no light…and you have to pass by [to the catechism room] running.” Another woman agreed by saying, “We need more lighting, more illumination [around the church].” Four women noted the lack of sidewalks and crosswalks. One woman believed that the lack of sidewalks inhibited her from walking on the street. Specifically, she stated, “In some streets, there are no sidewalks…or on some sidewalks, there are parked cars and then the only option [to walk] is the street.” Speeding traffic was noted as a concern among four other women. One focus group participant described how speeding cars were a barrier to physical activity for both her and her children. She said, “We want to, but can’t [walk on the street]…the children want to be out on the street with their bicycle, but when we go out we are just looking after them [because of speeding cars], so we leave.” Being chased by unleashed dogs was a barrier for engaging in physical activity among three focus group participants. One woman indicated, “When it’s not dark and you go out to walk and the neighbors have dogs and you are making noise, more so if you have children, the dogs chase you.”

For several women, public transportation also was noted as environmental factor that influenced physical activity. Several women expressed that public transportation was a barrier to physical activity because bus schedules were infrequent and bus stops were far from physical activity resources. The likelihood of using public transportation to access such community resources was very low.

Several focus group participants expressed that the aesthetics of the built (physical) environment was an important facilitator providing that it made areas more pleasant for exercise. In addition, neighborhood aesthetics discouraged vandalism and criminal behavior. For instance, one woman affirmed, “The prettier the streets, the more people there are, you feel more protected [safer] in that place.”

Participants also provided suggestions regarding physical changes in the built environment surrounding the church. These changes were regarded as approaches to motivate physical activity in the community. Two women suggested constructing jungle gyms so that children also could exercise. Another woman suggested planting trees to make the area more amenable for walking. Another woman agreed, stating that, “trees motivate a lot [with regard to physical activity], and provide shade.” Other focus group participants recognized the importance of keeping the streets clean to encourage more walkers.

Feasibility for promoting physical activity in a church setting

Focus group participants were asked how much support they believed a physical activity program would foster from their respective church communities. Seven women were ambivalent about the church community’s support for such a program, specifically because their churches tended to organize other types of wellness programs. As one woman said, “It [a physical activity program] is something new….Before you didn’t hear that they [the church] wanted to offer us something about health.” Other focus groups participants believed that the church community would eventually embrace a physical activity program, but that the biggest barrier lay in getting people to commit to the program. One woman stated that there were “many workshops at the church for parents, for families, but the Hispanic community does not attend.” Some focus group participants expressed concern over Latinos’ poor attendance in church programs and activities outside of mass. They noted that a well-executed promotion program could motivate people to participate in a physical activity program. Six women insisted in first obtaining the approval and endorsement of the church leaders and/or the Hispanic ministries.

Women were asked about how to promote a physical activity program in a faith-based/church setting. To promote such a program, women suggested several channels of communication. They gave examples such as making announcements after services, preferably by the priest, including announcements in church bulletins, and simply spreading the news by word of mouth. They also recommended giving people incentives for their participation.

Moreover, focus group participants provided suggestions of feasible physical activities in the churches. Women suggested activities like walking groups, dancing, aerobics, video aerobics, yoga, volleyball, and gardening or cleaning up around the church. Some focus group participants indicated that they preferred a “program that was not too difficult” and that accommodated people of different fitness levels. Regardless of the women’s preferences, most women recognized the need for physical activity programs. Moreover, with a little work, women considered it feasible to organize such a program in a church setting.

Feasibility for advocating for social and physical environmental changes

Women in the focus groups were not accustomed to advocating for environmental changes and one woman stated that “Latinos are not used to being involved in any sort of community advocacy.” While some focus group participants expressed feeling intimidated in advocating for environmental changes in the church neighborhood, most indicated that they would advocate for environmental changes because they deemed it important. Specifically, one women said, “I am convinced that any help for the community, our streets, our children, our parks, is always good and we should always support it.” Moreover, nine women demonstrated interest in community organizing and investment. One woman suggested doing something for the community in a fashion similar to the “Adopt a Street” initiative. Moreover, three women stated they would be willing to organize themselves to write letters to government officials to make physical environmental changes that would foster physical activity. One woman in particular demonstrated enthusiasm about community organizing because she had formerly participated in a successful neighborhood family walking club. However, not all focus group participants felt capable of making changes in the built environment surrounding the church. Indeed, some women who rented their homes did not feel empowered to make these types of changes in their neighborhood.

Although most focus group participants demonstrated an interest in advocating for environmental changes, they identified several barriers to making community environmental changes and playing an advocacy role. Four participants noted that they did not have the skills necessary to advocate for simple changes, such as asking neighbors to keep their dogs on a leash, much less asking the city for more lighting. Women were asked whether providing them with the skills necessary to advocate would be helpful. Eight women agreed that having advocacy skills would help them in being better prepared to ask for environmental changes. When asked what skills they would need to make environmental changes, one woman responded, “know each step, the process needed, for example, to make certain petitions in the city council.” Women also mentioned lack of childcare, work demands, and poor English language skills as barriers to playing an advocacy role. In order for them to participate in city meetings, focus group participants emphasized the importance of providing a translator. As one woman said, “well, if it’s going to be in English meaning that the people of power do not speak Spanish, and it will not be a meeting in Spanish, then there is no point in attending.”

Focus groups participants also described facilitators for making environmental changes around the church. Women stated that the church would support them in their effort to organize to make physical environmental changes. One woman thought of promoting the cause and fostering community support through a priest’s radio show. Another woman confirmed the availability of church members willing to work to make environmental changes. She stated, “We have a lot of people who help out a lot in the church, and women who have a lot of time to lend their service.”

One woman believed that providing the evidence that environmental changes could be made would encourage her and others to continue playing an advocacy role. She stated, “For example, if I am trying to get more lighting on a street, and that gets resolved, and I see the need for a mobile clinic or any other need, then I [would] work on that.” Finally, women described the social bonds that could be formed from organizing with others. One woman said, “When one organizes with the neighbors, one gets a chance to get to know them.”

DISCUSSION

Consistent with previous studies, individual barriers included economic limitations, family obligations (familismo), lack of time and motivation and social support.^{10, 12, 22} As noted in previous studies, focus group participants noted several socio-cultural factors that were unique among Latina churchgoers living in a border community.^{10, 22} As a result of women participants residing within minutes of the U.S.-Mexico border, some of the challenges Latinas faced dealt heavy border patrol, and possibly stronger Mexican cultural norms (e.g., gender roles). Participants feared being detained by the U.S. Border Patrol and avoided visiting frequently patrolled parks and recreation areas. In addition, gender roles, machismo, and social perceptions of women’s weight impacted physical activity engagement. For example, Latina participants expressed physical activity and sports as a male-gender role and some women were challenged by machismo influences (e.g., spouse/partner discouraging women from exercising). Focus groups also revealed that, in Latino culture, weight loss was not perceived as a positive health benefit, but a sign of a stress related experience.

As expected and reported in other studies, environmental barriers included lack of safety and inaccessible physical activity facilities.^{10, 12} In addition, focus group data further revealed physical environmental barriers to physical activity among Latinas of a low socioeconomic border community. These physical features included lighting, lack of sidewalks, and (heavy and speeding) traffic which made it challenging for children and women to engage in neighborhood activities, such as walking and bicycle riding. Furthermore, the presence of unleashed/unattended dogs, homelessness, and the lack of aesthetically pleasing views in the physical environment decreased opportunities for physical activity engagement in neighborhoods and parks. Lastly, infrequent bus schedules or no service to physical activity facilities decreased women’s opportunities for reaping the benefits of available resources.

Women provided much insight surrounding physical activity interventions for churchgoing Latinas living in a border community. Women were in favor of programs that focused on individual and environmental level barriers to physical activity, but that also were culturally sensitive. Some examples of individual level interventions included targeting economic barriers, such as a no cost faith-based physical activity program with a suggested donation collection for program leaders. Indeed, childcare was both an economic and familial barrier, therefore, establishing a babysitting cooperative, or child-friendly programs would increase opportunities for participating in a physical activity program. Inclusion of the dimension of social support, such as teaching women how to elicit support for exercise from family members, also was noted as important for facilitating physical activity engagement. Given that women expressed lack of time and motivation deterred them from being physically active, perhaps, programs should include time-management skills and increasing motivation to overcome some of the challenges that women faced. Additionally, teaching women the health benefits of physical activity, such as chronic disease prevention, might encourage them to meet the recommended levels of physical activity. Given that energy balance is a result of both diet and physical activity, it also is important to diversify programs by integrating nutrition as a means of engaging women in physical activity programs. Women also noted that a faith-based physical activity program could be successful if church leaders were included in all phases as a way to develop trust and mutual endorsement.

Cultural norms differ for many Latino immigrants and for those Latinos who are less acculturated to U.S. dominant social norms. Particularly, Latinos of border communities may retain Mexican cultural norms for a longer period of time given their proximity to Mexico and the likelihood of contact with Mexican influences. Although U.S. border communities exhibit some degree of American culture, there is a strong overlapping Mexican influence that creates a unique border culture. Programs targeting border communities should be culturally-sensitive to border culture and social norms, especially those pertaining to gender roles. For example, engaging male partners in physical activity programs may help to decrease machismo attitudes toward women being physically active. Furthermore, women indicated a larger body size preference and that losing weight was discouraged by other Latinas; thus, emphasizing fitness, nutrition and a healthy body size may be a more culturally appropriate way to intervene with this population.

Ecological models emphasize the importance of social and environmental influences on physical activity.⁸ Indeed, women discussed strategies for circumventing social and physical environmental barriers to physical activity. Participants were mostly Mexican immigrants and noted that advocating for environmental changes was not a cultural norm. As a result, women also indicated the importance of being taught how to advocate for physical environmental changes given the challenges one may face when attempting to modify the physical environment. The level of infrastructure and conditions of the built environment may be better-off in economically disadvantaged neighborhoods in the U.S. compared to those in Mexico. It may be beneficial to increase awareness about the association between the physical environment and physical activity given that this relationship may not be readily apparent. Women collaborate with experts to identify physical barriers in their community (e.g., lighting, sidewalks, aesthetics, traffic speed, and crosswalks) and know with whom to voice their concerns (e.g., church leaders, city council) and local authorities (e.g., police). Moreover, building advocacy capacity and teaming up with grass roots organizations would empower Latinas to advocate for community improvements that would benefit children and older adults, such as neighborhood aesthetics (to reduce vandalism), lighting, sidewalks (broken or lack of), traffic, and unattended dogs. Moreover, women could advocate for larger community involvement, such as “adopt a street” or “adopt a park” programs, geared toward keeping neighborhoods safe and clean.

Conclusion

This qualitative study revealed numerous individual, social and physical environmental barriers and facilitators to becoming physically active among Latina churchgoers living in a border community. Participants indicated facilitators of a physical activity program should include a knowledgeable guide, incorporating health and nutrition education, child-care, encouraging social support, and building advocacy capacity and time management skills. These research findings provided insight for the development and implementation of a program that promotes physical activity and environmental changes in a church setting comprising a Latina population.