A Multilevel Physical Activity Intervention for South Asian Women and Girls

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Project Summary Asian Indian and Pakistani (South Asian) immigrants have a high prevalence of physical inactivity and cardiometabolic risk factors. South Asian (SA) women and girls are particularly at high risk due to a confluence of immigration, culture, and gender which shape the health risk of SA women and girls across the life course. Our community-based participatory research found that SA women (85% of whom were 1st generation immigrants) experienced: a) social isolation and low social support, which reduced physical activity (PA) motivation and self-efficacy; b) desire to maintain traditional values and norms, which conflicted with local PA environments (e.g., mixed-gender exercise classes); and c) linguistic and environmental barriers. When SA girls (majority 2nd generation) entered adolescence, they described: a) acculturation-related family conflict because exercise was perceived as an “American behavior”; b) gender constraints; c) lack of role models; and d) their community's shared illness belief that “if you are thin, you don't need to exercise.” Importantly, the community also identified individual, interpersonal, and familial processes that empowered SA women and girls to become more active, including holistic benefits of PA, aspirations for children's health, and feeling connected and happy when exercising with other women and family. Building on a pilot study demonstrating feasibility and preliminary efficacy, the proposed study aims to testing the efficacy and implementation of the South Asians Active Together (SAATH) intervention. The 16-week intervention targets individual, interpersonal, and family levels through four main components: 1) group exercise classes for mother-daughter dyads; 2) dyadic mother-daughter PA counseling using motivational interviewing; 3) peer discussion groups, and 3) family walking groups. The intervention also targets the environment level by working with park districts, a public health department, and community organizations to make changes to the local environment that take into account sociocultural (e.g., gender, family focus) and environmental (e.g., same sex classes) expectations of SA. Aim 1 of the study is to determine the efficacy of the SAATH intervention to increase moderate-vigorous PA in SA mother-daughter dyads using a randomized wait-list control study design. Secondary outcomes are: walking and sedentary time in dyads and cardiometabolic risk factors in mothers. Aim 2 will evaluate the impact of the intervention on individual (self-efficacy, autonomy support, social support, motivation) and dyadic (acculturation conflict, communication, connectedness) factors hypothesized to mediate the intervention effect on PA. Aim 3 is to evaluate implementation and sustainability of SAATH, including the environment and systems changes made by cross-sector partners to promote and sustain PA in SA women and girls. Given the growth of the SA population and their increased risk for cardiometabolic disease, identifying interventions that increase PA among Asian Indian and Pakistani immigrant women is of significant public health import.