Physical Activity Perceptions in Adolescents: A Qualitative Study Involving Photo Elicitation and Discussion Groups

Introduction

Adolescence is a transitional period in life involving many physical, cognitive, and social changes that forge a person’s identity. This phase is key to emerging adults because it is when most of the habits and behavior patterns that comprise a lifestyle are developed (Eccles et al., 1993; Myers, 2007). Aspects as diverse as the perception and acceptance of one’s own body, the engagement in risky behaviors, as well as self-confidence and self-esteem are crucial to the future health of adolescents. In addition, adolescents need to acquire a habit of doing regular physical activity (PA) to prevent risk factors for health (Makinen, Viertomies-Puukko, Lindberg, Siimes, & Aalberg, 2012; Mond, van den Berg, Boutelle, Hannan, & Neumark-Sztainer, 2011; Nelson & Gordon-Larsen, 2006). However, to date, a successful and sustainable intervention for this age group has yet to be established. To design appropriate strategies based on their needs, it is necessary to conduct qualitative studies to yield firsthand information on the adolescent’s experience of PA. To this end, we used the photo elicitation (PE) technique to enable the adolescents to photograph and show their views, social spaces, preferences, habits, and routines. This technique gave us insights into the relevant aspects of the adolescents’ daily lives from their own points of view and of the main barriers they encounter. Second, we conducted group discussions (GD) to gather information that might have not been collected through the PE technique. Our objective was to understand the adolescent’s perception of PA, namely, aspects that generate satisfaction and rejection and the barriers that deter, which could help to lay the foundation for designing strategies and robust interventions for this segment of the population.

Method

Participants

The present study was conducted in Barcelona (Catalonia, Spain) during the academic year 2015-2016. The adolescents in the sample were students in the second stage of secondary education schools in a district of the City of Barcelona. Barcelona is comprised of 10 districts. The District of Sants-Montjuïc was randomly chosen for the study, picking up one of the 10 sealed envelopes. This district is the third largest district of Barcelona, with a population covering all socioeconomic levels, especially medium and low. The foreign population represents 50.7% and its origin is mainly from countries in Central and South America, Asia, and Oceania.

PE

Two schools were randomly chosen from the five schools in the district. The participants were adolescents between ages 14 and 16 years. Sixty-eight adolescents (43.3% girls and 34.2% boys) were invited to participate. However, only 26 of them (13 boys and 13 girls) were finally involved. The ethnic groups of adolescents were distributed as follows: 11 Caucasian, five Asian, three Arabic, and seven Latin American (see Table 1 for descriptive information). Each participant sent three photographs. Selfies were excluded (11). Finally, 67 photographs were analyzed.

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Table 1.

Characteristics of Participants.

Ethnic groups	Gender and age
	Boys	Girls
PE
Caucasian (11)	Six (2-16 years; 4-15 years)	Five (one teenager 14 years; 4-15 years)
Asian (five)	Three (15 years)	Two (15 years)
Arabic (three)	Two (16 years)	One (15 years)
Latin (seven)	Two (15 years; 14 years)	Five (two teenagers 14 years; 2-15 years; 1-16 years)
GD
Caucasian (seven)	Four (14 years)	Six (14 years)
Latin (three girls)

Note. PE = photo elicitation; GD = group discussion.

GD

Ten teenagers volunteered to participate (four boys and six girls). The average age was 14 years old (seven Caucasian and three Latino (girls). We invited a group class (15 girls and 21 boys), which showed interest to conduct GD, from one of the two schools that participated in the study. The first 10 students who volunteered to participate were eligible for GD.

Procedures

PE

With the approval of the directors of the participating schools, a meeting was held with the teenagers to present the study, in order to inform them about its objectives and the intended purpose. Adolescents were asked to send photographs taken by them through the smartphone application WhatsApp. Participants were told that photographs must be linked to their everyday life from a PA point of view and the different behaviors (barriers, perceptions, and motivations). Each photograph should be accompanied by an explanation in the form of title or phrase that participants wished (elicitation) without any restriction.

WhatsApp is a mobile application that many young people use as a primary communication tool in their daily lives (Ahad & Lim, 2014). It offers a forum for sociability (O’Hara, Massimi, Harper, Rubens, & Morris, 2014) and achievement of learning attitudes in students (Amry, 2014). It also represents some independence from the researcher.

The analysis of the photographic material was explored from two perspectives: Internal narrative: based on describing each photo by the different elements of photography, and external narrative: interpretive analysis looking at the relationship and coherence between the description, symbolism, and text accompanying the picture and between the image and the text they wanted to communicate (Banks, 2007).

The analysis of internal narrative and external narrative served as deductive-inductive categorization. This analysis was carried out independently by two members of the research team. We obtained 91% agreement, which exceeds the standard for acceptablity of 85% used in previous studies; 85% was considered acceptable. Disagreements among researchers occurred for only five photographs; subsequent discussion resulted in the researchers reaching agreement on four of those five photographs The only photograph with no consensus was not used for data analysis.

GD

The transcript in text format was systematically analyzed through different readings, which were used to identify meaningful quotes on the subject of the study. With the help of the Atlas-ti 6.2 program, a unit hermeneutics was created from which the researchers encoded and managed quotations. In the categorizing process, the criteria used for the division of the analysis units were separated segment by segment. Researchers identified and classified units by categories looking for topics of meaning and the subsequent allocation of a code. With the categories grouped, fragments were obtained relating to the same subject and a quantification was established based on the frequency of appearance. The categorization of the two parts of the study (PE and GD) was carried out in parallel fashion, providing both inductive and deductive assessment of the data. The constant comparison method was used to refine and merge the categories across methods (Table 2).

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Table 2.

Definitions of the Categories.

Deductive categories

Barriers

Physical, psychological, social, and environmental aspects perceived as limiting one for the practice of PA (Fernández Cabrera, Silvia, Herrera Sánchez, Rueda Méndez, & Fernández Del Olmo, 2011; Niñerola & Pintanel, 2006)

Classification PA

Collection of activities of daily life that can be considered forms of PA. Daily activities that generate increased consumption of calories, such as travel, leisure, homework, or academics (Caspersen, Powell, & Christenson, 1985)

Attitudes

Beliefs and sentiments that predispose to respond in a certain way to different situations (Martínez Baena et al., 2012; Pérez-Samaniego, Iborra Cuellar, Peiró-Velert, & Beltrán-Carrillo, 2010)

Association PA

Explore what activities the adolescent associates with PA

Facilitating factors. motivation

Aspects that encourage or facilitate the practice of PA. Includes aspects that teens identify as facilitators and motivators as opposed to barriers (Moreno Murcia, Cervelló Gimeno, & Martínez Camacho, 2007)

Inductive categories

Gender

Socially constructed roles, behaviors, activities, and attributes that a given society considers appropriate for men and women (WHO, 2013)

Body image

Dynamic perception of the body as it looks, feels, and moves, which can be influenced by mood, experience, and physical environment associated with the major changes that occur in adolescence (Croll, 2005)

Note. PA = physical activity; WHO = World Health Organization.

Reliability criteria (reflection, objectivity, and neutrality) and unit (reliability and consistency) decision making followed the criteria set out in the literature (Andreú Abela, 2002; Krippendorff, 2004; Mayring, 2000).

Results

As we have explained in the “Method” section, the analysis of the photographs gave us two visions: (a) descriptive, according to the internal narrative of the photograph, and (b) interpretive, through the external narrative of the photograph (Table 3).

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Table 3.

Results of the PE.

Categories	Subcategories	n
Internal narrative
People	Presence of people	36
Space	Outdoors	34
	Indoors	31
Places	Home	16
	Sports facilities	15
	Urban settings	15
	Mountain/beach	6
	School	4
Components	Material esportiu	25
	Transport	7
	Material escolar	5
	Apparel	5
	Animals	2
Sports	Team	16
	Individuals	6
	Minority	6
	Fitness/gymnastics	4
Food	Meals	10
External narrative
Barriers	Demotivation/fatigue/laziness	22
	Incompatibility obligations/lack of time	8
Classification PA	Entertainment/leisure	33
	Transport	7
Attitudes	Gratification	27
	Autonomy	16
	Security	7
	Improved appearance	8
Association PA	Sport	27
	Environment	20
	Health	17
	Interpersonal relations	14
	Body image	6

Note. PE = photo elicitation; PA = physical activity.

The internal narrative resulted in a series of elements present in the photograph (people, spaces, places, components, sports, and food). In 36 of the 67 photographs, present were people. The spaces element identified photographs taken in the interior or exterior context. The places element tells us where the photographs were made (home, sports facilities, urban or rural environments, or school/institute). The components elements include sports and school materials, transport (bicycles, motorcycles, skateboards, etc.), and electronic devices (mobile phones, computers, TV, etc.). The sports element identifies the type of sport that appears in the photograph (collegiate sports, individual, minority, or made in the gym). The last item that was labeled is food (it should be noted that all photographs with food presence were made by girls).

The external narrative generated results on inductive categories (barriers, classification PA, attitudes, and association PA) and the corresponding subcategories. We can identify that the most important barriers are demotivation, fatigue, and laziness. The realization of PA with leisure activities was identified. Gratification was the most prevalent attitude. Adolescents associated PA with sports followed by environment, health, and interpersonal relationships (Table 3).

As for the results obtained from the GD technique, coincidence was found in three deductive categories (barriers, motivation, and classification PA) regarding the analysis of the photographs. Also identified were two inductive categories (body image and gender) (Table 4). A selection of discourse categories is shown in Table 5.

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Table 4.

Classification of the Most Relevant GD Categories.

	Number of citations
Deductive categories
Barriers	37 (21.51)
Motivation	28 (16.27)
Classification PA	15 (8.72)
Inductive categories
Body image	39 (22.67)
Gender	37 (21.51)

Note. GD = group discussion; PA = physical activity.

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Table 5.

Selection of Narrative Segments More Representative of Each Category Explored.

Barriers

1. I prefer to stay and go out with friends. (RP_B)

2. If you do something without motivation, if you are forced, you end up rejecting it. (RP_B)

3. From the sofa to the bed, from the bed to the sofa. (RP_B)

4. I believe that we do not do sports because there are many exams and many things to do, besides, directly that we prefer to do other things. (AD_G)

5. I do not find that support . . . Well, to see, my mother likes me to do sports but they do nothing to motivate me. (JN_B)

Facilitating factors. Motivation

1. If I go running on my own, I kind of get bored, but when I play football I feel like I am doing more PA, I mean, I make a greater physical effort and I enjoy it because I’m doing something I like, and I feel like I am sharing this activity with someone and we have fun, I think. (PP_G)

2. It is easier to feel like making a physical effort if you are doing something you like, if you are doing something you don’t like, you won’t feel like making an effort . . . If you like it, even if you aren’t physically ok, you make an effort. (JN_B)

3. We like to have adrenaline. Do things that motivate us. (JA_B)

4. If you have motivation, the rest does not matter to you. (RO_G)

Body image

1. Because you see all these girls and you go, like, ok, and then you try to look like the ones in the magazines, for example, depending on how honest you are with yourself. (JN_B)a

2. Teenagers do not think about AF but stop eating and that’s it. (IL_G)

3. Of course, but the canons of beauty also because of her have influenced the girls to be anorexic or bulimic. (MC_G)But you should think that most people, I mean, people who keep themselves really, really, really fit are people on TV who make money and can afford stuff like things to keep fit, on top of that, by doing just a little bit of exercise. (PP_G)

Gender

1. It’s not because we’re inferior. Even teachers believe that “girls don’t enjoy sports as much as boys,” so they expect less from us. (RO_G)

2. In TV commercials, women always appear cleaning. I’ve never seen a boy advertising a cleaning product. Boys are shown in their cars. (JA_B)

3. There’s a TV channel called Deports 4, it is a channel about “sports,” but the whole time they are talking about football, non-stop. I’d like them to pay attention to other things like volleyball or other sports that are not even appreciated. (PP_G)

Note. DG = discussion group.

aIdentification codes are formed by: the initials of the name of the adolescents (fictitious), followed by the letter G or B, which identifies the sex (G = Girls; B = Bois).

Once the source of each result has been explained, the final results are written in a global way.

Family-related barriers were found due to the lack of support and motivation from the parents. Prominent within this category were references to laziness, brought about by the reproduction, of familiar sedentary patterns. The compulsory nature of physical education in the school was noted as contributing to rejection on the part of the adolescents who found repetitive and routine activities boring. This, in turn, generates a lack of motivation because of reduced enjoyment in doing PA. We found that most adolescents have practiced PA on a regular basis, but when they reached adolescence, they abandoned it because of a greater diversity of activities they considered to be more important than the performance of PA, such as studies or activities related to PA. Leisure and friends were associated with the lack of time for obligations (school or family) and incompatibility with other tasks.

Adolescents related PA with tasks such as playing, dancing, and going to the beach and also recognized transportation in their daily lives (displacements) as a form of PA. The environment closest to the adolescent is important and can be a facilitating element for the practice of PA, as the city and the neighborhood have adequate spaces and equipment for PA, but it was made explicit that the economic expense involving access to the sports facilities is a barrier, as their families cannot do this expense.

Motivational aspects or facilitators for the practice of PA were detected, such as satisfaction with the performance of PA, as a necessary factor. Interpersonal relationships and links with the group and friends, if these are given while practicing PA, are motivating elements. The geographical environment, considering that the city is open to the sea, being on the beach, and the proximity of outdoor spaces are facilitators of sports practice. Having models to follow within the family, at school, and in their immediate environment is a motivating factor.

Identified aspects related to perceived personal image are influenced by the beauty canons imposed by society, as not following them can result in discrimination. Personality, strength of will, and scale of values are relevant aspects, as they can sometimes have: with the following: “that can help adolescents to not be influenced by these canons and therefore avoid” consequences on health, such as the cases of bulimia and anorexia, as they associate the improvement of the image not with the practice of PA but with the diets. Beauty standards are perceived differently depending on the gender; for girls, thinness is synonymous with having a good body image, as the girls relate it to a good physical condition. As for the appearance, they reject the exaggerated representation of the body, considering it as a way of using the body to attract attention. Also, a good body image is linked to the effort and sacrifice it entails to get the body that you want. Finally, adolescents believe that a good image can provide social and economic recognition.

The girls showed aspects related to different social behaviors in relation to gender, such as the offer of sports directed at women, considering that it is inferior in relation to men or that the publicity surrounding the sport uses the figure of the woman that makes them feel that women are objects. Behaviors in the family, school, and society in general, in relation to sports practice, discriminate against them, as the preestablished patterns label women by relating them to specific tasks (sports for women, care of siblings, housework, worse physical condition, etc.), considering that these are social prejudices toward women and the realization of PA.

Discussion

The present study has given robust insights about three major findings: (a) the principal barriers to PA practice in a group of adolescents, (b) the perceptions of PA practice, and (c) the detection of the main facilitating and motivational factors to be able to enhance PA among this population.

The most significant barriers are related to lack of motivation, fatigue, and laziness, agreeing with the majority of studies on the perception of barriers toward the practice of PA in this age group (Garrido, García, Casero, & Flores, 2013). Several studies relate laziness with worse physical condition that generates unease and unwillingness to deal with physical exercise, which in turn may favor sedentary behavior and demotivation (Niñerola & Pintanel, 2006). Lack of motivation to PA practice is also caused by the high amounts of routine activities, mainly the ones imposed at school, which are compulsory. We believe that when designing an intervention, proposals have to be flexible (in contrast of the high amount of daily obligations), exciting, and creative, adding prominence to the teenager. PA with a dance approach has been found to offer numerous valuable opportunities such as a higher adherence in both boys and girls (Cain et al., 2015; O’Neill, Pate, & Beets, 2012). Another strategy worth exploring relates to the use of emerging technologies to generate motivation and stimulate the teenagers’ interest (Hernando, Arévalo, Mon, Batet, & Catasús, 2015; Moncada Jiménez & Chacón Araya, 2011; Zurano, 2011).

The lack of family support with the transmission of a sedentary lifestyle becomes a barrier for teens, causing the abandonment of the sport when no support is perceived (Isorna Folgar, Ruiz Juan, & Rial Boubeta, 2013; Martin-Matillas et al., 2011). Several authors have detected the role of the family and their healthy habits as the key variable most often considered as a preventive measure (Suárez, Del Moral, Martínez, John, & Musitu, 2015). The school should assume a leading role in including family counseling to enhance PA practice and the benefits of being sufficiently active (Hearst, Wang, Grannon, Davey, & Nanney, 2017)

The environment plays an important role to generate motivation and encourage increased PA. Studies related to the assessment of how the environment can help the population to be more active have shown that having a proper environment is important to enhance motivation to PA practice, such as being able to play sports in outdoor facilities (Artigos, 2008; D’Haese, Van Dyck, De Bourdeaudhuij, Deforche, & Cardon, 2015). Schools should explore all the outdoor possibilities that the city and the weather can offer, away from the classroom and the usual spaces the teenagers tend to be sedentary. Teenagers relate sports practice to the need to have specific equipment, which in turn involves an increased economic cost. This is shown to be a barrier associated with the lack of resources and the inability to practice some attractive sports. Some studies have attributed greater participation to PA practice of adolescents to higher socioeconomic levels (Finger, Mensink, Banzer, Lampert, & Tylleskär, 2014). The design of activities that did not entail the need for specific materials could be a good strategy to overcome such barrier.

Most adolescents pointed collective sports as their first option to being able to establish interaction with friends and colleagues (Cheng, Mendonca, & Farias Júnior, 2014). The peer group is one of the agents that most influences in a positive (generating motivation) or negative (encouraging abandonment) way (Fitzgerald, Fitzgerald, & Aherne, 2012; Isorna Folgar et al., 2013; Valdemoros San Emeterio, Sanz Arazuri, & Ponce de León Elizondo, 2012). We believe that interventions should encourage group activities to enhance motivation and improve interpersonal relationships with colleagues within the same context that PA is conducted (Eime, Young, Harvey, Charity, & Payne, 2013). In addition, team sports provide important values such as sense of identity and belonging, very marked in adolescents, as well as the acceptance of the sports rules and regulations while making them managers of sports victories and defeats (Ponce-de-León-Elizondo, Ruiz-Omeñaca, Valdemoros-San-Emeterio, & Sanz Arazuri, 2014).

The most common implementation of PA was associated with leisure time, which gives us an idea of their priorities and knowledge. The consulted studies demonstrate that PA done in leisure time does not suffice and may lead to high-risk or simply unhealthy activities (Kjønniksen, Torsheim, & Wold, 2008; Viñas, Majem, Barba, Pérez-Rodrigo, & Bartrina, 2006). As for the girls, consulted studies indicate that they tend to participate less in sports and leisure activities, so we should explore other contexts to encourage female participation (Eime et al., 2015).

Body image gives a double interpretation. On the one hand, from the barrier perspective (Garrido et al., 2013; Niñerola & Pintanel, 2006), teenagers perceive that the patterns of beauty imposed in our society can easily discriminate a person who does not achieve them. The girls perceive barriers more often related to physical appearance (Babic et al., 2014) and, in some cases, related to real diseases such as anorexia and bulimia. The concern reported by some girls of our sample should be noted as they report an ambivalent relation between body image and food ingestion. They reported the importance of eating properly with limited amounts, although if PA practice is performed, then the related energy expenditure allows to eat more (Carmona, Tornero-Quiñones, & Sierra-Robles, 2015; Daniels, 2009; Jones & Smolak, 2011). However, body image can also be used as a motivational approach to feel better and healthier while improving self-physical and better physical condition, coinciding with studies that have linked regular PA practice to psychological well-being generated by having a healthy body image, especially in adolescent girls (Fernández-Bustos, González-Martí, Contreras, & Cuevas, 2015).

In relation to gender, we found discrimination for being women both in the media and in everyday life, coinciding with previous studies (Cooky, Messner, & Musto, 2015). Regarding this aspect, we believe that until women do not become sports TV program consumers, it will not be a fair change (Trolan, 2013). This aspect can be related to the relationship between sports and fashion (Westerbeek, 2010).

The self-satisfaction perceived by women who undertake regular PA practice along with interpersonal relationships are the two most important facilitators and motivational factors perceived by teenagers, which coincides with previous studies (Moore et al., 2010; Salvy, Bowker, Germeroth, & Barkley, 2012; Walia & Leipert, 2012). It is clear that, for the design of a successful strategy aimed at promoting PA in this age group, social interactions should be a key factor as well as the involvement of parents, schools, and policy makers.

Conclusion

The present study provides a clear and understandable view of the links and perceptions of PA practice in a group of adolescents as well as their perceived barriers and motivations. We identified several factors that determine why or why not teenagers decide to be physically active. Family and social and cultural environment are the main drivers of adolescents’ habits and help incorporate PA practice into their daily lives and routine.

Future research should focus in greater depth on the study of other agents that influence the teenagers’ daily life, such as teachers, PA experts, and parents. Further research is also needed on adolescent girls, because the present study has shown that girls perceive several aspects they are discriminated against. This fact has been shown to influence their PA practice.

Regarding the methodology of the present study, we believe that the combination of the two techniques used has enriched this research, as they have helped to identify valuable aspects, such as those relating to gender, which would not have been possible if just one technique has been used. The information gathered in the present study could assist in finding incentives and design robust strategies to increase their regular PA practice. In addition, it might allow institutions and policy makers to plan effective interventions to improve the population’s long-term health.

Limitations and Suggestions for Future Research

This research is limited by the fact that it was conducted in a single district of Barcelona. Comparing data between different districts would provide a more objective view of Barcelona’s real situation in regard to the subject of study.

Second, PE provided a unique method for identifying perceptions toward PA practice and perceived barriers but may have restricted examples of PA practice identified to those situations that were easily photographed and represented situations that were most frequently encountered or that were most personally intrusive.

As for future lines of study, we believe that conducting further research on females could be useful for future interventions in this particular group, as girls participating in this study reported that they were occasionally discriminated against. Moreover, gathering information from PA experts and teenagers can be very useful to ascertain the adolescent perspective and to envisage future strategies with regard to PA.