Evaluation of a 20-Month Physical Activity Intervention to Improve Motivational and Affective Outcomes Among Disadvantaged Adult Women

Abstract

Grounded in self-determination theory, this study aimed to qualitatively examine women’s perception of a set of motivational and affective consequences during and immediately after a physical activity intervention. In total, 11 disadvantaged adult women participated in this 20-month intervention. A total of 102 physical activity sessions based on need-supportive strategies were performed. Six discussion groups, 14 semi-structured interviews, and field notes were used to collect data. A thematic analysis was conducted based on self-determination theory. Findings highlighted that it might be advisable among these disadvantaged women to begin with relatedness-support strategies to increase group cohesion, followed by competence support strategies to increase self-confidence, and, finally, autonomy support strategies to empower women to be physically active. The development of a need-supportive environment in a physical activity intervention may have the potential to achieve motivational and affective consequences, which might promote the empowerment of these disadvantaged women to be physically active.

Keywords

physical activity self-determination need-supportive behaviors basic psychological needs motivation qualitative thematic analysis

Introduction

Within disadvantaged populations, the Roma ethnic group is one of the largest disadvantaged populations in Europe (FOESSA, 2008). In Spain, this ethnic group represents between 1.7% and 2.1% of the total population (Laparra, 2011). The Roma population’s health status is affected by risk behaviors such as physical inactivity or unhealthy diets (Fernández-Feito et al., 2017; La Parra-Casado et al., 2015). For example, previous studies have shown that more than 50% of the Roma population do not do any physical activity (PA; Fundación Secretariado Gitano, 2009), particularly Roma women (La Parra-Casado et al., 2015). This fact has been associated with depression, Type 2 diabetes, cardiovascular illness, and migraine headaches (Fernández-Feito et al., 2017).

To overcome this public health issue, during the last years, the number of PA interventions in disadvantaged populations has increased. However, in spite of the efforts, small effect sizes or nonsignificant effects have been found in PA immediately after the program, followed by a decrease or disappearance of the effect size in the follow-up post-intervention assessments (Craike et al., 2018). The most promising strategies, characteristics, or behavior change techniques of these PA interventions among disadvantaged populations were group-based sessions, social support from significant others, long-term interventions, participatory action research approaches, and theory-based interventions (Bull et al., 2018; Craike et al., 2018, 2019).

In particular, PA interventions based on theoretical models of behavior change, may help enhance motivational outcomes and, consequently, maintain long-term effects on PA participation (Kwasnicka et al., 2016; Ntoumanis et al., 2020). Hence, given that one of the main perceived barriers to PA in disadvantaged population and, particularly, in the Roma population is lack of motivation (Sanz-Remacha et al., 2019), and that high attrition rates have been found in these populations (Craike et al., 2018), theory-based interventions such as self-determination theory (SDT), that help initiate and maintain PA behavior over time, are specifically required (Ntoumanis et al., 2020).

SDT

SDT (Ryan & Deci, 2017) is a human motivational theory that helps understand the motivational processes entailed to be active, so it can be considered a useful framework to drive PA interventions (Kwasnicka et al., 2016). This theory posits that there are three basic psychological needs (BPNs; i.e., autonomy, competence, and relatedness) that may be satisfied (i.e., people’ sense of choice, mastery, and integration with others) or frustrated (i.e., people’ sense of pressure, incompetence, and exclusion) by the social environment. A need-supportive environment characterized by the provision of autonomy, competence, and relatedness support may facilitate the fulfillment of BPNs (Ntoumanis et al., 2017; Teixeira et al., 2020) in leisure-time PA (LTPA; Rodrigues et al., 2018). In the opposite direction, a need-thwarting environment (i.e., providing controlling practices, a chaotic style, and cold interactions) has been positively associated with BPNs frustration in LTPA settings (Rodrigues et al., 2019). The degree to which BPNs are satisfied or frustrated determines, in turn, the type of motivation. According to SDT, different types of motivation have been identified across a continuum of self-determination, from more autonomous forms of motivation (i.e., intrinsic, integrated, and identified regulations) to more controlled forms of motivation (i.e., introjected and external regulations) and amotivation, which are associated with more positive or negative consequences, respectively (Ntoumanis et al., 2017).

A great amount of studies conducted in adults suggests that satisfaction of BPNs in LTPA is positively associated with autonomous motivation which, in turn, enhance affective (e.g., self-esteem, enjoyment, well-being), cognitive (e.g., quality of concentration), and behavioral positive consequences (e.g., intention to be physically active, long-term PA adherence; Fortier et al., 2012; Ntoumanis et al., 2017; Rodrigues et al., 2018). In contrast, frustration of BPNs in LTPA has been positively related to both controlled forms of motivation and amotivation and, consequently, to a wide range of maladaptive outcomes of PA participation (e.g., disengagement, boredom, exercise dropout; Rodrigues et al., 2018).

PA Intervention Programs Among Adults Based on SDT

Although most PA interventions based on SDT framework have focused on a quantitative approach among adults (e.g., Rodrigues et al., 2018), very few qualitative studies have been conducted (Gray et al., 2018; Kerkelä et al., 2015; Kinnafick et al., 2014; Lloyd & Little, 2010; Sabiston et al., 2009). For example, Kerkelä et al. (2015) conducted an SDT-based PA intervention over 6 months among adults, where the instructor was trained to use need-supportive strategies (e.g., providing decision-making and responsibilities, individualized activities, and group-based PA activities). Participants mentioned a positive change in social support from peers, as well as positive behavioral (i.e., intention to be physically active), affective (e.g., energy, self-image), and cognitive (e.g., self-awareness) consequences. In another qualitative SDT-based PA intervention, underpinned by group-based PA sessions, most of the women stated improvements in BPNs satisfaction, autonomous motivation, physical skills, and body self-awareness (Sabiston et al., 2009).

Another qualitative study that analyzed adult women’s experiences and outcomes, after participating in a diverse range of sport and PAs, showed that a need-supportive environment is particularly important to satisfy BPNs and, consequently, achieve affective outcomes (e.g., enjoyment; Lloyd & Little, 2010). Kinnafick et al. (2014), after a 10-month SDT-based walking intervention with adult women, identified a need-supportive environment as fundamental during adoption stages, whereas the satisfaction of autonomy proved to be more important to promote PA adherence.

However, to date and to the best of our knowledge, there are no SDT-based PA interventions that use a qualitative approach among disadvantaged adult women. More qualitative studies based on SDT framework are required to obtain a more detailed picture of the experiences and behavioral changes of these participants (Ryan & Deci, 2020). This information could be helpful not only to decrease the attrition of participants in these programs but also to culturally adapt the intervention to the needs, culture, and preferences of these disadvantaged adult women.

Contextualization of the Present Study

A community-based participatory action research (CbPAR) approach was used to design and develop this intervention program. The CbPAR has proven to be useful to reduce health inequalities and promote healthy lifestyles among disadvantaged populations (Suarez-Balcazar et al., 2018). The intervention involved dieticians, pediatricians, nurses, psychiatrists, teachers, a social worker, and PA researchers. The “Pio keeps moving” intervention lasted for two academic years (20 months), from September 2016 to June 2018, and comprised a total of 102 PA sessions that were divided into practical (i.e., weekly group-based PA and family PA sessions at the weekends) and cognitive (i.e., awareness raising activities) sessions implemented by an instructor with a degree in Sport Sciences and with expertise in SDT framework. This intervention was also divided into four phases: (a) catching attention, (b) awareness development, (c) empowerment development, and (d) learning to be autonomous. Based on SDT framework, at the beginning of the intervention (Phase 1), more emphasis was placed on relatedness-support strategies (e.g., group changes, group-based PA sessions, friendly and comfortable environment, and cooperative games) to create group cohesion. During the second phase, need-supportive behaviors were particularly focused on competence support (e.g., offering adapted activities with different levels, providing positive feedback, and setting individual goals). At the end of each academic year (Phases 3 and 4), the instructor paid particular attention to the use of autonomy-supportive strategies (e.g., facilitating decision-making and empowering women to be physically active). Although more emphasis was specifically placed on each need in each phase, need-supportive behaviors were used in all phases to a lesser extent.

The Present Study

Grounded in SDT, a community-based healthy lifestyle program called “Pio keeps moving” had previously shown to be effective in improving perceived PA-related behaviors, healthy eating, and other health-related outcomes among disadvantaged adult women, particularly Roma women. Given that 80% of the sessions of the healthy lifestyle program focused on PA promotion, examining women’s experiences in terms of SDT-related variables and affective outcomes may provide a good indicator for long-term PA maintenance (Ntoumanis et al., 2020). For this reason, the present study aimed to qualitatively examine disadvantaged adult women’s perceptions of a set of SDT-related variables during and immediately after the implementation of a PA intervention.

Materials and Methods

Recruitment and Study Participants

The present study was conducted in a disadvantaged neighborhood of a medium-sized city in Northeast Spain (Huesca), where 11.3% of the population live (23% are Roma or immigrants). A community-based intervention called “Pio keeps moving” was conducted due to a health problem related to high overweight or obesity rates observed in a group of disadvantaged children in this neighborhood school. The pediatrician and several teachers, who worked in this neighborhood, identified this health problem. Both agents contacted the school social worker, PA researchers, and other health workers (i.e., dieticians, nurses, psychiatrists) to solve the problem. Given that mothers’ unhealthy lifestyles can produce a ripple effect on their children’s health-related behaviors (Draper et al., 2015), the mothers of these children were invited to voluntarily participate in this community-based intervention. It should be noted that most of these mothers also had overweight or obesity problems. Although a purposive sample of 14 disadvantaged adult women initially participated in this PA intervention, given external causes (i.e., work conflicting schedules and family responsibilities), the final sample was made up of 11 disadvantaged women (seven of them from the Roma ethnic group), aged 27 to 56 years (M = 37.72 years, SD = 8.34 years). The participants were informed in writing and face-to-face of the study’s aims (e.g., improving women’s and their children’s health-related behaviors) and the inclusion criteria to participate in the intervention (e.g., having obesity or overweight children). All participants signed a written informed consent form to take part in the study.

Data Collection

Qualitative methods (i.e., discussion groups, one-to-one semi-structured interviews, and field notes) were used to collect data. Discussion groups and interviews, using open-ended questions on SDT-related variables, were divided into the following issues: social support for PA from significant others and need-supportive behaviors from the instructor, BPNs, motivation, and affective outcomes. Both discussion groups and interviews were carried out at different meetings with PA expert researchers in SDT framework before, during, and immediately after the intervention program. Six discussion groups were held during this PA intervention program, after the end of each school term (i.e., December 2016 and 2017, March 2017 and 2018, and June 2017 and 2018). Each discussion group lasted for approximately 45 minutes, involving an average of six women. A total of 14 one-to-one semi-structured interviews were also conducted at the end of each academic year (June 2017 and 2018, respectively). Eight of them were conducted in the first academic year, whereas the other six were conducted in the second academic year, lasting for 45 to 60 minutes.¹

Data Analysis

This research is guided by a relativist ontologist and a constructionist epistemologist, whose aim is to understand and interpret reality from the participants’ point of view (Sparkes & Smith, 2014) and the experiences gained in a sociocultural context (Braun et al., 2016). The data analysis involved a deductive process guided by SDT constructs. This procedure is in line with the aim of the study which was to examine women’s perceptions of a set of motivational and affective consequences using the SDT framework.

First, 214 pages were transcribed, using NVivo 11 Pro software to facilitate the thematic analysis later on. A deductive thematic analysis was conducted through a segmentation of the transcripts around women’s implicit perceptions underpinned by SDT themes. Following the thematic analysis process (Braun et al., 2016), reading and re-reading data was initially conducted while side notes were taken. Next, the first codes across data were created around the relevant candidate themes, guided by SDT constructs. After the code review, the final themes, which contained the relevant meanings of the data set, were refined. Four researchers supervised and shared points of view and interpretations to reach an agreement during the data analysis process. All themes and subthemes are shown in Table 1.

Table 1.

Summary of SDT Themes and Subthemes After Analysis Process.

Main Themes	Generic Themes	Subthemes
1. Social factors	Peers and family support for PA	—
	Need-supportive behaviors from the instructor	Autonomy-supportive strategies
		Competence-supportive strategies
		Relatedness-supportive strategies
2. BPNs	Autonomy	—
	Competence	—
	Relatedness	—
3. Motivation	—	—
4. Affective consequences	Well-being	—
4. Affective consequences	Enjoyment	—

Note. SDT = self-determination theory; PA = physical activity; BPNs = basic psychological needs.

Under constructivist epistemology, the universal criteria outlined by Tracy (2010) were used to demonstrate rigor in this qualitative research. A relevant topic to promote PA among disadvantaged populations is shown in the present study. Abundant and complex data sets that provide meaningful claims, as well as the use of an appropriate theoretical framework such as SDT and its main tenets (i.e., social factors, BPNs, motivation, and affective consequences), helped carry out a full discussion of the results and guarantee rich rigor. Sincerity was reached through self-reflexivity and transparency about the data analysis process, described in detail in this section. Numerous and different techniques (i.e., discussion groups, one-to-one semi-structured interviews, and field notes), as well as the involvement of many SDT expert researchers, permitted building a complex and in-depth reality, reaching study credibility through crystallization. A significant contribution related to PA promotion among disadvantaged adult women is provided, which, given the poor health status of this kind of population (Fernández-Feito et al., 2017), is an urgent public health problem. Finally, this research was approved by the Research Ethics Committee of the Community of Aragon (CEICA).

Results

This study aimed to qualitatively analyze women’s perception of a set of motivational outcomes and affective consequences during and immediately after a PA intervention. Through a deductive thematic analysis, four themes were identified using the motivational sequence based on SDT framework: (a) social factors, (b) BPNs, (c) motivation, and (d) affective outcomes. These themes and associated subthemes are developed below.

Social factors

Within disadvantaged populations, and especially among the Roma ethnic group, the cultural context and family are two fundamental elements that could affect the PA adoption stages. Specifically, social support for PA from family and peers seems to play a key role in promoting an active lifestyle in these disadvantaged adult women. In addition to social support for PA, these women also perceived the use of need-supportive behaviors from their instructor during the PA intervention. In this way, two subthemes resulted from social factors: (a) peers and family support for PA and (b) need-supportive behaviors from the instructor.

Peers and family support for PA

Social support for PA from peers (i.e., other women from the “Pio keeps moving” intervention) was perceived by some participants during the PA intervention. In particular, in the first academic year, social support for PA from peers was appreciated by the participants, especially when a sad mood or amotivation invaded them:

Me, for example I said, why am I going? And I said no, I don’t want to; and why? And I say no because I always feel . . . and Paula [her friend] quickly said “come on, come with us, we’re with you” even in private.

This perception revealed the importance of being part of a group and feeling warmly welcomed by the participants. The design of cooperative and group-based PA sessions, and a friendly and warm environment could explain the previous excerpt.

As opposed to social support for PA from peers, participants reported a lack of social support for PA from their husbands and children during the first academic year. The children felt embarrassed when their mothers participated in PA because they thought that overweight or obese women did not have sufficient physical skills to do PA:

Interviewer: Does your family support you?

Participant: My husband yes, he does now (supports me). The children not so much because they say I’m a bit hippie, but . . . it’s no longer a question of “mum, I’m ashamed of you, don’t do that you still (embarrass) me,” no, they no longer [say that].

The common low education levels among disadvantaged populations could bring about a lack of knowledge or awareness of the benefits of having an active lifestyle. However, during the second academic year, this social support for PA from their families evolved positively, especially from their husbands. The progressive involvement of the families during the PA sessions at the weekends could have enhanced the social support for PA from their families. Moreover, given the cognitive PA sessions, raising awareness of the benefits of PA and the risks associated with overweight and obesity among the members of the families was fundamental to support the women’s behavioral changes.

Need-supportive behaviors from the instructor

During the intervention program, women perceived a high use of need-supportive strategies (i.e., relatedness-supportive, competence-supportive, and autonomy-supportive strategies) directly developed by the instructor.

Relatedness-supportive strategies

Because the group was composed of disadvantaged adult women who did not know each other, the intervention focused above all on the use of relatedness-supportive strategies, especially at the beginning. The instructor developed strategies such as group-based PA sessions, cooperative and dynamic games to work on common solutions, a friendly and comfortable environment to facilitate group cohesion among these women, and positive relationships. As one of the participants claimed, this type of relatedness-supportive strategies resulted in strong group cohesion and unity, making them feel identified with it:

Hey, well, we’ve formed a group, we are more united, I think. And then, we encourage each other (among ourselves).

Particularly, the intentional development of group-based PA sessions from the beginning of the intervention was an important relatedness-support strategy that could encourage them to unconsciously participate in PA:

If the instructor encourages me, I feel more engrossed, and don’t think about whether I’m getting tired. It is more fun, and time flies with more people, at least for me.

Despite the use of relatedness-supportive strategies by the instructor during the entire intervention period, some women expressed a breakdown in group cohesion after the first year caused by a decrease in participation rates during the second academic year and different external causes related to their complex lives and priorities:

Well, the nice thing is to form a group like last year, when we went walking, we did Zumba, we went to Sport centres, we did the same things as this year but there were more of us. Even though there were just four of us, well, we four were also there, but this year, the instructor was alone, because the others didn’t do anything.

Competence-supportive strategies

Several competence-supportive strategies provided by the instructor, such as giving positive feedback or offering a variety of exercises with different levels of intensity and difficulty depending on the participants’ characteristics or physical limitations, were also perceived by the women:

I was really surprised by the swimming pool bit; the instructor said to me “come on, come on, you’re almost there” and I was exhausted, you know when you feel [I can’t do any more].

You told me “if you can’t do it like that, try it like this [the instructor proposed another kind of exercise easier]” they gave me more options.

Concurrently, the instructor also perceived similar feelings to the participants (e.g., the improvements of women’s competence). The instructor pointed out that the women made greater efforts to reach the goals when the exercises were adapted to their levels of skill. The instructor provided positive feedback for the women while other participants also did the exercises:

They liked changing things quite a bit; during the last series, I was with them, changing the speeds and this motivated them; they no longer complained (only at the end). However, when they do it on their own, they don’t make as much effort.

Setting and achieving both short- and long-term individual goals was important for the participants to continue participating in PA and increase attendance rates at the intervention. The women also mentioned the importance of the instructor’s role to set group goals to be motivated in the PA sessions:

For example, the instructor gives us motivation, like when she said to us “let’s do this, if you manage to do in within one month . . .,” the instructor sets a goal to achieve.

Autonomy-supportive strategies

Finally, women also perceived autonomy support from the instructor throughout the PA intervention and, particularly, during the second academic year. The increased responsibility and autonomy of these women during the last phases of this PA intervention may be explained by the fact that the instructor encouraged the women to be physically active in their LTPA. For example, one woman claimed that the instructor gave them different types of exercises—to be performed during PA sessions—to also do in their LTPA:

Interviewer: Do you feel that you depend on someone to do physical activity? Can you do it alone?

Participant: If I force myself, I can do it alone. Now that you’re going to give us exercises to do with the rubber bands, well I’ll go to Decathlon [a local shop] and buy one.

BPNs

The development of need-supportive behaviors by the instructor positively affected the perceptions of relatedness, autonomy, and competence of these women.

Relatedness

Most participants claimed positive relationships with their colleagues from “Pio keeps moving,” and a sense of belonging to a group. For example, in the discussion group, one woman expressed that the development of group-based PA sessions was fundamental:

Because you feel more accompanied, it’s not the same doing it on your own as having a person with you; this encourages you more.

Over the second year, attendance rates could decrease because of external causes related to their complex lives (e.g., daily financial problems, cultural responsibilities, greater problems). Many participants perceived the group breakdown and expressed their need for it to fulfill their relatedness satisfaction:

You feel sad because you expect to find the group; I’m not saying all of them from last year when there were more of us.

Competence

As a consequence of the competence-supportive strategies developed during the PA intervention (e.g., adapting the difficulty of the exercises to these women’s level of skill, providing positive feedback), most of the women mentioned that they felt more competent in a large variety of PAs (e.g., dancing, swimming, and walking):

Now I feel I’m capable of anything. I feel that I can go walking, go to Zumba, do squats; I didn’t think I would be able to do squats like I do now.

Providing a warm environment, where women could try new activities without the fear of making mistakes, helped them step out of their comfort zone and feel more self-confident. In this regard, one woman claimed that she was doing PAs that she thought she would never be able to do. Participants reported feeling new corporal experiences hitherto unknown:

Me, for example, I have discovered part of me that I had previously ignored; I didn’t think I could ever do . . . I always thought that . . . I used to get dizzy by just turning over.

Autonomy

However, the attendance rates seemed not to affect all the women the same, depending on their levels of autonomy. Although some women already felt independent to participate in PA, probably as a consequence of the autonomy-supportive strategies implemented by the instructor, some others emphasized that they, in particular, preferred to participate in PA with other women:

Interviewer: Are you more autonomous now when you practice PA than two years ago?

Participant: Yes, now I don’t mind going for a walk on my own. I used to say if nobody is coming with me, why am I going? And now, I put on my trainers and I go.

Some women also mentioned that autonomy-supportive strategies developed by the instructor during the intervention, such as providing a sense of choice regarding the variety of activities (e.g., dancing, walking), helped them choose among different options in their LTPA:

It has helped me a lot; just by wondering for example, what can I do now? Well, this and then that; it’s something that you are always saying to yourself. For example, now I say, come on, I’m going for a walk, I’m going to do this with the rubber bands, or let’s dance.

Motivation

Following the tenets of SDT, when an individual has satisfied the three BPNs, subject is likely to have more autonomous motivation. Providing need-supportive behaviors to satisfy the BPNs during the PA intervention could produce, consequently, changes in the reasons to participate in PA. For instance, one woman stated that the different activities provided by the instructor during the intervention helped her be more autonomously motivated, and to continue learning new activities in the PA sessions to incorporate them into her daily life. She was really excited about participating in the subsequent PA sessions and trying out new PAs:

I come here motivated and I leave physically tired because we’ve danced, we’ve done exercise, games, but my motivation is still the same. I look forward to new things that you want to add, new dances, new games.

Despite family problems, one woman said that she prioritizes the group-based PA with “Pio keeps moving,” which could suggest the existence of an autonomous motivation form:

If you want (to do something), you can, because you make time. I remember even when my mother was sick, I arrived on time [to the intervention program] arriving at 2.30 p.m. and staying until 4 p.m. I looked after my mother and I went to the PA sessions. Another person would have said “poor woman, I’m not going to leave her alone.”

Satisfying their needs for autonomy, competence, and relatedness during the intervention program could help them feel autonomously motivated. For example, many women felt autonomously motivated during the group-based PA sessions, and expressed their desire to participate in PA in the following sessions:

During the months that I’ve been coming, I’ve felt fantastic, more motivated, looking forward to doing exercise, to eating more healthily.

Many participants were able to feel more autonomously motivated, and consequently expressed their intention to be physically active when the intervention finished. The greater sense of autonomy perceived by these women seems to be strongly associated with more autonomous forms of motivation to participate in PA:

I join because I like it and because I feel like it; I don’t care if you come or not, because if I have to wait for you, I won’t go anywhere.

If they don’t want to support me, I don’t care. I am going to do PA because I want to.

Affective Consequences

During the “Pio keeps moving” intervention, and as a result of the SDT-based intervention, most women reported affective consequences such as enjoyment and well-being, which they even dared to make public, at least within their families. Most of the participants reported experiencing enjoyment during the PA intervention, especially in the first year, when they got involved in new PAs and there was greater group cohesion:

I also have a great time with you, I’m very happy to come [. . .] I feel really happy when I leave and I tell my husband about it.

However, it has to be noted that one woman expressed a decrease in enjoyment in the second year of the intervention. Although she felt good in the group-based PA sessions, she missed the regular attendance of her colleagues:

I come because I like it and I feel comfortable, but it’s not the same as last year.

Moreover, participants perceived an improvement in their well-being. Although, sometimes, their complex lives influenced their moods (i.e., sad or depressive), and their lifestyles (“lazy spiral”), participation in the “Pio keeps moving” intervention allowed them to escape from their concerns and feel better after each PA session:

I’ve managed to come here and leave my problems at home, regarding my daughter in particular; I’ve felt good and well supported, and I’ve felt very happy coming here every day, that’s the truth.

The women emphasized that if they did not participate in PA, they felt worse and started to think about their worries. For instance, a participant admitted that she needed to participate in regular PA to avoid thinking about her daily problems:

Well, let’s see, the week that I don’t go walking, for example, I feel worse, I can tell you. But, when I go walking I clear my head; I go with my brother-in-law or with the kid, and we chat. But, if there are weeks when I can’t go walking for some reason or another, well I start to churn things over in my head again.

Discussion

Recently, although numerous SDT-based PA interventions have been implemented with adult women or different ethnic groups (Gillison et al., 2019), few studies have qualitatively evaluated these interventions (Gray et al., 2018; Huntsman et al., 2018; Kerkelä et al., 2015; Lloyd & Little, 2010) and none in disadvantaged populations. Future avenues of research on SDT-based interventions, suggesting the need to evaluate participants’ experiences of need satisfaction or need frustration in different domains and cultures, have been recommended (Vansteenkiste et al., 2020). Even more, qualitative methodology has been required to provide new insights into little known contexts and cultures for the effective design of strategies to promote PA among disadvantaged populations (Teychenne et al., 2012).

Our findings suggest the significant influence of social support for PA from their peers and family, and need-supportive behaviors from their instructor, to satisfy women’s BPNs, which enhanced autonomous motivation, and affective outcomes in LTPA context. Social support for PA from significant others has been considered a key element to influence disadvantaged populations’ PA levels (Joseph et al., 2017), especially in this type of population where the lack of social support is often perceived as a barrier to PA (Sanz-Remacha et al., 2019). During the second academic year, this barrier may have been overcome because women perceived greater levels of social support for PA from their families (i.e., in particular from their husbands) and peers. Being aware of the importance of being active may greatly influence PA levels (Fortier et al., 2012; Teixeira et al., 2012). In this way, the increase of women’s awareness throughout the PA cognitive lessons (e.g., awareness and dynamic activities) may have spill-over effects on raising their husbands’ awareness, which may affect their social support for PA. Moreover, the involvement of husbands and children in family PA sessions at the weekends could justify the social support for PA from their families.

Furthermore, women perceived need-supportive behaviors from their instructor during the PA intervention. Consistent with previous studies (Teixeira et al., 2020), the use of motivation and behavior change techniques (MBCTs) based on autonomy (e.g., providing choice), competence (e.g., offering clear, constructive and relevant feedback), and relatedness support (e.g., seeking available social support) could positively influence the women’s perception of these need-supportive behaviors during PA sessions. Women perceived relatedness support from their instructor as one of the most important strategies to promote group cohesion and feel part of a group, particularly at the beginning of the intervention. In other studies, participants also mentioned that being part of a group during group-based PA sessions, and sharing experiences with people who are in the same boat, may be a facilitator to push harder during PA sessions, and, consequently, be more physically active (Danielsen et al., 2015). In spite of the importance of developing relatedness-support strategies at the beginning (Ntoumanis et al., 2020) to create a strong group, given the breakdown in group cohesion caused by low attendance rates during the second academic year, it is of paramount importance to keep the relatedness-support strategies during the whole intervention. The intensity of relatedness-supportive behaviors of exercise instructors could be effective to overcome two of the major problems in this population (i.e., low attendance rates and high attrition; Craike et al., 2018; Quested et al., 2018). Moreover, the women also progressively perceived competence and autonomy support from their instructor during the intervention. This could be because more emphasis was placed on competence support strategies, during the second phase, and autonomy support strategies during the third and fourth phases. Results of this PA intervention suggest that it might be advisable, in this population, to begin with relatedness-support strategies to increase group cohesion, followed by competence support strategies to increase self-confidence, and, finally, autonomy support strategies to empower women to be physically active in their LTPA. However, although particular attention should be paid to each need according to the different phases of the intervention, need-supportive behaviors are recommended throughout the intervention. Therefore, need-supportive instructor training should be highly recommended to design a PA intervention in this disadvantaged population.

Following SDT tenets, the need-supportive environment could contribute to the satisfaction of BPNs among these women (Rodrigues et al., 2018). A sense of group belongingness was remarked by these women, mainly at the beginning of the intervention. This is particularly important because a previous study showed the importance of satisfying the relatedness need in the initial PA adoption stages (Kinnafick et al., 2014). However, these feelings diminished during the second year among some women, given the low attendance rates. The implementation of relatedness-support strategies such as group-based PA sessions, particularly in the first phase, may explain the results found. Moreover, the low attendance rates and high attrition in PA intervention among socioeconomically disadvantaged groups (Craike et al., 2019) may explain the breakdown of group cohesion during the second academic year. Recent reviews in health domains have found nonsignificant or only small effects on relatedness satisfaction after SDT-based interventions (Gillison et al., 2019; Ntoumanis et al., 2020). Results suggest the need to design specific relatedness-support strategies during the whole intervention to reduce the high attrition rates in this population (Craike et al., 2019).

Our findings also support that trying a wide variety of new activities, which encourage disadvantaged people to step out of their comfort zone, may help these women to perceive competent to participate in some of these activities in their LTPA. A recent study in another domain (i.e., physical education) has shown that novelty support is positively related to competence satisfaction (Fierro-Suero et al., 2020). Consistent with previous studies (Lloyd & Little, 2010), the feelings of competence and self-confidence could also be due to the design of activities with different levels of complexity in this intervention. Finally, these women perceived a sense of choice and volition in their actions to participate in PAs conducted during the intervention, particularly during the second academic year. Given it might be more difficult to fulfill autonomy satisfaction among disadvantaged populations than the rest of the population (Ntoumanis et al., 2020), these results can be considered promising to empower these women to be physically active in their LTPA. Hence, designing long-term interventions among disadvantaged adult women should be considered as a key element to achieve motivational and affective changes. Autonomy-supportive strategies should be progressively introduced during the intervention so that women gradually feel more autonomous to be physically active.

Regarding the participants’ motivation, it seems that disadvantaged adult women improved their autonomous motivation to PA through the “Pio keeps moving” intervention. Although our data analysis did not focus on the different motivational regulations postulated by SDT, the reasons they participated in PA varied from controlled motivation forms (e.g., to improve their health or lose weight) to more self-determined reasons (e.g., for enjoyment, for the benefits). The motivational changes perceived by these women were particularly associated with the variety and novelty of exercises during the intervention, such as swimming, dancing, or walking. Previous studies have shown that both perceived variety and novelty have been positively and significantly associated with autonomous motivation for LTPA (González-Cutre et al., 2020; Sylvester et al., 2018). Therefore, providing a variety of novel activities may be key aspects in the design of PA interventions in disadvantaged populations. This could encourage these people to participate in one of these activities in their LTPA.

In line with other SDT-based interventions in different health domains (e.g., PA, diet, workplaces, health education; Gillison et al., 2019; Ng et al., 2012), all disadvantaged adult women perceived affective consequences such as enjoyment and well-being during and at the end of the intervention. The women mentioned that group-based PA sessions enhanced the feeling of being part of a group and increased their enjoyment. Other studies also showed that group-based PA sessions might enhance women’s enjoyment when participants share the same goals and have similar levels of motor skills, as occurred in this study (Lloyd & Little, 2010). These results are promising given that enjoyment in PA sessions has also been positively and closely related to LTPA among disadvantaged groups (Craike et al., 2019). In addition to enjoyment, most of the participants emphasized how being involved in “Pio keeps moving” intervention made them feel better, allowing them to get away from their concerns, and step out of their comfort zone. Given that disadvantaged populations often have mental worries and complex lives (Almeida et al., 2012; Coupe et al., 2018), participation in LTPA and, particularly, group-based PA sessions, as in this intervention, might provide them with an escape valve from their lives (Craike et al., 2019), and protect them from their current daily concerns. Previous studies have also shown that the development of group-based PA sessions may improve feelings of well-being and, consequently, continue being physically active in the future (Lloyd & Little, 2010), to escape from their complex lives. Hence, given that disadvantaged adult women often suffer depression or low self-esteem, among other disorders (Fernández-Feito et al., 2017), these positive affective feelings during PA interventions might be related to a better physical and psychological health status.

Although the findings of the present study are noteworthy, several limitations and future directions should be considered. First, the attendance rates throughout the intervention program, particularly during the second academic year, were low. Consequently, not all disadvantaged women participated in each interview and discussion group. Second, the motivational outcomes were exclusively analyzed during and at the end of the intervention. However, follow-up post-intervention assessments should be required to determine if the motivational and affective changes are maintained over time in these women. Finally, the main strength of the study was the use of qualitative methodology, which allowed a richer and deeper analysis of the SDT-related variables in a specific sample of disadvantaged adult women. Hence, given that qualitative evaluations of PA interventions based on SDT are still scarce, this approach is widely recommended for future studies.

Conclusion

Our findings suggest that SDT may be a useful framework to address PA interventions among disadvantaged adult women, and examine their perceptions of motivational outcomes in LTPA. Considering the difficulty of changing behaviors such as PA, providing a need-supportive environment can help perceive positive changes in BPNs satisfaction, autonomous motivation, and affective outcomes in LTPA among this disadvantaged population (Rhodes et al., 2017). These positive changes may facilitate long-term PA maintenance. Special attention should be paid to the use of relatedness-supportive strategies, in particular, at the beginning of the intervention, to create group cohesion in this disadvantaged population. Likewise, the results suggest that, in this population, it might be advisable to begin with the relatedness-support strategies to increase group cohesion, followed by competence support strategies to increase self-confidence and, finally, autonomy support strategies to empower women to be physically active in their LTPA. Finally, the “Pio keeps moving” intervention may also have sufficient potential to change affective outcomes such as enjoyment and well-being among women from this disadvantaged population. These positive behavior changes might be a key factor in dealing with their complex lives and, consequently, empowering disadvantaged women to be physically active.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the European ERDF funds within CAPAS CIUDAD-CITÉ project under grant (EFA O95/15).

Research Ethics

This study was approved by the Research Ethics Committee of the Aragon Region (PI16/0295 number reference) in Spain.

ORCID iD

María Sanz-Remacha

Notes

Author Biographies

María Sanz-Remacha is a PhD student at the University of Zaragoza, Spain

Alberto Aibar is a Lecturer at the University of Zaragoza, Spain

Javier Sevil-Serrano is a Lecturer at the University of Zaragoza, Spain

Luis García-González is a Senio Lecturer at the University of Zaragoza, Spain

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