title: A model for promoting physical activity among rural South African adolescent girls.
abstract: BACKGROUND
  In South Africa, the expanding epidemic of non-communicable diseases is partly fuelled by high levels of physical inactivity and sedentary behaviour. Women especially are at high risk, and interventions promoting physical activity are urgently needed for girls in their adolescence, as this is the time when many girls adopt unhealthy lifestyles.
  
  
  OBJECTIVE
  This qualitative study aimed to identify and describe facilitating factors and barriers that are associated with physical activity among adolescent girls in rural, north-eastern South Africa and, based on these, to develop a model for promoting leisure-time physical activity within this population.
  
  
  METHODS
  The study was conducted in and around three secondary schools. Six focus group discussions were conducted with adolescent girls from the schools, and seven qualitative interviews were held with sports teachers and youth leaders. The data were subjected to thematic analysis.
  
  
  RESULTS
  Seven thematic areas were identified, each of which was associated with the girls' self-reported levels of physical activity. The thematic areas are 1) poverty, 2) body image ideals, 3) gender, 4) parents and home life, 5) demographic factors, 6) perceived health effects of physical activity, and 7) human and infrastructural resources. More barriers to physical activity were reported than facilitating factors.
  
  
  CONCLUSIONS
  Analysis of the barriers found in the different themes indicated potential remedial actions that could be taken, and these were synthesised into a model for promoting physical activity among South African adolescent girls in resource-poor environments. The model presents a series of action points, seen both from the 'supply-side' perspective (such as the provision of resources and training for the individuals, schools, and organisations which facilitate the activities) and from the 'demand-side' perspective (such as the development of empowering messages about body image for teenage girls, and encouraging more parental involvement). The development of physical activity interventions that incorporate this supply- and demand-side model would represent an additional tool for ongoing efforts aimed at tackling the expanding non-communicable disease epidemic in South Africa, and in other resource-constrained settings undergoing rapid health transitions.
authors.affiliation: Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; john.kinsman@umu.se.
authors.forename: John
authors.initials: J
authors.lastname: Kinsman
authors.affiliation: MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Shane A
authors.initials: SA
authors.lastname: Norris
authors.affiliation: Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.|MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.|INDEPTH Network, Accra, Ghana.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kahn
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.|INDEPTH Network, Accra, Ghana.
authors.forename: Rhian
authors.initials: R
authors.lastname: Twine
authors.affiliation: MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Kari
authors.initials: K
authors.lastname: Riggle
authors.affiliation: Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.|MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.|Department of Nursing, Umeå University, Umeå, Sweden.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Edin
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mathebula
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Sizzy
authors.initials: S
authors.lastname: Ngobeni
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Nester
authors.initials: N
authors.lastname: Monareng
authors.affiliation: MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Micklesfield
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D015444:Exercise; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D036301:Qualitative Research; D012424:Rural Population; D012572:School Health Services; D013019:South Africa; D055815:Young Adult
keywords: South Africa; adolescence; girls; health intervention; physical activity; transition