|Year : 2020 | Volume
| Issue : 3 | Page : 77-85
Predicting the intention to practice physical activity among high school female students in Riyadh, Saudi Arabia
Aisha S Albuluwi, Nurah A Alteraiqi, Nadin M Alotaibi, Sara Alsuhaibani
Department of Health Sciences, College of Health and Rehabilitation Science, Princess Nourah Bint Abdurahman University, Riyadh, Saudi Arabi
|Date of Submission||15-Dec-2020|
|Date of Acceptance||25-Jan-2021|
|Date of Web Publication||02-Mar-2021|
Dr. Sara Alsuhaibani
Department of Health Sciences, College of Health and Rehabilitation Science, Princess Nourah Bint Abdurahman University, Riyadh
Purpose: This study aimed to predict the intention to perform physical activity (PA) of high school female students in Riyadh, Saudi Arabia, and to investigate the degree to which the elements of the Theory of Planned Behavior (TPB) mediate in the intention to participate in PA.
Methods: A cross-sectional study was conducted using a predesigned questionnaire applying TPB; this study was conducted for the duration of 3 months. The sample size was calculated to be 574 participants from randomly selected girl's high schools in Riyadh.
Results: It was found that 59.06% of the students had a positive intention toward practicing PA. It also revealed that regression weight on intention to practice PA of perceived behavioral control had (β = 0.301, P < 0.000), attitude (β = 0.270, P < 0.000), and subjective norms (β = 0.183 P < 0.000).
Conclusion: The findings of this study indicate that all TPB variables are useful tools and statistically significant with the intention to practice PA for prediction of the intention to practice PA among students. Further, perceived behavioral control had the strongest regression weight on the intention to practice PA.
Keywords: Adolescents, female, intention, physical activity, Riyadh, Saudi Arabia, theory of planned behavior
|How to cite this article:|
Albuluwi AS, Alteraiqi NA, Alotaibi NM, Alsuhaibani S. Predicting the intention to practice physical activity among high school female students in Riyadh, Saudi Arabia. Saudi J Sports Med 2020;20:77-85
|How to cite this URL:|
Albuluwi AS, Alteraiqi NA, Alotaibi NM, Alsuhaibani S. Predicting the intention to practice physical activity among high school female students in Riyadh, Saudi Arabia. Saudi J Sports Med [serial online] 2020 [cited 2021 May 6];20:77-85. Available from: https://www.sjosm.org/text.asp?2020/20/3/77/310621
| Introduction|| |
Introduction to the study
The promotion of physical activity (PA) remains a high priority among public health and researchers with reinforcing the importance of concerted efforts to promote PA. According to the World Health Organization (WHO), “Physical activity is defined as any bodily movement produced by skeletal muscles that requires energy expenditure.”
The important period of development during which personal lifestyle choices and behavior establish is adolescence, behavior developed in the early stage, and more likely to be maintained throughout the rest of life including the choice to be physically active. According to the WHO defined an adolescent as any person between aged 10 and 19 years. In 2018, WHO recommended that adolescence participate in daily PA of at least moderate intensity for 30-60 min. Regular PA of moderate intensity such as walking, cycling, or doing sports has significant benefits for health.
Lack of PA is a major global public health issue associated with a range of chronic disease outcomes, studies showed that lack of PA has been identified as the fourth leading risk factor for global mortality, and increases the risk of many adverse health conditions, including major noncommunicable diseases such as coronary heart disease, type 2 diabetes, breast and colon cancers, and shortens life expectancy. PA brings many health benefits, not only helps to improve body fitness but also prevents chronic diseases, fosters normal growth, makes people feel better, and extends social network.
Only 27.1% of high school students participate in PA at least 60 min per day in the United States. According to the WHO, adolescent girls have higher prevalence of physical inactivity than adolescent boys at 83% in the world. The rate in Saudi Arabia is 10% of girls among high school students joined in moderate PA per day.
The application of behavioral theories could help generate effective health intervention programs. Theory of Planned Behavior (TPB) is designed to predict individual behavior [Figure 1], it is one of the most widely used theories in predicting PA behavior, this theory assumes that individual behavior and decision is determined by behavior intentions, where behavior intentions are a function of three elements: an individual's attitude toward behavior, subjective norms, and perceived behavioral control; Ajzen separates three kinds of beliefs, each related to one of the TPB elements, behavioral beliefs are related to attitudes toward the behavior, normative beliefs are related to subjective norms, and control beliefs are related to perceptions of behavioral control.
Epidemiological evidence showed that PA decreased with age from early adolescence to adulthood, also showed that few studies have applied the TPB to adolescents. A study conducted in Saudi Arabia indicated that physical inactivity is higher among adolescent females than males; it is a major public health concern. Promote active lifestyles and increase PA to prevent disease and risk, need for effective interventions based on evidence-based theory.
The high rate of physical inactivity in the Kingdom of Saudi Arabia is a major personal and economic burden on the public health of the Saudi population through health care costs and physical and social environments.
Economic consequences of physical inactivity increase in the burden of noncommunicable diseases; prevention of these diseases through PA and healthy lifestyles is the most effective way to support positive social development; the WHO launched a global action plan to promote and support for the PA agenda.
Saudi Arabia has witnessed lifestyle changes over the past few decades where a PA has been set among direct objectives of Saudi vision 2030 which includes, preparing the appropriate environment for improving the lifestyle of individuals, families, and the economy in Saudi Arabia, promoting the participation of girls in PA across schools through the preparation of 1500 schools with GYMs, participation of 325,000 girls in the physical education classes, and the rehabilitation of 7500 teachers; the program also seeks to develop the infrastructure of physical activities in Saudi Arabia and the distinction globally.
This study aimed to investigate the degree to which the elements of the TPB mediate in the intention to participate in PA.
- There was a relationship between attitude and the intention to practice PA
- There was a relationship between subjective norm and the intention to practice PA
- There was a relationship between behavioral control and the intention to practice PA.
- Assess the level of intention toward practice PA among high school female students in Riyadh
- Measure the construct of TPB that has the highest weight on the intention to practice PA.
| Methods|| |
A cross-sectional study (quantitative) applied TPB to predict the intention to practice PA. This study was carried out in two phases: the first phase was the assessment phase, conducted to assess the level of intention toward practicing PA. The second phase focused on measuring which construct of the TPB has the strongest regression weight on the intention to practice PA. These two phases were obtained by analyzing a questionnaire assessed attitude, subjective norms and perceived behavioral control, and intentions; additional variables were obtained in this study and were phrased specifically to reflect practicing in moderate PA for at least 30 min, 3 times per week over the next 5 weeks.
Place and duration of study
The study took place at different female high schools in Riyadh, Saudi Arabia, which were from the five main regions in Riyadh (East, West, North, Southern, and Central). The study was conducted during 3 months from January 2019 to March 2019.
Study population and exclusion criteria
The target population in this study were high school female students who ranged in age from 16 to 18 years. Students who do not complete the questionnaire and had a health issue that prevents them from practice PA were excluded from the study.
Sampling technique and sample size
A multistage cluster sampling technique is used [Figure 2]. The purpose of this technique is to create more representative and targeted grouping.
Different stage was conducted to select the sample; in the first stage, one district from each five main regions (south region, west region, central region, north region, and east region) in Riyadh selected randomly by a website “random thing picker” “Random Thing Picker” that based on Java Script documentation. In the second stage, female high school decided randomly from each district by the same website. The number of students in each school decided based on systematic random sampling technique, used proportional allocation equation to determine the number of female students according to Riyadh regions.
The proportional allocation equation is equal:
nh = (Nh/N) × n
“where nh is the sample size for stratum h, Nh is the population size for stratum h, N is total population size, and n is total sample size.”
The total number of girl high school students in Riyadh according to the Ministry of Education was 83,806 where 27,900 from east, 22,382 from south, 17,451 from west, 8329 from north, and 7744 from central. The sample size was calculated to be 574 participants, using Epi software version 3.01. Assuming a design effect of 1.5 and prevalence is 50% to obtained maximum sample size dependent on cross-sectional study, sample size calculated by proportional allocation equation resulted number of female students at Riyadh from east 191, south 153, west 120, north 57, and central region 53.
The questionnaire was developed based on the TPB by Alselaimi, 2010, and predesigned questionnaire again with Arabic and English versions was used to collect data for this study. The Arabic version was used and modified to suit this study. Pilot testing of the questionnaire was carried out on 20 female students; it was performed as an important step for the study to check the clarity of the questionnaire and the time needed to complete it. The reliability of questions was tested using Cronbach's alpha to examine the internal consistency of questions, Cronbach's alpha test result for the questionnaire was (α = 0.753). The pilot test was administered to verify the questionnaire's clarity, readability, and cultural relevance. The application was applied to a group of 20 volunteers from high school female students, where the volunteers were excluded from the basic study. It has been reviewed by research experts, and the wording of many questions has been modified to suit the appropriate type of PA, gender, age, and its ability to complete in a timely manner. The final version includes five sections with a total of 21 questions, which covers all the following items.
The first section: Sociodemographic characteristics
The first section includes seven sociodemographic characteristics questions (name, age, mother's education level, etc., open questions and multiple-choice questions).
Theory of planned behavior variables
The four sections guided by the TPB to assess four items which were intention, subjective norms, perceived behavioral control, and attitude. The intention was the dependent variable and others were independent variables. Five-point semantic differential or strongly disagree/strongly agree options were used for assessing responses to the close-ended questions. The questionnaires were interpreted as a categorical outcome.
The second section: Intention
Three items were used to measure intention toward practice PA: (1) I intend to practice moderate PA for at least 30 min, 3 times per week over the next 5 weeks? (strongly disagree/strongly agree). (2) I will practice moderate PA for at least 30 min, 3 times per week over the next 5 weeks? (strongly disagree/strongly agree). (3) I plan to practice moderate PA for at least 30 min, 3 times per week over the next 5 weeks? (strongly disagree/strongly agree). They were scored in a 5-point Likert scale (strongly disagree, disagree, neutral, agree, and strongly agree). The intention was considered positive if the points were ≥11 points, considered neutral from 7 to <11 points, and considered negative from 3 to <7 points.
The third section: Subjective norms
Represent social practice of PA or not, which was assessed by four items:
(1) Most of my family practice moderate PA for at least 30 min 3 times per week over the next 5 weeks? (strongly disagree/strongly agree). (2) My family think that I should practice moderate PA for at least 30 min 3 times per week over the next 5 weeks? (strongly disagree/strongly agree). (3) Most of my friends practice moderate PA for at least 30 min 3 times per week over the next 5 weeks? (strongly disagree/strongly agree). (4) My friends think that I should practice moderate PA for at least 30 min 3 times per week over the next 5 weeks? (strongly disagree/strongly agree). These items were measured on a 5-point scale.
The fourth section: Perceived behavioral control
Refers to the degree to which an individual feels that practice PA is under his/her control. Perceived behavioral control was measured by three items: (1) I believe I have the ability to practice moderate PA for at least 30 min 3 times per week over the next 5 weeks? (strongly disagree/strongly agree). (2) Practice moderate PA for at least 30 min 3 times per week over the next 5 weeks is completely under my control? (strongly disagree/strongly agree). (3) The availability of a gym next to my house will make the practice PA for at least 30 min 3 times per week over the next 5 weeks completely under my control? (strongly disagree/strongly agree). These items were measured on a 5-point scale.
The last section: Attitude
The attitude was assessed using four items to represent a positive or negative evaluation of performing PA, which include: (1) for me, practice moderate PA for at least 30 min, 3 times per week over the next 5 weeks will be? (very bad/very good). (2) (never worth it/high value). (3) (Not quite satisfactory/very satisfactory). (4) (very boring/very fun). 5-point scale adjective pairs were used. The scales included the determined by beliefs about outcomes of practicing PA: (very bad/very good), (never worth it/high value) and experiential which is the individual's emotional response to the idea of performing PA: (Not quite satisfactory/very satisfactory), (very boring/very fun) items.
To analyze data, Statistical Package of Social Science (SPSS) version 22.0 Armonk, NY: IBM Corp. was used, with descriptive and analytical statistics. The suitable test was Pearson's correlation coefficient test to assess the relationship between intention and sociodemographic factors, 0.05 level was used as a cutoff point of significance. Linear regression analysis was used to predict which constructs of TPB have the highest weight on the intention to practice PA. This procedure estimates the strength of the association between each independent variable and the dependent variable. After checking for normality, linearity, and homoscedasticity of residuals, assumptions for regression were met [for more information see the Appendix].
Ethical approval was taken from the ethical committee (H-01-R-059) at the Health and Rehabilitation Sciences College at Princess Nourah Bint Abdulrahman University. This study was not funded. Informed consent attached with the questionnaires to obtained full consent from the participants included the importance of the study and ensured the protection of the privacy of research participants.
| Results|| |
[Table 1] demonstrates the sociodemographic characteristics of the studied sample. A total of 574 female students took part in the study and found that 31.18% of the participants' mothers had a bachelor's degree and 5.75% did not have an education, whereas 30.84% of the participants' fathers had a high school education and 3.14% did not have an education. There are different economic standards. It was found that 48.95% of the participants reported a family income of 10000 sr or more (per month) and 6.29% reported <3000 sr (per month). As for Riyadh residential areas of the participants. It found that 33.28% of the participants lived in the eastern sector, 26.66% in southern, 20.91% in western, 9.93% in northern, and 9.23% in the center sector of Riyadh.
[Table 2] demonstrates the number of items, mean, and standard deviation to each construct of TPB. The intention measure had a relatively high mean (mean = 3.68), (standard deviation = 0.95). What stands in [Figure 3] demonstrates the level of intention toward practice PA. It found that 59.06% of the students had positive intention, 35.19% had neutral intention, and only 5.75% had negative intention toward practice PA.
|Table 2: Mean and standard deviation for intention, attitude, perceived norm, and perceived behavioral control|
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|Figure 3: Level of intention toward practice physical activity among high school female students in Riyadh|
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[Table 3] demonstrates the subjective norms toward practicing moderate PA among high school female students in Riyadh. It was found that 49. 3% of the students disagree with that most of their friends practice moderate PA. Furthermore, 48.43% of the students agree with that most of their families think that they should practice moderate PA.
|Table 3: Participants subjective norm toward practicing moderate physical activity among high school female in Riyadh|
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[Table 4] demonstrates the perceived behavioral control toward practicing moderate PA among high school female students in Riyadh. It was found that 83.62% of the participants believe that they have the ability to practice moderate PA and 53.13% agree that the availability of a gym makes practice moderate PA under their control.
|Table 4: Participants perceived behavioral control toward practicing moderate physical activity among high school female students in Riyadh|
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[Table 5] demonstrates the attitude toward practicing moderate PA among high school female students in Riyadh. It was found that 78.75% of the participants practice PA would be valuable for them. However, only 4.7% practice moderate PA will be bad for them.
|Table 5: Participants attitude toward practicing moderate physical activity among high school female in Riyadh|
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[Table 6] demonstrates the correlation between income, mother's education, and intention to practice PA among high school female students in Riyadh. It was found significant positive correlation between intention and income (r = 0.122, P = 0.004*) and between intention and mothers' education (r = 0.084, P = 0.045*).
|Table 6: Correlation between intention to practice physical activity and sociodemographic characteristic among high school female students in Riyadh|
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[Table 7] demonstrates linear regression analysis that was used to predict intention to practice PA among high school female students in Riyadh. The intention was considered as the dependent variable, while variables that had a significant correlation with intention (attitude, subjective norm, and perceived behavioral control) were considered as independent variables. All variables showed a significant (P < 0.000) positive association with intention. Attitude, subjective norms, and perceived behavioral control accounted for about 54.7% of variance in intention. Perceived behavioral control had the strongest regression weight on intention to practice PA (β= 0.301, P > 0.000), followed by attitude (β= 0.270, P > 0.000), then the subjective norms (β= 0.183, P > 0.000). Pearson r was calculated to look at the effect size for the variables. Overall, there was weak to moderate positive correlation between attitude and intention and perceived behavioral control and intention, whereas subjective norm had a weak positive correlation with intention.
|Table 7: Linear regression predicting intention to practice physical activity among high school female students in Riyadh|
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| Discussion|| |
The aim of this study was to assess the level of intention toward practice PA and measure which construct of TPB that has the highest weight on the intention to practice PA. This study was conducted on 574 high school female students in Riyadh, Saudi Arabia, ranged in age from 16 to 18 years.
Most of the participants had a positive intention toward practicing PA; this finding was close to another study conducted in Scotland. This may be due to the implementation of physical education curriculums in the girls' schools of Saudi Arabia in 2017 which was done to achieve one of the objectives of Saudi vision 2030: To increase the prevalence of PA among the Saudi society.
Our study revealed a statistically significant correlation between intention toward practice PA and household income of the participants; a study conducted in Finland reported the same finding that individuals with higher family income had a higher PA. A previous study conducted among parents with low income to identify the barriers to practice PA within the family context proves that parents cited the high costs of enrolling in gym activities, purchasing equipment, and membership fees as barriers to their son's participation in PA and this may be the interpreted.
Also this study found, a statistically significant correlation between intention toward practice PA and mother's education. This was in contrast with a study carried in Canada stated that no association between PA and maternal education. This can be interpreted as maternal modeling include their education, may have a greater influence on children compared with paternal modeling and affect healthy behaviors such as PA.
Half of the participants agreed that the availability of a gym makes practice PA under their control. In a study conducted in Brazil, girl participants agreed on the lack of facilities nearby considered perceived barriers to practice PA. Therefore, the availability of facilities can help to increase PA practitioners.
All independent variables of TPB (attitude, subjective norms, and perceived behavioral control) were highly statistically significant in predicted intention to practice PA. Unlike, a study conducted in Iran stated that subjective norms and perceived behavioral control had significantly predicted intention, and the attitude had no significance in predicted intention to practice PA. TPB variables of attitude, subjective norm, and perceived behavioral control were found to explain 54.7% of the variance in intention. The amount of variance in intention explained by the TPB variables was higher than another study. The reason for these different findings may be the consistent with the recommendations of Ajzen in our study that subjective norms made to the prediction of intentions were assessed using both injunctive norms (what participants felt important others expected them to do) and descriptive norms (whether important others actually perform the behavior). Furthermore, the attitude assessed by instrumental and experiential variables and all items included reference to the specific time frame (over the next 5 weeks) that corresponded with the time frame of the intention measure.
Our results revealed that perceived behavioral control had the strongest regression weight on the intention to practice PA, followed by perceived norm then attitude. A study conducted in Hong Kong reported the same findings. Ajzen (1991, 2002) included the perceived behavioral control variable in the TPB to account for actions that are not completely under volitional control. Perceived behavioral control plays an important role when the behavior is less volitional and this may be interpreted.
The short duration was the biggest challenge we faced in carrying out the study, also because of the classes of students, the researchers need to find break time to make them complete the questionnaire. Further, authors did not assess the PA performance of studZents to comparison between intention of students and their performance.
| Conclusion and Recommendation|| |
This study reported a positive intention toward practice moderate PA among high school female students. Perceived behavioral control had the strongest regression weight on the intention to practice PA, followed by attitude then the subjective norms. Based on the findings of this study, it is recommended to design future PA interventions focusing on increasing perceived behavioral control of the target population since it influences the intention to adhere to PA.
The authors would like to express their gratitude to Dr. Sarah AlSuhaibani for supervising and guiding to complete this study. Furthermore, we are grateful for Princess Nourah Bint Abdulrahman University and our teaching staff: Dr. Huny Bakry, Dr. Hwaida Abu Saleh, and Dr. Samira Marey for their great help. We would also like to thank the Ministry of Education and schools' administrators for facilitating data collection procedures and for the cooperation of participants. Special thanks to our family for their support and motivation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| Appendix|| |
In the table above for Collinearity Test: VIF was less than 5-10 so there is no multicollinearity. Test of Auto-correlation: Durbin- Watson test is between 1.5 and 2.5 so there is no auto-correlation. This satisfies assumptions of residual independence.
Normality test: In the figure above, there are modest violations of normality, however it is robust with large sample sizes due to the central limit theorem. Research has shown that the sampling distribution will still be normally distributed, even if the raw data are skewed when sample sizes are at least 40, thereby satisfying assumptions of the mode. Test of outlier showed casewise diagnostics are for two participants who are outliers because they had standard residual <-3 and beyond 3 standard deviation. Their intention is far from their predicted values from their IV's. However, we fit the model with and without them, and the results were not different (same P value and similar parameter estimates)
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]