Context matters: Construct framing in measures of physical activity engagement among African American women

21 Context Matters McClure et al. Journal of Health Disparities Research and Practice Volume 12, Issue 3, Fall 2019, pp. 21-34 © 2011 Center for Health Disparities Research School of Community Health Sciences University of Nevada, Las Vegas Context Matters: Construct Framing in Measures of Physical Activity Engagement among African American Women Stephanie M. McClure, University of Alabama Travis Loux, Saint Louis University Enbal Shacham, Saint Louis University Eileen Gillespie, Saint Louis University Denise Hooks-Anderson, Saint Louis University Corresponding Author: Stephanie M. McClure, ABSTRACT Assessment of psychosocial factors influencing health behavior typically privileges conceptual consistency (framing constructs similarly across contexts) over conceptual specificity (context-specific framing). Modest statistical relationships between these factors and health behaviors, and persistent racial disparities in health outcomes raise questions about whether conceptually consistent framing fully captures relevant predictors. Ethnographic studies suggest not - that perceptions influencing health behaviors are multifaceted and contextual. To test this, we added items querying contextualized predictors of intention to engage in leisure-time physical activity (LTPA) to a Theory of Planned Behavior (TPB)-based survey and examined the psychometrics of the adapted subscales. We measured internal consistency (Cronbach’s alpha) and construct validity (exploratory factor analysis using polychoric correlations for ordinal data). Participants were a convenience sample of 200 African American women in a Midwestern, suburban University-affiliated family medicine practice. Reliability of the adapted subscales was notably lower than the original subscales. A twofactor model fit best for the attitudes subscale, but explained slightly less than 50% of the variance. The new items loaded strongly on one factor. A three-factor model best fit the norms subscale and accounted for around 57% of the variance. Two of the three new items loaded strongly on one factor. Factor analysis for the perceived control subscale was not possible due to low number of items; however, two of the three new items were highly correlated (.73). Including context-specific factors may improve assessment of intention to engage in LTPA. Further study of this question with a larger, representative sample is warranted. Keywords: African American women; physical activity; theory of planned behavior; gender norms; role conflict Journal of Health Disparities Research and Practice Volume 12, Issue 3, Fall 2019 http://digitalscholarship.unlv.edu/jhdrp/ Follow on Facebook: Health.Disparities.Journal Follow on Twitter: @jhdrp 22 Context Matters McClure et al. INTRODUCTION Regular engagement in leisure-time physical activity (LTPA) is now understood as an ecological phenomenon (i.e., a result of myriad individual and environmental factors). However, the nature of leisure time physical activity – electing to engage in individual or group pastimes that feature physical exertion – coupled with the individualistic bent of US dominant culture, has produced a very particular result: a preponderance of public health efforts to predict and encourage regular, leisure-time physical activity engagement seek to change individual attitudes, norms, beliefs, motivations, and habits (Agency for Healthcare Research and Quality, 2015). This is true both for the US population as a whole and for groups exhibiting physical activity rates below what is deemed optimal for health. African American women and girls have lower rates of physical activity than any other US race/gender group (Go et al, 2013, Marshall et al, 2009). Though many physical activity promotion efforts targeting this and other racial/ethnic minority groups claim to be ‘culturally tailored’ or ‘culturally appropriate’ (Gletsu and Tovin, 2010, Wilson, 2009; Beech and Jernigan, 2014), interventions consistently emphasize individual-level perception, motivation and decisionmaking. Measures reflect a valuation of conceptual consistency (measuring the same constructs in the same way across populations) over conceptual specificity (framing the construct in a way that is specific to the local cultural context). There are sound methodological reasons for privileging consistency; it facilitates comparison between groups. However, persistent health disparities - e.g., lower leisure-time physical activity levels among African American women and girls relative to other race/gender groups – invite questions concerning not only what factors influence physical activity, but how those factors may vary in their operation within and between groups. Such questions challenge investigators to find a balance between conceptual consistency and conceptual specificity when using existing theories, models and frameworks. The Theory of Planned Behavior (TPB) is used to frame many health behavior interventions (Ajzen 1991; Mantano & Kasprzyk, 2015). The premise of the theory is that intention predicts behavior. Three constructs [attitudes, subjective norms and perceived behavioral control (PBC)] are theorized to inform intention. The degree to which each construct correlates with intention is assessed through brief, declarative statements, to which participants respond using a Likert scale. Statements assessing these constructs tend to query attitudes, norms and control in a formulaic manner: e.g., ‘the people most important to me think that I should participate in physical activity on most days’ (strongly agree – strongly disagree) or, ‘participating in one or more physical activities in my free time is’ (very easy – very difficult). Such consistent item formatting makes for reliable, internally valid instruments. The assumption underlying this privileging of conceptual consistency appears to be that the attitudes, norms and control perceptions informing a given health behavior are one-dimensional and uniform – that there are no conflicting attitudes, coexisting norms or agentic tug-of-wars that bear on intention or behavior. However, ethnographic studies of health behavior contradict this assumption and raise questions about the degree to which relevant, meaningful predictors are being fully captured with one-dimensional, conceptually consistent measures. Activity-relevant Attitudes African American adolescent girls expressed concern with avoiding an appearance or behaviors perceived as ‘manly’ in an ethnographic study of body conceptualization and physical activity engagement (McClure, 2013). Though the appearances and behaviors that constituted Journal of Health Disparities Research and Practice Volume 12, Issue 3, Fall 2019 http://digitalscholarship.unlv.edu/jhdrp/ Follow on Facebook: Health.Disparities.Journal Follow on Twitter: @jhdrp 23 Context Matters McClure et al. trespass into ‘manliness’ varied in the sample, 41 of the 42 study participants mentioned or endorsed the importance of avoi (...truncated)