Exercise and dietary behaviour change in a sample of midlife Australian women

Abstract

The purpose of this study was to understand the factors that encourage midlife women to make exercise and dietary changes, the prevalence of those changes, the process by which women make them, the factors that support or impede them, and how we can enhance women’s capacity to make health behaviour changes in midlife. Since the literature highlighted the importance of self-efficacy in changing health behaviour, and of health-related quality of life as a widely recognized measure of women’s mental and physical wellbeing, the study sought to understand the relationship between exercise and dietary self-efficacy, health behaviour change and health-related quality of life (SF-36), by testing a modified version of Bandura’s 1977 and 2002/2004b models of self-efficacy. The methodology involved postal surveys as well as semi-structured interviews with a subsample of the women who completed the survey. Surveys were sent to 866 women aged 51-66 years from rural and urban locations in Queensland, Australia. Five hundred and sixty-four (69%) were completed and returned. Survey data was analysed using descriptive and bivariate statistics and structural equation modeling. Thematic analysis was used to analyse interviews. The results confirmed that midlife is a significant time for women to make positive health behaviour changes. Almost 40% of women made a change to their exercise and around 60% made a dietary change since turning 40. The main exercise change was doing more walking and the most common dietary change was reducing fat intake. Self-efficacy was shown to be a key influence on whether women made positive changes to their health in midlife. In the relationship between health behaviour change and health-related quality of life, making a positive change to exercise was significantly related to physical but not mental health, and making a dietary change was not related to either physical or mental health. Body mass index was shown to be an important influence on both self-efficacy and health-related quality of life (particularly physical health). Interviews were conducted with 29 of the participants. Interview data reinforced that the main motivations to make a positive health behaviour change among midlife women were being overweight, having an injury or being diagnosed with an illness or health condition. Witnessing the hardship experienced by others with a degenerative disease could also prompt a positive behaviour change. Successful changes mainly involved modifying existing practices and repeating new behaviours until they became part of the daily routine. The main facilitators of health behaviour change were having positive role models, having more time due to retirement, and having support from significant others (such as husbands), health professionals and organizations such as Weight Watchers. The main obstacles to making changes were work, care giving, illness and injury. Bandura’s (1977, 2000/2004b) model was partially supported, but the cross-sectional nature of the study may have been a limitation in demonstrating all aspects of the self-efficacy process. In summary, women are willing to make positive health behaviour changes in midlife, but they need education and support to have those changes be effective. It is anticipated that this research will lead to a greater understanding of the significance of midlife as a time for making healthy lifestyle changes that have the potential to improve women’s health and quality of life in later years.

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