This cross-sectional study was conducted from January 15, 2019, to March 30, 2019, simultaneously in the United States and Pakistan. A convenience sample was obtained from college students in both Pakistan and the United States. Participant eligibility was based on the on the following criteria: a) age (18-28 years), b) fluent in English, and c) No mental disorder. Institutional Review Board (IRB) approval was obtained from University XXX IRB and all participants provided informed online consent before filling out the survey and research were performed in accordance with relevant guidelines and regulations. There was no need to translate the survey in Urdu, the national language of Pakistan, because college-level education in Pakistan is delivered in English. College students from Pakistan and the United States participated in this study. The survey was fully confidential and anonymous and no identifiable information was collected. Participation was voluntary and only completed surveys were included for data analysis. In Pakistan, 290 college students attempted to fill out the survey; two did not give consent, 155 did not complete the survey, and 133 completed the survey (21.05 ± 2.09 years of age, 87 females). Participants were not provided compensation for completing the study. In the United States, 178 college students attempted to fill out the survey, and 167 completed it (20.37 ± 1.22 years of age, 128 females).
Instruments:
Data were collected using the electronic questionnaire on the Qualtrics Research Suite posted through social media, such as Whatsapp, and emails. Participants first provided demographic information (e.g., age, gender, major, marital status). After that, the International Physical Activity Questionnaire (IPAQ)20 was used to gauge PA levels and trends in students from both countries. The IPAQ short form is a questionnaire developed to monitor the physical activity in adults. IPAQ is considered to be a reliable and valid instrument for PA surveillance; it was tested in 12 countries (14 sites) in 2000.20 Findings suggest that IPAQ is an acceptable instrument used to gauge PA trends in many settings and different countries. The instrument consists primarily of seven items relaying information about sedentary, moderate, and vigorous PA levels during the last seven days. For sedentary behavior, participants were asked to report the average time spent sitting (sitting and lying down awake at work, at home, while doing course work, and during leisure time). Based on the IPAQ, moderate PA is categorized as activities (such as carrying loads, bicycling at a regular pace, badminton, tennis, etc.) that cause an increase in respiration rate, heart rate, and sweating for a minimum of 10 minutes, which is equivalent to three to six metabolic equivalents (MET).21 Similarly, vigorous PA comprises those activities (such as heavy lifting, digging, aerobics, or fast bicycling) that produce a vigorous increase in the respiratory rate, heart rate, and sweating for a minimum of 10 minutes, which is equivalent to six or more MET.21 IPAQ can inform about PA levels in students of two countries; however, it cannot determine the perceived barriers to PA for these students.
The Perceived Barriers to Physical Activity Questionnaire (BPAQ) was used to understand the different perceived barriers to PA in college students in the two countries.9 The BPAQ consists of 26 items; each item is a perceived internal barrier (e.g., lack of confidence, lack of a partner, lack of facilities etc.). Each item is scored on a numerical scale from 1-10, with 1 representing not a barrier to 10 being a major barrier. Respondents addressed each barrier by rating them using the numerical scale.
In addition, participants were also asked whether they knew the recommended level of physical activity to gauge their literacy regarding weekly physical activity recommendations.
Statistical Analysis:
Descriptive statistics were calculated for the respondents’ age, sex, matriculation information, and household income (frequency, mean, mode, and standard deviation). Chi-square analyses were performed to evaluate associations between the categorical variables. The categorical variables included in this analysis comprised of nationality, sex, physical activity level, and access to healthcare facilities. Independent t-tests were conducted to evaluate the mean difference between independent variables of nationality and sex regarding minor and major barriers to physical activity. Twenty-six common barriers to physical activity were listed for respondents to choose. Barriers were considered minor or not a barrier when given a score of 1 to 4 and major when given a score of 7 to 10 on a scale from 1 to 10. The number of minor and major barriers were calculated for each respondent to conduct pertinent t-tests. Alpha was set to a level of p ≤ 0.05 for all analyses.