Five focus group discussion sessions were held with the participation of the personnel of Malard Healthcare Network, the West Healthcare Center, Hazrat-e Rasool Hospital, Hasheminejad Hospital and the staff of Iran University of Medical Sciences. A total of 68 people with a mean age of 40.7±7.29 years participated in these sessions. Mean duration of the meetings was 95±35.76 minutes. Table 1 presents participants’ demographic details. The analysis of the data led to the identification of three general themes, including challenges and barriers, strategies, and incentives (facilitators), which are separately presented and explained in Table 2-4.
This theme included four subthemes and 37 codes. The main four subthemes of challenges and barriers were policy-making and legislation, organizational factors, structural factors, and personal factors.
To identify the largest possible number of barriers to physical activity from the participants’ views, the number of times each code in the barrier theme was repeated was counted. The majority of the codes pertained to the subtheme of personal factors, followed by organizational factors and structural factors. Only a few of the codes pertained to the subtheme of policy-making and legislation. Figure 1 presents the repetition of the codes in this theme.
- Policy-making and legislation
In the policy-making and legislation subtheme, some of the participants believed that the personnel’s physical activity not being a priority for the managers and their being non-compulsory were an important barrier. “The main problem is that there’s no compulsory law on it. There must be compulsion in anything you want to motivate people to do; like, we have to work because it’s the law and we have to work to get paid” (P9).
The participants believed that the authorities’ priority was working, and the personnel’s physical activity and physical and mental health play no part in the job policies.
“The priority of the unit managers is working, and not physical activity. If there is some compulsion, I mean, if a value system is defined or but if a payment would be allocated to exercise on the payment scale” (P2).
Regarding organizational factors, the most frequently-discussed items were organizational culture, type of desk work, heavy workloads, and large number of shifts. Moreover, long work hours, the shortage of workforce, and being assigned multiple roles in the system were other issues emphasized by the participants.
“I personally believe that the thing that has led me to have less physical activity is that my work in this job and my work hours are excessive, and since I get very tired, when I finally get to leave work, I can’t handle much physical activity anymore” (P17).
The main barriers in the subtheme of structural factors that were emphasized by the participants included the lack of physical space for exercise or the poor conditions of the physical space for physical activity both size-wise and quality-wise and also the distance from home to the gym. The challenges of performing physical activity for women, especially married women, comprised some other reasons for inactivity in this category.
“If we want to use the gym facilities at the university after work, since the space is small, we have to wait for our turn on the machines” (P60).
“For example, if they said that we should gather round in the praying room every Monday to both have a chat and exercise in between, we would have gone, but we were face with limitation. Well our praying room is not just a praying room; it is also the lecture theater, the conference room, and the praying room. For instance, whenever we went there to exercise, others would want to come in after us and do their praying” (P2).
“Well, most staff in health setting are women, married, and have kids, like myself. With kids, when I go home after work I have to pick the kids up from kindergarten or school, and then do the house work. I have to handle all these, and then if I want to spend some time exercising, which I like very much, can I? I love going to the gym, I might even plan for it, but I can’t really manage it” (P6).
In the subtheme of personal factors, the main barriers extracted in the present study included the shortage of time, physical and mental exhaustion, the lack of motivation, and financial problems.
“I think the main thing that makes us have no physical activity at all is the multiplicity of tasks assigned to us that fall beyond our field of work. We have forgotten ourselves altogether; we don’t show love toward ourselves at all, as if we do not pay attention to ourselves. Our seniors don’t care about us at all, like, do they ever ask if their personnel be physically and mentally healthy or not? We feel we have been forgotten” (P19).
The strategies for promoting physical activity were classified into three subthemes and 19 codes, including policy-making and legislation, organizational factors, and environmental factors.
- Policy-making and legislation
The findings related to this subtheme emphasized the development and implementation of exercise breaks, allocating funds to the personnel’s physical activity at the macro level, and raising awareness and engaging the managers and officials.
“There must be a law for this in the country, like the breastfeeding break that makes the employees actually get up and go to breastfeed their child. A period of, like, half an hour or twenty minutes should be legislated for this, and it should become the law, forcing employees to take it” (P14).
“There should be a budget specifically allocated for exercise, so we can create a space for our colleagues. We must first have the space” (P15).
“When the organization and senior managers understand the necessity of it and if I don’t have to face the ramifications of not being at my desk for half an hour from ten to ten thirty [that would be good]; I mean, if I don’t have to be stressed over not being at my desk if my direct manager contacts me when I’m not at my desk” (P52).
The strategies emphasized by the participants included needs assessment and assigning a sports liaison, recruiting a sports coach to teach the right exercises according to the people’s physical conditions, increasing the workforce to reduce work pressure and stress, creating opportunities for performing physical activities and reforming the organizational culture.
Needs assessment and assigning a sports liaison
“For general and specialized exercises, I think there should first be a responsible and expert liaison to assess the exercise needs of the personnel and see what their general or specialized needs are, and then based on those needs, the expert liaison should interview the people one by one; perhaps one person is incapable of performing many of the exercises and they are harmful for her” (P10).
Recruiting a coach
“A particular exercise is suitable for each person depending on his/her physical conditions, and the coach should advise the individuals on which physical activities to perform” (P59).
Increasing the workforce
“As we said, we are short of workforce. We should reduce our work hours, so we have time for exercise. When I do not have the ability and strength, I cannot come first to exercise” (P11).
Reforming the organizational culture
“I think the organizational culture should be reformed, and then we must definitely have a personnel health record. I mean, each person should consider it their obligation, so that he can monitor his progress, in terms of evaluation, and think about exercise physically and mentally, whether during work hours or outside the work hours, and now, the workload should be somewhat adjusted too” (P9).
The results in this section emphasized the need for diversity in physical activities, forming sports teams, creating a suitable, standard and safe place for all the personnel, especially women, and easy access to these places.
Diversity in physical activity and forming sports teams
“Team sports and group activities are good and make the place energetic” (P9).
“Team sports are motivating. To guide these, you should form groups and networks, make sports networks, and then choose one person as the leader to guide the rest along” (P68).
Creating an appropriate place with easy access
“I think the university should dedicate a place, be it a gym, a pool, some place, where everyone can use for free or for a small amount of money, and if they have these facilities, everyone can use them and do their exercise there. Signing contracts with gyms close to each hospital or close to where the personnel live is also good” (P46)
- Motivators (Facilitators)
The theme of motivators led to the extraction of organizational and motivational subthemes, with seven and 13 codes, respectively.
Most participants believed the main facilitators of physical activity to include the organization paying fitness subsidies, including the personnel’s physical activity in their performance evaluation, and building a healthy fitness culture.
Paying fitness subsidies and drawing contracts with gyms and pools
“Paying fitness subsidies by drafting contracts with gyms and pools and giving the staff passes or subsidies, and expanding the university gymnasium” (P60).
“If they draft a contract with some place and tell us that both men and women can go on certain days without restrictions on time, I think it will be welcomed by all the staff. But there is always the issue of the costs, and we don’t expect it to be free of charge, just at a lower cost” (P46).
“The staff should be given passes to various gyms for free or half price, which should be financed by the ministry and not the network. There should be different places across Tehran, they should be obligatory, and the staff should be forced by the directors to use them, and subsidies should be paid to motivate the personnel” (P2).
Including the personnel’s physical activity in their performance evaluation
“An evaluation system should be defined for this, because there’s currently nothing in the civil service law at all; a payment should be considered for exercising on the payment scale; institutionalizing exercise, laying the groundwork for it and building a culture of physical activity are key. Our civil service law should be revised” (P11).
Laying the groundwork and building a culture of physical activity
“It has to do with the culture. Generally, we don’t feel the need neither at school nor in the family to perform physical activities. You grow up in this way; you go to college and then to the workplace in this way, and then if one day they give me this opportunity [to exercise regularly], I don’t welcome it much. It has partly to do with the culture; its necessity has not been internalized. Now building a culture of physical activity is associated with knowledge. If I don’t know how to sit correctly, then I don’t sit correctly. It is the same with walking; I don’t walk correctly if I don’t know how to” (P55).
The participants believed that building and improving motivation are key components of encouraging physical activity. Material and immaterial incentives, holding competitions in fields such as mountain-climbing, hiking and nature tours with the family were some of the discussed measures.
Material and immaterial incentives
“Giving points for exercise. Giving points to someone who exercises rather than deducting points from someone who doesn’t exercise” (P60).
Holding competitions
“Another issue is that competitions should be ongoing. We only have few different occasions on which competitions are held, such as the anniversary of the Islamic Revolution, the ten-day celebration of Khomeini’s return to Iran, the government week, etc.; however, if these were ongoing, like, if they were seasonal, in all disciplines, then I think it would be motivating. The personnel should all be somehow allowed to take part in these competitions or hiking tours; they should be performed in the same way with fairness, so that everyone can take part” (P4).
Mountain-climbing, hiking, and nature tours with the family
“Creating a family atmosphere so that family members and friends can also attend these sports activities and turning them into group activities will certainly make them more effective” (P50).