Physical activity is a major factor in self-care approaches to controlling DM and its related complications. According to Bandura’s social theory, factors such as social support systems are effective in adherence of behaviour. Socioeconomic status has also been shown to be associated with adherence to behaviour. Based on these premises, we aimed to determine whether neighbourhood support systems were significantly difference according to participants’ places of residence, and also to determine whether SES and neighbourhood support system could be associated with adherence to cardiovascular fitness/PA among persons with DM in Ghana.
At the end of the study we found that there were significant mean difference in receiving low and high social/neighbourhood supports according to participants’ places of residence. We also found that high SES (quintile 3) and moderate SES (quintile 3) were associated with adherence to moderate cardiovascular fitness/PA, while low SES (quintile 3) was associated with sedentary behaviours. Furthermore, we noticed that high social neighbourhood supports (quintile 2) was associated with adherence to moderate cardiovascular fitness/PA and low social/neighbourhood support system (quintile 1) was associated with adherence to sedentary behaviours.
Socioeconomic status refers to individuals’ social position relative to others in a society. Socioeconomic status is known to be a strong determinant of overall survival of human beings but many health care providers and policy makers pay less attention to this. It is reported that people of low socioeconomic status are more likely to have poorer health outcomes, and shorter life expectancy than people of higher socioeconomic status[20, 21] , and this could be attributed partly to lower prevalence of PA among this persons. It is also reported elsewhere that low SES is associated with large increased in cardiovascular disease (CVD) risk in men and women. These observations could be interpreted in two ways. Firstly, people on low socioeconomic quintile or class (low SES) may lack knowledge and information about existing health promotion strategies they can take advantage of to promote their health. Secondly, they may lack the ability to purchase and consume health promoting foods and other products that could directly improve their health (CVD risk). In a Meta-Ethnographic approach to understanding socioecological complexities in participating in PA, it was observed that participation in PA was influenced by accessibility to resources that support PA. These finding are consistent with our finding. In our study we noticed that high and moderate socioeconomic statuses were associated with adherence to moderate PA while low SES was associated with adherence with sedentary behaviour. In the Meta-Ethnographic approach to understanding socioecological complexities in participating in PA, people were desired to travel to parks, public sports centres, or local private health clubs to pursue PA but lack access to reliable transportation such as private cars, public transport, and bicycle infrastructure militated against their desires.
In other development, PA level was found correlated with increasing SES. It is reported that adopting moderate to vigorous physical activity by individuals lowers risk of cancer other chronic diseases. Physical activity is also shown to be safe and helpful to most people before, during, and after cancer treatment, and can improve the quality of life as well, and give the needed energy to help the individuals cope with the side effects of treatment and possibly decrease the risk of new cancers in the future. Indeed PA is the magic bullet providing direct benefits to people living with chronic non-communicable diseases and giving protective effects to the entire population in general. However, population, individuals and environmental factors make adoption and adherence to PA quit problematic, thus causing many people to have low adherence to PA. For instance, across countries, studies show that children’ outdoor PAs are associated with features of the environment, including walking-related features, and physical activity resources [27, 28]. Environmental safety has been reported to influence PA among children with and without Autism Spectrum Disorder, with significant association found between feeling safe and engaging in PA among children .
Apart from the build in environment in neighbourhood that can influence PA, other factors such supports from the neighbourhood can also influence PA[30, 31]. These finding are consistent with our findings. In our study we realized that high social/neighbourhood support system increase the odds of participating in PA whereas low social/neighbourhood support system decreased the odds. These results could be true because neighbourhood cohesion and social capital are shown to be good predictors for adherence to health promoting behaviours.
In a study among school children, it is reported that favourable social environment was positively associated with physical activity, thus re-affirming the importance of social support on incidence and adherence of PA. In a different development among persons with DM, participation in community organizations was shown to be associated with more physical activity (OR = 1.53), also affirming the impact of neighbourhood support on the adherence to PA.
Other studies have also reported on the impact of social/neighbourhood support on adherence to other treatment regimens in general among persons with chronic non-communicable diseases [34-36], which supported our finding. Although significant results were found in our study, we cannot conclude that significant associations exist in household socioeconomic status and neighbourhood support system for adherence to cardiovascular fitness/PA among persons with DM in Ghana. This is because our study suffers some biases, limitations and methodological flaws.
Our study employed facility based cross sectional study to investigate the associations between the study variables. Since cross sectional study cannot detect causal associations of study variables, we cannot conclude based on our results, and therefore suggest that subsequent studies should consider adopting stronger study design like longitudinal cohort study or clinical trial to investigate this matter. Other limitation is that we recruited relatively small sample size (530) which limits the power of our study; in this regard we again recommend that subsequent studies should consider larger sample size to improve the power of the study.
Despite these biases, limitations and methodological flaws, the strength of our study is that it has contributed knowledge in literature by exploring the association of household socioeconomic status and neighbourhood support system for adherence to cardiovascular fitness/PA among persons with DM in Ghana. This will contributes knowledge in the care of persons with DM in Ghana and other part of the world.