A Theory-Informed Systematic Review To Understand Physical Activity Among Women In GCC Countries

Aim: The aim of this systematic review is to identify health beliefs and modifying factors influencing physical (in)activity among adult women in the six countries of the Gulf Cooperation Council: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Methods: A comprehensive literature search was conducted to locate published studies in the following databases; MEDLINE (Ovid), EMBASE, the Cochrane CENTRAL, Web of science, and the Google Scholar databases for studies published between 2009 to 2019. The quality of the included studies has been assessed using the Mixed Methods Appraisal Tool (MMAT). Based on the health belief model, the data collection and analysis systematically identified evidence on the relationships of health beliefs and modifying factors with physical activity. Results: Six studies are from Saudi Arabia and five studies are from Oman. Two studies were reported from each of Qatar and Kuwait for a a total n=(15) studies. Reported physical ctivity prevalence is low, ranging from 50 percent to almost zero, depending on location, subpopulation and measurement instrument. The evidence on relationship of modifying factors and health beliefs with physical activity is scarce and sometimes inconclusive. Of the modifying factors, middle age and employment are positively associated with physical activity, whereas marital status, education, income, and BMI were not significantly associated with physical activity. Regarding health beliefs, the only conclusive evidence found was that lack of time was not significantly associated with physical activity, for the population of males and females combined. Lack of social support and lack of skills are the two beliefs reported significantly more frequently by female respondents and which therefore may explain the gender difference in physical activity prevalence. Differences in reporting of fear of injury and lack of willpower were non significant. Conclusions: Robust qualitatative and quantitative research on health beliefs and modifying factors explaining low prevalence of physical activity among female adults in the GCC is urgently needed. Current evidence reveals that unemployed women and women of age below 25 and elderly women are less likely to be physically active. Compared to male adults, female adults are more likely to believe to lack social support and skills for physical activity . Many of the known factors and health beliefs appear not to be significantly related to physical activity for adult women in GCC countries.