1. Comparisons between countries
Physical Activity for Health Research Centre (PAHRC)
Comparisons between countries
Tessa Strain
PhD student, University of Edinburgh
Talk today in 3 parts: differences, similarities and thoughts on where next.
Main focus will be on the differences. Hope to highlight that seemingly minor differences in q’aire can lead to differences of similar magnitude to those we are interpreting as “real” or “true”. Although I will be specific to these countries, I hope the message is of interest to others as there are many initiatives to compare between countries.
@tessastraining

2. (insufficiently active)
Are there differences in activity levels?
Basic metric in all studies – meeting guidelines or not.
Minutes of MVPA/week
England
(2012)
Scotland
(2013)
Northern Ireland
( )
≥ 150 (active)
61%
64%
45%
(insufficiently active)
22%
19%
20%
17%
36%
This table shows proportion that meet the guidelines across the three nations. In all studies we stratified on this variable.
At face value, we might conclude that northern Ireland are a step behind Eng and Scot. But that Scotland has its shoulders in front.
Sources: England: Roberts et al. (2016); Scotland: Strain et al. (2016); N. Ire: Murphy et al. (unpublished)

3. Who cares? These figures also reported in GoPA! country cards.
Is Scotland really the most active home nation?
And this would be the interpretation that the BBC had when the GoPA country cards were released. And I can say the Scot Gov are well aware of their relative position within the home nations accordingly.
But do we believe this? Should we be looking to Scotland to see what they are doing right?

4. Where are the differences?
Active,
Weekly minutes
Now I am going to focus on Eng and Scot for a bit.
Eng and Scot health surveys are very similar. Up until 2006 they were identical. They are still run by the same company and so many changes that occur to one, also happen to another. But not always.
Here I am now looking at total weekly minutes of MVPA for active men and women. I am looking here to see what clues there are for why there are 3% more people in this category in Scotland.
Data from Roberts et al. (2016) and Strain et al. (2016). Averages of all ‘active’ men and women.

5. Occupational activity?
Active,
Weekly minutes
Occupational activity stands out as the domain that is most different. Indeed, in 2008 England changed. They ask about 6 different questions on activity at work, while Scotland asks just one.
The result is that England has a more gradual variable frequency distribution while Scotland is more binary.
Data from Roberts et al. (2016) and Strain et al. (2016). Averages of all ‘active’ men and women.

6. Occupational activity?
Reanalysed data from the Health Survey for England 2012 using two different methods of calculating occupational activity.
% meeting guidelines
Unpublished data, using Health Survey for England 2012 dataset.

7. Anything else? Active, Weekly minutes
So is there anything else?
Removed occupational activity.
Data from Roberts et al. (2016) and Strain et al. (2016). Averages of all ‘active’ men and women.

8. Is there a real difference in the sport and exercise domain?
Active,
Weekly minutes
Sport different by about 100 mins per week for men and 60 for women.
Data from Roberts et al. (2016) and Strain et al. (2016). Averages of all ‘active’ men and women.

9. How do we measure this domain?
England
Scotland
Can you tell me if you have done any activities on this card during the last 4 weeks?
Showcard 1
Showcard 1
Anything else?
Showcard 2
Anything else?

10. Consistent prompting matters
Proportion of adults undertaking sport in last 28 days
SHeS
(one showcard)
2013 SHeS
(two showcards)
% change
Sports added to the second showcard
Golf
3.9%
5.4%
38%
Bowls
1.2%
1.9%
58%
Hill walking/
hiking/rambling
0.2%
9.4%
4600%
Sports on the original showcard
Running/jogging
11.2%
12.7%
13%
Swimming
12.9%
14.3%
11%
Football/Rugby
6.7%
6.2%
-7%

11. Consistent prompting matters
% meeting guidelines
Using almost comparable methods for all other domains
Unpublished data, Scottish Health Survey and datasets

12. Sport by age group Active, Weekly minutes Scotland England
And the effect may not be uniform across the age groups – sports like golf and bowls particularly older adults.
Data from Roberts et al. (2016) and Strain et al. (2016).

13. Conclusion
Small differences in the questionnaire can lead to differences of similar magnitudes to those we are interpreting as “real”. They may account for/amplify/distort the differences between the countries. This has implications for making country comparisons and for any making changes to questionnaires.

14. What do we have in common?
Active men,
Relative
Even amongst active, sport and exercise makes up the minority of PA
England
Scotland
Northern Ireland
Even amongst men, the most they get to is 50% sport and exercise activities
Data from Roberts et al. (2016), Strain et al. (2016)., Murphy et al. (unpublished)

15. What do we have in common?
Active men,
Relative
Walking is important especially for older adults.
England
Scotland
Northern Ireland
Even amongst men, the most they get to is 50% sport and exercise activities
Data from Roberts et al. (2016), Strain et al. (2016)., Murphy et al. (unpublished)

16. What do we have in common?
Inactive men,
Relative
3) Domestic activity makes up a large proportion of MVPA for the insufficiently active
England
Scotland
Northern Ireland
Mention this particularly because when I gave a talk to the Scot Gov, very interested to discuss what the policy implications were – do we promote domestic activity?

17. How can we use these domain analyses?
Broad simple domain analyses can support key messages like PA is more than just sport
Design interventions for specific groups
Could it be used to help justify funding decisions, or to hold policies to account?
But remember: know your survey!

18. Thank you for listening
@tessastraining
References
Roberts, D., Townsend, N., & Foster, C. (2016). Use of new guidance to profile 'equivalent minutes' of aerobic physical activity for adults in England reveals gender, geographical, and socio-economic inequalities in meeting public health guidance: A cross- sectional study. Preventive Medicine Reports, 4, doi: /j.pmedr Strain, T., Fitzsimons, C., Foster, C., Mutrie, N., Townsend, N., & Kelly, P. (2016). Age-related comparisons by sex in the domains of aerobic physical activity for adults in Scotland. Preventive Medicine Reports, 3, doi: Information on GoPA country cards: Hallal, P. C., Martins, R. C., & Ramirez, A. (2014). The Lancet Physical Activity Observatory: promoting physical activity worldwide. Lancet, 384(9942), doi: /S (14) Corbett, J., Day, J., Davidson, M., Doig, M., Dowling, S., Gharib, W., Roth, M. (2013). The Scottish Health Survey Volume 2: Technical Report. Edinburgh: The Scottish Government. Craig, R., & Mindell, J. (2013). Health Survey for England 2012: Volume 2 Methods and documentation. Leeds: The Health and Social Care Information Centre.