A scoping review comparing individual and multi-level physical activity interventions in rural women in the United States.

backgroundWomen residing in rural areas of the United States tend to have worse cardiovascular, mental, and pregnancy-related health than their urban counterparts. Physical activity is a modifiable and likely promising strategy to reduce these health disparities. The aim of this review is to summarize physical activity interventions in rural women in the US using the socio-ecological model of health framework.

methodsWe conducted a scoping review of peer-reviewed literature in Medline, CINAHL Complete, Web of Science, and PsychINFO in August 2023. Studies had to be published in a peer-reviewed journal, quantitatively assess physical activity effects of an intervention in the US, include women who were on average aged 18 years or older and live in a rural setting, and be written in English. Studies that did not separately analyze the effects of physical activity interventions on rural, women were excluded. We narratively synthesized the evidence and, in studies with a comparison group, calculated pooled estimates to compare effects between individual vs multi-level approaches. Multi-level interventions were defined as those intervening at two or more levels of the socio-ecological model. We used an adapted GRADE approach to assess study quality.

resultsOur search yielded 41 reports on 38 different interventions that met our eligibility criteria (24 individual and 17 multi-level). After initial completion of the intervention (n = 38), 19/23 individual (83%) and 11/15 multi-level (73%) interventions increased physical activity. Pooled estimates indicated that multi-level interventions increased physical activity to a greater extent (d 1.09 [-0.44, 2.16]) than individual-level interventions (d 0.18 [-0.26, 0.62]). Limited studies included measurements of feasibility, acceptability, strengths, and barriers or defined rurality, identifying a need to better report these measures. Considerations for designing interventions include ensuring that participants feel supported, employing strong interventionists, new technology, and cost-effectiveness.

conclusionsOur results found that more individual-level interventions increased physical activity compared to multi-level interventions. Yet, meta-analysis results suggest that multi-level interventions yielded a larger pooled effect than individual-level interventions; however, with overlapping confidence intervals, we cannot definitively claim that either approach was more successful. More high-quality interventions, including randomized controlled trials, are needed. Reporting should be detailed and thorough.