Cultural considerations in health messaging for physical activity interventions – A comparison of the meaning of health to Chinese and UK school-aged children

Purpose: According to the health promotion model, a vital step to effective health promotion is understanding the target population’s health experiences and their value about health, i.e. what health means to them. For physical activity (PA) interventions targeting children, often the value of PA/health was ‘preached’ by researchers or public health practitioners, thus lacking relevance to the target population, particularly to inactive children, which might have contributed to the futility of PA interventions. Given that health behaviours are contextual, cultural differences in the meaning of health is expected. Therefore, the aim of the study is to qualitatively explore the meaning of health to Chinese and UK children.
Methods: Chinese children aged 6-12yrs (n=320) and UK children aged 6-11yrs (n=146) were recruited from local primary schools in Hong Kong and in the UK respectively. All participants wore a peizo-electric pedometer for 3 consecutive weeks for habitual PA measurement. Focus groups were formed based on participants’ PA level (highest vs lowest quartile), study year group and sex. Altogether 22 focus groups were formed for the Chinese participants and 20 for the UK participants. Semi-structure focus group discussions on the meaning of health took place at respective schools. During the discussions, participants were asked to depict their answers in drawing to promote engagement.
Findings: Common themes from both groups are physical health and cognitive health. For physical health, lower-ordered themes include optimal body functioning, absence of illness and having ‘energy’ – all were valued for the purpose of developing independence. The oldest Chinese children also expressed weight status represents health. Under cognitive health, UK children considered the ability to make appropriate lifestyle decisions and creativity as being healthy, whereas for Chinese children, being alert and free from worries was considered healthy. Themes not shared are social health (i.e. being with friends, UK children) and mental health (i.e. being relaxed and in good mood, Chinese children).
Conclusion: This study highlighted the similarities and differences in the meaning of health to children of different cultural backgrounds. In future PA interventions, promoting PA through health messages that resonate with children’s health values may enhance their effectiveness.