Barriers and Strategies for Promotion of Physical Activity Among Older Adults in South India- A Qualitative Study Using Focus Group Discussions with Stakeholders

Study Design and Methodology: This project will employ a qualitative research design with focus group discussions to gain in-depth perspectives on the barriers and facilitators for PA among older adults in India. Two distinct groups will be recruited.

Focus Group 1 - Health Care Professionals (HCPs): A diverse group of potential participants will be recruited from a tertiary care medical college hospital including (but not limited to) general medicine practitioners, geriatric specialists, physiotherapists, occupational therapists, and rehabilitation experts involved in caring for the older adults. The discussion probes will be directed to challenges faced while prescribing PA, strategies to integrate and encourage PA into their prescription, role of healthcare providers in promoting PA. Focus group 2 - Older adults: Older adults aged 60 and above will be recruited using a purposive sampling approach to ensure diversity in age, sex, socioeconomic background, and environmental location. Potential participants will be identified through collaboration with local community centres and old age homes. Additional snowball sampling will be used to further recruit participants. To be eligible, participants must have not had significant cognitive impairment. The discussions will delve into personal experiences and perspectives on PA, the importance of engaging in PA, the values of PA in the community, perceived barriers/motivators, and strategies to promote PA in older adults with limited resources.

Data collection: We will conduct two rounds of FGDs. In the first round, FGD will be conducted separately for HCPs, and older adults to ensure an open environment for discussions. Each group will consist of 8-12 participants to engage diverse perspectives. In the second round, we will conduct FGDs with a combined group of HCPs and older adults to further share and discuss the potential views that emerged in the first round**.**

Procedure: A facilitator trained in qualitative research methods and a note-taker will conduct the focus group discussions. The facilitator will guide the group discussions using a semi-structured interview guide that is tailored to each participant group. The facilitator will encourage open dialogue and ensure all the participants have the opportunity to share their experiences and viewpoints. The note-taker will record the comments and interpersonal interactions during the interview without intervening. The interview guide will consist of open-ended questions regarding barriers and facilitators, experiences, and strategies for adherence, sociocultural and environmental determinants of PA, and will be formulated using theoretical domains framework (TDF).6 The discussions are expected to last approximately 60-90 mins for each session and will be conducted in a quiet environment ensuring the confidentiality and comfort of all the participants.

  **Data analysis:**Thematic content analysis will be employed to analyse the data. All the FGDs will be audio-recorded and transcribed verbatim. Transcripts will be read several times for accuracy and any identifying information will be anonymized. Initially, two researchers will independently read and code the transcripts to identify emerging themes related to PA in older adults. The researchers will then meet to discuss and refine the identified themes, achieving consensus through discussions.

Data triangulation:  Data triangulation will be performed by comparing and contrasting the themes arising from the FGDs with those from the different participant groups (HCPs and older adults) strengthening the validity of the findings.