This study showed that factors related to the built environment were the most frequently reported barriers, followed by factors related to the interpersonal and social environment. The most common interpersonal barriers were lack of time (47.4%), fatigue (24%), and cost (22.4%). The most important social barriers were work (30.6%), harassment outside (22.2%), not being accompanied by a friend or family member (19%) and not being authorized by the family (15.4%). The most common built environment barriers included lack of pedestrian paths (34.4%), limited accessibility to exercise facilities (25.8%), and environmental pollution (21%). .
In the current study, lack of time was the most common interpersonal barrier to physical exercise among women. Other significant interpersonal barriers include fatigue and cost. Another study from Singapore also identified time and fatigue as the main barriers to physical activity in the general adult population (15). Another study from Saudi Arabia also recognized fatigue and lack of time as the main interpersonal barriers among a sample of women with diabetes mellitus (22). Affordability or cost was also a significant barrier in a study of the disadvantaged female population in Canada (14).
Most women, whether single or married, young or old, have many responsibilities, such as caring for children, cooking and cleaning at home, in addition to working or studying. As a result, they usually feel tired and lack time for leisure activities such as physical exercise. Lack of time was significantly higher among employed women and students.
Cost is also a significant barrier since participation in physical exercise programs at health/fitness clubs or gyms is relatively expensive in Erbil (minimum USD 100 per month). Women have limited choices because the culture does not encourage them to exercise in parks and open spaces. In the present study, the cost factor was particularly important for women in rural areas and those with lower economic status.
In our study, only child and family care and age-related interpersonal barriers were significantly associated with participants’ age. Childcare and family barriers were more prevalent among women aged 36 to 45. The age barrier was more prevalent among those 46 and older. A Brazilian study showed that older adults and older adults reported intrapersonal barriers to exercise more frequently than younger women (23).
This study determined that work was the most common social environmental barrier to physical exercise, followed by harassment outside, not being accompanied by a friend or family member, and not be authorized by the family. Unsupportive cultural and social norms were also significant social barriers among disadvantaged women in Canada (14). A systematic review also identified similar social barriers to physical exercise among young women, including social support, religious and cultural norms, and safety concerns related to sexual harassment and other forms of sexual violence in schools. public spaces (24). Despite the notable progress made in the political and social participation of women in Kurdistan, many social and cultural factors still restrict women in their rights and freedoms. The relatively high prevalence of harassment and not being allowed by family indicates such restriction (19, 20).
Women who were younger, less educated, single, students, unemployed, and with lower economic status were more likely to not be allowed by their family to exercise. Many other barriers related to the social environment were significantly higher among women with lower levels of education, employment, and economic status. This finding indicates that less empowered women are at higher risk of having their family and husband control their behavior. These women may not only be at risk of being deprived of physical exercise. However, they may be vulnerable to other human rights violations and suffer health problems (25). Research has shown that women’s empowerment programs have helped increase women’s motivation to change their physical activity behavior (26).
Research has shown a positive relationship between support for physical exercise from partners and family and participation in physical exercise (27). Sometimes partners or families prevent or discourage women from exercising because they disapprove of exercise clothing, think sports are for men, prevent women from leaving the house, fear or fear. are worried about neighborhood safety, or think that exercise is harmful to reproduction (28,29,30,31,32).
In this study, the most common barrier to the built environment was the lack of pedestrian paths, bike paths or parks. This was followed by limited accessibility to gyms or other exercise facilities and environmental pollution. Another study of Singapore’s adult population also identified a lack of walking paths, cycling paths or parks, as well as pollution as the top three barriers to physical activity (15). Lack of pedestrian paths, bike paths, or parks was an important factor for transportation-related physical activity. The Canadian study of disadvantaged women also identified lack of accessibility as a major barrier to leisure-time physical activity (14).
Erbil does not have special cycle paths and walking paths are generally not in good condition. When walking along roads and streets, people often need to travel on roads and run the risk of road accidents. On the other hand, the number of parks is also limited and many are not in good condition. Most small parks and gardens near residential neighborhoods include large generators that provide electricity to surrounding homes. The noise and pollution from these generators make these gardens and parks unsuitable for physical exercise.
Most built environment barriers were more prevalent among older women, women with higher education, and those who were employed. This could indicate greater awareness of these barriers among these groups of women. However, working women and those with limited time and fatigue may find such excuses not to exercise.
This study assessed the main barriers to physical exercise among women in a predominantly Kurdish and Muslim context. Other studies have shown a high level of interest but low level of activity for participation in physical exercise among Muslim women. Muslim women face many obstacles and challenges when it comes to physical exercise, and progress is slow. Barriers preventing Muslim women’s participation include religious and cultural barriers, lack of dedicated spaces or facilities for women, lack of modest sports attire, and risk of discrimination (33, 34). Interventions to encourage Muslim women’s engagement in physical exercise should address multiple layers of the socioecological model to overcome key barriers at different levels. These different levels of barriers include intrapersonal barriers, such as lack of self-efficacy, motivation, and knowledge; interpersonal barriers, such as lack of social support; and environmental barriers, such as lack of affordable facilities and appropriate cultural and religious beliefs regarding the participation of women wearing modest and gender-sensitive dress (35).
This study is the first conducted in Iraq and the Iraqi Kurdistan region to investigate barriers to physical exercise among women. Similar studies in neighboring and other Arab and Middle Eastern countries are also very limited. This study shows the main types and details of barriers to physical exercise among women in these contexts. Although interest and engagement in physical exercise has recently increased in the region, women, particularly those from conservative and disadvantaged societies, have limited engagement in physical exercise, which could be due to different types of obstacles. Determining these barriers can help in taking appropriate measures to overcome these barriers to increase the level of women’s participation in physical exercise.
This study has certain limitations. The type of study and sampling method affect the generalizability of the results. Convenience sampling method is generally used when it is difficult to get the list of population to choose a random sample. The snowball sampling method is most useful when it is difficult to identify respondents and there are stigma issues in the research topic. In the ideal situation, random sampling method should have been used for this study. However, convenience and snowball sampling methods were used due to the difficulty of obtaining a detailed list of the study population with their contacts and directly contacting women in that society based on a selection random. A longitudinal study applying random sampling and taking into account confounding variables is necessary to provide generalizable results. This study mixed girls and women for the same barriers. Married and single women face different barriers to physical exercise in Kurdish and Muslim community contexts. There are several valid and reliable questionnaires to assess barriers to physical activity, such as the Benefits/Barriers to Exercise Scale (36). However, we decided to use a new tool because existing tools do not cover all potential barriers relevant to the Kurdish and Muslim contexts.
