Perceived Barriers and facilitators for Physical activity in South African patients with axial spondyloarthritis : An explanatory sequential mixed methods approach with the transtheoretical model as a conceptual framework

Background: Physical activity (PA) for individuals with axial spondyloarthritis (axSpA) is highly recommended for the management of the disease. However, maintaining physical activity is challenging for individuals with axSpA.Aim: The aim was to explore perceived facilitators and barriers to PA in relation to stages of change (SOC) in individuals living with axSpA in South Africa. Methods: A mixed method design involving 65 participants with axSpA was used. A web-based survey assessed facilitators and barriers with the Inflammatory Arthritis Facilitators and Barriers questionnaire, SOC, and demographic data. 10 participants were contacted for follow-up interviews and data were analysed with content analysis. Results: Knowledge about the PA benefits to health (69,2%) and mood (60%) were predominant facilitators and levels of symptoms (66.2%) and lack of mindset (64.5%) were barriers indicated in the survey. Lower levels of education were associated with higher barriers. The interview analysis uncovered four barriers: interaction of symptoms, inappropriate care, unsupportive external environment, mindset and three facilitators: mental strength, symptom relief and supportive external environment. Conclusion: There is a complex interplay between physical symptoms, psychological, interpersonal, and environmental barriers and facilitators to physical activity. Since physical activity in axSpA is important for management, future research should involve behavioural medicine approaches