Understanding effective university programs on physical activity: A realist review guided by the health-belief model

Introduction: The study aimed to understand why and how effective university programs on physical activity work. Methods: Guided by the Health Belief Model in the context of a realist review design, the researchers conducted a search among seven peer-reviewed electronic databases in the health and education fields. Two reviewers independently conducted title, abstract, and full-text screening for each study. Disagreements in the screening and study selection phases were resolved through consensus. Data pertaining to the contexts, mechanisms, and outcomes (CMO) of university-based physical activity programs were extracted and analyzed using descriptive statistics. Content analysis was also conducted to inform the CMO configurations. Results: The search identified a total of 6219 records, of which 16 programs contributed to data synthesis. Eight CMO statements were created with the following key themes: 1) tailored and individualized interventions, 2) medium-term incentivization, 3) lifestyle education programs utilizing information and communications technology, 4) interdisciplinary multicomponent programs, 5) use of self-monitoring strategies, 6) social support, 7) shared experiences among employees and students, and 8) theory-based physical activity programs. Analysis of the mechanisms of these effective university-based physical activity programs revealed processes and structures that were consistent with the elements of the Health Belief Model. Discussion: The results of this review demonstrate that effective university wellness programs on physical activity are those that address elements of behavior change. Physical therapists working in and with universities can further advocate for physical activity engagement among university constituents through their involvement in program and policy creation, implementation, and evaluation.