Table 4 Focus group discussions themes, elaboration, illustrative quotes and potential implications beneath research questions^a

Participants appreciate the program.

Non-attenders and attenders all appreciated the program. Attenders wanted the program to be sustained. They described being empowered to continue regardless of the program itself continuing, which may relate to their connection with the group.

“The most I just do a bit of walking to the market that’s all. So after, this program started, I make more regular trips to the park (FGD3, P5).”

The exercise sessions were valued by attenders.

Telephone follow-up was valued by all.

The exercise sessions were valued by attenders.

The phone counselling was described as a motivator by attenders and non-attenders.

Program re-design could consider that non-attenders found follow-up a motivator for unstructured activity.

The park prescription was referred to initially.

It was referred to initially, but they felt they knew it and did not need to refer back to it.

One participant suggested the prescription could be repeated.

The planning sheet was used more as a recording tool, mostly by attenders.

This was consistent across attenders and non-attenders.

A common explanation is that the activities they engage in don’t vary much.

Some suggestions were provided for condensing it.

Future programs may need to encourage completing it.

Less paper, more interaction

All groups commented positively about reminders including telephone follow-up.

WhatsApp messages from people in their exercise classes were spontaneous.

Situational and dispositional justifications for not attending the exercise classes: No time! Family and work come first.

Non-attenders provided most of these justifications. Family time and work commitments were common justifications. Some discussion was situational (e.g. clashes with work), some was dispositional (e.g. choosing to prioritise time for family and domestic work).

An example of a barrier to participation only mentioned by the attenders was a lack of motivation.

Preference for unstructured activity in their own time.

Another time-related justification discussed only by non-attenders was a preference for unstructured activities that they could do in their own time.

“For me, after work I walk to MRT .. my office is on the 6th floor; I will walk up every morning.” (FGD3P1)

External: Socialisation and the group dynamic.

There was a large volume of discussion about this as a motivator for attendance by attenders. There was an obvious bond amongst the participants, who shared how exercising is fun because of the group.

“I’m not those really disciplined type. But I feel that I need more kakis, so that they’ll encourage...” (FGD3, P6) [Kaki’s is a colloquial term for ‘buddy’ or ‘one of us’].

External: Knowledge and skills of the instructor.

This was a strong theme amongst attenders. Passing on technical information, tailoring exercises to the individual and building rapport with attendees were mentioned.

“..he’ll tell us that this will help do this... In fact it’ll add to our additional knowledge, or our daily life.” (FGD3, P4).

External: Being monitored and reminded.

Contact via the telephone counsellor was highly valued. This was discussed by all groups.

“Like a wake up, woah you call, better buck [up].” (FGD3, P7)

Internal: Developing a routine to attend sessions.

Developing a routine meant people attended these sessions as part of their everyday lives.

“Don’t know leh; I’m like ‘time to [exercise], don’t go out, will feel very uncomfortable.” (FGD1, PX).

Internal: Perceived health susceptibility and perceived benefits to health.

Health as an internal motivator to program adherence was a strong theme across all groups, and this discussion often related to their age.

They also noted the perceived benefits of attending the sessions such as having more energy, better mood and improved physical functioning.

“For me it’s uhh, I’ve high cholesterol […] So got a bit of improvement lah.” (FGD2, P7).

“Ah, body system will be healthier, .. have more energy, and will be beneficial to mood as well.” (FGD1, P8)

Internal: Empowerment.

Being empowered, either by the program to do group exercise just by doing their own exercise, was implicit in comments across all groups.

“I just do a bit of walking to the market .. So after, this program .., I make ..regular trips to park (FGD3P5).”

Internal: Other individual factors.

A variety of factors were also mentioned as motivation for program participation, mostly in the context of attending the exercise sessions. Having personal responsibility for one’s health, for financial savings in terms of the cost of maintaining health were examples.

“In Singapore, you can die but you cannot fall sick. You won’t have the ability. You have to... rely on yourself” (FGD2, P4).