Associations Between Health-Related Quality of Life, Self-Reported and Accelerometer-Measured Physical Activity, and Socioeconomic Status among Schoolchildren in Gqeberha

Background: Health-related quality of life (HRQoL) and physical activity (PA) are critical factors for overall well-being, with PA positively impacting HRQoL. However, socioeconomic challenges in South Africa pose barriers to PA participation for underprivileged children, affecting their HRQoL. When studying relations between HRQoL, PA and socioeconomic status (SES), self-reports and accelerometers each present methodological implications by reflecting different facets of PA. Understanding these relationships using both measures of PA could improve guiding interventions and policies.
Methods: Cross-sectional data of 572 children (8 – 13 years) from underprivileged neighborhoods in Gqeberha, South Africa, was analyzed. ANCOVAs and spearman rank correlations were performed to examine relationships between PA and HRQoL. To explore relations for PA and HRQoL across SES, either Kruskal-Wallis-Tests or ANOVAs, and spearman rank correlations were performed.
Results: Self-reported PA predicted HRQoL (p=0.023), while accelerometer-measured PA did not (p=0.325). Stratified by sex, correlations between self-reported PA and HRQoL remained in girls only (p=0.015). Self-reported PA differed between groups of SES (p<0.001), while sex-specific group differences remained in boys (p<0.001). WHO PA guidlines were met by 82% of boys and only 45.5% of girls. No associations were found between HRQol and SES.
Conclusion: Findings demonstrate that self-reported PA is positively associated with HRQoL and provides valuable information when used in combination with accelerometer-measured PA. The fact that girls`PA levels are low and remain unchanged across SES highlights the need for more PA opportunities and enhancing social correlates for girls to engage in PA. Structural adjustments are needed to provide equitable access to PA across SES in South Africa.