Determinants of physical activity among homeless people in Durban, South Africa

Abstract

Homelessness poses significant public health challenges, with people experiencing homelessness (PEH) facing heightened risks due to economic hardship, limited housing, and social instability. Despite that physical activity (PA) is a key determinant of health, little is known about PA behaviours among PEH in low-resource urban settings. This mixed-methods study examined PA and its determinants among 165 PEH at Bellhaven Harm Reduction Centre (BHRC) in Durban, South Africa. Data from PEH were complemented by interviews with all three fulltime staff members at BHRC. Quantitative data were examined using descriptive and inferential techniques, whereas qualitative data underwent thematic analysis. Most participants were male (78.7%), and although 79.4% rated their physical and 92.1%, mental health as good, 76.4% reported poor nutrition. Walking was the most common PA among PEH, but 31.5% reported no activity. Key barriers included lack of routine, limited resources, poor nutrition, excessive substance use and mental health challenges. Age was significantly associated with PA, particularly in relation to mental health, while gender and education showed no significant relationship. Effective interventions should adopt holistic, context-sensitive approaches that integrate harm reduction, peer support, stable routines, accessible facilities, nutritional support, and age-sensitive mental health services to enhance participation and wellbeing. The findings highlight key structural and psychosocial barriers to PA among PEH and provide evidence to inform health interventions for marginalised populations in low-resource urban settings.