Barriers and facilitators to structured, out-of-school physical activity participation among rural youth in the United States: a systematic review

Barriers to physical activity (PA) participation affect United States (US) youth’s ability to meet PA guidelines. There is evidence showing lower PA among rural versus urban youth due to fewer PA opportunities and resources. Out-of-school programs can help reduce geographic disparities in PA, but there is a dearth of literature on participation factors among rural youth. This study aimed to identify, describe, and synthesize peer-review literature on barriers and facilitators to participation in structured, out-of-school PA at multiple ecological levels for rural-dwelling, US youth. A systematic review was conducted November 2024 using Medline, PubMed, SPORTDISC, Web of Science, APA Psychinfo, and CINAHL for articles published 2000–2024. Articles needed to be (1) peer-reviewed; (2) English-language; (3) conducted among US rural populations; (4) examining barriers and/or facilitators to out-of-school, structured PA; and (5) conducted among youth ages 6–17. Articles focusing on participants with additional needs were excluded. A search of 3,070 articles was refined to a final sample of 39 articles. Participant factors were identified at multiple ecological levels, including environmental and program (programs and facilities, transportation and accessibility, resources and infrastructure, safety, cost/fees); social (family support and role models, peer support, lack of social support); and individual (interest, motivation, and enjoyment; skill development; time constraints and prioritization) levels. Rural youth participation in structured, out-of-school PA is informed by multi-level factors, including facilities and programs, transportation, resources and infrastructure, social support, and interest/motivation. Additional research is needed to examine participation factors among this population. Findings can be used to design and adapt out-of-school programs that meet the unique needs of youth in rural settings.