Relationships between self-determination theory and theory of planned behavior applied to physical activity and exercise behavior in chronic pain

Effects of physical health beliefs on college students' physical exercise behavior intention: mediating effects of exercise imagery

OBJECTIVE

This study explores the relationship between physical health beliefs and physical exercise behavior intention of college students and constructs a mediation model through the mediation role of exercise imagery.

METHODS

Using the stratified cluster sampling method, 1356 college students were measured in group psychology by using the Physical Health Beliefs Scale, Exercise Imagery Inventory, and Physical Exercise Behavior Intention Scale. The statistical software Mplus 8.1, SPSS 22.0 and SPSS PROCESS 3.3 were used for statistical processing. The common method deviation test was carried out by Harman single-factor control method. Finally, the bootstrap sampling test method and process plug-in were used to test the significance of intermediary effect.

RESULTS

(1) physical health beliefs have a significant predictive effect on physical exercise behavior intention (β = 0.32, p < 0.001); (2) exercise imagery (β = 0.13, p < 0.001) mediate the relationship between physical health beliefs and physical exercise behavior intention (physical health beliefs → exercise imagery → physical exercise behavior intention (95% Cl: 0.14, 0.32)).

CONCLUSION

physical health beliefs can directly improve the physical exercise behavior intention of college students, which can also affect college students' physical exercise behavior intention indirectly through exercise imagery. The findings suggest that exercise imagery are important variables that mediate the effect of the college students' physical health beliefs on their physical exercise behavior intention.

The Effectiveness of Combined Exercise and Self-Determination Theory Programmes on Chronic Low Back Pain: A Systematic Review and Metanalysis

Low back pain is a pervasive issue worldwide, having considerable prevalence and a significant impact on disability. As low back pain is a complicated condition with many potential contributors, the use of therapeutic exercise, combined with other techniques such as self-determination theory programmes, has the potential to improve several outcomes. The aim of this systematic review was to explore the effectiveness of combined exercise and self-determination theory programmes on chronic low back pain. This study was designed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A systematic search in three databases (PubMed/MEDLINE, Web of Science, and Scopus) was conducted from September to November 2023. After screening, a total of five random control trials with patients with chronic low back pain were included in this systematic review and meta-analysis. The results showed significant differences in disability (SMD = -0.98; 95% CI = -1.86, -0.09; p = 0.03) and in quality of life (SMD = 0.23; 95% CI = 0.02, 0.44; p = 0.03) in favour of the intervention group versus the control group.

Understanding Physical Activity Determinants in an HIV Self-Management Intervention: Qualitative Analysis Guided by the Theory of Planned Behavior

BACKGROUND

People living with HIV have long life expectancy and are experiencing more comorbid conditions, being at an increased risk for developing cardiovascular disease (CVD) and diabetes, further exacerbated due to the HIV or inflammatory process. One effective intervention shown to decrease mortality and improve health outcomes related to CVD and diabetes in people living with HIV is increased regular physical activity. However, people living with HIV often fall short of the daily recommended physical activity levels. While studies show that mobile health (mHealth) can potentially help improve people's daily activity levels and reduce mortality rates due to comorbid conditions, these studies do not specifically focus on people living with HIV. As such, it is essential to understand how mHealth interventions, such as wearables, can improve the physical activity of people living with HIV.

OBJECTIVE

This study aimed to understand participants' experiences wearing a fitness tracker and an app to improve their physical activity.

METHODS

In total, 6 focus groups were conducted with participants who completed the control arm of a 6-month randomized controlled trial (ClinicalTrials.gov NCT03205982). The control arm received daily walk step reminders to walk at least 5000 steps per day and focused on the overall wellness of the individual. The analysis of the qualitative focus groups used inductive content analysis using the theory of planned behavior as a framework to guide and organize the analysis.

RESULTS

In total, 41 people living with HIV participated in the focus groups. The majority (n=26, 63%) of participants reported their race as Black or African American, and 32% (n=13) of them identified their ethnicity as Hispanic or Latino. In total, 9 major themes were identified and organized following the theory of planned behavior constructs. Overall, 2 major themes (positive attitude toward tracking steps and tracking steps is motivating) related to attitudes toward the behavior, 2 major themes (social support or motivation from the fitness tracker and app and encouragement from family and friends) related to participant's subjective norms, 1 theme (you can adjust your daily habits with time) related to perceived behavioral control, 2 themes (reach their step goal and have a healthier lifestyle) related to participant's intention, and 2 themes (continuing to walk actively and regularly wearing the fitness tracker) related to participant's changed behavior. Participants highlighted how the mHealth interface with the avatar and daily step tracking motivated them to both begin and continue to engage in physical activity by adjusting their daily routines.

CONCLUSIONS

Findings from this study illustrate how features of mHealth apps may motivate people living with HIV to start and continue sustained engagement in physical activities. This sustained increase in physical activity is crucial for reducing the risk of comorbid conditions such as diabetes or CVD.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03205982; https://classic.clinicaltrials.gov/ct2/show/NCT03205982.

Investigating the Psychological, Social, Cultural, and Religious Predictors of COVID-19 Vaccine Uptake Intention in Digital Age: A Media Dependency Theory Perspective

Media exposure to health communication contents related to the COVID-19 pandemic alone is inadequate to measure the influence of media on individuals in adopting precautionary behaviors against COVID-19, such as vaccine uptake. Certain individuals may pay attention to and be influenced by communication content. However, literature has suggested other instrumental determinants in developing and adopting health precautionary measures, such as culture or religion, especially regarding vaccination. In times of crisis, such as the COVID-19 pandemic, it is valuable to examine the interrelationships among psychological, sociocultural, and informational factors. This can provide valuable insights for policymakers in developing effective communication strategies. Drawing an analogy between the Media dependency theory (MDT) and the Theory of Planned Behavior (TPB) model, this study unravels the factors underpinning the COVID-19 vaccine uptake intention among Pakistanis. The study utilized a cross-sectional research design and employed a survey method to gather data from a sample of 993 participants. The findings obtained from the PLS-SEM analysis confirmed that individuals relied on both traditional and social media to cope with the COVID-19 pandemic. The findings show that individuals rely more on the informational content disseminated through conventional media channels. The findings also suggest that individuals from Asian countries, such as Pakistan, tend to be more inclined toward collectivism. The findings about the moderating role of religiosity suggest that religious beliefs significantly shape individuals' reliance on traditional media. Hence, this study has uniquely contributed to public health and media management by providing a strategy for managers to address disseminating misinformation related to religion and its impact on vaccination-related health issues. The study has theoretically confirmed the principles of media dependency theory. As a result, it is recommended that various information sources be utilized to cultivate resilience among individuals to manage health crises effectively.

Exploring the relationship between planned behavior and self-determination theory on health-seeking behavior among older adults with hearing impairment

This study aimed to examine the relationship between planned behavior and self-determination theory in predicting health-seeking behavior among older adults with hearing impairment. A total of 103 participants aged 60 years and above completed a self-administered questionnaire that measured variables related to health-seeking intention, knowledge competence, relatedness, attitudes, stigma, and perceived competence and autonomy. The results of the study indicated that both the planned behavior and self-determination theory models significantly predicted health-seeking intention and behavior among older adults with hearing impairment. Higher knowledge competence, relatedness, positive attitudes, and perceived competence and autonomy were found to be significant predictors of health-seeking intention and behavior. The findings of this study suggest that interventions aimed at increasing knowledge competence, relatedness, positive attitudes, and perceived competence and autonomy may be effective in promoting hearing health-seeking behavior among older adults with hearing impairment. Future research may further explore the role of these variables in predicting health-seeking behavior and the effectiveness of interventions in promoting hearing health in this population. Clinical practitioners and healthcare professionals may benefit from these findings in designing targeted interventions for this population.

Which outcome variables are associated with psychological inflexibility/flexibility for chronic pain patients? A three level meta-analysis

The psychological flexibility model can be seen as a basis for an integrated and progressive psychological approach to chronic pain management. Some researchers suggest that psychological flexibility and inflexibility represent distinct processes and constructs. This meta-analysis is the first to provide a summary estimate of the overall effect size for the relationship between psychological (in)flexibility and common outcomes among chronic pain patients. The research protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO, https://www.crd.york.ac.uk/PROSPERO/), registration number CRD42021285705. Four databases were searched (PsycINFO; PubMed; Web of Science, CINAHL) along with reference lists. Thirty-six cross-sectional studies were included (7,779 participants). Meta-analyses (random effects model) indicated a significant medium negative association between psychological flexibility and pain intensity or functional impairment. The present study also indicated a significant small to medium association between psychological inflexibility and pain intensity, a nearly large association between psychological inflexibility and functional impairment as well as the quality of life, and a large association between psychological inflexibility and anxiety/depression. Due to the limited number of included studies, the relationship between risk behavior and psychological inflexibility may not be significant. Types of countries and instruments measuring psychological inflexibility may explain part of the heterogeneity. These findings may carry significant implications for chronic pain patients regarding the potential relationship between psychological inflexibility or flexibility and these outcomes. It may consequently form the basis for more robust testing of causal and manipulable relationships.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021285705.

Predicting physical activity among adults with visual impairments using the theory of planned behavior

BACKGROUND

Using the theory of planned behavior (TPB), Haegele et al.1 created the beliefs of individuals with visual impairments about physical activity scale (BIVIPA-1) to examine individuals with visual impairments' (VI) motivation toward physical activity (PA). The overall factorial tenability of the BIVIPA-1 remains unclear due to its item configuration.

OBJECTIVE/HYPOTHESIS

The purposes of this cross-sectional study were to: (a) use confirmatory factor analysis to explore the structure of the expanded BIVIPA-2 and (b) test the predictive utility of TPB constructs on PA among adults with VI.

METHODS

Adults with VI (n = 236) completed the BIVIPA-2 and a multi-item PA recall instrument. A CFA was performed on the BIVIPA-2, and structural equation modeling was used to explore the relationship between theory constructs and PA.

RESULTS

The CFA results showed that the underlying structure of BIVIPA-2 was tenable for adults with VI based on TPB. Structural equation modeling showed limited support for the theorized predictive roles of theory variables on PA, as attitude predicted physical activity intention. Interestingly, subjective norm was a direct predictor for PA among adults with VI (β = 0.145).

CONCLUSIONS

TPB had limited predictive utility for physical activity among individuals with VI. The predictive relationship of subjective norms on PA may be somewhat unique to this population. Researchers may consider expanding the model to examine social support and subjective norms constructs and PA among individuals with VI.

Understanding Physical Activity and Exercise Behavior in China University Students: An Application of Theories of the Flow and Planned Behavior

Objectives

The purpose of this study was to examine a extended model of the theory of planned behavior (TPB) model by adding the variables of the flow theory and to investigate Chinese university students' exercise behavior and its influence factors.

Methods

The hypothesized model was validated through testing three competing models using a sample collected from 248 Chinese university students involving 165 males and 83 females.

Results

The three competitive models fitted well and predicted exercise behavior significantly. Among them, the enjoyment + TPB model is the optimal model.

Conclusions

Enjoyment and concentration can all predicting exercise behavior directly or indirectly. Enjoyment is stronger than concentration in predicting TPB constructs and exercise behavior, and it is a more important predictor than concentration in the field of exercise behavior research. Values. Research provides insights to better understand the exercise behavior of Chinese university students as well as useful information for designing exercise interventions and developing university students' education and training.

Stroke survivors' perceptions of the factors that influence engagement in activity outside dedicated therapy sessions in a rehabilitation unit: A qualitative study

OBJECTIVE

To investigate stroke survivors' perceptions of factors influencing their engagement in activity outside of dedicated therapy sessions during inpatient rehabilitation.

DESIGN

Qualitative study.

SETTING

Four metropolitan rehabilitation units in Australia.

PARTICIPANTS

People undertaking inpatient rehabilitation after stroke.

METHODS

Semi-structured interviews conducted in person by a speech pathologist A stepped iterative process of inductive analysis was employed until data saturation was achieved with themes then applied against the three domains of the Theory of Planned Behaviour (perceived behavioural control, social norms and attitude).

RESULTS

Interviews of 33 stroke survivors (60% female, median age of 73 years) revealed five themes (i) uncertainty about how to navigate and what was available for use in the rehabilitation unit restricts activity and (ii) post-stroke mobility, fatigue and pre- and post-stroke communication impairments restrict activity (perceived behavioural control); (iii) unit set up, rules (perceived and actual) and staff expectations influence activity and (iv) visiting family and friends are strong facilitators of activity (social norms), and (v) personal preferences and mood influence level of activity (attitude).

CONCLUSION

At the individual level, stroke survivors perceived that their ability to be active outside of dedicated therapy sessions was influenced by their impairments, including mood, and their attitude towards and preference for activity. At the ward level, stroke survivors perceived that their ability to be active was influenced by ward set-up, rules and staff expectations. Visitors were perceived to be important facilitators of activity outside of therapy sessions.

Predictors of Health Promotion Behaviors Among Working Adults at Risk for Metabolic Syndrome

BACKGROUND

Metabolic syndrome has a high global prevalence, affecting 26% of South Koreans. Lifestyle modifications have shown benefits in studies involving health behavior enhancement, specifically through workplace eating and exercise interventions. However, workplace interventions focusing on health behaviors have been inadequately explored.

OBJECTIVES

This study examined factors affecting health promotion behaviors of workers at high risk of metabolic syndrome by applying Theory of Planned Behavior constructs (attitude, subjective norm, perceived behavioral control, and intention).

METHODS

This correlational cross-sectional study collected survey data from 164 hotel workers in South Korea. The study applied factor analysis and structural equation modeling for the data analysis.

RESULTS

Analysis revealed five health promotion behaviors: exercise, making healthy food choices, avoiding fatty foods, eating a nutritious and balanced diet, and eating regular moderate meals. Participants were grouped as total participants, those with one risk factor and those with two risk factors. In the total group, four behaviors were influenced by perceived behavioral control: exercise, making healthy food choices, eating a nutritious and balanced diet, and eating regular moderate meals. In the one risk factor group, intention and attitude influenced the eating regular moderate meals behavior, and two other behaviors were influenced by perceived behavioral control: exercise and eating a nutritious and balanced diet; in the two risk factors group, only perceived behavioral control directly affected exercise.

DISCUSSION

Perceived behavioral control was a key predictor of health behaviors, and theory constructs partially explained behaviors. Perceived behavioral control influenced four behaviors and influenced exercise in all three groups. Also, theory constructs showed a greater effect on behaviors in the one risk factor group than in the two risk factor group, indicating that participants with one risk factor more effectively managed their behaviors on their own and with health care providers' support. Occupational health providers should conduct early assessments of workers showing metabolic syndrome risk factors to identify their particular risks, intention, and behaviors. As the number of risk factors affects behaviors and perceived behavioral control primarily influences exercise, these findings should be incorporated in metabolic syndrome interventions.

Associations Between Six Core Processes of Psychological Flexibility and Functioning for Chronic Pain Patients: A Three-Level Meta-Analysis

The previous research showed contradictions in the relationships between psychological flexibility processes and functioning. This meta-analysis is the first to provide a comprehensive meta-analysis of the associations between six core processes of psychological flexibility and functioning among chronic pain patients. Four databases were searched (PsycINFO; PubMed; CINAHL; Web of Science) along with reference lists. Thirty-six cross-sectional studies were included (7,812 chronic pain patients). A three-level meta-analytic model was used to examine the associations. The publication bias was assessed with the Egger test, funnel plot, and p-curve analysis. Significant associations were found between functioning and six processes of psychological flexibility (i.e., acceptance, defusion, present moment, committed action, self as context, and values). Except for the relationship between defusion and functioning, the relationships between the other five psychological flexibility processes and functioning were all moderated by domains of functioning. No moderators were found regarding age, percentage of females, country, or type of instrument used to measure functioning. These findings may carry significant implications for chronic pain patients and clinical workers. It might be more effective to focus on functioning-related psychological flexibility processes rather than all therapy packages if the relationships between functioning and specific processes of psychological flexibility were better informed. Limitations were also discussed.

Role of motivation in the return of blood donors: mediating roles of the socio-cognitive variables of the theory of planned behavior

The starting point of this study is based on a ground observation in Tunisia: The unsustainable blood donations and the shortage of clinical blood in some periods of the year (i.e. holidays; covid-19). This observation is also avowed in over the world. The present study extends the theory of planned behavior (TPB) by incorporating relevant variables from Self-determination Theory (SDT). The latter suggests that individuals persist with a behavior when they are internally motivated than externally motivated. Online survey was administrated to assess TPB constructs (attitudes, social norms, perceived behavioral control (PBC), personal moral) and two of SDT factors (autonomous and controlled). 321 donors responded to the questionnaire. Results revealed that effects of autonomous and controlled motivation on behavioral intention were mediated by attitude, PBC as well as moral norms. This paper proposes practical recommendations to social marketing designers to better retain blood donors.

An Analysis and Evaluation of the Theory of Planned Behavior Using Fawcett and DeSanto-Madeya's Framework

The theory of planned behavior has been prominently applied in nursing, but no known critique of the theory has been published. Using Fawcett and Desanto-Madeya's framework, we scrutinized and assessed the theory to determine its appropriateness for nursing investigations of behavior. The theory makes explicit assertions regarding human social behavior, incorporating some nursing metaparadigm concepts. Although not derived from the discipline, the theory's scope, content, and context are relevant to nursing, and its significance to nursing research and practice is clear. Studies incorporating all the theory's concepts and relationships are needed to confirm its testability and empirical and pragmatic adequacy.

Motivation and Intention Toward Physical Activity During the COVID-19 Pandemic: Perspectives From Integrated Model of Self-Determination and Planned Behavior Theories

Background: In attempts to hinder the spread of the Coronavirus disease 2019 (COVID-19), many countries have continued distancing, isolation, and quarantine measures, which has led to limited opportunity of physical activity. This study provides empirical support for a motivational process behind physical activity during the COVID-19 pandemic by testing the influence of psychosocial variables derived from the integrated model of self-determination theory (SDT) and the theory of planned behavior (TPB). Methods: A cross-sectional survey was conducted among Korean adults (N = 248). Participants completed the measures of SDT and TPB constructs modified to reflect their participation in physical activity during the COVID-19 pandemic. A sample size of 243 participants was employed, and the integrated model was tested using serial multiple mediation analysis to check the hypothesized relationships. Results: Findings indicated that in the COVID-19 context, the satisfaction of basic psychological needs positively predicts the level of self-determined motivations for physical activity, which is partially related to the level of social cognitive beliefs and intentions. The findings also demonstrated that attitude toward physical activity during COVID-19 was a major variable explaining the serial multiple relationships between the SDT and TPB constructs. The potential influence of demographics (gender, age, marital status, and past physical activity) was controlled as a covariate, and no significant effects were identified. Conclusion: The current study identified the psychosocial mechanisms of intention of South Koreans' physical activity during the COVID-19 pandemic, which could be used as an empirical basis for the development of interventions to maintain or strengthen physical activity in unprecedented situations.

Chronic non-cancer pain in adolescents: a narrative review

Introduction

Chronic pain is defined as a pain lasting more than 3–6 months. It is estimated that 25% of the pediatric population may experience some kind of pain in this context. Adolescence, corresponding to a particular period of development, seems to present the ideal territory for the appearance of maladaptive mechanisms that can trigger episodes of persistent or recurrent pain.

Methods

A narrative review, in the PubMed/Medline database, in order to synthetize the available evidence in the approach to chronic pain in adolescents, highlighting its etiology, pathophysiology, diagnosis, and treatment.

Results

Pain is seen as a result from the interaction of biological, psychological, individual, social, and environmental factors. Headache, abdominal pain, and musculoskeletal pain are frequent causes of chronic pain in adolescents. Pain not only has implications on adolescents, but also on family, society, and how they interact. It has implications on daily activities, physical capacity, school performance, and sleep, and is associated with psychiatric comorbidities, such as anxiety and depression. The therapeutic approach of pain must be multimodal and multidisciplinary, involving adolescents, their families, and environment, using pharmacological and non-pharmacological strategies.

Discussion and conclusion

The acknowledgment, prevention, diagnosis, and treatment of chronic pain in adolescent patients seem not to be ideal. The development of evidence-based forms of treatment, and the training of health professionals at all levels of care are essential for the diagnosis, treatment, and early referral of these patients.

Pain, Goal Engagement, and Eudaemonic Well-Being: Moderation by Autonomous Motivation

OBJECTIVES

Pain may decrease well-being in older adults by limiting social and leisure activities. However, some activities can exacerbate pain. We hypothesized that autonomously motivated goal engagement could ameliorate negative effects of pain on goal engagement and amplify positive effects of goal engagement on eudaemonic well-being (EWB).

METHOD

Midlife and older women (N=200) were oversampled for chronic pain. Daily diaries (n=10,697) including goal lists and ratings, pain, and EWB were completed for 7 days every 3 months for 2 years.

RESULTS

Pain was not a correlate of goal engagement. More engagement was associated with higher EWB when motivation was autonomous. However, more goal engagement correlated with lower EWB the next day and, when not autonomously motivated, higher pain.

DISCUSSION

Goal engagement can benefit people with or without physical pain, but the motivation behind goal engagement is equally if not more important. Goals motivated by autonomous sources increase EWB and may protect against maladaptive patterns of activity associated with pain.

Using a Narrative Practice Approach to Understand In-Depth Experiences of Individuals Coping with Chronic Pain

OBJECTIVE

Current psychological interventions to enhance management of chronic pain report small to moderate effects. There is a need to explore the experiences and coping of individuals with chronic pain in depth and expand beyond current knowledge paradigms to enhance psychological interventions. The current literature recommends narrative practice as a qualitative approach in a group to facilitate sharing of knowledge on coping with chronic pain. Therefore, we conducted group sessions incorporating narrative practice to explore the experiences of individuals coping with chronic pain.

DESIGN

We explored the experiences of 11 individuals coping with chronic pain from two group sessions that incorporated narrative practice. Themes emerging from participants' sharing were triangulated from interview transcripts, field notes, and participants' response worksheets. Data analysis adopted thematic analysis and narrative practice approaches.

RESULTS

Themes on coping found include "refocusing," "distraction," "inspiration and perspective taking," and "acknowledgement of skills, knowledge, and attitude." "Distraction" and "refocusing" complimented one another. This provided a new perspective, in contrast to current research that views both as mutually exclusive. Social environmental factors were found to help participants share existing coping methods of "connection," "deepen perspective," "inspiration and perspective taking," and "acknowledgement of skill, knowledge and attitude." The possible relationships between the themes also provided support to the theoretical foundations of Acceptance and Commitment Therapy. Results suggest that adopting a narrative practice sequence helped individuals to acknowledge chronic pain experiences and facilitated their identification of ways to cope.

CONCLUSIONS

Narrative practice identified themes of coping that can inform clinical practice. Narrative practice is indicated as a feasible and acceptable research and clinical approach for individuals with chronic pain.

Combining the Integrated-Change Model with Self-Determination Theory: Application in Physical Activity

Background: Critically testing and integrating theoretical models can aid health promotion research and intervention planning. This study aimed to critically compare and integrate Self-Determination Theory (SDT) and Integrated-Change Model (ICM) for explaining physical activity behaviour. Methods: A dataset was used with Dutch adults, consisting of information on demographics and socio–cognitive and behavioural determinants. There were three measurements over a period of six months, with the baseline sample consisting of 1867 participants. Confirmatory factor analysis was conducted to assess the reliability of the items and their corresponding scales. To examine cognitive pathways, we applied Structural Equation Modelling (SEM). Results: For SDT, none of the pathways were significant but the model fit was decent (R² = 0.20; RMSEA = 0.07; CFI = 0.91). For ICM, the model fit was similar (R² = 0.19; RMSEA = 0.07; CFI = 0.73), with many significant pathways, as stipulated by the theory. The integration of STD and ICM constructs revealed similar explained behavioural variance (R² = 21%), with no significantly different model fit. Conclusion: The integration of SDT and ICM added no value as a prediction model. However, the integrated model explains the underlying mechanism of STD constructs, as well as the determinants of attitude, social influences, and self-efficacy. In the context of intervention design, ICM or the integrated model seem most useful as it reveals the stages and pathways to behaviour change.

An Investigation of Occupational Therapists' and Physical Therapists' Perspectives on the Process of Change That Occurs among Clients during Rehabilitation, Including Their Use of Response Shift and Transformative Learning

Purpose: A significant change in one's health status creates a process of change that has an impact on one's health-related quality of life. This process has been conceptualized in several theories, including response shift (RS) and transformative learning (TL). The purpose of this study was to investigate occupational therapists' and physical therapists' perspectives on the process of change that occurs in clients during rehabilitation. Method: An interpretive description approach guided this study. Five profession-specific focus groups were conducted. Participants were asked about their ideas, thoughts, and understanding of processes of change. Focus group discussions were recorded and transcribed. Data analysis was carried out using both inductive and deductive methods. Results: Participants were 14 physiotherapists and nine occupational therapists with 5-30 years of experience in rehabilitation settings. Participants recognized personal change in clients and noted that it involves many steps. They tried to facilitate this change by identifying signs of readiness. Without using theory-specific terminology, participants described observing and using concepts of RS and TL. Conclusions: Occupational therapists and physiotherapists play an important role in helping people learn to live with their chronic illnesses and disabilities. Further studies are needed to investigate how therapists can facilitate the process of change, including using RS and TL concepts and how this facilitation could improve clients' health-related quality of life.

Enhancing Motivation for Change in the Management of Chronic Painful Conditions: a Review of Recent Literature

PURPOSE OF REVIEW

The purpose of this review is to evaluate and summarize recent empirical research investigating motivational factors for management of chronic pain and headache disorders.

RECENT FINDINGS

Research on motivation for non-pharmacological treatment of chronic pain and headache disorders has identified factors that influence initiation of and adherence to treatment. To address common factors that inhibit initiation of treatment (i.e., cost, time commitment), several electronic treatments have been developed. Self-efficacy is the most commonly studied psychosocial influence on treatment adherence, with evidence that it is positively correlated with adherence. Other studies have sought to improve adherence to treatment using motivational interviewing interventions. There is currently limited research on how to enhance motivation for initial adherence to non-pharmacological treatment for chronic pain and headache disorders. Instead of enhancing motivation, researchers have looked to reduce barriers to treatment with electronic health treatments; however, many of these studies have focused on intervention feasibility, rather than efficacy or effectiveness. Numerous studies have identified a relationship between self-efficacy and treatment adherence. Although motivational interviewing interventions have been shown to improve adherence to treatment, there is little evidence that they improve treatment outcomes. Recommendations for further investigation include improving interventions to enhance accessibility and adherence to treatment with the goal of improving outcomes, as well as identifying ways to improve treatment initiation and adherence in patients who are currently engaged in long-term opioid therapy.

The use of psychological methodologies in cardiovascular disease interventions promoting a Mediterranean style diet: A systematic review

AIMS

To evaluate theory-based psychological approaches that have been effective in promoting behavior change in interventions promoting a Mediterranean style diet (MD) for the reduction of cardiovascular disease (CVD) risk.

DATA SYNTHESIS

A systematic review of primary research articles using PRISMA recommendations was conducted. References were retrieved using keyword searches from MEDLINE via PUBMED and included studies targeted participants at high risk for CVD. Two hundred and ninety one studies were reviewed; however, only six met the inclusionary criteria. Three articles describe the same intervention; therefore, only four were included. Included studies incorporated social cognitive theory, social learning theory, goal-system theory, social ecological theory, selfdetermination theory, and the transtheoretical model of behavior change. Overall, studies were nutrition interventions in clinical settings with participants at high risk for or with CVD.

CONCLUSIONS

Results from use of the social cognitive theory and self-determination theory in increasing MD adherence for the reduction of CVD risk and events are encouraging. However, we encourage future long-term interventions focusing on dietary behavior change to provide not only an in-depth description of the psychological methodologies used but also how these methodologies were implemented in order ascertain the most effective theory for promoting dietary behavior change towards patterns of a MD.

Understanding physical activity behavior of Chinese female college students with/without vulnerable conditions: a theory of planned behavior perspective

Guided by the theory of planned behavior (TPB), this study examined the relationships between three constructs of TPB (attitude, subjective norm, perceived behavioral control [PBC]) and physical activity intention and behavior among Chinese female college students, and evaluated whether the relationships differed between healthy and vulnerable individuals within this population. Participants included 436 female college students (301 healthy and 135 vulnerable; Mean age = 19.24 years; SD = 0.97 years) recruited from five universities in China, and the data collection was completed in Fall 2015. Path analysis supported the direct and indirect relations of TPB constructs to physical activity intention and behavior among female college students, and the path model was invariant across the two groups. The vulnerable group reported significantly lower attitude, subjective norm, intention, and physical activity behavior than the healthy group but not for PBC. These findings suggest fostering positive attitudes and intention toward physical activity are important among Chinese female college students, regardless of their health status.

Drive for muscularity behaviors in male bodybuilders: a trans-contextual model of motivation

BACKGROUND

The drive for muscularity behaviors are very common in male athletes, especially in male bodybuilders. Studies have related drive for muscularity behaviors to body dissatisfaction, eating disorders and muscle dysmorphia.

METHODS

This study applied the trans-contextual model of motivation to the drive for muscularity behaviors of male bodybuilders at risk of developing muscle dysmorphia. The relationships between self-determination theory constructs and drive for muscularity behaviors, via the theory of planned behavior variables (i.e., attitude, subjective norm, perceived behavioral control, and intention) were examined. A total of 175 Swiss male bodybuilders (M _age = 27.34; SD _age = 7.53) completed measures on motivation for sport, theory of planned behavior variables, and drive for muscularity behaviors. They practiced bodybuilding from three to 24 h per week (Mhours per week = 6.59; SDhours per week = 3.45) and had done so for 7.19 years on average (SDnumber of years = 6.91). Using bootstrapped maximum likelihood estimation with the AMOS 7.0 program, a series of confirmatory factor analyses was performed on each subscale and a series of path analyses was performed to determine the final model.

RESULTS

The fit indices of the final model were satisfactory: χ² (11) = 13.81; p = .244; TLI = .98; CFI = .99; RMSEA = .04. The model explained 29% of the variance of drive for muscularity behaviors. The final path analysis supported the motivational sequence, with autonomous motivation for sport showing a positive, significant and indirect association with the drive for muscularity behaviors via perceived behavioral control and intention to gain muscle mass, and controlled motivation for sport showing a positive association with the drive for muscularity behaviors both directly and via attitude and intention to gain muscle mass.

CONCLUSIONS

It was concluded that the trans-contextual model of motivation applies only partially to the drive for muscularity behaviors in male bodybuilders.

PERSPECTIVE

The motivational mechanisms explaining the development of drive for muscularity behaviors might be better understood through complementary analyses of motivational profiles. Such investigations would guide the design of programs to lower the risks associated with these behaviors.

The value of measurement for development of nursing knowledge: Underlying philosophy, contributions and critiques

AIM

A philosophical discussion of constructive realism and measurement in the development of nursing knowledge is presented.

BACKGROUND

Through Carper's four patterns of knowing, nurses come to know a person holistically. However, measurement as a source for nursing knowledge has been criticized for underlying positivism and reductionist approach to exploring reality. Which seems mal-alignment with person-centred care.

DESIGN

Discussion paper.

DISCUSSION

Constructive realism bridges positivism and constructivism, facilitating the measurement of physical and psychological phenomena. Reduction of complex phenomena and theoretical constructs into measurable properties is essential to building nursing's empiric knowledge and facilitates (rather than inhibits) person-knowing.

IMPLICATIONS FOR NURSING

Nurses should consider constructive realism as a philosophy to underpin their practice. This philosophy supports measurement as a primary method of inquiry in nursing research and clinical practice. Nurses can carefully select, and purposefully integrate, measurement tools with other methods of inquiry (such as qualitative research methods) to demonstrate the usefulness of nursing interventions and highlight nursing as a science.

Grado de predicción de la motivación hacia las actividades físicodeportivas a través de la orientación de metas, la percepción del éxito y el grado de satisfacción. Un análisis transcultural

El objetivo de este estudio fue conocer en qué medida se puede predecir el tipo de motivación hacia la práctica de Actividad Físico-deportiva en función de la orientación de metas, la percepción del éxito y el grado de satisfacción en un análisis transcultural a lo largo de tres países latinos: España, México y Costa Rica. 2168 escolares (Edad 11-16 años) fueron evaluados con 4 instrumentos: Sport Motivation Scale (SMS), Task and Ego Orientation Sport Questionnaire (TEOSQ), Satisfaction Instrument (SSI) y Beliefs About the Causes of Sport Success Questionnaire (BACS). Los resultados mostraron que valores altos de orientación a la tarea, diversión y esfuerzo pueden predecir significativamente la manifestación de motivación intrínseca en los sujetos de los tres países.

Health Promotion for People with Disabilities: A Primer for Rehabilitation Counsellors

To engage in the community and the workplace requires physical, mental, and social health and wellbeing. Health promotion is a crucial rehabilitation counselling function for the health and wellbeing of people living with chronic illness and disability (CID). This exploratory review seeks to examine theories and models of motivation applicable to health promotion interventions in rehabilitation counselling practice. Although no single theory can address all the potential variables affecting people with CID's health behaviours, Bandura's (1977) concept of self-efficacy and outcome expectancy appear to be the most common factors in the health promotion models we surveyed. Among theories of motivation, only self-determination theory specifically includes a motivation variable, autonomy (internal and external motivation). We developed a diagram to depict a model, including all the theories and models covered in this exploratory review and identify commonalities among their constructs. This diagram can be used by rehabilitation counsellors to apply theories and models of motivation in case conceptualisation, formulating clinical hypotheses, developing treatment plans, and selecting and implementing evidence-based health promotion interventions for their clients.

Physical Activity, Functional Ability, and Obesity in Older Adults: A Gender Difference

Disability, institutionalization, and loss of independence may be directly caused or exacerbated by physical inactivity and obesity. The purpose of the current cross-sectional survey was to explore the impact of gender and obesity on functional ability tasks, physical activity, and psychosocial factors in older adults. Participants comprised 964 University retirees (55% female, mean age = 75.3 years, SD = 6.7 years) with a mean body mass index (BMI) of 26.1 kg/m² (SD = 4.7 kg/m²). Results revealed significant gender and BMI interaction effects. Women were less active than men and obese women were most functionally impaired, particularly in activities that target lower extremity function, regardless of weight status. These findings suggest that physical activity interventions for older adults should focus on exercises that improve functional ability and are tailored to meet individual needs while considering weight and gender. Type, intensity, frequency, and duration of exercises should be individualized to limit injuries and improve functional ability and physical activity adherence. [Journal of Gerontological Nursing, 43(9), 38-46.].