Process Evaluation of A Physical Activity Self-Management Program For Children: Spark

Abstract

SPARK is a controlled field study of a multi-component elementary school program to promote physical activity. One component is a weekly classroom-based self-management program, with the goal of increasing physical activity outside of school. The curriculum included goal setting, behavioral skills training, a reward system, and parent involvement. An evaluation of curriculum implementation and association between process and outcome was conducted using direct observation of lessons, subjective ratings by 24 teachers and 391 parents, and participation records of 549 students. Teachers viewed the self-management curriculum less positively than the physical education curriculum. Teachers were observed implementing an average of 65% of curriculum elements, which may have contributed to the limited effects of the self-management program. Student participation in the program, measured by points earned for doing out of school physical activity, was correlated significantly with changes in body mass index and multiple psychosocial variables among boys but not girls. Barriers to full program implementation were identified, and a remaining challenge is to improve self-management curriculum implementation by teachers.     

Physical activity levels in young adult Hispanics and Whites: Social cognitive theory determinants

The psychosocial determinants of health-impairing physical inactivity among Hispanic populations have not been well explored nor have systematic comparisons been made with White populations using Social Cognitive Theory (SCT) measures. Three exercise-relevant efficacy measures (task, scheduling, and response efficacy), three exercise-relevant expectancy measures (physical health, psychological health, and self-evaluative), and self reports of activity levels were obtained from 20-year-old male and female Hispanics (n?=?94) and Whites (n?=?94). Activity levels for the two groups were analyzed in separate regression analyses that included the six SCT measures and gender as predictors. The set of seven predictors accounted for 51% of the variance in self-reported activity levels in each analysis. For young adult Hispanics, task efficacy, response efficacy, mental-health expectancies, and self-evaluative expectancies predicted activity level. For young adult Whites, scheduling efficacy and self-evaluative expectancies predicted activity level. Gender was not a significant predictor of activity level for either group. A multivariate analysis of variance indicated that the only SCT predictor on which Hispanics and Whites significantly differed was mental-health expectancies. The results of this study indicate that the psychosocial determinants of exercise are qualitatively different for the two groups and that the determinants of physical activity levels for young adult Hispanics may not be as effective as those of young adult Whites in sustaining lifelong exercise habits. Thus the present study offers a promising strategy for detecting inactivity-related physical- and mental-health risks at an age when lifelong habits of physical activity are still being formed.     

Predicting short and long-term exercise intentions and behaviour in patients with coronary artery disease: A test of protection motivation theory

The purpose of this study was to examine the utility of protection motivation theory (PMT) in the prediction of exercise intentions and behaviour in the year following hospitalisation for coronary artery disease (CAD). Patients with documented CAD (n?=?787), recruited at hospital discharge, completed questionnaires measuring PMT's threat (i.e. perceived severity and vulnerability) and coping (i.e. self-efficacy, response efficacy) appraisal constructs at baseline, 2 and 6 months, and exercise behaviour at baseline, 6 and 12 months post-hospitalisation. Structural equation modelling showed that the PMT model of exercise at 6 months had a good fit with the empirical data. Self-efficacy, response efficacy, and perceived severity predicted exercise intentions, which, in turn predicted exercise behaviour. Overall, the PMT variables accounted for a moderate amount of variance in exercise intentions (23%) and behaviour (20%). In contrast, the PMT model was not reliable for predicting exercise behaviour at 12 months post-hospitalisation. The data provided support for PMT applied to short-term, but not long-term, exercise behaviour among patients with CAD. Health education should concentrate on providing positive coping messages to enhance patients’ confidence regarding exercise and their belief that exercise provides health benefits, as well as realistic information about disease severity.     

The lived experiences of people diagnosed with multiple sclerosis in relation to exercise

The purpose of this study was to examine the lived experiences of people diagnosed with Multiple Sclerosis (MS). Seven active exercisers with MS participated in semi-structured interviews regarding their exercise experiences since diagnosis. Data were analysed using Interpretative Phenomenological Analysis (IPA; Smith?&?Osborn, 2003 Smith, JA and Osborn, M. 2003. “Interpretive phenomenological analysis”. In Qualitative psychology: A practical guide to research methods, Edited by: Smith, JA. 51–80. London: Sage.  [Google Scholar]). Interpretive Phenomenological Analysis. The results and interpretations of narratives revealed a number of functional limitations due to the severity of MS symptoms, which were found to have a major effect on the ability of the participants to exercise. Furthermore, psychological problems and the heightened behavioural adjustments to the progressive disability led to re-appraisal of ability to exercise. Previous, relevant exercise experience made participants more determined to continue to be able to exercise after diagnosis. The wider exercise experience narratives were related to concerns about safety, dependability on others to overcome the challenges, and potential environmental hazards. The loss of spontaneous opportunities to exercise because of these actual and perceived barriers was key to this population. This research highlighted the need to rethink the health and social service arrangements in relation to exercise provision for individuals with MS.     

Self-determination and functional persuasion to encourage physical activity

This research advances a novel approach to promoting physical activity, based on the principle of functional matching in persuasion, and the self-concordance (SC) of people's motivations for physical activity. We propose that SC establishes a positive or negative orientation toward the challenge inherent in physical activity, and that the maximum yield of participation will be achieved by communications that appeal to each orientation. In two studies, we compared how messages emphasizing challenge versus available social support would influence recipients’ self-reported practices of physical activity and attitudes toward a physical activity setting. As hypothesized, these messages had differential effects for recipients whose pursuit of physical activity varied in SC, such that favorable outcomes were more reliably associated with challenge-oriented messages among respondents higher in SC versus support-oriented messages among respondents lower in SC. The findings suggest the merits of using self-regulatory, compared with object- or personality-based, constructs and measures to indicate psychological functions of ongoing health-related behaviors.     

Examining the role of parental self-regulation in family physical activity: A mixed-methods approach

Physical activity (PA) is essential for good health. However, parents risk becoming less active because of the demands of parenting. This has consequences for children as parents are role models. The present study used a mixed-methods approach to explore parental self-regulation associated with PA. Data were collected from 36 parents with preschool-aged children. They were interviewed about their PA and their family’s PA. Parents also completed PA and self-regulation questionnaires and wore an accelerometer for five days. Qualitative data were examined using an inductive approach to thematic analysis. It showed that parents felt that they had limited time for personal PA. Mothers’ self-regulation was driven by an ethic of care and subjective norms, whereas fathers’ self-regulation was driven by beliefs about the importance of autonomy. Nevertheless, both parents saw caring for their children as the main priority. Quantitative data were examined using multiple regression analyses. Results showed that different self-regulatory behaviours predicted the PA of mothers and fathers. Which predictors were significant depended on the type of activity and how it was measured. The findings warrant longitudinal research that would enable the effect of family dynamics on self-regulation associated with PA to be assessed.     

Physical activity and diabetes: An application of the theory of planned behaviour to explain physical activity for Type 1 and Type 2 diabetes in an adult population sample

Physical activity (PA) plays a key role in the management of Type 1 (T1D) and Type 2 diabetes (T2D) but there are few theory-based, effective programs to promote PA for individuals with diabetes. The purpose of this study was to investigate the utility of the Theory of Planned Behaviour (TPB) in understanding PA in an adult population with T1D or T2D. A total of 2311 individuals (691 T1D; 1614 T2D) completed self-report TPB constructs of attitude, subjective norms, perceived behavioural control (PBC), intention and PA at baseline and 1717 (524 T1D; 1123 T2D) completed the PA measure again at 6-month follow-up. Multi-group Structural Equation Modelling was conducted to: (1) test the fit of the TPB structure (2) determine the TPB structural invariance between the two types of diabetes and (3) to examine the explained variances in PA and compare the strength of associations of the TPB constructs in the two types of diabetes. The TPB constructs explained ≥40% of the variance in intentions for both diabetes groups. In cross-sectional models, the TPB accounted for 23 and 19% of the variance in PA for T1D and T2D, respectively. In prospective models, the TPB explained 13 and 8% of the variance in PA for T1D and T2D, respectively. When adjusting for past PA behaviour, the impact of PBC and intention on behaviour was reduced in both groups. The findings provide evidence for the utility of the TPB for the design of PA promotion interventions for adults with either T1D or T2D.     

Social cognitions measured in 4 to 6 year olds are predictive of objectively measured physical activity

Objective: This study tested whether social cognitions from the reasoned action approach (RAA) can be reliably measured in a sample of primary school children (aged 4–6 years) and whether these RAA measures are predictive of physical activity.

Design: Longitudinal observational study with repeated measures over six months.

Measures: RAA variables were measured using a novel choice paradigm between physically active and sedentary pastimes. Relative reinforcing value, covariates (sex, age, deprivation and BMI) and physical activity by accelerometry (primary outcome) were also measured.

Results: RAA cognitions could be measured with acceptable retest reliability and discriminant validity and social norms regarding parents and teachers (but not friends) were correlated with physical activity and change in physical activity when relative reinforcing value and other covariates were controlled for.

Conclusions: RAA cognitions can be reliably measured in primary school children aged 4–6 and RRA measures appear useful in understanding children’s activity choices and may potentially inform future interventions.     

The health benefits of writing about positive experiences: The role of broadened cognition

This study tested the potential to elicit a broadened attentional focus through writing about a positive life experience and to derive health benefits from such writing. Participants (n = 38) wrote for 20 min each day for 3 consecutive days about either a positive life experience or a control topic. Writing about positive experiences led to improved physical health (measured 4–6 weeks after writing) compared to control and higher levels of global cognitive focus after writing mediated this effect. Notably, while the positive writing condition was more broadened than control, positive affect was not responsible for this difference. Implications for disclosive writing and the broaden and build model are discussed.     

Effects of a physical exercise session on state body image: The influence of pre-experimental body dissatisfaction and concerns about weight and shape

The effects of a physical exercise session on state body image and mood were examined. In a cross-over design, participants were randomised to two groups starting either with physical exercise (PE; experimental condition) or with reading a newspaper (RN; control condition). Before and after PE and RN, participants (N = 65) rated their body dimensions using a digital photo distortion technique and indicated their attitudinal body image and mood. Participants’ judgements of their ‘felt’ body dimensions and attitudes toward their own body were affected differently by PE and RN, indicating that participants felt slightly slimmer and were more satisfied with their bodies after PE. Exercise-induced changes in body perception were greater, the higher the pre-experimental drive for thinness, body dissatisfaction and weight/shape concerns were. Especially in those participants with higher body image disturbances, physical exercise can have a reinforcing effect on immediate body image and mood improvement.