Development and validation of a social cognitive theory-based instrument to predict physical activity among people with spinal cord injury

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University of Alabama Libraries

Background: There are over 200,000 people with spinal cord injury in the U.S. alone and each year another 15,000 to 20,000 incidents occur. Massive trauma to the spine can result in a SCI leaving behind devastation to the body including paralyzed muscle and loss of sensation. People with SCI are more susceptible to sedentary lifestyles because of the displacement of physical functioning caused by the spinal cord injury and the overwhelming majority are physically inactive. Benefits of physical activity for people with SCI include physical fitness, functional capacity, social integration and psychological well-being. Theoretical constructs have been operationalized to measure social cognitions towards physical activity for this population; however a valid and reliable instrument is lacking. Purpose: Therefore, the purpose of this study was to develop and validate a social cognitive theory-based instrument to predict physical activity among people with SCI. Methods: An instrument was drafted utilizing previous items from the literature. To examine content validity of the instrument, an expert panel of six people reviewed it, and the instrument was modified based on feedback. Cognitive interviewing with five people with SCI was conducted to assess readability, comprehensibility, and time. The final 64-item version of the instrument was used to collect data from participants via an online survey in order to test the validity and reliability. Results: One-hundred twenty-six people with SCI completed the survey with the majority being male (64.3%), white (79.4%), married (39.7%), with a mean age of 42.8 (± 13.7). The most prevalent level of SCI was complete paraplegia (34.9%) and the mean years from time since injury was 14.0 (±11.6). The physical activity outcome variable was significantly and positively correlated with self-regulatory efficacy (r = 0.575), task self-efficacy (r = 0.491), self-regulation (r = 0.432), social support (r= 0.284), and outcome expectations (r = 0.247). A prediction model for the physical activity outcome consisted of self-regulatory efficacy (B = 4.883; p < .001) and social support (B = 1.389; p = .050). Discussion: Multivariate analysis revealed that self-regulatory efficacy and social support were the strongest predictors of physical activity among people with SCI. Based on findings from the study, physical activity interventions targeted at people with spinal cord injury should focus on improving self-regulatory behaviors and providing social support to increase physical activity. A strategy for increasing self-regulatory efficacy within an intervention may involve the development of an action plan by each participant. The action planning would include setting goals and objectives, scheduling times for physical activity, and identifying barriers and a plan for coping with each barrier. Social support is the perceived support from others concerning the behavior and may include family, friends, or online communities. Targeting social support in an intervention may include peer modeling, peer support, health messages from participant doctor, and family involvement.

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Health education, Health sciences