Chung Yi Chiu

The Health Action Process Approach as a motivational model for physical activity self-management for people with multiple sclerosis: A path analysis.

OBJECTIVE To evaluate the Health Action Process Approach (HAPA) as a motivational model for physical activity self-management for people with multiple sclerosis (MS). DESIGN Quantitative descriptive research design using path analysis. PARTICIPANTS One hundred ninety-five individuals with MS were recruited from the National Multiple Sclerosis Society and a neurology clinic at a university teaching hospital in the Midwest. OUTCOME MEASURES Outcome was measured by the Physical Activity Stages of Change Instrument, along with measures for nine predictors (severity, action self-efficacy, outcome expectancy, risk perception, perceived barriers, intention, maintenance self-efficacy, action and coping planning, and recovery self-efficacy). RESULTS The respecified HAPA physical activity model fit the data relatively well (goodness-of-fit index = .92, normed fit index = .91, and comparative fit index = .93) explaining 38% of the variance in physical activity. Recovery self-efficacy, action and coping planning, and perceived barriers directly contributed to the prediction of physical activity. Outcome expectancy significantly influenced intention and the relationship between intention and physical activity is mediated by action and coping planning. Action self-efficacy, maintenance self-efficacy, and recovery self-efficacy directly or indirectly affected physical activity. Severity of MS and action self-efficacy had an inverse relationship with perceived barriers and perceived barriers influenced physical activity. CONCLUSIONS Empirical support was found for the proposed HAPA model of physical activity for people with MS. The HAPA model appears to provide useful information for clinical rehabilitation and health promotion interventions.

State vocational rehabilitation services and employment in multiple sclerosis

Background: Obtaining and maintaining suitable employment can be a significant challenge for people with multiple sclerosis (MS). Objective: The objective of this article is to identify what vocational rehabilitation (VR) services helped MS clients obtain and maintain employment, after controlling for the effect of demographic covariates and disability-related government benefits. Methods: We retrieved data from the Rehabilitation Services Administration (RSA) 911 database in the fiscal year (FY) 2009, and used VR services as predictors to predict employment outcomes of people with MS by hierarchical logistic regression. Results: A total of 924 out of 1920 MS clients (48.1%) were successfully employed after receiving VR services. Logistic regression analysis results indicated that cash benefits (OR =0.51, p < 0.001) and public medical benefits (OR =0.76, p < 0.01) were negatively associated with employment outcomes, whereas counseling and guidance (OR = 1.68, p < 0.001), job placement assistance (OR = 2.43, p < 0.001), on-the-job supports (OR = 1.62, p < 0.01), maintenance services (OR = 1.59, p < 0.01), and assistive technology services (OR =2.09, p < 0.001) were significant predictors of positive employment outcomes. Conclusion: VR services were found to be associated with employment status. MS patients experiencing problems obtaining or maintaining employment should be encouraged to pursue services from state VR agencies.

The association of stress-coping variables to quality of life among caregivers of individuals with traumatic brain injury

The purpose of this study was to determine the degree to which stress-coping variables contribute to quality of life (QOL) among caregivers of individuals with traumatic brain injury (TBI). This study examined the direct effects of the following variables: functional competency, caregiving appraisal, coping, perceived social support, and family needs on QOL. In addition, the unique variance accounted for in QOL by each set was investigated, and whether perceived social support, coping, and family needs mediate or moderate the relationship between caregiving appraisal and QOL. The sample consisted of 108 caregivers recruited from support groups who were predominantly white females. The majority of care-recipients had a severe head injury. Measures administered were the Interpersonal Support Evaluation List, Family Needs Questionnaire, Modified Caregiving Appraisal Scale, and the World Health Organization Quality of Life--Brief Version. Results showed that the full model accounted for 68% of the variance in QOL; caregiving appraisal, perceived social support and family needs remained significant after other stress-coping variables were partialled; and of these sets, emotional social support, social needs, and perceived burden were the significant individual predictors. Emotional social support and social needs mediated the relationship between perceived burden and QOL.

Multiple sclerosis patients need and want information on exercise promotion from healthcare providers: a qualitative study.

There is growing recognition of the benefits and safety of exercise and its importance in the comprehensive care of persons with multiple sclerosis (MS), yet uptake is low.

Predictive Ability of Pender's Health Promotion Model for Physical Activity and Exercise in People with Spinal Cord Injuries: A Hierarchical Regression Analysis.

The main objective of this study was to validate Pender’s Health Promotion Model (HPM) as a motivational model for exercise/physical activity self-management for people with spinal cord injuries (SCIs). Quantitative descriptive research design using hierarchical regression analysis (HRA) was used. A total of 126 individuals with SCI were recruited through the National Spinal Cord Injury Association, other SCI support groups, and professors in rehabilitation counseling across the United States. Outcome measures used were the International Physical Activity Questionnaire and the Physical Activity Stages of Change Instrument. The HRA results indicated that preinjury physical activity/exercise level, severity of SCI, and commitment to a plan for exercise and physical activity were predictive of postinjury exercise and physical activity level. In addition, friend/family support, perceived self-efficacy, and perceived benefits were the strongest predictors of commitment to a plan of action for exercise and physical activity. The research findings support the applicability of Pender’s HPM as a motivational model for exercise/physical activity for people with SCI. The information can be used to design health promotion behavioral interventions for people with SCI living in the community.

Family history of chronic disease and meeting public health guidelines for physical activity: the cooper center longitudinal study.

We aimed to assess whether a family history of coronary heart disease, diabetes, or cancer is linked to meeting public health guidelines for health-promoting physical activity. To achieve this objective, we analyzed data on 29,513 adults who came to the Cooper Clinic (Dallas, Texas) between January 1, 1990, and December 31, 2010, for a preventive medicine visit. Patients completed a comprehensive medical survey including information on family medical history, physical activity, and other lifestyle behaviors. Bivariate and multivariate logistic regression were used to examine the relationship between having a family history of chronic disease and meeting physical activity guidelines. The results indicated that individuals with a family history of disease had reduced odds for meeting or exceeding physical activity guidelines. For example, participants with a family history of 3 diseases were 36% less likely to meet or exceed physical activity guidelines than their counterparts without a family history of disease (odds ratio, 0.64; 95% CI, 0.58-0.72), while controlling for covariates. Among this large sample of adults, those with a family history of chronic disease were less inclined to regularly engage in physical activity. Thus, targeted programs encouraging adoption and maintenance of health-promoting physical activity might be warranted, specifically targeting individuals with familial history of disease.

Employment as a health promotion intervention for persons with multiple sclerosis

OBJECTIVE To examine the relationship between employment status (no employment, part-time employment, and full-time employment) and functional disability, health-related quality of life, and life satisfaction of people with MS. METHODS 157 individuals with MS completed a survey packet, including employment status, self-report disability severity, and health-related scales. A series of multivariate analysis of variance was performed to determine the differences between employment groups in health-related outcomes. RESULTS The unemployed group had the highest levels of incapacity and social impairments among the three groups. They also had the lowest physical health-related quality of life and life satisfaction. The part-time employed group had the lowest levels of depression and higher levels of physical activity participation among the three groups of individuals with MS. CONCLUSIONS Employment is significantly related to health-related quality of life, and as a result, it should be considered an important public health intervention for people with MS.

Motivational and Volitional Variables Associated With Stages of Change for Exercise in Multiple Sclerosis A Multiple Discriminant Analysis

The main objective of this study was to determine whether motivational and volitional variables identified in the health action process approach (HAPA) model can be used to successfully differentiate people with multiple sclerosis (MS) in different stages of change for exercise and physical activity. Ex-post-facto design using multiple discriminant analysis was used. Participants were 215 individuals with MS. The outcome variable was measured by the Physical Activity Stages of Change Instrument, along with motivational and volitional measures (severity, action self-efficacy, outcome expectancy, risk perception, perceived barriers, intention, maintenance self-efficacy, action and coping planning, and recovery self-efficacy). Participants in the precontemplation, contemplation, and action groups can be maximally separated by two significant canonical discriminant functions, volition and motivation. The action group can be differentiated from other groups based on high group mean (centroid) score on the volition function, and the precontemplation group can be differentiated based on low group means on both the motivation and volition functions. The contemplation group can be differentiated based on high centroid score on the motivation function. Research findings of this study support the concept of stage-matching exercise and physical activity intervention. The HAPA framework can be used to design health promotion behavioral interventions for people with MS in vocational rehabilitation.

Levels and Rates of Physical Activity in Older Adults with Multiple Sclerosis

There is much evidence supporting the safety and benefits of physical activity in adults with multiple sclerosis (MS) and recent evidence of beneficial effects on physical function in older adults with MS. However, there is very little known about physical activity participation in older adults with conditions such as MS. This study compared levels of physical activity (i.e., sedentary behavior, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA)) and rates of meeting public health guidelines for MVPA (i.e., ≥30 min/day) among young (i.e., ages 20-39 years), middle-aged (i.e., ages 40-59 years) and older adults (i.e., ages ≥60 years) with MS. The sample included 963 persons with MS who provided demographic and clinical information and wore an accelerometer for a 7-day period. The primary analysis involved a between-subjects ANOVA on accelerometer variables (i.e., accelerometer wear time; number of valid days; sedentary behavior in min/day; LPA in min/day; and MVPA in min/day). Collectively, our data indicated that older adults with MS engaged in less MVPA and more sedentary behavior than middle-aged and young adults with MS. Such results highlight the importance of developing physical activity interventions as an effective means for managing the progression and consequences of MS in older adults.

Career development of young adult cancer survivors: A conceptual framework

BACKGROUND: Research with young adult cancer survivors has found that they are often lacking appropriate career development skills. As a result, they are often disconnected with the labor market and deal low levels of career readiness, low career self-efficacy, and higher rates of under and unemployment. OBJECTIVE: The purpose of this article is to describe a multi-domain model that provides a framework for conceptualizing the career development of young adult cancer survivors. METHODS: This study utilized a comprehensive review of the literature to develop a theoretical based conceptual model. RESULTS: The model emphasizes the interaction of contextual and career development domains to improve participation in the areas of work, society, community, and home. CONCLUSION: A brief discussion of potential implications regarding research, service and policy are offered with the overall goal of conceptualizing career development as a public health intervention for young adult cancer survivors and other young adults with chronic health conditions.