John Kowal

Motivational Determinants of Flow: Contributions From Self-Determination Theory

Abstract The study examined the relationships between different types of situational motivation and flow and situational motivational determinants (perceptions of autonomy, competence, and relatedness) and the experience of flow. Immediately following a swim practice, 203 Canadian masters-level swimmers completed a questionnaire that assessed different variables. Results indicated that situational self-determined forms of motivation (intrinsic motivation and self-determined extrinsic motivation) and perceptions of autonomy, competence, and relatedness were positively related to flow, whereas amotivation was negatively related to flow.

Testing Relationships from the Hierarchical Model of Intrinsic and Extrinsic Motivation Using Flow as a Motivational Consequence

Abstract The purpose of this study was to test a motivational model based on Vallerands (1997) Hierarchical Model of Intrinsic and Extrinsic Motivation. This model incorporates situational and contextual motivational variables, and was tested using a time-lagged design. Masters level swimmers (N = 104) completed a questionnaire on two separate occasions. At Time 1, situational social factors (perceptions of success and perceptions of the motivational climate), situational motivational mediators (perceptions of autonomy, competence, and relatedness), situational motivation, and flow were assessed immediately following a swim practice. Contextual measures of these same variables were assessed at Time 2, 1 week later, with the exception of flow. Results of a path analysis supported numerous links in the hypothesized model. Findings are discussed in light of research and theory on motivation and flow.

Self-perceived burden in chronic pain: Relevance, prevalence, and predictors

Summary Self‐perceived burden, that is, patients’ perception of being a burden to others, is a clinically relevant and commonly reported experience in patients with chronic pain. Abstract Chronic pain is a debilitating condition that can have an impact on various facets of interpersonal functioning. Although some studies have examined the extent to which family members are affected by an individual’s chronic pain, none have examined patients’ perceptions of feeling that they have become a burden to others. Research on self‐perceived burden in different medical populations, such as cancer, amyotrophic lateral sclerosis, and stroke, has shown that it is associated with physical symptoms and, more robustly, with psychological difficulties and concerns. The present study examined the prevalence and predictors of self‐perceived burden in a tertiary chronic pain sample. Participants were consecutive patients (N = 238) admitted to an outpatient, interdisciplinary, chronic pain management program at a rehabilitation hospital. At admission, participants completed a battery of psychometric questionnaires assessing self‐perceived burden, as well as a number of clinically relevant constructs. Their significant others (n = 80) also completed a measure of caregiver burden. Self‐perceived burden was a commonly reported experience among chronic pain patients, with more than 70% of participants endorsing clinically elevated levels. It was significantly correlated with pain intensity ratings, functional limitations, depressive symptoms, attachment anxiety, pain self‐efficacy, and caregiver burden. Self‐perceived burden was also correlated with an item assessing suicidal ideation. In a hierarchical regression model, depressive symptoms, pain self‐efficacy, and adult attachment significantly predicted self‐perceived burden after controlling for demographic and pain‐related variables. In conclusion, self‐perceived burden is a clinically relevant and commonly reported interpersonal experience in patients with longstanding pain.

A randomized controlled psycho-education intervention trial: Improving psychological readiness for successful HIV medication adherence and reducing depression before initiating HAART

Abstract The purpose of this study was to evaluate a novel psycho-educational intervention intended to increase patients’ medication preparedness and treatment adherence skills before initiating highly active antiretroviral therapy (HAART). Sixty-three HIV-positive patients not currently on antiretroviral therapy participated in a randomized controlled trial of a standardized, four-session psycho-educational intervention (Supportive Therapy for Adherence to Antiretroviral Treatment; STAART). Session topics included learning techniques to increase medication adherence and learning effective strategies to cope with stress and depression. Patients completed psychological questionnaires assessing psychological readiness to initiate HAART and depressed mood. They completed both measures at study baseline and at four-weeks post-baseline. After controlling for baseline medication readiness scores, intervention patients (n=30) reported significantly higher mean medication readiness following the STAART intervention (four-weeks post-baseline) (27.3±6.9) compared to controls (n=33; 24.6±9.9; p<0.05). Among depressed patients (n=27), those receiving the intervention (n=15) reported significantly lower mean depression scores at four-weeks post-baseline (22.5±12.9) compared to controls (n=12; 27±9.9; p<0.05). The STAART intervention enhanced HIV treatment readiness by better preparing patients prior to initiating HAART. It was also beneficial for reducing depressive symptoms in depressed, HIV-positive patients.

Physical Activity Behavior Change in Middle-aged and Older Women: The Role of Barriers and of Environmental Characteristics

The majority of North American women are insufficiently active. Using an ecological approach to examine physical activity behavior in a sample of middle-aged and older women, this study aimed to (1) describe barriers to physical activity behavior change as well as environmental characteristics present in their neighborhoods, (2) examine relationships between barriers and physical activity behavior change, and (3) investigate environmental characteristics that may contribute to physical activity behavior change. Participants were 149 women ranging in age between 39 and 68. At Time 1, self-reported physical activity was assessed. Six months later (Time 2), barriers and environmental characteristics were measured, and physical activity was re-assessed. The most prevalent barriers were daily activities and fatigue. Over time, inactive women reported higher levels of barriers (e.g. fatigue, lack of interest in physical activity) than women who remained active or increased their physical activity level. Certain environmental characteristics (e.g. enjoyable scenery, seeing others exercising in their neighborhood) are suggested as potential contributors to physical activity behavior change.

Chronic pain and the interpersonal theory of suicide.

OBJECTIVE Chronic pain is a known risk factor for suicide. To date, however, few studies of people with chronic pain have tested specific predictions about suicidal ideation that are derived from theory. The interpersonal theory of suicide proposes that the psychological constructs of thwarted belongingness and perceived burdensomeness are unique and independent precursors to suicidal ideation. We tested this hypothesis in a clinical sample of patients with chronic pain. METHOD A total of 303 patients of a chronic pain rehabilitation program completed measures of pain severity, duration, and disability; cognitive-affective measures of depression and catastrophizing; and interpersonal measures of relationship distress and self-perceived burden to others. The latter measures were included as indices of the belongingness and burdensomeness constructs. Participants also rated two items pertaining to suicidal ideation. RESULTS In a multiple regression analysis, both distress in interpersonal relations (β = 0.12, p = .037) and self-perceived burden to others (β = 0.25, p < .001) were significant predictors of suicidal ideation, even after adjusting statistically for demographic characteristics, pain severity and duration, functional limitations, catastrophizing, and depression. CONCLUSIONS These findings suggest that the interpersonal theory is relevant to understanding elevated rates of suicidal ideation among people with chronic pain, and may have broader applicability to other populations with chronic illness or disability.

The Role of Psychological and Behavioral Variables in Quality of Life and the Experience of Bodily Pain Among Persons Living with HIV

With increased life expectancy of individuals living with HIV, quality of life (QOL) has become a focus of treatment. More research is needed to address pain-related QOL and modifiable variables, such as health behaviors, depressive symptoms, and coping styles, which could be included in treatment protocols to improve QOL among individuals with HIV. Objectives of this study were to (1) examine relationships among health behaviors, psychological variables, and QOL, particularly pain-specific QOL, (2) examine the relationships among coping, depressive symptoms, and QOL, and (3) compare QOL scores of individuals with HIV and population-based normative data. HIV positive men and women not currently on highly active antiretroviral therapy were recruited during regular visits to an HIV outpatient clinic. They completed the Medical Outcome Study Health Survey SF-36 scale, which includes a physical components scale, a mental components scale, and a bodily pain subscale. They also completed questionnaires assessing health behaviors, depressive symptoms, and coping styles. Participants (n=97) scored significantly lower on most aspects of QOL than age-matched Canadian and U.S. norms. Hierarchical multiple regressions revealed that physical activity and CD4 cell count were independently related to lower physical components scale scores; smoking and depressive symptoms were independently associated with lower mental components scale scores; and education, physical activity, and depressive symptoms were independently associated with lower pain-related QOL. Depressive symptoms mediated the relationship between coping styles and the mental components scale and pain-related QOL. Results suggest that targeting depressive symptoms, physical activity, and coping strategies as part of comprehensive treatment protocols could help improve pain-specific QOL and overall QOL among individuals with HIV.

Development and validation of the HIV Medication Readiness Scale.

Excellent medication adherence (>95%) is required for optimal HIV treatment success. This study aimed to develop and validate a brief scale to assess psychological readiness for successfully starting and adhering to HIV medications. HIV-positive men and women (N = 142) from an HIV outpatient clinic completed the proposed HIV Medication Readiness Scale (HMRS) prior to starting HIV medications. The 10-item HMRS demonstrated high internal consistency (alpha = .90), test-retest reliability (r = .83), and sensitivity to change following a standardized 4-session psychoeducational intervention designed to increase readiness for successful adherence. Predictive validity was supported by higher readiness scores on the day starting HIV medications, predicting higher treatment adherence at 1-month follow-up. The HMRS is a brief, easy-to-use, clinically relevant tool that can assist in identifying people living with HIV at high risk of nonadherence, who might benefit from tailored readiness counseling prior to initiating HIV medications.

Development and psychometric validation of the HIV Treatment Knowledge Scale

Abstract Accurate treatment knowledge is required for patients to successfully manage complex medical conditions. Existing HIV knowledge scales focus on disease transmission and risk factors. This is the first study to develop and validate a scale to measure HIV treatment knowledge about complex treatment issues such as adherence, side-effects and drug resistance. A total of 346 participants were recruited into this cross-sectional study. Participants included HIV-positive patients (n=130), HIV-hepatitis C co-infected patients (n=22), hepatitis C patients, (n=78), community healthcare providers (n=35) and college students (n=81). Participants completed the proposed HIV Treatment Knowledge Scale and a validated measure of general knowledge about HIV transmission and risk factors. Two-week test-retest data were collected. Results demonstrated that the HIV Treatment Knowledge Scale was significantly correlated with general HIV knowledge across all samples. Among HIV-positive patients, the HIV Treatment Knowledge Scale was positively associated with time since HIV diagnosis. HAART-experienced patients had significantly higher treatment knowledge than HAART-naïve patients. HIV-positive patients scored significantly higher than hepatitis C patients and college students on HIV treatment knowledge. Test-retest reliability (r=0.83) and internal consistency (reliability coefficient=0.90) were both satisfactory. The HIV Treatment Knowledge Scale is a novel, easy-to-administer measure demonstrating high levels of validity and reliability. It has important applications as a clinical teaching tool with patients and healthcare workers and it could be used as an outcome indicator in HIV educational intervention studies.

Intentions and actual physical activity behavior change in a community‐based sample of middle‐aged women: Contributions from the theory of planned behavior and self‐determination theory

Abstract This two‐study research assessed intentions and actual physical activity behavior change in a community‐based sample of Canadian middle‐aged women by integrating concepts from two strong and complimentary psychological theories: the Theory of Planned Behavior (TPB) and Self‐Determination Theory (SDT). Specific objectives were 1) to examine associations among TPB variables, motivation, and intention to increase physical activity and 2) to examine the relative influence of intentions and motivation on reported physical activity behavior change over time. First, in a cross‐sectional study, French‐speaking women (n = 109) recruited from community‐based facilities completed validated measures of TPB variables (attitudes, perceived behavioral control, subjective norms, and intentions) and motivation (autonomous and controlled). In a follow‐up longitudinal study, one hundred and forty‐nine English‐speaking women from similar facilities completed these measures and reported on actual physical activity at baseline and at six months. In the first study, attitudes, perceived behavioral control, and autonomous motivation were significantly associated with physical activity intentions. In the second study, attitudes, subjective norms, and autonomous motivation were significantly related to intentions to increase physical activity. In turn, intentions predicted change in physical activity behavior over time; however, the relationship was modest. Results highlight the role of intentions in physical activity behavior change among middleaged women and are discussed in light of current research and theory. Future research directions are proposed