Ruth Torkelson Lynch

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.

Correlates of Depression in Adult Siblings of Persons with Traumatic Brain Injury.

Using Pearlins stress process model, this study examined correlates of depression in 170 adult siblings of persons with traumatic brain injury (TBI). Approximately 39% of adult sibling participants evinced Center for Epidemiologic Studies—Depression (CES—D; Radloff, 1977) scores indicating clinically significant depressive symptoms. Background characteristics found to be related to higher ratings of depression included being female and history of a pre-TBI depressive episode. In addition, results indicated that perceptions of more restrictions in valued family activities and less accessibility to social support were related to higher ratings of depression. Contrary to study hypotheses, an inverse relationship was found between subjective caregiving burden and depression. Practice and research implications of these findings are discussed.

Measuring Clinical Significance in Rehabilitation Research.

Measurement of clinically significant change is critical for rehabilitation research because it can enhance the credibility of rehabilitation efforts and guide evidence-based practices. The practical appeal of clinically significant change is that it can bridge research and clinical practice by focusing on individual rather than group differences. In response to current challenges in rehabilitation outcome measurement, the authors describe methods and strategies for the analysis of clinically significant change. The complementary approaches of reliable change index scores as proposed by Jacobson and Truax (1991) and regression-based z scores as proposed by McSweeney, Naugle, Chelune, and Luders (1993) are highlighted. The article concludes with a case example and discussion of implications for future directions in rehabilitation research.

Long-term follow-up of outpatient interdisciplinary pain management with a no-treatment comparison group

The long-term psychosocial and physical functioning impact of an outpatient interdisciplinary pain management program was evaluated by comparison of pain management completors and a no-treatment group. Although pain intensity did not change and there were no significant differences between groups in several aspects of daily activity, the group that completed the program reported a greater sense of control over pain, had a more hopeful outlook on the future, perceived pain as interfering less with their life, and used strategies that are considered adaptive for long-term management of pain. The results suggest that patients with chronic, complex pain problems can improve perceptions regarding pain control and reduce the interference of pain in their lives. Outlook regarding the future was identified as a critical assessment and treatment variable. Individuals who were more optimistic about the future perceived a greater control over pain and endorsed coping strategies that involve diverting attention, ignoring pain sensations, and making coping self-statements. Although pain intensity rating did not differ, individuals who had a more pessimistic outlook on life considered pain to interfere with their work activity, mood, relations with other people, and overall enjoyment of life to a greater extent than individuals who were more optimistic.

Integrating individuals with traumatic brain injury into the group process

Abstract This article provides information on traumatic brain injury (TBI) and suggestions for integrating individuals with TBI into the group process.

Expanding the Health Action and Process Approach to Predict Physical Activity in African Americans With HIV/AIDS A Hierarchical Regression Analysis

The current study investigated an expanded Health Action and Process Approach (HAPA) as a health-promotion model of physical activity/exercise behavior for African Americans living with HIV/AIDS. Predictions of physical activity/exercise participation were investigated among 110 African Americans living with HIV/AIDS. Results indicate the expanded HAPA model accounts for 35% of the variance in physical activity/exercise participation. The most significant predictor variables were symptom severity, outcome expectancy, and action and coping planning. Action and coping planning also partially mediated the relationship between physical activity/exercise intention and behavior. Results of the study provide partial support for the use of this expanded HAPA model in the design and implementation of health-promotion behavioral interventions targeting physical activity/exercise for Africana Americans with HIV/AIDS.

The Health Action Process Approach as a Motivational Model of Dietary Self-Management for People With Multiple Sclerosis: A Path Analysis

The main objective of this study was to evaluate the health action process approach (HAPA) as a motivational model for dietary self-management for people with multiple sclerosis (MS). Quantitative descriptive research design using path analysis was used. Participants were 209 individuals with MS recruited from the National MS Society and a neurology clinic at a university teaching hospital in the Midwest. Outcome was measured by the Healthy Dietary Stages of Change Instrument, along with 10 predictor measures. The HAPA dietary self-management model fit the data relatively well (goodness-of-fit index = .95, normed fit index = .90, comparative fit index = .95, and root mean square error approximation = 0.07) explaining 15% of the variance in dietary self-management behavior. Recovery self-efficacy and action and coping planning directly contributed to the prediction of dietary health behaviors. Action self-efficacy, outcome expectancy, risk perception, and social support influenced intention, and the relationship between intention and dietary health behaviors is mediated by action and coping planning. Action self-efficacy, maintenance self-efficacy, and recovery self-efficacy directly or indirectly affected dietary health behaviors. Empirical support was found for the HAPA model of dietary self-management for people with MS. The HAPA model can be used to design behavioral health promotion interventions for people with disabilities in vocational rehabilitation.