Sandra Fitzgerald

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.

Psychometric validation of the Clubhouse climate questionnaire as an autonomy support measure for people with severe mental illness

Abstract Background: Self-determination represents a paradigm shift from “shoulds” to “decisions and behaviors” as the best options for helping people with mental illness achieving recovery goals. Autonomy support plays an important role in self-determination. Aims: The purpose of this study was to validate the Clubhouse climate questionnaire (CCQ) as an autonomy support measure. Method: One hundred and twenty-four participants were recruited from eight Clubhouse programs in Hawaii. Measurement structure of the CCQ was evaluated using exploratory and confirmatory factor analysis. Findings: CCQ is a unidimensional scale with good reliability and acceptable levels of divergent and convergent validity. Conclusions: CCQ is a brief, reliable and valid instrument for assessing autonomy support and contributes to the use of self-determination as a paradigm for improving recovery outcomes in psychiatric rehabilitation.

Perceived Preparedness to Implement Evidence-Based Practice by Certified Rehabilitation Counselors: A Qualitative Content Analysis:

The implementation of evidence-based practice (EBP) in rehabilitation counseling has the potential to improve the effectiveness of vocational rehabilitation (VR) services and employment outcomes of people with disabilities. The purpose of this content analysis was to explore certified rehabilitation counselors’ (CRCs) perceptions of the effectiveness of EBP and their preparedness to implement EBP in a variety of rehabilitation counseling settings. Three hundred fourteen CRCs responded to two open-ended questions related to their perceived effectiveness and preparedness to use EBP in VR service delivery practices. Results of this content analysis indicate that CRCs generally recognize the value of EBP and support its use in rehabilitation counseling. However, they identified major individual-level and organizational-level barriers that could hinder the implementation of EBP in the professional practice of rehabilitation counseling. Strong administrative support, adequate funding, time, and continuous training to update skills will be needed to fully implement EBP in rehabilitation counseling.

Psychometric Properties of the Vocational Rehabilitation Engagement Scale When Used with People with Mental Illness in Clubhouse Settings.

Purpose: The purpose of this study was to validate the Vocational Rehabilitation Engagement Scale (VRES) for use in the Clubhouse Model of Psychosocial Rehabilitation. Method: There were 124 individuals with serious mental illness recruited from 8 Clubhouse programs in Hawaii. Measurement structure of the VRES was evaluated using exploratory factor analysis. Results: Exploratory factor analysis of the Clubhouse version of the VRES yielded 2 reliable factors (cognitive-affective engagement and behavioral engagement). Both the cognitive-affective engagement and behavioral engagement factors were found to correlate with other self-determination theory constructs including autonomy support, relatedness, and outcome expectancy. Conclusions: The Clubhouse version of the VRES is a brief, reliable, and valid instrument for assessing vocational rehabilitation (VR) engagement and contributes to the use of self-determination as a paradigm for improving recovery outcomes in psychiatric rehabilitation.

Social-Cognitive Predictors of Readiness to Use Evidence-Based Practice: A Survey of Community-Based Rehabilitation Practitioners

Community-based rehabilitation organizations (CBRO) play an important role in providing rehabilitation and support services to individuals with disabilities. Increased utilization of CBROs by state vocational rehabilitation (VR) agencies requires a better understanding of how evidence-based practices (EBPs) are used in CBROs. The aim of the study was to examine the readiness of CBRO practitioners to implement EBP, based on social-cognitive predictors of confidence in knowledge and use of EBP, expected benefits of EBP, and perceived barriers and supports to use EBP. A total of 187 CBRO practitioners were surveyed using the Evidence-Based Practice CBRO (EBP-CBRO) survey. Participants were in moderate agreement that they were ready to implement EBP. They were moderately confident in their knowledge about EBP, in high agreement about the expected improvements by using EBP, and perceived low barriers and moderate supports to implementing EBP. The social-cognitive predictors accounted for 55% of the variance in readiness to implement EBP, with knowledge about EBP as the most significant predictor of readiness to use EBP. Social-cognitive theory is a useful framework for exploring CBRO practitioners’ attitudes toward and knowledge of EBP. CBRO practitioners are in moderate agreement about readiness to use EBP. Improving practitioner confidence to use EBP might be the best means of increasing utilization.