A dynamic analysis of physical activity barriers experienced by adults with spinal cord injury

Abstract

To track and evaluate changes in the number and types of physical activity barriers experienced by adults with spinal cord injury (SCI) in response to a physical activity counselling intervention, using a newly-developed tracking and coding method. DESIGN: A secondary analysis of data from a randomized controlled trial of a physical activity behavioural intervention (#NCT03111030). SETTING: General community. PARTICIPANTS: Adults with chronic SCI (n = 14). INTERVENTION: An introductory behavioural coaching session followed by eight, weekly follow-up sessions were delivered inperson or by phone/video call. The interventionist utilized behaviour-change techniques tailored to individual participants' readiness for change, barriers, and preferences. Participants set goals for achieving the SCI exercise guidelines. Coaching sessions were audio-recorded and transcribed verbatim. MAIN OUTCOME MEASURE(S): Changes over time in the number of barriers reported within each level of a social-ecological model of influences on physical activity (intrapersonal, interpersonal, institutional, community, policy). RESULTS: A total of 152 physical activity barriers were identified across 122 coaching sessions. Within each level of influence, the number of identified barriers decreased significantly over the intervention period. Intrapersonal barriers (e.g., lack of motivation, low self-efficacy) were most frequently reported and showed the greatest reductions over time. CONCLUSIONS: Using a new coding method to track changes in physical activity barriers, this pilot project showed a significant decrease in barriers over the course of a counselling intervention. Understanding physical activity barrier dynamics can improve the design of physical activity-enhancing interventions. Dynamic barrier-tracking methods could also be used to improve intervention implementation and evaluation.

Theory- and evidence-based best practices for physical activity counseling for adults with spinal cord injury

“… You should always: Review: [ 1 , 2 ] Other: [ 25 , 27 , 41 ] Assessing physical activity behavior Counselors should always ask about their clients’ physical activity Ask your client about their current physical activity behavior. HAPA [ 30 ] COM-B [ 29 ] Review: [ 1 , 2 , 13 ] Other: [ 25 , 40 , 41 ] Barrier identification and problem solving Counselors should understand clients’ context and their physical activity needs and preferences. Understanding your client’s physical activity capability, opportunity and motivation.…”

“…To illustrate, the HAPA-model has informed the development of the ProACTIVE SCI intervention, an 8-week SCI PA counseling intervention that resulted in the largest effect sizes to date for improving self-reported PA in adults with SCI [ 26 , 27 ]. We used new knowledge from the ProACTIVE SCI counseling sessions to inform the best practices [ 25 , 40 , 41 ]. Drawing upon behavior change theories and approaches that have been tested and applied in previous SCI-specific PA counseling interventions may enhance the relevance and use of the best practices in SCI PA counseling interventions.…”

“…Panel members were asked to review the preparation material prior to the meetings. The evidence base was used to prepare the discussion meetings and inform the best practices and included (1) key literature on SCI PA counseling from three reviews [ 1 , 2 , 13 ], and (2) new knowledge on SCI PA counseling characteristics from an effective SCI-specific PA counseling intervention [ 23–27 ]. Appendix 4 provides further details on how we identified the reviews and the evidence base.…”

Theory- and evidence-based best practices for physical activity counseling for adults with spinal cord injury

“…Panel members were asked to review the preparation material prior to the meetings. The evidence base was used to prepare the discussion meetings and inform the best practices and included (1) key literature on SCI PA counseling from three reviews [1,2,13], and (2) new knowledge on SCI PA counseling characteristics from an effective SCI-specific PA counseling intervention [23][24][25][26][27]. Appendix 4 provides further details on how we identified the reviews and the evidence base.…”

“…To illustrate, the HAPA-model has informed the development of the ProACTIVE SCI intervention, an 8-week SCI PA counseling intervention that resulted in the largest effect sizes to date for improving selfreported PA in adults with SCI [26,27]. We used new knowledge from the ProACTIVE SCI counseling sessions to inform the best practices [25,40,41]. Drawing upon behavior change theories and approaches that have been tested and applied in previous SCI-specific PA counseling interventions may enhance the relevance and use of the best practices in SCI PA counseling interventions.…”