Examination of the social-environmental and motivational processes operating in dance contexts: a self-determination theory approach

Grounded in the self-determination (SDT; Deci & Ryan, 1985, 2000) and achievement goal (Nicholls, 1989) theories this thesis had the broad aim of expanding current knowledge and theoretical understanding of motivational processes. This was achieved via four studies in dance addressing contemporary conceptual and methodological issues raised in the motivation literature. The studies aimed to progress the conceptualisation and measurement of key motivational constructs (i.e., the teacher-created motivational climate and motivation regulations) by examining their application in dance using quantitative and qualitative methods. Additionally, the studies aimed to enhance understanding of the motivational processes via which the motivational climate, as a multi-dimensional construct, predicts dancers’ psychological well- and ill-being. Specifically, the mediating roles of basic psychological needs and motivation regulations between dancers’ perceptions of the motivational climate and affective states were examined. Collectively the thesis supports the central features of the SDT framework, including Duda’s (2013) conceptualisation of the motivational climate as multi-dimensional, and basic psychological need thwarting (as detailed in Bartholomew, Ntoumanis, Ryan, & Thøgersen-Ntoumani, 2011b). The studies in this thesis will substantiate the need for and inform theoretically-grounded interventions which aim to educate teachers in how they can support dancers’ psychological well-being in a variety of dance settings

Systematic scoping review of frameworks used to develop rehabilitation interventions for older adults

Objectives: Rehabilitation interventions for older adults are complex as they involve a number of interacting components, have multiple outcomes of interest and are influenced by a number of contextual factors. The importance of rigorous intervention development prior to formal evaluation has been acknowledged and a number of frameworks have been developed. This review explored which frameworks have been used to guide the development of rehabilitation interventions for older adults.Design: Systematic scoping review.Setting: Studies were not limited for inclusion based on setting.Participants: Studies were included that featured older adults (>65 years of age).Interventions: Studies were included that reported the development of a rehabilitation intervention.Primary and secondary outcome measures: Data was extracted on study population, setting, type of intervention developed and frameworks used. The primary outcome of interest was the type of intervention development framework.Results: Thirty-five studies were included. There was a range of underlying medical conditions including mild cognitive impairment and dementia (n=5), cardiac (n=4), stroke (n=3), falls (n=3), hip fracture (n=2), diabetes (n=2), breast cancer (n=1), Parkinson’s disease (n=1), depression (n=1), chronic health problems (n=1), osteoarthritis (n=1), leg ulcer (n=1), neck pain (n=1) and foot problems (n=1). The intervention types being developed included multicomponent, support-based, cognitive, physical activities, nursing-led, falls prevention and occupational therapy-led. Twelve studies (34%) did not report using a framework. Five frameworks were reported with the Medical Research Council (MRC) Framework for Developing and Evaluating Complex Interventions being the most frequently cited(77%, n=17).Conclusion: At present the MRC Framework is the most popular for developing rehabilitation interventions for older adults. Many studies do not report using a framework. Further, specific guidance to assist this complex field of rehabilitation research is required

Putting self-determination theory into practice: application of adaptive motivational principles in the exercise domain

Grounded in self-determination theory (SDT), and in the group exercise context, this qualitative study explored: (1) instructors’ experiences of operationalising motivational strategies following participation in an SDT-based training programme, (2) exercisers’ views on instructors use of motivational strategies and any impact on exercisers’ basic psychological needs and motivation and (3) the challenges and facilitators reported by instructors when implementing motivation strategies in practice. Thirteen indoor group cycling instructors and 15 exercisers, who had been regularly attending a group cycling class taught by one of the instructors, participated in semi-structured interviews. Ten instructors also completed self-reflective diaries detailing their experiences of implementing the need-supportive strategies. Data were analysed using the Framework Method and coding was performed using an abductive reasoning approach. Analysis revealed specific examples of ‘how to’ operationalise motivation strategies within group exercise settings. Challenges to implementation included: the structured nature of the group exercise class, initiating meaningful one-to-one conversations, phrasing instructions in a need-supportive way, and breaking old habits. Facilitators to implementation included establishing a connection with exercisers and understanding SDT. Findings are discussed in relation to the theoretical, practical and research implications. The findings of the present study could potentially be used to improve the design and training content of SDT-based training programmes in group exercise contexts and other similar group activity settings within sport and healthcare settings

Physical Activity and Subjective Vitality in Older Adults From Community-and Assisted-Living Settings

Purpose: There is a growing number of older adults moving into assisted-living facilities to maintain their independence while being assisted with certain tasks and having convenient access to services. Physical activity (PA) and vitality play an important role in independence, as well as in mental health, of older adults. However, no research has examined the difference in older adults' levels of vitality (defined as the state of feeling alive and alert) between those living in assisted-living facilities and those from community-living settings. We also explored sociodemographic predictors of PA and vitality among older adults living in two different types of housing.Methods: This cross-sectional study examined differences in PA levels and vitality between older adults (aged ≥ 60 years; n = 148, mean age = 74.70 years) living in assisted-living facilities (n = 85, mean age = 77.46 years) and those in community-living settings (n = 63, mean age = 70.98 years). PA was assessed by accelerometry, and vitality was measured using the subjective vitality scale.Results: Engagement in light PA and moderate to vigorous PA was higher in individuals living in community-living settings after controlling for sociodemographic variables. However, vitality was not significantly different between the two types of housing after controlling for sociodemographic variables. Marital status, education, and number of diagnosed diseases were associated with vitality.Conclusion: The support the need for designing strategies to increase PA in older adults living in assisted-living facilities. More attention should be paid to increasing subjective vitality of older adults in both types of housing to promote healthy aging

Collaboration between adult patients and practitioners when making decisions about prescribing opioid medicines for chronic non-cancer pain in primary care: a scoping review

Background:Long-term opioid therapy (>12 months) is not effective for improving chronic non-cancer pain and function. Where patients are not experiencing pain relief with long-term opioids, the opioid should be tapered and discontinuation considered. Practitioners may find it challenging to tell patients experiencing pain that they are better off reducing or not taking medicines that do not help. This review aims to ascertain what is published about: (1) the interaction and (2) the nature of the relationship between practitioners and patients when prescribing opioids for chronic non-cancer pain in primary care.Method:A scoping review of English-language qualitative, quantitative or mixed-method studies in databases including: MEDLINE, Embase, PsycINFO, AMED, BNI, CINALH EMCARE and HMIC. The identified papers were reviewed to provide a descriptive summary of the literature.Results:The review identified 20 studies. The studies used a range of methods including interviews, focus groups, audio and video recordings of clinical consultations, telephone survey and data from patient records. One study reported that researchers had engaged with a patient advisory group to guide their research. Patients expressed the importance of being treated as individuals, not being judged and being involved in prescribing decisions. Practitioners expressed difficulty in managing patient expectations and establishing trust. Opioid risk and practitioner suspicion shape opioid prescribing decisions. There is a paucity of literature about how precisely practitioners overcome interactional challenges and implement personalised care in practice.Conclusion:The studies in this review ascertain that practitioners and patients often find it challenging to achieve shared decisions in opioid review consultations. Effective communication is essential to achieve good clinical practice. Collaborative research with PPI partners should be aimed at identifying communication practices that support practitioners to achieve shared decisions with patients when reviewing opioids for chronic non-cancer pain

Adherence to limiting weight-bearing activity in patients with diabetic foot ulcers: A qualitative study

Aims: Patients with diabetic foot ulcers are advised to limit weight-bearing activity for ulcers to heal. Patients often disregard this advice although the reasons are not yet fully understood. This study explored 1) patients’ experiences of receiving the advice and 2) factors influencing adherence to the advice. Methods: Semi-structured interviews were conducted with 14 patients with diabetic foot ulcers. Interviews were transcribed and analysed using inductive thematic analysis.Results: Advice regarding limiting weight-bearing activity was described by patients as directive, generic and conflicting with other priorities. Rapport, empathy and rationale supported receptivity to the advice. Barriers and facilitators to limiting weight-bearing activity included: demands of daily living, enjoyment of exercise, sick/disabled identity and burden, depression, neuropathy/pain, health benefits, fear of negative consequences, positive feedback, practical support, weather, and active/passive role in recovery.Conclusions: It is important that healthcare professionals pay attention to how limiting weight-bearing activity advice is communicated. We propose a more person-centred approach in which advice is tailored to individuals’ specific needs with discussion around patient priorities and constraints

Evaluating quality of implementation in physical activity interventions based on theories of motivation: Current challenges and future directions

The evidence base pointing towards the maladaptive health consequences of an inactive lifestyle highlights the need for interventions that are effective in changing and maintaining physical activity behaviours. Theories of motivation are frequently applied to inform the content and delivery of such interventions. Systematic monitoring and evaluation of the quality of intervention implementation is therefore an important step in understanding if and how theories of motivation can be adopted and effectively applied to promote and/or sustain physical activity behaviours. However, intervention implementation quality in studies that aim to apply motivation theory to promote physical activity is often under-reported. The purpose of this article is, first, to review contemporary approaches used to monitor and evaluate intervention implementation; we outline the degree to which these methods have been used effectively in research concerned with applying theories of motivation to impact physical activity behaviours. Second, we identify and discuss specific challenges in effectively measuring quality of implementation faced by researchers who adopt a motivation theory basis to their work. Finally, recommendations for methods to monitor and evaluate intervention implementation in future trials aiming to promote physical activity based on theories of motivation are also proposed. © 2016 The Author(s)

Development of a motivation communication training programme to aid diabetes-specialist podiatrists with adherence discussions

Diabetic foot ulcers (DFUs) impact a substantial proportion of patients with diabetes, with high recurrence rates, severe complications, and significant financial burden to health care systems. Adherence to treatment advice (e.g., limiting weight-bearing activity) is low with patients reporting dissatisfaction with the way in which advice is communicated. This study aimed to address this problem via the systematic development of a motivation communication training program. The program was designed to support diabetes-specialist podiatrists in empowering patients to actively engage with treatment. The development process followed an intervention mapping approach. Needs assessment involved observations of 24 patient–practitioner consultations within a diabetes-specialist foot clinic. This informed specification of a theory of change (self-determination theory) and relevant evidence-based communication strategies (drawing from motivational interviewing). The training program was developed iteratively with changes made following feedback from five diabetic foot health care professionals. The resulting training program, consisting of six one-hour face-to-face sessions over an 8-week period, was delivered to a further six diabetes specialist podiatrists, with five participating in postprogram telephone interviews to assess acceptability. Deductive thematic analysis of interview data revealed positive aspects of the training (e.g., valuable and relevant content), ideas for improvement (e.g., online resources and context-specific video examples), the acceptability of motivation strategies, and challenges putting the strategies into practice (such as time constraints and breaking old communication habits). This study contributes to our understanding of integrating motivation principles into routine consultations and holds potential for enhancing adherence to treatment recommendations in patients living with diabetic foot ulcers

Motivation as a mechanism underpinning exercise-based falls prevention programmes for older adults with cognitive impairment: a realist review

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ. Objectives This review aimed to identify mechanisms underlying participation in falls prevention interventions, in older adults with cognitive impairment. In particular we studied the role of motivation. Design A realist review of the literature. Data sources EMBASE, MEDLINE, CINAHL, the Cochrane Library, PsycINFO and PEDRO. Eligibility criteria Publications reporting exercise-based interventions for people with cognitive impairment, including dementia, living in the community. Data extraction and synthesis A â €" rough programme theory' (a preliminary model of how an intervention works) was developed, tested against findings from the published literature and refined. Data were collected according to elements of the programme theory and not isolated to outcomes. Motivation emerged as a key element, and was prioritised for further study. Results An individual will access mechanisms to support participation when they think that exercise will be beneficial to them. Supportive mechanisms include having a â €" gate-keeper', such as a carer or therapist, who shares responsibility for the perception of exercise as beneficial. Lack of access to support decreases adherence and participation in exercise. Motivational mechanisms were particularly relevant for older adults with mild-To-moderate dementia, where the exercise intervention was multicomponent, in a preferred setting, at the correct intensity and level of progression, correctly supported and considered, and flexibly delivered. Conclusion Motivation is a key element enabling participation in exercise-based interventions for people with cognitive impairment. Many of the mechanisms identified in this review have parallels in motivational theory. Clinically relevant recommendations were derived and will be used to further develop and test a motivationally considered exercise-based falls intervention for people with mild dementia. PROSPERO registration number CRD42015030169