Assessing Self-Efficacy for Physical Activity and Walking Exercise in Women with Fibromyalgia

Background: Exercise and physical activity are an evidence-based practice for chronic pain. Health profes- sionals need instruments to assess self-efficacy for this practice taking into account the specific barriers of patients with these health problems. Purpose: To develop and test the psychometric properties of a new self-efficacy scale for physical activity and walking exercise in patients with fibromyalgia. Design: A cross-sectional and prospective study was conducted in a Spanish Fibromyalgia Unit. Two hun- dred and eleven new patients signed the informed consent and participated in the study. All of them were women, referred to by either Primary or Specialized Health Care. In addition to the new scale, they filled out several self-reported and validated instruments to collect the data present in this study. Results: Exploratory factor analysis showed a three-factor model (GFI = .99; RMSR = .06) that explained 74.2% of the total variance. They assessed how confident patients felt about walking quickly in both 30- and 60-minute sessions, (Factor I: 10 items; α= .97), to perform daily physical activities (Factor II: 10 items; α= .93) and to undertake moderate physical activity (Factor III: 5 items; α= .95). The total score of the scale and the three-factor scores showed good criterion validity and adequate validity based on the relationships with other constructs. Conclusions: The scale showed adequate psychometric properties and can be a useful tool to help health professionals monitor patients’ self-efficacy perception and customize both physical activity and walking exercise intervention goals and their implementatio

What Do Adolescents Believe About Performing and Accepting Intimate Partner Violence Behaviors? A Reasoned Action Approach

Intimate partner violence against adolescent girls is of increasing political and social concern. This paper presents formative research on the reasoned action approach (RAA) to the prediction of boys’ perpetration and girls’ acceptance of four psychologically abusive behaviors. Our objectives were: (1) to identify the behavioral and normative modal beliefs behind males’ performance and girls’ acceptance of the behaviors and (2) to explore the relationship between attitudes, perceived social norm, intention and behavior. A total of 479 adolescents between 14 and 18 years of age completed questionnaires on the performance (boys) or acceptance (girls) of a specific behavior. We used a grouping process to identify modal beliefs and carried out eight exploratory multiple regression analysis (one per behavior) to study attitude and social norm as predictors of intention and behavior. Positive and negative behavioral beliefs coexist in boys’ and girls’ minds, which can reflect an unclear positioning against abusive behaviors. Positive outcomes seem to be influenced by socialization processes and love myths. Peers can be a risk factor whereas parents are a protective factor against the performance and acceptance of these behaviors. Results showed significant relationships between the constructs in the sense specified by the model. Prevention programs could benefit by: managing participants’ individual behavior, intervening separately with boys and girls, overcoming adolescents’ confusion regarding these behaviors, and targeting parents as a means of discouraging their performance and acceptance. The RAA appears a useful tool for explaining and predicting the performance and acceptance of abusive behavior

¿Cuáles son las señales de alarma más representativas de la violencia de pareja contra las adolescentes?

Identifying which warning signs (WS) of intimate partner violence against girls (IPV) must be included in prevention programs is essential, since there is not an explicit consensus. Our first aim was identifying the most frequent WS included in the reviewed Spanish prevention guides by means of a content analysis performed independently by three judges.  Our second aim was subjecting these to a sample of adolescents (n=60) to know: (1) if they identify them as abusive behaviours; (2) how frequently do they consider they have to occur to be WS, and; (3) how frequently they observe them in their peer environment. Among the 23 identified WS, controlling (n=11) and devaluating behaviours (n=6) are the most frequent in the reviewed literature and the formers´ the most observed in the adolescents’ environment (rank: 52.5% - 90%).  The majority labelled the 23 behaviours as abusive.  Four controlling and 3 devaluating behaviours had to occur very often to be an IPV warning sign. Therefore their tolerance to these WS is high.  The outcomes are valuable for the development of prevention programs and suggest the need of investigating on the explanatory factors of such tolerance.Identificar qué señales de alarma de violencia de género (VG) en la adolescencia deben incluirse en los programas de prevención es esencial.  Al no existir un acuerdo explícito al respecto, nuestro primer objetivo fue identificar qué señales son más frecuentes en las guías de prevención españolas revisadas, mediante un análisis de contenido realizado independientemente por 3 juezas.  Nuestro segundo objetivo fue valorar una muestra de adolescentes (n= 60) para conocer: (1) si las identifican como conductas violentas; (2) con qué frecuencia consideran que deben ocurrir para ser señales de alarma, y (3) con qué frecuencia las observan en su entorno de iguales.  Entre las 23 señales identificadas, las conductas de control (n = 11) y desvalorización (n = 6) son las más frecuentes en la literatura revisada y prevalentes en los grupos de iguales (52.5% - 90%).  La mayoría identificó las 23 conductas como violentas. Cuatro conductas de control y 3 de desvalorización tienen que darse a menudo para ser consideradas señales de alarma de VG.  Por tanto, su tolerancia a las mismas es elevada. Estos resultados son útiles para la elaboración de programas de prevención y sugieren la necesidad de investigar sobre los factores explicativos de dicha tolerancia

Predicting walking as exercise in women with fibromyalgia from the perspective of the theory of planned behavior

Based on the theory of planned behavior, this study examined factors related to the intention to adhere to an unsupervised walking program and the intention-behavior gap in relation to walking adherence in women with fibromyalgia. We also accounted for specific variables: fear of movement, pain intensity, distress and disability. TPB constructs, walking behavior and the above-mentioned variables were assessed in 274 women aged 18 to 70 years old (mean 51.8, range 25.5–69.1 years) at baseline and seven weeks later (n = 219) during 2012. Intention to adhere to a walking program showed medium scores at baseline and was associated with attitude and perceived behavioral control (PBC). Self-reported walking adherence at Time 2 was only predicted by perceived behavioral control. The intention-behavior gap was present in 33% of participants. Logistic regression analysis showed PBC associated with being a successful intender. Women with fibromyalgia were motivated to walk; however, they did not act on their intentions, and PBC appeared as the main explanation. Women who perceived high control in comparison to those who perceived low control, increased their likelihood of adhering to a walking program about three-fold. Women with fibromyalgia should increase their perceived control through different strategies

Do women with fibromyalgia adhere to walking for exercise programs to improve their health? Systematic review and meta-analysis

Background: Walking is recommended for fibromyalgia, but the rate of adherence to this exercise is not known. Poor adherence to physical exercise can limit the effectiveness in health benefits. Objectives: To examine adherence to interventions that include walking for fibromyalgia and to explore its moderators among the characteristics of patients, of the walking prescription and of the interventions. Data sources: References from 2000 to 2016 have been collected through PubMed, PsycINFO, CINAHL, SPORTDiscus, Cochrane, and Teseo. Study selection: We included quasi-experimental and randomized controlled trials in adults with fibromyalgia that involved walking for exercise. Two authors screened records independently and disagreements were resolved by discussion. Data extraction: Independently extracted by two assessors. Methodological quality of the studies was assessed using an ad hoc scale. Data synthesis: Nineteen trials, 32 experimental groups, recruited a total of 983 participants (96.78% women) with mean ages between 45 and 60.60. Adherence to the intervention program was reported in 19 of 32 experimental groups and ranged, on average, from 73 to 87.20% depending on the type of assessment. Most relevant moderators of adherence were the recruitment of participants through physicians and the nurses as supervisors of exercise. Conclusion: Adherence rates (attendance at sessions) to programs with walking were high. However, a lack of information precludes knowledge of whether participants sustained walking between sessions or after the treatment. Further work is required to examine in greater depth such contextual variables of interventions as the professional-participant relationship or to explore other possible moderators such as patient expectations of the treatment

Activity patterns and functioning. A contextual–functional approach to pain catastrophizing in women with fibromyalgia

The psychological flexibility model states that activity patterns are not deemed to be intrinsically functional or dysfunctional; it is considered that underlying factors, such as personal goals and contextual factors, are what will determine their effects on disability. Pain catastrophizing has frequently been associated with several important pain-related outcomes. Despite its recent conceptualization within affective–motivational approaches, its moderating role between activity patterns and dysfunction has not been analyzed. Methods: This study analyzes the moderating role of pain catastrophizing and its dimensions (Pain Catastrophizing Scale) between activity patterns (Activity Patterns Scale) and disease impact (Fibromyalgia Impact Questionnaire—Revised) in 491 women with fibromyalgia. Results: Activity avoidance (p < 0.001), excessive persistence (p < 0.001) and pacing (p < 0.01) patterns were positively associated with fibromyalgia impact. Helplessness shows a moderating role between pain avoidance (B = 0.100, t =2.30, p = 0.021, [0.01, 0.18]), excessive persistence (B = −0.09, t = −2.24, p = 0.02, [−0.18, −0.01]), pain persistence (B = −0.10, t = −2.04, p = 0.04, [−0.19, −0.004]) and functioning. Conclusion: Helplessness (within pain catastrophizing) is a relevant variable within psychological flexibility models applied to activity patterns. Specifically, pain avoidance is especially dysfunctional in patients with high helplessness. To improve excessive persistence and pain persistence, it is necessary to reduce helplessness before regulating activity patterns

Goal Preferences, Affect, Activity Patterns and Health Outcomes in Women With Fibromyalgia

Some motivational models understand health behavior as a result of the interaction between goal preferences and mood. However, this perspective has not been explored in fibromyalgia. Furthermore, in chronic pain, it has only been explored with regard to negative affect. Thus, our aims were: (1) to develop a Spanish version of the Goal Pursuit Questionnaire (GPQ); (2) to explore the relationships between goal preferences and health outcomes, testing the moderator role of affect and the mediating role of chronic pain activity patterns. We conducted two cross-sectional studies. In Study 1, after a double translation/back-translation process, we interviewed 94 women attending the Fibromyalgia Unit of the Community of Valencia in order to identify the cultural feasibility and the content validity of the GPQ. Study 2 comprised 260 women. We explored the GPQ structure and performed path analyses to test conditional mediation relationships. Eight activities from the original GPQ were changed while maintaining the conceptual equivalence. Exploratory factor analysis showed two factors: ‘Painavoidance goal’ and ‘Mood-management goal’ (37 and 13% of explained variance, respectively). These factors refer to patients’ preference for hedonic goals (pain avoidance or mood-management) over achievement goals. Robust RMSEA fit index of the final models ranged from 0.039 for pain to 0.000 for disability and fibromyalgia impact. Pain avoidance goals and negative affect influenced pain mediated by taskcontingent persistence. They also affected disability mediated by task and excessive persistence. Pain avoidance goals and positive affect influenced fibromyalgia impact mediated by activity avoidance. We also found a direct effect of negative and positive affect on health outcomes. Preference for pain avoidance goals was always related to pain, disability and fibromyalgia impact through activity patterns. Affect did not moderate these relationships and showed direct and indirect paths on health outcomes, mainly by increasing persistence and showing positive affect as an asset and not a risk factor. Intervention targets should include flexible reinforcement of achievement goals relative to pain avoidance goals and positive affect in order to promote task-persistence adaptive activity patterns and decreased activity avoidance

Predicting Abusive Behaviours in Spanish Adolescents’ Relationships: Insights from the Reasoned Action Approach

(1) Background: Partner violence prevention programmes do not produce the expected behavioural changes. Accordingly, experts suggest applying evidence-based behavioural models to identify the determinants of abusive behaviours. In this research, we applied the reasoned action approach (RAA) to predict the performance (boys) and acceptance (girls) of abusive behaviours in adolescents. (2) Method: We designed a questionnaire based on the RAA and performed a crosssectional study. We analysed the predictive capacity of the RAA constructs on intentions with the sample of single adolescents (n = 1112). We replicated the analysis only with those who were in a relationship (n = 587) and in addition analysed the predictive capacity of intention on future behaviour (3 months later). (3) Results: The hierarchical regression analysis performed with the sample of single adolescents showed that the model explained 56% and 47% of the variance of boys’ intentions to perform the controlling and devaluing behaviours, respectively; and 62% and 33% of girls’ intention to accept them. With those in a relationship, the model explained 60% and 53% of the variance of boys’ intentions to perform the controlling and devaluating behaviour, respectively, and 70% and 38% of girls’ intention to accept them. Intention exerted direct effects on boys’ performance of controlling and devaluing behaviours (31% and 34% of explained variance, respectively) and on girls’ acceptance (30% and 7%, respectively). (4) Conclusions: The RAA seems useful to identify the motivational determinants of abusive behaviours, regardless of adolescents´ relationship status, and for their prediction. Perceived social norms emerge as a relevant predictor on which to intervene to produce behavioural changes with both sexe

Analysing motivation to do medicine cross-culturally: The international motivation to do medicine scale

Vaglum, Wiers-Jensen, &amp; Ekeberg (1999) developed an instrument to assess motivation to study medicine. This instrument has been applied in different countries but it has not been studied cross-culturally. Our aims were to develop a Motivation to do Medicine Scale for use in international studies and to compare motivations of UK and Spanish medical students (UK: n= 375; Spain: n= 149). A cross-sectional and cross-cultural study was conducted. The Vaglum et al. (1999) Motivation to do Medicine Scale (MMS) was used. The original MMS factor structure was not supported by the Confirmatory Factor Analysis. Exploratory Factor Analyses within each country identified four factors: “People”, “Status”, “Natural Science” and “Research”. Students scored higher on the “People” and “Natural Science” than on the other factors. The UK sample scored higher than the Spanish sample on the “Research” factor and there were greater difference between genders in Spain for both “People” and “Research” factors. The scale is suitable for use in cross-cultural studies of medical students’ motivation. It can be used to investigate differences between countries and may be used to examine changes in motivation over time or over medical disciplines.Con el objetivo de analizar la percepción sobre la crianza materna y paterna, 1182 niños y adolescentes (45,3% chicos y 54,7% chicas) con edades comprendidas entre 8 y 16 años, fueron evaluados mediante el Child Report Parental Behaviour Inventory (CRPBI; Shaefer, 1965). Los resultados muestran una mayor sensibilidad de las chicas a la afectividad y en los chicos al control y la hostilidad parentales. La madre obtiene mayores puntuaciones en todos los factores con la excepción de hostilidad. A medida que los hijos crecen, éstos informan de un decremento en el afecto, la comunicación y la supervisión, en ambos padres, y por el contrario, de un incremento en la percepción de la hostilidad

Promoting unsupervised walking in women with fibromyalgia: a randomized controlled trial

The objective of this study is to test the efficacy of a group motiva-tional plus implementation intentions intervention in promoting adherence to an unsupervised walking program recommended for fibromyalgia, compared to an implementation intentions condition and to an active control condition. A triple-blind, randomized, long-itudinal study with measures at baseline, short (seven weeks post- intervention), mid (12 weeks) and long-term (36 weeks) is performed. Data are analyzed using multilevel longitudinal growth curve two- level modelling. Participants are 157 women with fibromyalgia. In the short-term, adherence to the minimum and to the standard walking program (primary outcome measures) is explained by time (both p <.001), motivational plus implementation intentions intervention (both p <.001) and by their interaction (both p <.001). Regarding the secondary outcomes, only physical function is explained by time (p <.001), motivational plus implementation intentions intervention (p <.05) and by their interaction (p <.05). Motivational plus imple-mentation intentions intervention achieve the promotion of walking as an exercise in the short-term; furthermore, physical function of the women in this condition is better than in the other two intervention groups, which is a relevant outcome from a rehabilitation point of view. However, more studies are needed to maintain the exercise at mid and long-term