Exploring Stereotypes of Athletes With a Disability: A Behaviors From Intergroup Affect and Stereotypes Map Comparison.

Identifying as a regular exerciser has been found to effectively alter stereotypes related to warmth and competence for adults with a physical disability; however, it remains unclear how sport participation can influence this trend. Therefore, this study aimed to examine warmth and competence perceptions of adults with a physical disability portrayed as elite and nonelite athletes relative to other athletic and nonathletic subgroups of adults with and without a physical disability in the context of the stereotype content model. Using survey data from able-bodied participants (N = 302), cluster analyses were applied to a behaviors from intergroup affect and stereotypes map for displaying the intersection of warmth and competence perceptions. The results demonstrated that adults with a physical disability who are described as elite athletes (i.e., Paralympians) are clustered with high warmth and high competence, similar to their able-bodied athletic counterparts (i.e., Olympians). The findings suggest that perceiving athletic and elite sport statuses for adults with a physical disability may counter the stereotypes commonly applied to this group.

Changing health-promoting behaviours through narrative interventions: A systematic review.

The objective of this review was to summarize the literature supporting narrative interventions that target health-promoting behaviours. Eligible articles were English-language peer-reviewed studies that quantitatively reported the results of a narrative intervention targeting health-promoting behaviours or theoretical determinants of behaviour. Five public health and psychology databases were searched. A total of 52 studies met inclusion criteria. In all, 14 studies found positive changes in health-promoting behaviours after exposure to a narrative intervention. The results for the changes in theoretical determinants were mixed. While narrative appears to be a promising intervention strategy, more research is needed to determine how and when to use these interventions.

Narrative interventions for health screening behaviours: A systematic review.

Health information can be presented in different formats, such as a statistically-based or a story-based (e.g. narrative) format; however, there is no consensus on the ideal way to present screening information. This systematic review summarizes the literature pertaining to narrative interventions' efficacy at changing screening behaviour and its determinants. Five psychology and public health databases were searched; 19 studies, 18 focused on cancer and 1 on sexual health, met eligibility criteria. There is consistent evidence supporting the efficacy of narratives, but mixed evidence supporting an advantage for narratives over statistical interventions for screening behaviour and its determinants. Further investigation is warranted.

Psychosocial factors associated with physical activity in ambulatory and manual wheelchair users with spinal cord injury: a mixed-methods study.

PURPOSE: To identify psychosocial factors which explain lower levels of leisure time physical activity (LTPA) in persons with spinal cord injury (SCI) who are ambulatory relative to those who use manual wheelchairs. METHOD: For the quantitative study component, 347 adults with SCI (78% male; M age = 47.7) completed baseline measures of LTPA attitudes, subjective norms, perceived behavioural control and intentions. Six months later, LTPA was assessed. The qualitative component involved semi-structured interviews with six ambulant adults with SCI (five male, M age = 52.8) addressing LTPA experiences with an emphasis on barriers and facilitators. RESULTS: Ambulatory individuals had poorer attitudes towards LTPA than chair users (p = 0.004). Their attitudes had significant indirect effects on LTPA, through intentions. Perceived behavioural control was a significant negative predictor of LTPA. Qualitative analysis revealed three themes: an underestimated disability, low wheelchair skill self-efficacy and experiencing chronic pain. CONCLUSIONS: Poorer attitudes towards LTPA may partially explain why ambulatory individuals are less active. The qualitative and quantitative data suggest ambulators are an often-overlooked subgroup in need of targeted resources to enhance their attitudes, wheelchair skill self-efficacy and awareness of LTPA opportunities. Implications for Rehabilitation Rehabilitation practitioners must be sensitive to the unique needs of spinal cord injured individuals who are ambulatory, and tailor physical activity promotional strategies to suit the needs of this distinct group. Lack of wheelchair skills is a participation barrier for ambulators; ambulators should be introduced to activities that do not require wheelchair use, such as swimming, hand-cycling and adapted forms of circuit training. Strategies that encourage wheelchair skill development in non-wheelchair using ambulators, may increase physical activity opportunities for this segment of the spinal injured population.

Sport participation among individuals with acquired physical disabilities: group differences on demographic, disability, and Health Action Process Approach constructs.

BACKGROUND: Despite numerous physical, social, and mental health benefits of engaging in moderate and vigorous intensity physical activities (e.g., sport), few individuals with acquired physical disabilities currently participate in adapted sport. Theory-based sport promotion interventions are one possible way to increase the amount of individuals who engage in sport. OBJECTIVES: The primary objective of this study was to examine the profiles of three different sport participation groups with respect to demographic, injury, and Health Action Process Approach (HAPA) constructs. METHODS: ANOVAs and Chi-square tests were used to determine group differences on demographic and disability-related constructs. A MANCOVA was conducted to determine differences between three sport participation groups (non-intenders, intenders, and actors) with age, years post-injury, mode of mobility, and sex included as covariates. RESULTS: A cohort of 201 individuals was recruited; 56 (27.9%) were non-intenders, 21 (10.4%) were intenders, and 124 (61.7%) were actors. The MANCOVA revealed significant differences between groups on the HAPA constructs, F(22,370) = 9.02, p < .0001, Pillai's trace = .70, demonstrating that individuals with acquired physical disabilities will rate important health behavior constructs differently based on their sport intentions. CONCLUSION: These results provide an important framework that adapted sport organizations can use to tailor their sport promotion programs.

Narrative environments and the capacity of disability narratives to motivate leisure-time physical activity among individuals with spinal cord injury.

PURPOSE: Few individuals with spinal cord injury (SCI) engage in the recommended amount of leisure time physical activity (LTPA). Yet little is known about how, and why, active individuals engage in specific types of LTPA. This study explored how a unique narrative environment and disability narratives motivated individuals with SCI to engage in LTPA. METHOD: Fourteen individuals with SCI from a physical activity program participated in approximately hour-long interviews. Interviews were then subjected to a narrative analysis. RESULTS: Individuals who used a restitution narrative (n = 6) were motivated to engage in functional LTPA because of the desire to maintain the body and restore the past self. The individual who used the chaos narrative (n = 1) preferred solitary LTPA as exposure to others with SCI was a constant reminder of the lost, pre-injury self. Individuals who used a quest narrative (n = 7) explored LTPA options that fit with their interests; these individuals were open to new types of LTPA, such as sport and outdoor recreation. CONCLUSION: The plot of three disability narratives can all motivate the pursuit of LTPA; however, not all types of LTPA are seen as equal. LTPA interventions can be enhanced through the lessons learned from this unique type of environment. IMPLICATIONS FOR REHABILITATION: Despite individuals' views about their disability, they can still be motivated to engage in routine LTPA. Different theoretical determinants, such as health or social benefits, hold different relevance for LTPA among individuals with differing disability narratives. The environment provided by practitioners can therefore elicit some stories of SCI while stifling others. Open narrative environment will attract individuals to listen and maintain involvement in LTPA.

Identifying physical activity information needs and preferred methods of delivery of people with multiple sclerosis.

PURPOSE: The purpose of this study was to examine the preferred sources and methods for acquiring physical activity information of individuals with multiple sclerosis (MS) using the Comprehensive Model of Information Seeking. A secondary objective was to explore the barriers and facilitators to physical activity information seeking. METHODS: Twenty-one participants diagnosed with MS participated in focus groups or telephone interviews. RESULTS: A direct content analysis of the transcripts revealed that individuals appeared to generally prefer receiving physical activity information during period of relapse and remission. Participants also had positive beliefs toward physical activity and a clear preference for a time when physical activity messages would be relevant. Receiving physical activity information from credible sources such as the MS Society of Canada, healthcare professionals and peers with MS was also deemed important. The Internet was a preferred source to receive information due to its accessibility, but it often was considered to lack credibility. The lack of physical activity information specific to MS is the greatest barrier for individuals with MS to learn about physical activity. CONCLUSIONS: Healthcare professionals, National MS Societies, and peers should work together to deliver specific and relevant physical activity messages the MS population. IMPLICATIONS FOR REHABILITATION: People with MS want more physical activity information from credible sources. Multiple vehicles of physical activity information delivery (i.e. healthcare providers, peers, MS Society) should be utilized. Physical activity information should be tailored to the individual with MS.

Evidence-informed recommendations for constructing and disseminating messages supplementing the new Canadian Physical Activity Guidelines.

BACKGROUND: Few validated guidelines exist for developing messages in health promotion practice. In clinical practice, the Appraisal of Guidelines, Research, and Evaluation II (AGREE II) Instrument is the international gold standard for guideline assessment, development, and reporting. In a case study format, this paper describes the application of the AGREE II principles to guide the development of health promotion guidelines for constructing messages to supplement the new Canadian Physical Activity Guidelines (CPAG) released in 2011. METHODS: The AGREE II items were modified to suit the objectives of developing messages that (1) clarify key components of the new CPAG and (2) motivate Canadians to meet the CPAG. The adapted AGREE II Instrument was used as a systematic guide for the recommendation development process. Over a two-day meeting, five workgroups (one for each CPAG - child, youth, adult, older adult - and one overarching group) of five to six experts (including behavior change, messaging, and exercise physiology researchers, key stakeholders, and end users) reviewed and discussed evidence for creating and targeting messages to supplement the new CPAG. Recommendations were summarized and reviewed by workgroup experts. The recommendations were pilot tested among end users and then finalized by the workgroup. RESULTS: The AGREE II was a useful tool in guiding the development of evidence-based specific recommendations for constructing and disseminating messages that supplement and increase awareness of the new CPAG (child, youth, adults, and older adults). The process also led to the development of sample messages and provision of a rationale alongside the recommendations. CONCLUSIONS: To our knowledge, these are the first set of evidence-informed recommendations for constructing and disseminating messages supplementing physical activity guidelines. This project also represents the first application of international standards for guideline development (i.e., AGREE II) to the creation of practical recommendations specifically aimed to inform health promotion and public health practice. The messaging recommendations have the potential to increase the public health impact of evidence-based guidelines.

Factors that influence physical activity in long-term care: perspectives of residents, staff, and significant others.

Physical activity has been linked to positive health outcomes for frail seniors. However, our understanding of factors that influence the physical activity of residents in the long-term care (LTC) setting is limited. This article describes our work with focus groups, one component of a multi-component study that examined factors influencing the physical activity of LTC residents. Residents, significant others, and staff from nine LTC facilities participated in these focus groups. Analysis of group discussions revealed three themes reflecting factors that mitigate the provision of physical activity: (a) inadequate support for physical activity, (b) pervasive institutional routines, and (c) physical environment constraints. All participants considered physical activity important to health preservation. Individual, structural, and environmental factors affected the quantity and quality of physical activity accessed by residents. These findings confirm the need to develop practical strategies and ways to address modifiable barriers and embed physical activity into LTC systems of care.

Driving poststroke: problem identification, assessment use, and interventions offered by canadian occupational therapists.

BACKGROUND AND PURPOSE: Driving is a key factor in maintaining autonomy and participation in life. Occupational therapists (OTs) are expected to assess individuals who want to resume driving post stroke and to provide retraining where appropriate. Research from the 1980s and 1990s indicated that patients were, for the most part, not being assessed and retrained. However, little is known about current practice management. Thus, this study examined clinicians' management of driving-related issues when treating clients with stroke. METHODS: We performed a Canadawide telephone survey of 480 OTs providing stroke rehabilitation in both inpatient rehabilitation and community-based settings. Clinicians reported on problems they noted and assessments and interventions they would provide for a "typical patient" described in a vignette that matched their work setting. RESULTS: 20% and 34% of clinicians responding to the inpatient rehabilitation and community-based vignettes, respectively, identified return to driving as a problem. Clinician and work environment variables significantly associated (P < .01) with identifying driving as a potential problem included being male, involvement in university teaching, research conducted in setting, and hosting student placements. The use of driving-specific assessments was under 12%. Less than 6% of clinicians offered driving retraining, and their desired use of retraining was low. CONCLUSION: Few clinicians identified driving as a problem post stoke, raising concern that patients attempt to drive on their own or never resume driving because of a lack of attention to driving during their rehabilitation. Poststroke driver assessment and retraining is a critical component of poststroke community reintegration that requires greater awareness by clinicians.

The risk of motor vehicle crashes and traffic citations post stroke: a structured review.

BACKGROUND: Stroke impacts the domains known to be important for driving and is a primary condition for driving evaluation referrals. Given the high prevalence of stroke, the objective was to summarize the evidence regarding risk of crashes and traffic citations post stroke. METHODS: A structured review of six databases was conducted to retrieve studies that included stroke as a separate exposure from other disorders and measured crashes or traffic citations as an outcome. RESULTS: Four cohort and three case-control studies met the inclusion criteria. Five of the seven studies found increased odds or risk ratios ranging from 1.9 to 7.7, while two found an association of 0.8. Only one result was statistically significant (RR=2.7). One study examined the outcome traffic citations and found no significant association. CONCLUSION: There is cause for concern regarding increased risk of crashes post stroke. Future studies that examine the impact of stroke severity and sequelae will help health professionals, families, and those with stroke make informed decisions regarding driving post stroke. This review indicates that drivers with stroke have an increased risk of crashing compared to their counterparts without stroke, as demonstrated by increased risk estimates in five out of the seven studies that have examined this issue. This review also points to an urgent need for rigorous studies investigating the risk of crashes according to specific stroke sequelae: an understanding of crash risk based on stroke severity, impairments, and function will assist clinicians in making informed decisions regarding the need for comprehensive driving evaluation and the potential for driver retraining for specific subgroups.

Patient factors associated with return to driving poststroke: findings from a multicenter cohort study.

OBJECTIVE: To estimate the extent to which body structure, function, activity, and context explain driving resumption at 1 year. DESIGN: Cohort study with relationships modeled in a path analysis. SETTING: Three urban Canadian communities. PARTICIPANTS: Patients admitted to hospital with acute stroke who had driven before their stroke (n=290) who participated in a longitudinal study of stroke outcomes. MAIN OUTCOME MEASURES: Driving resumption 1 year after the initial stroke diagnosis. RESULTS: One hundred seventy-seven patients (61%) returned to driving after 1 year. Direct relationships were found between measures of strength and motor activity (Stroke Impact Scale), cognition (Mini-Mental State Examination), type of stroke (hemorrhagic vs ischemic), and driving resumption at 1 year. The effects of stroke severity, fatigue, and sex on driving resumption were mediated through strength and motor activity shown by a model that had excellent fit (comparative fit index=.985, Tucker-Lewis Index=.952, root mean square error of approximation=.046). CONCLUSIONS: There are multiple direct and indirect influences on driving resumption at 1 year, from the type of stroke, physical strength and motor activity, cognition, sex, and fatigue measured at 3 months. The paths outlined by this model highlight how stroke sequelae influence community mobility, as well as factors related to driving resumption that are amenable to intervention.