Caring Rehabilitation Climate, the Tripartite Efficacy Framework, and Adherence to Rehabilitation Programs Among Individuals With Parkinson's Disease: A Multiple Mediation Analysis.

BACKGROUND AND PURPOSE: Adherence to physical therapy (PT) and secondary prevention programs (SPPs) is particularly low for individuals with Parkinson's disease. Preliminary research has linked perceptions of caring climates as well as enhanced tripartite efficacy perceptions to adherence during rehabilitation programs. In light of such preliminary research, the purpose of this study was threefold: (1) to examine relationships between perceptions of a caring climate and the 3 efficacy constructs within the tripartite model, (2) to examine the relationship between the tripartite efficacy constructs and adherence to PT/SPP exercises, and (3) to determine whether tripartite efficacy beliefs mediated the relationship between caring climate perceptions and adherence. METHOD: A total of 77 individuals with Parkinson's disease who were currently or recently enrolled in PT or an SPP were recruited and surveyed about their perceptions of the caring climate of their rehabilitation clinic, their tripartite efficacy perceptions, and their adherence to rehabilitation. Correlations and a multiple mediation analysis were conducted to address the purposes of this study. RESULTS AND DISCUSSION: Results showed significant positive associations between all variables; however, all paths within the proposed mediation model were not significant. Specifically, the c paths linking the tripartite efficacy constructs with adherence were not significant. A follow-up analysis was undertaken to address potential suppression effects within the mediating variables, and this analysis revealed a statistically significant model with relation-inferred self-efficacy (RISE) as a sole mediator of the relationship between caring perceptions and adherence to rehabilitation. CONCLUSIONS: Several practical implications can be gleaned from the current study. First, practitioners should strive to enhance the caring climate of their clinic by employing techniques reported in previous literature, such as creating a supportive atmosphere, displaying benevolence, and paying attention. In addition, the results suggest that individuals' RISE perceptions, in particular, could be a viable target for enhancing adherence.

Caring Interactions in Secondary Prevention Programs: A Qualitative Inquiry of Individuals With Parkinson's Disease.

BACKGROUND AND PURPOSE: With Parkinson's disease (PD) prevalence rates steadily increasing and long-term adherence to regular physical activity and exercise often difficult to achieve, it is imperative to investigate factors promoting adherence to secondary prevention programs (SPP) that help limit the progression of motor and nonmotor signs and symptoms of the disease. Caring interactions between patients and their rehabilitation team may be particularly germane to individuals with PD, given the physical and psychosocial issues that often accompany this disease (eg, loss of physical function, depression, apathy, and cognitive impairments). Considering this reasoning, the purpose of the present study was twofold: (1) to gain a better understanding of the nature of caring in an SPP setting from a patient perspective and (2) to discover what implications, if any, caring has on relevant patient-centered behaviors such as effort and adherence to SPPs. METHOD: Ten individuals with PD were recruited. In-depth, qualitative interviews were performed using a semistructured interview guide. Inductive content analysis was used to identify themes representing participants' experiences of caring in the SPP setting. RESULTS AND DISCUSSION: Six themes emerged from the data analysis. The first 4 themes described how rehabilitation providers fostered caring in the SPP setting: showing interest, creating a supportive atmosphere, benevolence, and paying attention. Participants described instances when rehabilitation providers (physical therapy assistants, physical therapy students, and exercise specialists) showed interest by asking personal questions and remembering personal information. A supportive environment was facilitated by making participants feel supported, welcomed, and valued. Benevolence was apparent when rehabilitation providers demonstrated kindness and approached their work as "more than just a job." Finally, the importance of feeling that rehabilitation providers "paid attention" to patients by giving them undivided consideration and by aiding with exercises was emphasized. This latter finding is akin to Nodding's concept of "engrossment," a key component of caring, which may be an important issue in the face of increasing use of technological devices (eg, laptop computers and i-pads) that may unintentionally direct rehabilitation providers' attention away from their patients. The final 2 themes-rehabilitation attendance and rehabilitation effort-pertaining to aim 2 of the study, are novel in underscoring the importance of caring with respect to patient behaviors. CONCLUSIONS: Several practical implications can be gleaned from the current study including (but not limited to) remembering personal information about the patient, providing patients with undivided attention, providing support for patients, and making patients feel welcome. These findings underscore the importance of addressing affective skills in training future rehabilitation practitioners. Findings also reveal salient implications associated with caring, namely enhanced rehabilitation attendance and effort. Finally, results highlight the need to examine the generalizability of caring elements identified in the current study and to quantitatively assess caring antecedents and outcomes in SPP settings.