Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2017 Exercise Adherence Among Active Working Women Roxane Evonne Hearn Walden University Follow this and additional works at: https://scholarworks.edu/dissertations Part of the Medicine and Health Sciences Commons, and the Psychology Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact ScholarWorks@waldenu. Walden University College of Social and Behavioral Sciences This is to certify that the doctoral dissertation by Roxane Hearn has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made.
Review Committee Dr. Amy Sickel, Committee Chairperson, Psychology Faculty Dr. William Disch, Committee Member, Psychology Faculty Dr. Rachel Piferi, University Reviewer, Psychology Faculty Chief Academic Officer Eric Riedel, Ph.
Walden University 2017 Abstract Exercise Adherence Among Active Working Women by Roxane E. Hearn MHA, University of Phoenix, 2006 BS, Seton Hall University, 1994 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Health Psychology Walden University May 2017 Abstract Low levels of exercise adherence has contributed to the increased prevalence of heart disease, cancer, and diabetes in American women. These low levels, coupled with high exercise program dropout rates, point to a need for strategies to increase exercise frequency in women who exercise, but not enough to improve their health and reduce risks. Real-time interventions, such as text messaging, could be useful in improving the cognitions that regulate adherence.
Using a snowball sampling strategy, a cross-sectional sample of working women (N =130), ages 18-64, in the volitional stage of exercise behavior, completed a 60-item survey on exercise behavior. Social Cognitive Theory SCT and the Health Action Process Approach HAPA served as the guiding theories to test the first hypothesis that the mean strength of maintenance-self efficacy, action and coping planning skills, and limitation of real-life demands between women who adhered to exercise frequency recommendations and women who did not, would differ. Findings from an independent t test revealed significant differences in each of the variables of interest between adherers and nonadherers. A Pearson correlation test of the second hypothesis, which was guided by the SCT and the Technology Acceptance Model, revealed a significant positive relationship between the perceived usefulness of texting and the limitation of real-life demands reported by participants.
This study highlights a need for further research into these differences so interventions can be more effectively aimed at addressing the factors that most affect an active working woman’s ability to maintain adequate exercise frequency levels. Doing so could improve their quality of life, reduce mortality rates, and the societal burden of healthcare costs. Exercise Adherence Among Active Working Women by Roxane E. Hearn MHA, Walden University, 2006 BS, Seton Hall University, 1998 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Health Psychology Walden University May 2017 Dedication I dedicate every second spent researching and writing, and every tear of joy and frustration to my pride and joy.
My daughter Nevaeh Nicole. She sacrificed a great amount of her childhood years watching me spend countless hours working to achieve what at times felt like an unattainable goal. Despite her inability to understand the magnitude of this undertaking, she was untiring in her support, self-less with her patience and loving during every rewarding and painful step of this journey. Acknowledgements First and foremost I thank God for giving me the ability, patience and work ethic to complete such a monumental task.
I will be forever grateful and indebted to my mother, Mary Hearn, for going above and beyond what would ever be expected of a parent. She was sacrificial with her time and helped to fill in the many gaps where my daughter would have been robbed of precious childhood memories due to my limited time. She, my father Joe, and my brother Wesley were unwavering in their financial and emotional support in helping me to navigate the many twists, turns and detours that threatened the successful completion of this degree. I am blessed beyond measure to have such a supportive family.
I would have never completed this journey without the patience, understanding and unrelenting support given by my dissertation chair Dr. Her calming, yet practical advice helped to keep me level headed during times of panic, and her consistent words of hope and encouragement kept me going when I wanted to throw in the towel. I also appreciated the countless resources provided to support not only my research and writing efforts, but my overall health and well-being. My other invaluable committee member, methods guru, and lover of health statistics, Dr.
William Disch, also played a key role in ensuring I did not trade in my dreams of attaining a PhD, for an ABD. His obsessive attention to detail, expansive knowledge base, contagious optimism and enduring belief in me were priceless! I am grateful to the both of them for always believing in me, and never giving up hope. Table of Contents List of Tables. vi List of Figures .vii Chapter 1: Introduction to the Study.
4 Disproportionate Body Weight and Exercise Adherence in Women .5 Poor Health Outcomes .6 Health Benefits of Exercise Adherence .6 Purpose of the Study. 8 Quantitative Research Questions, Hypotheses and Measurement. 10 Nature of the Study. 13 Definition of Key Terms.
16 Scope and Delimitations. 20 Chapter 2: Literature Review. 22 i Purpose of Study. 22 Organization of the Chapter.
23 Literature Search Strategy. 26 Social Cognitive Theory. 36 Technology Acceptance Model (TAM). 42 The Self-Regulation of Exercise Adherence.
51 Barrier Perception & Barrier Limitations. 63 The Role of Text Messaging. 63 Feasibility, Acceptability and Efficacy in Healthcare. 64 Utility and Efficacy in Exercise Interventions.
67 Review of Quantitative Methodology. 70 Web-Based Surveys. 73 Final Summary and Conclusions. 74 Chapter 3: Research Design.
77 ii Research Design and Rationale. 78 Quantitative Research Questions. 84 Statistical Power and Sample Size. 85 Recruitment, Participation Procedures and Data Collection.
88 Protection of Data. 90 Measures and Materials. 103 Threats to Validity. 105 Threats to Statistical Conclusions.
109 Research Questions and Hypotheses. 109 iii Data Collection. 111 Preliminary Data Analyses. 123 Summary of Findings.
127 Interpretation of Findings. 128 Limitations of the Study. 136 Implications for Social Change. 143 Appendix A: Recruitment Flyer.
189 Appendix B: Script for Recruiters. 191 Appendix C: Intro to Study & Informed Consent. 193 Appendix D: Participant Eligibility Questions. 195 Appendix E: Survey Exit Pages.
196 Appendix F: Participant Demographics Questions. 197 Appendix G: Maintenance Self-Efficacy for Exercise Measure. 199 iv Appendix H: Action Planning and Coping Planning for Physical Exercise. 200 Appendix I: Limitations of Real Life Demands Measure.
202 Appendix J: Exercise Adherence Measure. 205 Appendix K: TAM Measure. 206 v List of Tables Table 1. Summary of Measurement Instruments by Variables of Interest.
Frequencies and Percentages for Demographic Descriptors…………………. Frequencies and Percentages for Demographic Descriptors …………………118 Table 4. Central Tendency, Standard Deviation, Skewness, Kurtosis, and Reliability…………………………………………………………………………. Levene’s Test for the Equality of Variances………………………………….
Mean Scores, Standard Deviations & Confidence Intervals for Low, Moderate, and Vigorous Exercisers………………………………………………………………………………. One-Way Analysis of Variance (ANOVA) for Low, Moderate, and Vigorous Exercisers………………………………………………………………………………. Correlations Between Perceived Usefulness of Texting and Maintenance Self- Efficacy, Action-Planning Skills, Coping Planning Skills, Limitation of Real-life Demands and Exercise Frequency……………………………………………….130 vi List of Figures Figure 1. Overview of the Social Cognitive Theory.
Health Action Process Approach. System Self-Efficacy and the Technology Acceptance Model. Role of Self-Efficacy and the Psychosocial Behavior Change. Research Model for the Current Study.
Health Action Process Approach. Conceptual Model for Technology Acceptance. Normal Probability Plot for MSE Scores. Normal Probability Plot for Action Planning Scores.
Normal Probability Plot for Coping Planning Skills Scores………. Normal Probability Plot for Limitation of Real-life Demand Scores. Normal Probability Plot for Perceived Usefulness of Texting Scores…….118 vii 1 Chapter 1: Introduction to the Study Introduction In the United States, more than 62% of adults over age 20 are overweight or obese (Schiller, Lucas, Ward, & Peregoy, 2012). The excessive levels of unhealthy weight are largely attributed to the dangerously low levels of exercise adherence.
Only an estimated 20% of adults over age 20 meet the recommended guidelines for aerobic and muscle- strengthening activities (National Center for Health Statistics [NCHS], 2016; Schiller et al. Low levels of exercise adherence are a problem for society due to its correlation with the increase in heart disease, type 2 diabetes, arthritis, hypertension, breathing problems, certain cancers and other comorbid diseases that are largely preventable (Baer et al., 2011; Danaei et al. Department of Health and Human Services (DHHS), 2008; WHO, 2010). The onset of these conditions is not only more frequent, but also diagnosed prematurely for most Americans.
As a result, health care costs are skyrocketing as evidenced in the 50% increase in health-related expenditures during 2000-2011 (NCHS, 2013). More specifically, women have a higher incidence of mortality from heart disease, stroke, and Alzheimer’s disease; moreover, they have higher occurrences of arthritis, depression, and are significantly less physically active (Blackwell, Lucas, Clarke, 2014; Eyler et al., 2003; Iwasaki, MacKay, & Mactavish, 2005). The numerous roles women must fulfill leave little time for self-care (Gilligan, 1982; Henderson, & Allen, 1991; Hendry et al. This neglect has partially contributed to the conditions listed above and to the low levels of exercise adherence (Brittain, Dinger, Classen, Sage, & Han, 2012; King, Castro, Wilcox, 2 Eyler, Sallis, & Brownson, 2000).
Developing and implementing low-cost, practical interventions to help women adopt and maintain the recommended amount of exercise, while upholding their many roles may help reverse reduce mortality rates, improve the quality of life, and ultimately reduce healthcare costs for these working women and men. The subsequent sections will discuss the gap in literature and the problem addressed by the study will address. The next section will cover the focus of the study, research questions and hypotheses, theoretical foundation, research design, operational definitions, assumptions, scope and delimitations and limitations. Lastly, discussion of the significance of the study to positive social change will emphasize the underlying principles that fueled the need for the study (Annesi, 2004, Brittain, Dinger, Classen, Sage, & Han, 2012).
Background There have been decades of research and evidence of the psychological factors that motivate people to engage in healthy behaviors, such as exercise, in the preintention phase of behavior change. However, interest and investigation into the postintention volitional phase is not as abundant (Conner & Norman, 2005; Rothman 2000) and research exploring this phase has not translated into effective interventions. Given the success of research employing appropriate theory and health behavior models as a guide, many argue the need for theoretical grounded-behavior change techniques to yield effective results (Annesi & Whitaker, 2010; Michie & Johnston, 2012). Since there appears to have been less attention given to the postintention volitional phase of heath behavior, there may have been a wide spread notion that the factors that play a role in the 3 postintention motivational phase mirror those in the postintention volitional phase of behavior maintenance.
This assumption has been difficult to uphold (Rothman, 2000). Recent investigation indicates the factors that motivate individuals to initiate exercise behavior, do not necessarily facilitate a sustainable exercise behavior change into the postintention volitional phase of behavior maintenance (Connor 2008; Rothman, 2000; Schwarzer, 2008a; Schwarzer & Luszczynska, 2008). Evidence suggests exercise adherence in women is difficult due to self-regulatory deficits in maintenance self- efficacy, action planning, coping planning, along with the perception real-life demands as barriers (Annesi, 2004; Bandura, 1977,1991; Barg et al., 2012; Gollwitzer, 1996; Hendry et al.