Psychosocial mediators of change in physical activity in the Welsh national exercise referral scheme: secondary analysis of a randomised controlled trial.
Psychosocial mediators of change in physical activity in the Welsh national exercise referral scheme: secondary analysis of a randomised controlled trial.
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DOI：
10.1186/s12966-014-0109-9
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发表时间：
2014-08-27
期刊：
影响因子：
--
通讯作者：
Murphy S
中科院分区：
文献类型：
--
作者：
Littlecott HJ;Moore GF;Moore L;Murphy S
虽然越来越多的随机对照试验报告了运动转诊计划（ERS）对身体活动的影响，但很少有研究探究身体活动增加的产生机制。本研究考察威尔士的一项全国运动转诊计划（NERS）是否与自主动机、自我效能和社会支持的改善相关，以及身体活动的变化是否由这些心理社会过程的变化所介导。
在威尔士的12个地方卫生委员会（LHBs）进行的一项关于NERS的实用性随机对照试验。问卷在基线时测量了人口统计学数据和身体活动情况。患有抑郁症、焦虑症或冠心病（CHD）风险因素的参与者（N = 2160）由卫生专业人员转诊，并随机分配到对照组或干预组。在6个月时，通过问卷收集心理过程指标。在12个月时，通过7天身体活动记录（PAR）电话访谈评估身体活动。回归分析检验了干预对心理社会变量、在调整中介因素和社会人口统计学模式前后的身体活动的影响。
在6个月时，发现干预对运动的自主动机和社会支持有显著影响。未观察到对自我效能的干预影响。数据与自主动机对干预效果的部分中介作用这一假设相符。对调节因素的分析显示，所有亚组的相对自主性都有显著改善。在基线时活动最少的患者中，自主动机的改善最大。
本研究对运动转诊计划中的心理社会变化过程提供了关键见解，身体活动的影响由自主动机介导。研究结果支持将自我决定理论作为ERS的框架。需要进一步的研究来解释对ERS反应的社会人口统计学模式，因为所有参与者亚组的动机都发生了变化，但并不总是导致更高的依从性或行为改变。这凸显了社会生态学方法在开发和评估行为改变干预措施中的重要性，这种方法考虑个体之外的因素，包括动机改善会或不会产生行为改变的条件。
ISRCTN47680448
While an increasing number of randomised controlled trials report impacts of exercise referral schemes (ERS) on physical activity, few have investigated the mechanisms through which increases in physical activity are produced. This study examines whether a National Exercise Referral Scheme (NERS) in Wales is associated with improvements in autonomous motivation, self-efficacy and social support, and whether change in physical activity is mediated by change in these psychosocial processes. A pragmatic randomised controlled trial of NERS across 12 LHBs in Wales. Questionnaires measured demographic data and physical activity at baseline. Participants (N = 2160) with depression, anxiety or CHD risk factors were referred by health professionals and randomly assigned to control or intervention. At six months psychological process measures were collected by questionnaire. At 12 months physical activity was assessed by 7 Day PAR telephone interview. Regressions tested intervention effects on psychosocial variables, physical activity before and after adjusting for mediators and socio demographic patterning. Significant intervention effects were found for autonomous motivation and social support for exercise at 6 months. No intervention effect was observed for self-efficacy. The data are consistent with a hypothesis of partial mediation of the intervention effect by autonomous motivation. Analysis of moderators showed significant improvements in relative autonomy in all subgroups. The greatest improvements in autonomous motivation were observed among patients who were least active at baseline. The present study offered key insights into psychosocial processes of change in an exercise referral scheme, with effects on physical activity mediated by autonomous motivation. Findings support the use of self-determination theory as a framework for ERS. Further research is required to explain socio-demographic patterning in responses to ERS, with changes in motivation occurring among all sub-groups of participants, though not always leading to higher adherence or behavioural change. This highlights the importance of socio-ecological approaches to developing and evaluating behaviour change interventions, which consider factors beyond the individual, including conditions in which improved motivation does or does not produce behavioural change. ISRCTN47680448
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影响因子：
1.3
作者：
Moore, Graham;Raisanen, Lawrence;Murphy, Simon
通讯作者：
Murphy, Simon
影响因子：
7.6
作者：
BARON, RM;KENNY, DA
通讯作者：
KENNY, DA
影响因子：
4.2
作者：
Anderson, Eileen S.;Wojcik, Janet R.;Williams, David M.
通讯作者：
Williams, David M.
影响因子：
5
作者：
BLAIR, SN;HASKELL, WL;WOOD, PD
通讯作者：
WOOD, PD
影响因子：
5.2
作者：
Morgan, O
通讯作者：
Morgan, O