Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore.
Department of Psychology, National University of Singapore, Singapore, Singapore.
PLoS One. 2024 Mar 28;19(3):e0292442. doi: 10.1371/journal.pone.0292442. eCollection 2024.
Although the benefits of regular physical activity (PA) after stroke are well established, many stroke survivors do not achieve recommended PA levels. To date, studies exploring determinants to PA have not used a behaviour change theory and focused on stroke survivors with physical disabilities. As a precursor to an intervention development study, we aimed to use the Theoretical Domains Framework (TDF) to identify factors influencing PA in stroke survivors with physical disabilities in Singapore.
Between November 2021 and January 2022, we conducted interviews with 19 community-dwelling stroke survivors with a weak arm and/or leg. An interview guide based on the TDF was developed. We analysed the data deductively by coding interview transcripts into the theoretical domains of the TDF, and then inductively by generating themes and belief statements. To identify relevant TDF domains, we prioritised the domains based on the frequencies of the belief statements, presence of conflicting belief statements and evidence of strong belief statements.
Eight of the 14 TDF domains were relevant, and included environmental context and resources, knowledge, social influences, emotion, reinforcement, behavioural regulation, skills and beliefs about capabilities. The lack of access, suitable equipment and skilled help often limited PA participation at public fitness spaces such as parks, gyms and swimming pools (environmental context and resources). While a few stroke survivors expressed that they had the skills to engage in regular PA, most expressed not knowing how much and how hard to work, which exercises to do, which equipment to use and how to adapt exercises and equipment (knowledge and skills). This often left them feeling afraid to try new activities or venture out to new places for fear of the unknown or adverse events (e.g., falls) (emotion). For some, doing the activities in a group encourage them to get out and engage in PA (social influences).
In stroke survivors with physical disabilities, environmental context and resources had a significant influence on PA participation, and this often had a spill over effect into other domains. Our results inform a complex behaviour change intervention to improve PA after stroke, and has implications for intervention design for people with physical disabilities.
尽管有规律的身体活动（PA）对中风后康复有好处，但许多中风幸存者并未达到推荐的 PA 水平。迄今为止，探索 PA 决定因素的研究并未使用行为改变理论，并且侧重于身体残疾的中风幸存者。作为干预发展研究的前奏，我们旨在使用理论领域框架（TDF）来确定新加坡身体残疾的中风幸存者 PA 的影响因素。
2021 年 11 月至 2022 年 1 月，我们对 19 名居住在社区的上肢和/或下肢无力的中风幸存者进行了访谈。根据 TDF 制定了访谈指南。我们通过将访谈记录编码为 TDF 的理论领域，对数据进行了演绎分析，然后通过生成主题和信念陈述进行了归纳分析。为了确定相关的 TDF 领域，我们根据信念陈述的频率、存在冲突的信念陈述和强烈信念陈述的证据，对领域进行了优先级排序。
14 个 TDF 领域中有 8 个相关，包括环境背景和资源、知识、社会影响、情绪、强化、行为调节、技能和能力信念。缺乏进入公共健身场所（如公园、健身房和游泳池）的途径、缺乏合适的设备和熟练的帮助，经常限制了 PA 的参与（环境背景和资源）。虽然一些中风幸存者表示他们有能力进行定期 PA，但大多数人表示不知道要做多少和多努力，要做哪些锻炼，要使用哪些设备，以及如何调整锻炼和设备（知识和技能）。这使他们经常感到害怕尝试新的活动或冒险去新的地方，因为害怕未知或不良事件（例如跌倒）（情绪）。对于一些人来说，在小组中进行活动鼓励他们外出并参与 PA（社会影响）。
在身体残疾的中风幸存者中，环境背景和资源对 PA 的参与有重大影响，这通常会对其他领域产生溢出效应。我们的结果为改善中风后 PA 的复杂行为改变干预提供了信息，并对身体残疾者的干预设计具有启示意义。
