Revision of the Barriers to Self-Care Scale Physical Activity ... - IUPUI

Revision of the Barriers
to Self-Care Scale
Physical Activity
Subscale
Deborah Erickson Ph.D., R.N.
July 15, 2010
1

Facts About Diabetes
• 23.6 million people in U.S.
• Complications include heart disease, stroke,
HTN, blindness, kidney disease, nervous
system disease, & dental diseases
• Economic impact in 2007:
• $116 billion in direct health care costs
• $58 billion from lost productivity
2

Diabetes Self-management
• Dietary management
• Exercise/physical activity
• Self blood glucose monitoring
• Medications
3

Benefits of Physical Activity
• Improved glycemic control by
• increasing action of insulin
• Increasing uptake of insulin by muscle
• Decreased risk for cardiovascular
disease
• Loss of body fat
• Increased physical fitness
• Enhanced psychological well-being
4

Exercise & Diabetes
• People with diabetes reported least likely to
follow recommendations for lifestyle changes
such as diet and exercise (Ruggiero et al,
1997)
• Exercise significantly reduces HbA 1c (Boulé
et al., 2001; Castaneda et al., 2002;
Goldhaber-Fiebert et al., 2003; Di Loreto et al.,
2003)
5

Worksite Diabetes
Management Program (WDMP)
• Reduce absenteeism, increase employee
retention, reduce health care costs, and
increase employee satisfaction
• Voluntary
• Choose area of self-management
• Theoretical framework: transtheoretical
model of change (TTM)
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Theoretical Framework:
Transtheoretical Model of
Change
Stages of Change
• Precontemplation: has no intention to change
behavior in foreseeable future
• Contemplation: is aware that a problem exists &
considers making change in future
• Preparation: intends to take action within next
month & is making small changes
• Action: changes behavior
• Maintenance: continues with the changes made
over a period of time
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The Study
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Hypothesis
Barriers to physical activity will be
greater for individuals in the early
stages of physical activity adoption as
compared with individuals in the later
stages of adoption.
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Design, Sample & Setting
• Descriptive, cross-section, correlation research
design
• People with type 2 diabetes who were
participants in a WDMP offered by a
manufacturing company in the Midwestern U.S.
• Convenience sample of 600 people who met
the inclusion criteria
• Inclusion criteria: at least 18 years old, with type
2 DM, enrolled in the WDMP for > 3 months,
and able to participate in physical activity.
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Procedures
• Letters introducing study sent to participants
from WDMP office
• Study materials sent to those indicating
interest in participating
• Returning response form and completed
questionnaires implied consent
• Approval from Rush University IRB and
Bradley University CUHSR
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Instruments
1. Demographic Questionnaire
2. Physical Activity Staging Algorithm
• 4 item instrument
• Definition of physical activity: accumulation of
180 minutes of moderate intensity physical
activity per week…it causes you to break into
a sweat and/or increases your breathing rate
3. Barriers to Self-Care Scale Physical Activity
Subscale (BSCS PAS)
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Instruments
Barriers to Self-Care Scale Physical Activity
Subscale (BSCS PAS)
• Original subscale contained 8 items
• Literature review results
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Scale
Revision
Process
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Barriers Identified in
Literature Review
• Inconvenient (#1)
• Not important (#3)
• Equipment needs (#4 & #8)
• Too busy/not enough time (#6)
• Other health problems (#7)
• Lazy/not ready to change (pre-contemplative
stage of change)
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Barriers Identified in
Literature Review, cont.
• No one to exercise with (#9)
• No family support (#10)
• Too overweight (#11)
• Changes in DM management (#12)
• No good place / no safe place (#13)
• Boring/don’t like to exercise (#14)
• It hurts/discomfort (#15)
• I can’t do it (#16)
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Content Validity
• The degree to which the items in an
instrument adequately represent/measure the
content for the concept being measured
• Utilize scale to determine relevance of item
(Waltz, Strickland, & Lenz, 1991)
• (1) not relevant
• (2) somewhat relevant
• (3) quite relevant
• (4) very relevant
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Content Validity Index (CVI)
• CVI equals the proportion of items given a
rating of 3 or 4 by the judges
• If all items are rated a 3 or 4 by both raters,
the CVI = 1.0
• If half of the items are jointly rated as 1 or 2,
and the other half are jointly classified as 3 or
4, the CVI = 0.50. This is an unacceptable
level of content validity
• CVI of .80 or greater is considered a good
content validity (Polit & Beck, 2004)
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CVI of Proposed Barriers to
Physical Activity Subscale
Judge 1
Judge 2
1 or 2 not/
somewhat
relevant
3 or 4 quite/
very relevant
Total
1 or 2 not/
somewhat
relevant
3 or 4 quite/
very relevant
Total
1 0 1
7 8 15
8
8 16
CVI (15/16)
= 0.93
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Findings
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Sample Characteristics
• 75/600 (12.5%) participants returned study
materials that were used for analysis
• Male (77.3%)
• Caucasian (90.7%)
• Age 45-69
• Mean BMI 34.31
• Some college education/degree (84%)
• Employed/retired from management (50.6%)
• Length of program participation
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Stage of Change
for Physical Activity
Stage of Change for Physical Activity
• Precontemplation 7 9.3%
• Contemplation 3 4.0%
• Preparation 22 29.3%
• Action 9 12.0%
• Maintenance: 34 45.3%
43 (56.3%) participants physically active
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Findings
Reliability
• Reliability is the consistency with which an
instrument measures the attribute it is
designed to measure (Polit & Beck, 2004)
• Value range between .00 and +1.00, with
higher values reflecting a higher internal
consistency (Polit & Beck, 2004)
• Cronbach’s alpha of the 16-item instrument
was .704
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Hypothesis
Findings
Participants who were physically active had
significantly lower mean barrier scores than
inactive participants (p

Findings
Barriers with highest means
• Item 12: “I think about how participating
in physical activity could change how I
manage my diabetes.” (M=2.99)
• Item 5: “I feel sore & stiff.” (M=2.76)
• Item 6: “I think about how much time it
takes to participate in physical activity.”
(M=2.76)
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Findings
Barriers with lowest means
• Item 10: “I am discouraged from
participating in physical activity by others.”
(M=1.17)
• Item 13: “I do not have a safe place to
participate in physical activity.” (M=1.24)
• Item 8: “I think about the cost of
necessary equipment or fees for
participating in physical activity.” (M=1.46)
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Limitations
• Two judges determined content validity
• Convenience sample
• Participants were primarily male, Caucasian,
management employees/retirees, & college
educated
• Self-report data
• Selection bias
• Cross-sectional design
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Conclusions
• Revised BSCS PAS is a brief, internally
consistent, self-report measure of barriers
that interfere with DM self-management.
– CVI of additional 8 items on the BSCS PAS was
0.93
– Internal consistency for the revised BSCS PAS
was .704
• Participants who were active had significantly
lower mean barrier scores than inactive
participants
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Future Research
• Utilize revised scale in future studies
• Possible translation into Spanish
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