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Personality traits, perceived barriers, and self-determined motivation with respect to exercise behaviour in patients with type 2 diabetes mellitus
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Type
Thesis
Author
Kang, Heon Jin
Supervisor
Wang, John Chee Keng
Burns, Stephen F.
Abstract
Regular exercise has shown optimal outcomes for helping to manage type 2 diabetes mellitus (T2DM). However, many reports have indicated that patients with T2DM engage in less than the recommended volume of exercise (Krug, Haire-Joshu, & Heady, 1991; Morrato, Hill, Wyatt, Ghushchyan, & Sullivan, 2003). In response, researchers have explored and identified barriers specific to exercise in individuals with T2DM and distinguished them from the exercise barriers reported by healthy counterparts. Individuals with T2DM undertake many self-care responsibilities in order to achieve optimum glycaemic control every day. However, the difficulties of the daily task can exhaust these individuals and affect their adherence to regular exercise. In addition, T2DM is an illness that typically onsets in adulthood, generally appearing above the age of 40 with the majority of patients being diagnosed between the ages of 45 and 64 years old (Wild, Roglic, Green, Sicree, & King, 2004). This could result in T2DM patients having to exert more during exercise as a consequence of aging. Therefore, it is important to identify and recognize their perceived barriers to exercise as an initial step in diabetes self-care management (Booth, Lowis, Dean, Hunter, & McKinley, 2013; Chlebowy, Hood, & LaJoie, 2010).
Besides needing to examine patients’ exercise barriers and exercise behaviour in patients with T2DM, this study also focused on two important determinants of behavioural outcomes- motivation and personality traits. Motivation is a well-known antecedent to exercise behaviour, and is a kind of impetus or inspiration to human behaviour (Ryan & Deci, 2000). Personality traits are found to be important antecedents of exercise behaviours, and were employed in this thesis to explore how individual differences relate to exercise behaviour. Using self-determination theory (SDT, Deci & Ryan, 1985; Ryan & Deci, 2000) as the framework, together with the motivational sequence model (Vallerand & Losier, 1999) and its usage on Alexandris’s constraint model (2002), this thesis constructed the proposed theoretical framework. In order to fully predict the health behavioural outcomes with other variables, personality traits were added as a distal predictor.
Before examining the relationships between personality traits, perceived barriers to exercise, and self- determined motivation with regard to exercise behaviour in the T2DM population using self-reported measures, proper measurements that can be employed were first determined. It was found that while there are valid and reliable scales for personality traits and self-determined motivation (e.g. the mini-international personality item pool; the behavioural regulation in exercise questionnaire), there are still limited scales in exercise barriers, as shown in the literature review.
Hence, Study 1 looked at the development of a new exercise barrier scale for the T2DM population. This scale consisted of a number of factors coupled with multiple items that have been validated by both T2DM and the general population. Three stages were conducted for the development of this questionnaire and they are, i) items and scale generation and justification, ii) reliability test by exploratory factor analysis, and iii) validation test by confirmatory factor analysis. Conclusively, a 10-factor model with 44 items was formulated. These ten factors, in which three to seven items were retained each, are willpower, dislike, misconception, support, health, knowledge, environment, tiredness, time, and finance.
With the developed exercise barriers scale, Study 2 employed a cross-sectional design to examine the correlations among personality traits, perceived barriers, self-determined motivation, and volume of exercise in patients with T2DM. The findings demonstrated that exercise barriers had significant negative prediction towards exercise and self-determined motivation. Specifically, the health and willpower barriers showed significant negative correlation to the volume of exercise. Likewise, dislike, misconception, and health barriers negatively correlated with self-determined motivation. On the other hand, personality traits and consciousness showed significant positive prediction of exercise behaviour. However, when perceived barriers were added, there was no significant prediction of exercise barrier. This was similar to self-determined motivation, who also showed no significant prediction despite having a strong correlation with some of the barriers (i.e., lack of willpower, dislike, and misconception). This could give rise to an indirect effect of self- determined motivation on exercise behaviour through barriers.
To further understand the proposed model in Study 2, especially on the relationship among barriers, self-determined motivation and exercise behaviour, Study 3 explored the relationship through two levels of motivation using both qualitative and quantitative design methods. Study 3 found that patients with higher self-determined motivation were better at managing their perceived exercise barriers, while patients with lower self- determined motivation were greatly affected by a variety of exercise barriers. In addition, willpower and dislike barriers to exercise were only shown in patients with lower self-determined motivation. Health and time barrier were cited as an influential barrier to exercise regardless of motivation levels. Negative body image was emerged as a new perceived exercise barrier. The finding of the new barrier theme suggested the consideration for future research to refine the PEBS.
In summary, through the development of a fixed exercise barriers measurement, determining the impact of these barriers on exercise, and understanding exercise perception of T2DM patients through structured interviews based on the new exercise barrier scale, this thesis has shed some light on the relationships of personality traits and motivation with exercise behaviour in the T2DM population. Future intervention research would centre on enhancement of self-determined motivation concerning with perceived exercise barriers in individuals with T2DM.
Besides needing to examine patients’ exercise barriers and exercise behaviour in patients with T2DM, this study also focused on two important determinants of behavioural outcomes- motivation and personality traits. Motivation is a well-known antecedent to exercise behaviour, and is a kind of impetus or inspiration to human behaviour (Ryan & Deci, 2000). Personality traits are found to be important antecedents of exercise behaviours, and were employed in this thesis to explore how individual differences relate to exercise behaviour. Using self-determination theory (SDT, Deci & Ryan, 1985; Ryan & Deci, 2000) as the framework, together with the motivational sequence model (Vallerand & Losier, 1999) and its usage on Alexandris’s constraint model (2002), this thesis constructed the proposed theoretical framework. In order to fully predict the health behavioural outcomes with other variables, personality traits were added as a distal predictor.
Before examining the relationships between personality traits, perceived barriers to exercise, and self- determined motivation with regard to exercise behaviour in the T2DM population using self-reported measures, proper measurements that can be employed were first determined. It was found that while there are valid and reliable scales for personality traits and self-determined motivation (e.g. the mini-international personality item pool; the behavioural regulation in exercise questionnaire), there are still limited scales in exercise barriers, as shown in the literature review.
Hence, Study 1 looked at the development of a new exercise barrier scale for the T2DM population. This scale consisted of a number of factors coupled with multiple items that have been validated by both T2DM and the general population. Three stages were conducted for the development of this questionnaire and they are, i) items and scale generation and justification, ii) reliability test by exploratory factor analysis, and iii) validation test by confirmatory factor analysis. Conclusively, a 10-factor model with 44 items was formulated. These ten factors, in which three to seven items were retained each, are willpower, dislike, misconception, support, health, knowledge, environment, tiredness, time, and finance.
With the developed exercise barriers scale, Study 2 employed a cross-sectional design to examine the correlations among personality traits, perceived barriers, self-determined motivation, and volume of exercise in patients with T2DM. The findings demonstrated that exercise barriers had significant negative prediction towards exercise and self-determined motivation. Specifically, the health and willpower barriers showed significant negative correlation to the volume of exercise. Likewise, dislike, misconception, and health barriers negatively correlated with self-determined motivation. On the other hand, personality traits and consciousness showed significant positive prediction of exercise behaviour. However, when perceived barriers were added, there was no significant prediction of exercise barrier. This was similar to self-determined motivation, who also showed no significant prediction despite having a strong correlation with some of the barriers (i.e., lack of willpower, dislike, and misconception). This could give rise to an indirect effect of self- determined motivation on exercise behaviour through barriers.
To further understand the proposed model in Study 2, especially on the relationship among barriers, self-determined motivation and exercise behaviour, Study 3 explored the relationship through two levels of motivation using both qualitative and quantitative design methods. Study 3 found that patients with higher self-determined motivation were better at managing their perceived exercise barriers, while patients with lower self- determined motivation were greatly affected by a variety of exercise barriers. In addition, willpower and dislike barriers to exercise were only shown in patients with lower self-determined motivation. Health and time barrier were cited as an influential barrier to exercise regardless of motivation levels. Negative body image was emerged as a new perceived exercise barrier. The finding of the new barrier theme suggested the consideration for future research to refine the PEBS.
In summary, through the development of a fixed exercise barriers measurement, determining the impact of these barriers on exercise, and understanding exercise perception of T2DM patients through structured interviews based on the new exercise barrier scale, this thesis has shed some light on the relationships of personality traits and motivation with exercise behaviour in the T2DM population. Future intervention research would centre on enhancement of self-determined motivation concerning with perceived exercise barriers in individuals with T2DM.
Date Issued
2018
Call Number
RC661.E94 Kan
Date Submitted
2018