Harnessing motivational forces in the promotion of physical activity: the Community Health Advice by Telephone (CHAT) project.

Physical inactivity among middle- and older-aged adults is pervasive, and is linked with numerous chronic conditions that diminish health and functioning. Counselor-directed physical activity programs may enhance extrinsic motivation (reflected in social influence theories, such as self-presentation theory) and, in turn, physical activity adherence, while the counselor is in charge of program delivery. However, external influences can undermine intrinsic motivation, making it more difficult to maintain physical activity once counselor-initiated contact ends. In contrast, programs that diminish the socially evaluative and controlling aspects of the counseling interchange may promote intrinsic motivation (described in cognitive evaluation theory), and, thus, physical activity maintenance, even when counselor-initiated contact ceases. The objective of the Community Health Advice by Telephone (CHAT) project is to compare these two theories by conducting a randomized controlled trial evaluating the effects of a telephone-administered counseling program delivered by a person (social influence enhancement) or computer (cognitive evaluation enhancement) on physical activity adoption and maintenance over 18 months. Healthy, sedentary adults (n = 225) aged 55 years and older are randomized to one of these programs or to a control arm. This study will contribute to advancing motivational theory as well as provide information on the sustained effectiveness of interventions with substantial public health applicability.

[1]  K. Vranizan,et al.  Assessment of habitual physical activity by a seven-day recall in a community survey and controlled experiments. , 1985, American journal of epidemiology.

[2]  A. Kluger,et al.  Person- versus computer-mediated feedback , 1993 .

[3]  Floyd J. Fowler,et al.  Survey Research Methods , 1984 .

[4]  Roy F. Baumeister,et al.  Self-esteem and responses to success and failure: Subsequent performance and intrinsic motivation , 1985 .

[5]  L. Pearlin,et al.  The structure of coping. , 1978, Journal of health and social behavior.

[6]  J. Pynoos,et al.  A model telephone information and support program for caregivers of Alzheimer's patients. , 1990, The Gerontologist.

[7]  A. King,et al.  Predicting the Adoption and Maintenance of Exercise Participation Using Self-Efficacy and Previous Exercise Participation Rates , 1998, American journal of health promotion : AJHP.

[8]  L. L. Cummings,et al.  FEEDBACK AS AN INDIVIDUAL RESOURCE: PERSONAL STRATEGIES OF CREATING INFORMATION , 1983 .

[9]  R. Hutchinson.  Cost-Benefit and Cost-Effectiveness Analysis in Health Care: Principles, Practice, and Potential , 1983 .

[10]  B H Marcus,et al.  Assessing motivational readiness and decision making for exercise. , 1992, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[11]  Paul Resnik,et al.  The Influence of Self-Esteem on Cognitive Responses to Machine-Like versus Human-Like Computer Feedback , 1985 .

[12]  A. King,et al.  Long-term effects of varying intensities and formats of physical activity on participation rates, fitness, and lipoproteins in men and women aged 50 to 65 years. , 1995, Circulation.

[13]  E. M. Bertera,et al.  The cost-effectiveness of telephone vs clinic counseling for hypertensive patients: a pilot study. , 1981, American journal of public health.

[14]  M. Aigrain,et al.  The technological perspective , 1986, Future Gener. Comput. Syst..

[15]  D Markland,et al.  On the factorial and construct validity of the Intrinsic Motivation Inventory: conceptual and operational concerns. , 1997, Research quarterly for exercise and sport.

[16]  Charles S. Carver,et al.  The Self-Consciousness Scale: A revised version for use with general populations. , 1985 .

[17]  John E. Stollerman,et al.  A telecommunications system for monitoring and counseling patients with hypertension. Impact on medication adherence and blood pressure control. , 1996, American journal of hypertension.

[18]  C. Bouchard,et al.  Physical Activity, Fitness, and Health: International Proceedings and Consensus Statement , 1994 .

[19]  James F. Sallis,et al.  Determinants and interventions for physical activity and exercise. , 1994 .

[20]  W L Haskell,et al.  Comparative effects of two physical activity programs on measured and perceived physical functioning and other health-related quality of life outcomes in older adults. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[21]  J. Tedeschi.  Impression Management Theory and Social Psychological Research , 1981 .

[22]  W L Haskell,et al.  Effects of diet and exercise in men and postmenopausal women with low levels of HDL cholesterol and high levels of LDL cholesterol. , 1998, The New England journal of medicine.

[23]  W. Haskell,et al.  Medically directed at-home rehabilitation soon after clinically uncomplicated acute myocardial infarction: a new model for patient care. , 1985, The American journal of cardiology.

[24]  A. Manley.  Physical Activity And Health: A Report Of The Surgeon General , 2004 .

[25]  Brian W. McNeill,et al.  Reconceptualizing social influence in counseling: The Elaboration Likelihood Model. , 1989 .

[26]  R. Niaura,et al.  Self-efficacy and the stages of exercise behavior change. , 1992, Research quarterly for exercise and sport.

[27]  Amy B. Rummel,et al.  Cognitive Evaluation Theory: A meta-analytic review of the literature , 1988 .

[28]  J. R. Knapp,et al.  Effects of Computer Privacy on Help‐Seeking1 , 1988 .

[29]  J A Epstein,et al.  Attributional processes in behavior change and maintenance: smoking cessation and continued abstinence. , 1987, Journal of consulting and clinical psychology.

[30]  R S Paffenbarger,et al.  Associations of light, moderate, and vigorous intensity physical activity with longevity. The Harvard Alumni Health Study. , 2000, American journal of epidemiology.

[31]  J. Tomaka,et al.  Measures of self-esteem. , 1991 .

[32]  J. Sallis,et al.  Personal and mediated health counseling for sustained dietary reduction of hypercholesterolemia. , 1986, Preventive medicine.

[33]  A. Bandura.  Social Foundations of Thought and Action: A Social Cognitive Theory , 1985 .

[34]  M. Leary.  CHAPTER 5 – Social Anxiety, Shyness, and Related Constructs , 1991 .

[35]  S. Blair,et al.  Physical activity behavior change: issues in adoption and maintenance. , 2000, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[36]  J. E. Martin,et al.  A home-based behavioral intervention to promote walking in sedentary ethnic minority women: project WALK. , 1998, Women's health.

[37]  H. Kraemer,et al.  Can we identify who will adhere to long-term physical activity? Signal detection methodology as a potential aid to clinical decision making. , 1997, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[38]  B E Ainsworth,et al.  Accuracy of five electronic pedometers for measuring distance walked. , 1996, Medicine and science in sports and exercise.

[39]  P. Balch,et al.  In person versus telephone treatment for obesity , 1976 .

[40]  Spencer Dc,et al.  Patient telephone call documentation. Quality implications and an attempted intervention. , 1988 .

[41]  C E Basch,et al.  The Telephone as a Communication Medium for Health Education , 1997, Health education & behavior : the official publication of the Society for Public Health Education.

[42]  B. Marcus,et al.  The transtheoretical model: applications to exercise behavior. , 1994, Medicine and science in sports and exercise.

[43]  T. Patterson,et al.  The development of scales to measure social support for diet and exercise behaviors. , 1987, Preventive medicine.

[44]  Jane S. Webster,et al.  Rational and social theories as complementary explanations of communication media choices: two polic , 1995 .

[45]  Robert M. Arkin,et al.  15 – Self-Presentation Styles , 1981 .

[46]  M. Scheier,et al.  Public and private self-consciousness: Assessment and theory. , 1975 .

[47]  D. Spencer,et al.  Patient telephone call documentation. Quality implications and an attempted intervention. , 1988, The Journal of family practice.

[48]  M. Weinberger,et al.  Cost-effectiveness of increased telephone contact for patients with osteoarthritis. A randomized, controlled trial. , 1993, Arthritis and rheumatism.

[49]  E. Deci,et al.  The general causality orientations scale: Self-determination in personality , 1985 .

[50]  Robert H. Friedman,et al.  Synthesis of Research: The Virtual Visit: Using Telecommunications Technology to Take Care of Patients , 1997, J. Am. Medical Informatics Assoc..

[51]  Bryan R. Luce,et al.  Cost-Benefit and Cost-Effectiveness Analysis in Health Care: Principles, Practice, and Potential , 1982 .

[52]  John D. Corrigan,et al.  Counseling as a social influence process: A review. , 1980 .

[53]  Edward McAuley,et al.  Self-Efficacy, Perceptions of Success, and Intrinsic Motivation for Exercise1 , 1991 .

[54]  Edward L. Deci,et al.  Intrinsic Motivation and Self-Determination in Human Behavior , 1975, Perspectives in Social Psychology.

[55]  Internet resources on aging: seniors on the net. , 1996, The Gerontologist.

[56]  E H Wagner,et al.  Evaluation of intrinsic and extrinsic motivation interventions with a self-help smoking cessation program. , 1991, Journal of consulting and clinical psychology.

[57]  T. Kamarck,et al.  A global measure of perceived stress. , 1983, Journal of health and social behavior.

[58]  A. King,et al.  Diet vs exercise in weight maintenance. The effects of minimal intervention strategies on long-term outcomes in men. , 1989, Archives of internal medicine.

[59]  John P. Robinson,et al.  Measures Of Personality And Social Psychological Attitudes , 1991 .

[60]  Abby C. King,et al.  Predicting Long-term Adherence to Aerobic Exercise: A Comparison of Two Models , 1991 .

[61]  B H Marcus,et al.  Determinants of physical activity and interventions in adults. , 1992, Medicine and science in sports and exercise.

[62]  S. Zimmerman,et al.  Outcome expectations for exercise scale: utility and psychometrics. , 2000, The journals of gerontology. Series B, Psychological sciences and social sciences.

[63]  M. Stephens,et al.  Mastery in women's multiple roles and well-being: adult daughters providing care to impaired parents. , 1998, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[64]  E. Deci,et al.  The support of autonomy and the control of behavior. , 1987, Journal of personality and social psychology.

[65]  B H Marcus,et al.  Physical activity interventions using mass media, print media, and information technology. , 1998, American journal of preventive medicine.

[66]  E H Wagner,et al.  Intrinsic and extrinsic motivation for smoking cessation. , 1990, Journal of consulting and clinical psychology.

[67]  D M Buchner,et al.  Physical activity interventions targeting older adults. A critical review and recommendations. , 1998, American journal of preventive medicine.

[68]  T Heeren,et al.  Older women and physical activity: using the telephone to walk. , 1997, Women's health issues : official publication of the Jacobs Institute of Women's Health.

[69]  A. Stewart,et al.  Evaluation of champs, a physical activity promotion program for older adults , 1997, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[70]  D. Abrams,et al.  The stages and processes of exercise adoption and maintenance in a worksite sample. , 1992, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.