The health action process approach to promote regular physical activity among people with disabilities: A hierarchical regression analysis.

OBJECTIVE: People with disabilities continue to cope with high levels of stress, such as disability-related stress and sociopolitical stress. Helping people with disabilities engage in regular physical activity to improve health and reduce stress is more important than ever. This study evaluated demographic covariates, the health action process approach (HAPA) constructs (action self-efficacy, outcome expectancy, risk perception, intention/commitment, maintenance and recovery self-efficacy, and action and coping planning), and positive person-environment variables (autonomous motivation, resilience, hope, and social support) as motivators for regular physical activity in a sample of people with disabilities. METHODS: People with disabilities participated in an online study (N = 266). Hierarchical regression analysis was used to determine the incremental variance in physical activity scores accounted for by variables in the regression model. RESULTS: Demographic covariates, HAPA constructs, and positive person-environment variables accounted for 38% of the total variance in physical activity scores (a large effect size). Low income was a risk factor that significantly and negatively associated with regular physical activity, while self-efficacy, action and coping planning, and social support were significantly and positively associated with reular physical activity after controlling for other variables. Autonomous motivation, resilience, and hope were significantly associated with regular physical activity at the zero-order correlation level, but not significant in the regression model. CONCLUSIONS: This study provides strong empirical support for the HAPA constructs, which can be used to inform the development of theory-driven and empirically supported physical activity interventions to improve health, stress management, and well-being of people with disabilities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Quality of life in people with epilepsy: The associations of anti-seizure medications and biopsychosocial variables.

People with epilepsy, on average, experience lower quality of life (QOL) than healthy controls. This study examined the associations between specific anti-seizure medications, biopsychosocial factors, and QOL in people with epilepsy. Analysis of covariance revealed that individuals taking three or more anti-seizure medications had significantly lower QOL than those taking levetiracetam. Findings also demonstrated that when examining biopsychosocial factors as predictors of QOL in hierarchical regression, anxiety, depression, and daytime sleepiness were significant predictors of QOL. Once these factors were entered into the model, number of medications was no longer significant. The final model predicted 59.6% of the variance in QOL. In clinical settings, providers should take a patient-centered approach that includes regular assessment of QOL and an emphasis on good psychological care for those coping with anxiety, depression, and sleep difficulty. These findings underscore the importance of addressing psychological health and sleep factors within the epilepsy population.

Subjective well-being of adults with multiple sclerosis during COVID-19: Evaluating stress-appraisal-coping and person-environment factors.

BACKGROUND: People with multiple sclerosis (MS) have been coping with high levels of stress during the ongoing coronavirus pandemic, affecting their employment, physical, and mental health, and overall life satisfaction. OBJECTIVE: This study evaluated constructs of the stress-appraisal-coping theory and positive person-environment factors as predictors of subjective well-being for adults with MS. METHOD: Participants included 477 adults with MS recruited through the National Multiple Sclerosis Society. Hierarchical regression analysis was used to determine the incremental variance in subjective well-being accounted for by demographic covariates, functional disability, perceived stress, stress appraisal, coping styles, and positive person-environment contextual factors. RESULTS: Positive stress appraisal and coping flexibility were significantly associated with subjective well-being at the bivariate correlation level and at the step they were entered into the regression model. Marital status, household income, functional disability, perceived stress, hope, core self-evaluations, and social support were significant predictors in the final model, accounting for 60% of the variance in subjective well-being scores (R² = .60, f² = 1.48; large effect size). CONCLUSIONS: Findings from this study support a stress management and well-being model based on constructs of Lazarus and Folkman's stress-appraisal-coping theory and positive person-environment contextual factors, which can inform the development of theory-driven and empirically supported stress management and well-being interventions for people with MS during the ongoing global health crisis. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Non-suicidal self-injury in a college sample: Intrapersonal and family factors.

Objective: Adolescents and young adults are at risk for non-suicidal self-injury (NSSI) and suicidal behavior. This study examined intrapersonal (depressive symptoms, self-criticism) and family (perceived family functioning, parenting style, parental attachment) factors associated with reported history of NSSI in a college sample. Method: Participants included 111 undergraduate students (Mage = 20.2) from a private, nonprofit university. Data were collected via online survey. Hierarchical logistic regression analysis was conducted. Results: The final model was statically significant, Nagelkerke R2 = .40, suggesting a robust association between the predictors and history of NSSI. Self-criticism and unhealthy family functioning were significant predictors of NSSI behaviors after controlling for study variables and demographic characteristics. Reported history of engaging in NSSI was positively correlated with parent alienation, unhealthy family functioning, self-criticizing behaviors, and depressive symptoms. Conclusion: College mental health providers should be familiar with risk factors of NSSI as well as strategies to address self-criticism.

Mediators of quality of life in brain injury.

PRIMARY OBJECTIVE: This study examined the mediating role of perceived social support and mastery on quality of life (QOL) among adults with brain injury. RESEARCH DESIGN: An a priori structural model hypothesizing the relationships among symptom severity, mastery, social support, and QOL variables were tested. METHODS AND PROCEDURES: Individuals with brain injury across the United States participated in an online survey (N = 183). Structural equation modeling (SEM) was used to examine the model fit. MAIN OUTCOMES AND RESULTS: The model fit the data well (χ2(15) = 13.68). The Normed Bentler-Bonnet Fit Index (NFI) was.97; Goodness-of-Fit Statistic (GFI) was .98; Adjusted-Goodness-of-Fit (AGFI) was.96; and the Comparative Fit Index (CFI) was 1.00. The direct effects supported all expected relationships among the study variables. Social support and mastery fully mediated the relationship between symptom severity and QOL. Mastery partially mediated the relationship between social support and QOL. CONCLUSIONS: These findings underscore the importance of incorporating psychosocial factors into interventions, with attention on increasing levels of perceived social support and mastery skills to foster greater QOL.

Microaggressions experienced by people with multiple sclerosis in the workplace: An exploratory study using Sue's taxonomy.

PURPOSE: Microaggressions are subtle forms of discrimination and include verbal, nonverbal, or environmental slights that convey disparaging messages to people based upon their group membership, such as disability. The purpose of this study was to investigate the experience of microaggressions in the workplace among individuals with multiple sclerosis (MS). METHOD: This study used a community-based participatory research approach and qualitative design. Adults with MS (N = 29) with current or recent work experience were recruited to participate in a focus group study. Eight focus groups were conducted and transcripts analyzed using qualitative content analysis to generate themes and subthemes. Study protocol, coding, and interpretations underwent a validity check by an external advisory group consisting of researchers in the field and individuals with MS. RESULTS: Almost all of the participants in this study reported experiencing some form of microaggressions in their workplace. Several important themes emerged, including pathologizing, assumption of disability status, second-class, lack of awareness, social distance, and denial. This study also found that perceived stress was associated with microaggressions and that microaggression exacerbated the negative impact of uncertainty related to symptoms and job security. Participants also identified various coping strategies used to deal with microagressions, such as involvement in support groups and meditation. IMPLICATIONS: The themes that emerged from the focus groups further our understanding of microaggressions as a factor impacting the work experiences of people with MS. Findings have implications for rehabilitation practitioners and future research to promote work life, job retention, and well-being of people with MS. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A Psychometric Validation of the Employers' Stigmatizing Attitudes Toward Cancer Survivors Scale.

Purpose The aim of this study was to evaluate the measurement structure of the Employers' Stigmatizing Attitudes Toward Cancer Survivors Scale (ESATPD-Cancer Scale). Methods A quantitative descriptive design using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). One hundred and seventy-seven Taiwanese human resources (HR) professionals participated in this study. Results EFA revealed a one-factor measurement structure accounting for 50% of the total variance. We conducted a CFA to confirm the one-factor structure; after two pairs of error terms were correlated, the re-specified model was found to fit the data adequately: χ2/df = 1.69, GFI = 0.97, CFI = 0.98, and RMSEA = 0.06. Internal consistency reliability coefficient (Cronbach's alpha) for the ESATPD-Cancer Scale was computed to be 0.80. In addition, stigmatizing attitudes were found to be negatively associated with HR professionals' willingness to hire cancer survivors. Conclusions The results of this study support a one-factor measurement structure for the ESATPD-Cancer Scale in a sample of HR professionals in Taiwan. Findings also support a relationship between ESATPD-Cancer Scale scores and HR professionals' willingness to hire cancer survivors, demonstrating support for the construct validity of the scale.

Social factors predictive of social integration for adults with brain injury.

INTRODUCTION: Individuals with acquired brain injury (ABI) may not only struggle with physical and cognitive impairments, but may also face challenges reintegrating into the community socially. Research has demonstrated that following ABI, individuals' social networks tend to dwindle, support may decline, and isolation increases. This study examined factors impacting social integration in a community-based sample of 102 individuals with ABI. METHODS: Potential predictors included emotional support, instrumental support, problem solving confidence, and approach-avoidance style (AAS) of problem solving, while controlling for age, gender, education, and time since injury. Hierarchical regression was used to analyze whether these factors were predictive of social integration. RESULTS: The final model accounted for 33% of the variance in social integration outcomes. Results demonstrated that emotional support was initially a significant predictor; however, when controlling for emotional support the variance in social integration was better accounted for by social problem solving - specifically, AAS. A follow-up mediation analysis indicated that the relationship between social problem solving (specifically, AAS) and social integration was partially mediated by emotional support. CONCLUSIONS: This suggests that for individuals with ABI, a tendency to approach rather than avoid social problem solving issues is a significant predictor for social integration both directly and indirectly through its association with emotional social support. Implications for Rehabilitation Both instrumental and emotional social support should be assessed in patients with acquired brain injury (ABI), ensuring that emotional needs are met in addition to the more obvious instrumental needs. Barriers to problem solving for people with ABI may limit optimal social integration; thus, assessment and intervention aimed at increasing AAS are recommended. To enhance the social integration outcomes of people with brain injury, strength-based psychosocial rehabilitation should optimally balance an individual's abilities with areas requiring compensation, focusing on how to approach rather than avoid problems as well as strategies to cultivate emotional social support.

Testing an integrated self-determined work motivation model for people with disabilities: A path analysis.

OBJECTIVE: Individuals with disabilities are more likely to live in poverty, have more health issues, and be less likely to be employed than their same-aged peers. Although these issues may be attenuated by vocational rehabilitation services, amotivation and ambivalence to employment can limit the readiness of persons with disabilities to engage in these services. Drawing on self-efficacy, self-determination, and stages of change theories, the purpose of this study was to develop and test an integrated self-determined work motivation model for people with disabilities. METHOD: Participants included 277 people with disabilities recruited through vocational rehabilitation agencies across 8 states. Path analysis was used to evaluate the contribution of functional disability, self-determination, and social efficacy variables in a hypothesized integrated self-determined work motivation model. Model estimations used maximum likelihood estimation and model-data fit was examined using several goodness-of-fit indices. RESULTS: The initial path analysis indicated a less than optimal fit between the model and the observed data. Post hoc model modifications were conducted based on examination of the critical ratios and modification indices and theoretical consideration. The respecified integrated self-determined work motivation model fit the data very well, χ²ldf = 1.88, CFI = .99, and RMSEA = 0.056. The R2 for the endogenous variables in the model ranged from .19 to .54. CONCLUSIONS: Findings from this study support the integrated self-determined work motivation model in vocational rehabilitation as a useful framework for understanding the relationship among functioning levels, self-determination and self-efficacy factors, vocational rehabilitation engagement, and readiness for employment. (PsycINFO Database Record

Factors impacting sense of community among adults with brain injury.

PURPOSE: Despite increasing interest in examining community outcomes following disability, sense of community (SOC) has received relatively no attention in the rehabilitation literature. SOC refers to feelings of belonging and attachment one has for a community and is of particular relevance for people with brain injury who are at increased risk of social isolation. The aim of this study was to investigate factors contributing to SOC for individuals with brain injury. METHOD: Members from 2 brain injury associations (n = 98) participated in this survey-based study. Hierarchical regression analysis was used to explore demographic, disability-related, community and social participation variables' impact on SOC with regard to one's town or city. Follow-up mediation analyses were conducted to explore relationships among social self-efficacy, support network, neighboring behavior, and SOC. RESULTS: Findings indicated that disability-related and community variables accounted for over 40% of the variance in SOC. Size of social support network was the only significant independent contributor to SOC variance. Follow-up analyses provided support for (a) the partial mediating effect of social support network size on the relationship between social self-efficacy and SOC, and (b) the mediating effect of neighboring behavior on the relationship between social self-efficacy and social support network size. CONCLUSIONS: Findings from this study highlight the particular importance of self-efficacy, social support, and neighboring behaviors in promoting SOC for people with brain injury. Recommendations are provided to advance research efforts and inform intervention approaches to improve the felt experience of community among people with brain injury. (PsycINFO Database Record

Symptom severity and life satisfaction in brain injury: The mediating role of disability acceptance and social self-efficacy.

BACKGROUND: Although the negative impact of symptom severity on subjective well-being outcomes has been established among individuals with brain injury, the mediating and protective role that positive human traits might have on this relationship has not been adequately explored. OBJECTIVE: The purpose of this study was to examine the impact of social self-efficacy and disability acceptance on the relationship between symptom severity and life satisfaction among individuals with brain injury. METHODS: Hierarchical regression analysis and correlation techniques were used to test a hypothesized dual-mediation model of life satisfaction in a sample of 105 adults with acquired brain injury. RESULTS: Results indicated that social self-efficacy and disability acceptance fully mediated the relationship between symptom severity and life satisfaction, lending support for a dual-mediation model with disability acceptance being the strongest contributor. CONCLUSIONS: These findings suggest there may be considerable value for rehabilitation providers to develop strengths-based service strategies and/or specialized intervention programs that focus on capitalizing these positive human traits to promote life satisfaction and well-being for clients with brain injury. Implications for clinical practice and future research direction are also discussed.

Post-concussion symptoms in mild traumatic brain injury: findings from a paediatric outpatient clinic.

Purpose Mild traumatic brain injury (mTBI) is common among children and is associated with a range of symptomatology and clinical presentations. This study uses data from a paediatric outpatient TBI clinic to (1) investigate characteristics associated with more severe post-concussive symptoms and (2) examine differences in the proportion of individuals endorsing specific post-concussion symptoms based on group (e.g., sex, type of injury, and psychiatric history). Methods Data from the Children's Hospital of Richmond's TBI outpatient programme were analysed (N = 157). Results Gender and sports injury were associated with severity of symptoms. In addition, females endorsed a greater number of overall symptoms than males. A number of specific symptoms were found to be endorsed to a greater extent based on psychiatric history and type of injury; however, overall total number of symptoms endorsed did not differ based on these characteristics. Conclusions Findings from this study provide further evidence that mTBI affects a wide range of youth and that associated symptomatology can indeed be varied. Moreover, results revealed differences in endorsement of specific symptoms and symptom severity based on patient and injury characteristics which have implications for concussion assessment and treatment. Implications for Rehabilitation Symptoms following mild traumatic brain injury (mTBI) in children and adolescents can have varied presentation, ranging from minimal to severe. Females and those with non-sports-related injuries are more likely to endorse greater symptoms following concussion. Symptom evaluation is an essential component of the concussion assessment and treatment of paediatric patients following mTBI, and clinicians should be aware of patient characteristics associated with increased symptoms, especially when baseline symptom data are not available.

Predictors of social integration for individuals with brain injury: An application of the ICF model.

OBJECTIVE: People with brain injury often experience significant challenges to social and community engagement following injury. The purpose of this study was to investigate factors impacting social integration for adults with brain injury using the International Classification and Functioning, Disability and Health (ICF) as a conceptual model. METHODS: Adults with brain injury (n = 103) recruited through two US state brain injury associations participated in a survey study. Hierarchical regression analysis was used to examine the predictive impact of components of the ICF model on social integration outcomes. Specifically, demographic (age, gender, SES), disability (severity of functional limitations), personal (disability acceptance, social self-efficacy) and environmental (neighbourhood climate, stigma, social support network) factors were entered as four conceptual groups of predictors to examine the incremental contribution of the variance in social integration explained by each set. RESULTS: As hypothesized, the inclusion of each block of predictors significantly improved the model. The overall regression model explained 41% of the variance in social integration. Specifically, SES (ß = 0.25), severity of functional limitations (ß = 0.29) and social support network (ß = 0.29) emerged as the strongest independent predictors. CONCLUSION: Findings from this study highlight the importance of adopting a biopsychosocial approach to understanding social integration for people with brain injury.

Validation of the Social Provisions Scale in people with multiple sclerosis.

OBJECTIVE: This study examined the factorial and construct validity of the Social Provisions Scale (SPS) in a sample of people with multiple sclerosis (MS). METHOD: Participants included 292 individuals with MS (83.9% women) recruited from the Greater Illinois, Gateway, and Indiana chapters of the National Multiple Sclerosis Society. Participants completed the SPS and pain, fatigue, depression, anxiety, MS self-efficacy, quality of life, and satisfaction with life measures. Factorial validity was tested using confirmatory factor analysis (CFA), and construct validity was examined based on the strength of bivariate correlations with scores on related measures. RESULTS: Findings from the CFA indicated that a first-order, 6-factor measurement model provided a good fit for the 24 items of the SPS (CFI = .94, TLI = .93, RMSEA = 0.07) and that the 6 factors could be described by a single, second-order factor of the overall social provisions (CFI = .93, TLI = .92, RMSEA = 0.08). Cronbach's alpha was .89 for the global score and between .66 and .81 for the 6 subscales. The SPS global and subscale scores correlated significantly with satisfaction with life, depression, anxiety, MS self-efficacy, and quality of life measures. CONCLUSIONS: Findings from this study support the factorial validity, construct validity, and reliability of the SPS as a measure of social provisions for use with people with MS. (PsycINFO Database Record

Effect of supported employment on vocational rehabilitation outcomes of transition-age youth with intellectual and developmental disabilities: a case control study.

The purpose of this study was to examine the effect of supported employment intervention on the employment outcomes of transition-age youth with intellectual and developmental disabilities served by the public vocational rehabilitation system using a case-control study design. Data for this study were extracted from the Rehabilitation Services Administration Case Service Report (RSA-911) database for fiscal year 2009. The sample included 23,298 youth with intellectual and developmental disabilities aged between 16 and 25 years old at the time of application. The classification and regression tree (CART) method was used to estimate propensity scores and to adjust for selection bias on the basis of all prominent covariates relevant to the dependent variable (i.e., competitive employment). Results yielded six homogeneous subgroups, and receipt of supported employment was found to increase the employment rates across all of the groups. The effect of supported employment was especially strong for youth who were Social Security beneficiaries, special education students, and individuals with intellectual disabilities or autism who were high school graduates. These findings suggest that supported employment is an effective service for enhancing the vocational rehabilitation outcomes of young adults and provides valuable information for policy makers, health care providers, rehabilitation counselors, and educators.

Testing a path-analytic mediation model of how motivational enhancement physiotherapy improves physical functioning in pain patients.

PURPOSE: Pain is a complex phenomenon not easily discerned from psychological, social, and environmental characteristics and is an oft cited barrier to return to work for people experiencing low back pain (LBP). The purpose of this study was to evaluate a path-analytic mediation model to examine how motivational enhancement physiotherapy, which incorporates tenets of motivational interviewing, improves physical functioning of patients with chronic LBP. METHODS: Seventy-six patients with chronic LBP were recruited from the outpatient physiotherapy department of a government hospital in Hong Kong. RESULTS: The re-specified path-analytic model fit the data very well, χ (2)(3, N = 76) = 3.86, p = .57; comparative fit index = 1.00; and the root mean square error of approximation = 0.00. Specifically, results indicated that (a) using motivational interviewing techniques in physiotherapy was associated with increased working alliance with patients, (b) working alliance increased patients' outcome expectancy and (c) greater outcome expectancy resulted in a reduction of subjective pain intensity and improvement in physical functioning. Change in pain intensity also directly influenced improvement in physical functioning. CONCLUSIONS: The effect of motivational enhancement therapy on physical functioning can be explained by social-cognitive factors such as motivation, outcome expectancy, and working alliance. The use of motivational interviewing techniques to increase outcome expectancy of patients and improve working alliance could further strengthen the impact of physiotherapy on rehabilitation outcomes of patients with chronic LBP.

State rehabilitation services tailored to employment status among cancer survivors.

PURPOSE: Previous analyses of vocational rehabilitation services for unemployed cancer survivors indicated that counseling and guidance, job search assistance, and job placement services are significantly associated with increased odds for employment. However, many cancer survivors with jobs to return to may require vocational interventions that are different from unemployed cancer survivors. It is unclear whether the public rehabilitation system provides vocational services that are based on the work status of cancer survivors rather than providing the same set of services for all cancer survivors. This study examined whether differences in the types of services were indeed based on the employment status of those with a history of cancer at the time of application. METHODS: Administrative data on 1,460 cancer survivors were obtained through the US Rehabilitation Services Administration Case Service Report (RSA-911) dataset for fiscal year 2007. Data on demographic characteristics and vocational service patterns were extracted and analyzed. Multiple discriminant analysis was used to identify differential services received by cancer survivors based on employment status at time of application for vocational rehabilitation services. RESULTS: Results of the multiple discriminant analysis indicated one significant canonical discriminant function, with Wilks's λ = .92, χ (2)(19, N = 1,456) = 114.87, p < .001. The correlations between the discriminating variables and the significant canonical discriminant function were highest for diagnoses and treatment (-.526), job placement (.487), transportation (.419), job search (.403), vocational training (.384), job readiness (.344), university training (.307), and rehabilitation technology (-.287). The group centroids along the significant discriminant function (the distance of each group from the center of the canonical function) indicated that the employed applicant group (-.542) and the unemployed applicant group (.153) can be differentiated based on vocational rehabilitation services received, with the employed applicant group receiving primarily diagnostic and treatment services and rehabilitation technology/job accommodation services, while the unemployed applicant group received more vocational training, job seeking skills training, and job placement services. CONCLUSIONS: Employed cancer survivors who are at risk of losing their job and unemployed cancer survivors who are looking for a job receive different vocational services tailored to needs, suggesting that state vocational rehabilitation services for cancer survivors is responsive to individual client needs.

Factors influencing korean international students' preferences for mental health professionals: a conjoint analysis.

Asian students comprise over half of all international students in the United States, yet little is known about their help-seeking behaviors and preferences for mental health professionals. The purpose of this study was to use conjoint analysis to examine characteristics of mental health professionals influencing Korean international students' preferences when choosing a mental health professional. Korean international students from three universities in the United States were recruited on a volunteer basis to participate in this study (N = 114). Results indicated that mental health professional characteristics, including ethnicity, age, professional identity, and training institution, were significant factors in students' preference formation; however, gender of the mental health professional was not found to be a significant factor in the present study. Ethnic similarity was the most powerful predictor of preference formation. Implications for promoting help-seeking and mental health service utilization among Asian international students are discussed.

Stigma and intellectual disability: potential application of mental illness research.

PURPOSE: Individuals with intellectual disabilities (ID) and individuals with mental illness are consistently found to be among the most socially excluded populations and continue to face substantial health, housing, and employment disparities due to stigma. Although this has spurred extensive research efforts and theoretical advancements in the study of stigma toward mental illness, the stigma of ID has received only limited attention. In this article we explore the application of mental illness stigma research for ID. DESIGN: We carefully reviewed the existing research on mental illness stigma as a foundation for a parallel summary of the empirical literature on attitudes and stigma related to ID. RESULTS: Based on our review, there has not been a systematic approach to the study of stigma toward ID. However, multilevel conceptual models of stigma have received much attention in the mental illness literature. These models have been used to inform targeted interventions and have application to the study of the stigma process for individuals with ID. Nonetheless, there are indeed key differences between-as well as substantial variability within-the ID and mental illness populations that must be considered. CONCLUSIONS: Stigma is an issue of social justice impacting the lives of individuals with ID, yet there remains virtually no systematic framework applied to the understanding of the stigma process for this group. Future research can draw on the stigma models developed in the mental illness literature to guide more rigorous research efforts and ultimately the development of effective, multilevel stigma-change strategies for ID.

Stigma and intellectual disability: a review of related measures and future directions.

The theoretical construct of stigma has received much attention in psychiatric disability research, leading to the development of widely used measures. Such measures have had real world impact in that they allow for the assessment of stigma change efforts. The study of stigma has not received the same level of attention for persons with intellectual disabilities. In this manuscript we evaluate existing measures of intellectual disability stigma through a systematic review of the literature. Twenty-four scales were reviewed and evaluated. Findings indicate a paucity of stigma measures based on theoretical conceptualizations pointing to a need for further development of measures to pursue the study of public, self, and family stigma as related to intellectual disability.