Critical factors influencing the decision to enroll in a physical activity intervention among a predominant group of adults with spinal cord injury: a grounded theory study.

STUDY DESIGN: Grounded theory qualitative approach. OBJECTIVES: To examine critical factors associated with interest in enrolling in a physical activity (PA) research intervention among a predominant group of adults with spinal cord injury (SCI) and develop a theory that can enhance future recruitment success. SETTING: Participants were recruited through the network of a community exercise facility for people with physical disabilities. METHODS: Interviews were conducted with 22 wheelchair users (mean age 46 ± 13 years; SCI [n = 19], cerebral palsy [n = 1]; multiple sclerosis [n = 1]; and bilateral limb loss [n = 1]) in either a one-on-one format or focus group. Interview data were coded, and these codes were organized into conceptual categories using a constructivist grounded theory framework. RESULTS: Adults with SCI conceive three core concerns with enrolling into a PA trial: (1) capability to participate in the program due to scheduling, transportation, and secondary health conditions; (2) mental balancing of anticipated benefits versus the difficulty of starting the program; and (3) desirability of the program characteristics based on their preferences and needs. Concerns were organized into a theory that may enhance future recruitment success. CONCLUSIONS: Recruitment is often overlooked in PA research for people with SCI despite it being a primary rate-limiting factor that severely limits the external validity of published studies. Study findings identified core recruitment concerns that are likely similar with general barriers to PA participation. This paper proposed a 3-step decision-making process that can serve as a starting point for overcoming recruitment issues in PA research with people with SCI.

Retrospective evaluation of a pilot eHealth/mHealth telewellness program for people with disabilities: Mindfulness, Exercise, and Nutrition To Optimize Resilience (MENTOR).

Background: People with disabilities have few options to participate in wellness programs that are tailored to their health, functional level, specific interests/needs, and available in the comfort of their home. To address this need, we evaluated a mobile health wellness program for people with physical disabilities. Methods: Retrospective pilot evaluation of MENTOR (Mindfulness, Exercise, and Nutrition To Optimize Resilience), an 8-week, 40-hour online telewellness program adapted from the peer reviewed literature on wellness. The three core wellness domains-mindfulness, exercise, and nutrition-were delivered via Zoom to groups of participants with a disability. Each group met weekly with an assigned health coach who responded to Q&A about the program and presented new material on several additional wellness domains that could impact their health (e.g., relationships, contribution to society/community, spending outdoor time in nature). Pre/post measures included the Godin Leisure-Time Exercise Questionnaire (GLTEQ) and the UAB/Lakeshore Wellness Assessment (LWA). Participants were also interviewed and provided feedback after the program, which was thematically analyzed. Results: A total of 154 people from 15 states enrolled in the MENTOR program and 135 completed it (87.7% completers). Data were analyzed from a subset of participants (n=53) who were asked to complete a pre/post assessment and had complete data. Participants who were physically inactive at baseline improved their GLTEQ total activity (P=0.002; effect size =0.56) and moderate-to-vigorous activity scores (P=0.005; effect size =0.53). LWA results demonstrated that participants increased their exercise behavior (P=0.006; effect sizes =0.39) and contribution to society/community (P=0.013; effect size =0.37). Participants with low overall wellness (mental, physical & emotional health) at baseline had statistically significant improvements in exercise, nutrition, sleep, core values, self-care, hobbies, contribution to society/community, relationships, and overall wellness (all P<0.05 with effect sizes ranging from 0.43 to 1.07). Resultant qualitative themes were: (I) lifestyle transformation occurred through new positive experiences, physical and mental health benefits, and adoption of healthy behaviors; and (II) engagement through accessible online bonding through enjoyable and professional experiences. Conclusions: A pilot telewellness program for people with disabilities is feasible and potentially effective in improving several domains of wellness. There is a need for precision-based mobile health (mHealth) programs that are tailored for people with disabilities and that can be accessed from various portable devices including their phone and/or tablet.