Irizarry, Taya
(2017)
The Role of mHealth Application Design in Individually Tailored Self-Management Interventions to Promote Adherence to an Exercise Program for Older Adults with Osteoarthritis of the Knee and Hypertension.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
Little is known about how individually tailored self-management interventions (ITSMIs) and mobile health technology (mHealth) might work together to promote adoption and maintenance of exercise among people living with chronic conditions that impede physical functioning. The objective of this mixed-method study was to generate a contextually rich assessment of how adoption and maintenance of an exercise routine were supported within a mHealth-ITSMI designed specifically for older adults with osteoarthritis of the knee and hypertension. Quantitative and qualitative data from the intervention arm of the Staying Active with Arthritis (STAR) trial (R01 NR010904, PI Schlenk) were utilized in this mixed-method study. Latent trajectories of tailoring and adherence of lower extremity exercises (LEE) and fitness walking (FW) over the 24-week intervention period were identified using group based trajectory modeling. Bivariate associations between identified tailoring and adherence trajectory groups were evaluated. Multivariable multinomial logistic regression was used to identify predictors of adherence trajectory groups. Purposive sampling was performed based on adherence and tailoring trajectory group membership. Actor Network Theory was used to scaffold the descriptive analysis of transcribed audio-recorded participant-interventionist interactions to examine the role the eDiary played in tailoring and exercise adherence. Three distinct trajectories were identified for LEE adherence and tailoring; four were identified for FW adherence and tailoring. A moderate association was observed between LEE and FW adherence trajectories (p<.001), between LEE and FW tailoring trajectories (p=.001), and between LEE tailoring and adherence trajectories (p=.007), but not between FW tailoring and adherence trajectories (p=.12). The LEE “remained highly tailored” trajectory group had greater odds of belonging to the “quick decline” (OR=16.89) and “steady decline” (OR=3.74) adherence trajectory groups. The FW “slight rise/remained highly tailored” trajectory group had greater odds of belonging to the “quick/steady decline” adherence trajectory group (OR=5.65). The eDiary played a role in the participant-interventionist relationship, decision-making, and motivation to exercise. Motivation was explained by concepts from social cognitive theory, self-determination theory, and goal-setting theory. The degree of individual fit between how a goal was defined and the way it was measured via the eDiary impacted participants’ overall sense of accomplishment, thereby directly impacting one’s motivation to initiate and sustain an exercise routine.
Share
| Citation/Export: |
|
| Social Networking: |
|
Details
| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
|
| ETD Committee: |
|
| Date: |
28 August 2017 |
| Date Type: |
Publication |
| Defense Date: |
17 July 2017 |
| Approval Date: |
28 August 2017 |
| Submission Date: |
4 August 2017 |
| Access Restriction: |
1 year -- Restrict access to University of Pittsburgh for a period of 1 year. |
| Number of Pages: |
124 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Nursing > Nursing |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
mHealth, hypertension, osteoarthritis, older adults, exercise adoption, adherence, patient-provider relationship |
| Date Deposited: |
28 Aug 2017 16:17 |
| Last Modified: |
28 Aug 2018 05:15 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/32992 |
Metrics
Monthly Views for the past 3 years
Plum Analytics
Actions (login required)
 |
View Item |
![[feed]](/images/feed-icon-32x32.png){kind=icon}