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Behavioural change based on the self-categorisation theory: promotion of physical activity among sedentary older adults (intervention study among older adults on intrinsic and social determinants of physical activity and health-related behaviour).
Regular physical activity has been recognized as a major contributor toindividuals health and well-being. Moreover, physical activity engagement has been shown to be crucial for healthy ageing and for improving (older) adults ability to perform daily activities. Nevertheless, only half of the Western population attains the recommended physical activity level for health, with decreasing participation rates with advanced age. Considering the continuously growing proportion of older adults as well as the economic burden associated with physical inactivity, physical activity promotion has emerged as one of the public health priorities, particularly among the older adult population.
Various physical activity promoting strategies have been found to positively impact on individuals physical activity behavior. However, those grounded in a theoretical framework have been shown to be most effective, particularly in thelong term. Therefore, the main purpose of this thesis was to examine the extent to which the Self-Determination Theory and the Self-Categorization Theory contribute to the adoption and the (year-round) maintenance of physical activity behavior among (older) adults who do not attainthe physical activity recommendations for health. More specifically, westudied whether, in accordance with the tenets of the Self-Determination Theory</>, creating a need-supportive environment yields autonomous forms of motivation and consequently sustained behavioral changes in different population groups, i.e. employees (Study 1</>) and olderadults (Study 2</>). Individuals are autonomously motivated when they engage in an activity because the activity is personally important and meaningful and will help them to attain valued goals (i.e. identified regulation), because the activity fits their personality and overalllifestyle (i.e. integrated regulation) or for reasons of interest, enjoyment or challenge (i.e. intrinsic motivation). Autonomous motivation isself-initiated and therefore assumed to facilitate longer-term behavioral engagement than controlled motivation.
Furthermore, we evaluated whether, in accordance with the Self-Categorization Theory</>, integrating group processes and postulating social identity-based normative support for physical activity produce a more autonomous form of motivation, and consequently larger and longer-term increases in older adults physical activity than individually-tailored need-supportive counseling (Study 3</>). Given that both the Self-Determination Theory and the Self-Categorization Theory involve assumptions that are related tobehavior as well as to health, this doctoral thesis evaluated and compared the impact of the theoretically-grounded physical activity promotingstrategies not only on individuals behavioral persistence (i.e. over aperiod of one year) but also on their health perceptions.
The first intervention study</> aimed at examining the effectiveness of a four-month physical activity counseling based on the Self-Determination Theory amonguniversity employees who did not attain the physical activity recommendations for health (n = 126). Participants of the intervention condition</> (n = 92) received an individually-tailored need-supportive coaching from a bachelor in Kinesiology. Specifically, the coach facilitated participants physical activity behavior by supporting their need for autonomy (e.g., by exploring physical activity options rather than prescribing physical activities), their need for competence (e.g., by drafting a structured and appropriate physical activity plan or by providing positive feedback) and their need for interpersonal relatedness (e.g., by creating a warm relationship within an empathetic environment). Participants of the waiting-list control condition</> (n = 34) did not receive any physical activity adviceor coaching.
With respect to self-reported physical activity</>, results showed significantly different changes over time between the intervention and control condition. In particular, the intervention condition increased in moderate (+ 158%) and strenuous (+ 436%) physical activity from baseline to four-month follow-up and in mild (+ 81%), moderate (+ 215%) and strenuous (+ 386%) physical activity from baseline to one-year follow-up. In the control condition, no changes emerged in (the different intensities of) physical activity. Autonomous motivation and self-efficacy (i.e. the confidence one has to be physically active in adverse situations such as fatigue or bad weather conditions) significantly mediated the intervention effect on (strenuous) physical activity from baseline to four-month follow-up. Social support from significant others (e.g., friends) mediated the intervention effect from baseline to one-year follow-up.
With respect to physical well-being</>, results showed a significantly different change over time between the intervention and control condition. In particular, the intervention condition substantially improved in physical well-being from baseline to four-month follow-up and from baseline to one-year follow-up whereas no changes emerged in the control condition. The intervention effect on physical well-being was mediated by strenuous physical activity. With respect to psychological well-being, no significant changes were found in the intervention or control condition from baseline to four-month follow-up,but however, a significant decrease emerged in both conditions from baseline to one-year follow-up.
We concluded</> that an individually-tailored physical activity program based on the Self-Determination Theory can positively impact on employees physical activity behavior and their (physical) well-being, even after a one-year follow-up period. Moreover, the results underscored the importance of high quality motivation and social support in the adoption and maintenance of physical activity behavior.
The second intervention study</>aimed at examining and comparing the effectiveness of three physical activity programs varying in counseling procedure and intensity among adults aged 60 years or older who did not attain the physical activity recommendations for health (n = 442). The first strategy (i.e. referral condition</>; n = 146) consisted of a 15-minute contact in which a Health Fitness Specialist referred participants to local physical activityprograms. The second strategy (i.e. walking condition</>; n = 146) embraced a 15-minute contact in which a Health Fitness Specialist provided participants a structured program consisting of walking schemes that gradually increased in volume and intensity. The walking program wasassumed to inherently support participants need for competence. The third strategy (i.e. need-supportive coaching condition</>; n = 150) comprised a ten-week multiple-contact individually-tailored physical activity counseling in which a Health Fitness Specialist supported participants needs for autonomy, competence and relatedness, consistent withthe tenets of the Self-Determination Theory.
With respect to physical activity</>, each of the programs yielded significant and substantial increases in daily steps and self-reported physical activity from baseline to ten-week follow-up. However, significantly larger increases emerged in the walking condition (e.g., self-reported physical activity: + 104%) and the need-supportive coaching condition (e.g., self-reported physical activity: + 116%) compared with the referral condition (e.g., self-reported physical activity: + 65%). Similarly, each of the programs yielded significant increases in self-reported physical activity frombaseline to one-year follow-up, with larger increases in the walking condition (+ 131%) and the need-supportive coaching condition (+ 166%) than in the referral condition (+ 92%). With respect to daily steps from baseline to one-year follow-up, significant increases were found in the walking and the need-supportive coaching condition whereas no changes emerged in the referral condition, but however, no significant time by condition interaction effect emerged. Autonomous motivation mediated the relation between participants perceived need-support of the coach and theirphysical activity level, irrespective of intervention condition.
With respect to subjective health</>, results showed no significantly different changes over time between the referral condition, the walking condition and the need-supportive coaching condition. However, each of the programs yielded significant improvements in subjective well-beingand trait anxiety, from baseline to ten-week follow-up and from baseline to one-year follow-up. From baseline to two-year follow-up, no changesemerged in subjective well-being, indicating a relapse to baseline level two years after the intervention. Similarly, trait anxiety significantly increased from baseline to two-year follow-up. The improvements in participants health perception were significantly predicted by their increases in physical activity. Also a higher level of perceived need-support of the coach contributed to a better subjective health.
We concluded</> that physical activity promoting programs varying incounseling strategy and intensity can positively affect older adults physical activity and subjective health, even after a one-year follow-up period. However, an individualized and (partially) need-supportive physicalactivity program seemed to be more successful in producing long-term physical activity engagement than a referral to widespread opportunities. In this respect, and considering its one-contact character, providing a structured (walking) program appears to be a potentially effective strategy to implement at a large scale. Furthermore, the findings pointed out the key role of autonomous motivation in the transition from an inactive to regularly active lifestyle in older adults. At the same time, an increased physical activity level and satisfactory feelings of perceived need-support emerged as important determinants of older adults subjective health over a one-year follow-up period.
The third intervention study</> aimed at examining and comparing the effectiveness of three six-week identity-based physical activity counseling strategies among adults aged 55 to 70 years who did not attain the physical activity recommendations for health (n = 169). The first strategy (personal</> identity condition</>; n = 56) consisted of an individually-tailored need-supportive physical activity coaching based on the Self-Determination Theory. A Health Fitness Specialist targeted participants personal self, and thus their unique characteristics. Participants were encouraged to engage in physical activity for their own personally valued reasons (e.g., because of the health-related benefits, because of the social contact, in order to work off steam etc.). The second strategy (social identity condition</>; n = 57) embraced a socially-oriented physical activity promoting program based on the Self-Categorization Theory. A Health Fitness Specialist targeted participants social self and provided group-based normative support for physical activity. More specifically, physical activity behavior was proposed as prototypical for a relevant reference group within this population. Based on the results of a preliminary survey (n = 1340), sociallyengaged persons and independent persons were considered as the most appropriate reference groups to be used in the physical activity intervention. The third strategy (joined identity condition</>; n = 56)comprised a physical activity counseling procedure based on the Self-Determination and Self-Categorization Theory. A Health Fitness Specialist facilitated participants physical activity behavior by targeting both their personal and social self.
With respect to physical activity</>, each of the strategies yielded significant and substantial increases in daily steps, daily aerobic minutes and self-reported physical activity, from baseline to six-week follow-up (e.g., steps: personal identity condition: + 75%; social identity condition: + 68%; joined identity condition: + 71%) and from baseline to one-year follow-up (e.g., steps: personal identity condition: + 62%; social identity condition: + 56%; joined identity condition: + 69%). Changes over time did not significantlydiffer between the interventions, except for aerobic minutes, which increased significantly more in the social identity condition from baselineto six-week follow-up than in the personal identity condition. Consistent with the tenets of the Self-Determination Theory, the relation between perceived need-support and physical activity was mediated by identified regulation (i.e. being physically active because of its valued outcomes such as health benefits). Consistent with the Self-Categorization Theory, the relation between perceived normative support and physical activity was mediated by integrated regulation (i.e. being physically active because it fits your personality and your overall lifestyle and goals).
With respect to the self-rated health</>, significant increases emerged in the social identity condition and the joinedidentity condition from baseline to six-week follow-up and from baseline to one-year follow-up whereas no changes emerged in the personal identity condition. Physical well-being significantly increased in the joinedidentity condition from baseline to six-week follow-up and from baseline tot one-year follow-up whereas no changes occurred in the personal identity condition and the social identity condition. Finally, psychological well-being significantly improved in the joined identity condition from baseline to six-week follow-up whereas no changes emerged in the personal identity condition and the social identity condition. Participants self-rated health and physical well-being were positively related to their daily steps. In addition, participants degree of identificationwith a relevant social identity was significantly and positively related to each of the proposed dimensions of their subjective health.
We concluded</> that physical activity promoting strategies targeting individuals personal self, their social self or both their personal and social self are (equally) effective in increasing physical activity in the older adult population, even after a one-year follow-up period. However, the socially-oriented strategy that postulated group-based physical activity norms involved a non-individualized approach, and accordingly entailed relatively low costs. Therefore, a Self-Categorization Theory-based program appears to be particularly beneficial to implement in the wider community compared with individually-tailored Self-Determination Theory-based physical activity coaching. Moreover, the findings pointed out the importance of activating a highly qualitative behavioral regulation, either identified or integrated, to perform physical activity behavior in the short and the long term. With respect to perceived health, it was concluded that emphasizing older adults membership of a meaningful and positively valued group can positively affect their subjective health and well-being. In this respect, it seems that not only being but also perceiving oneself as a physically active person contributesto satisfactory health perceptions.
In conclusion</>, both the Self-Determination and Self-Categorization Theory have been demonstrated to be valuable frameworks within the domain of physical activity promotion. Specifically, various individually-tailored need-supportivestrategies as well as a socially-oriented procedure that postulated normative support yielded substantial and equal increases in (older) adults physical activity level, even after a one-year follow-up period. In this respect, the number of individuals who attained the physical activityrecommendations for health increased up to 50% after participation in one of the programs. In addition to facilitating behavioral changes, eachof these strategies has been shown to positively affect different dimensions of subjective health and well-being. However, it should be pointedout that both a one-contact need-supportive strategy and a group-based counseling are less time-consuming procedures than a multiple-contact personalized physical activity coaching. Therefore, these two strategies appear to be particularly beneficial to implement at a large scale, and accordingly impact on public health. Finally, both personally-oriented and socially-oriented physical activity programs should strive to facilitate highly qualitative forms of behavioral regulation, either identified,integrated or intrinsic, in order to successfully encourage individuals to perform physical behavior in the short and the long term. Physical activity promoting strategies should thus put emphasis on the valued outcomes of physical activity, on its harmony with individuals lifestyle or on the fun that is associated with it.
</>
Various physical activity promoting strategies have been found to positively impact on individuals physical activity behavior. However, those grounded in a theoretical framework have been shown to be most effective, particularly in thelong term. Therefore, the main purpose of this thesis was to examine the extent to which the Self-Determination Theory and the Self-Categorization Theory contribute to the adoption and the (year-round) maintenance of physical activity behavior among (older) adults who do not attainthe physical activity recommendations for health. More specifically, westudied whether, in accordance with the tenets of the Self-Determination Theory</>, creating a need-supportive environment yields autonomous forms of motivation and consequently sustained behavioral changes in different population groups, i.e. employees (Study 1</>) and olderadults (Study 2</>). Individuals are autonomously motivated when they engage in an activity because the activity is personally important and meaningful and will help them to attain valued goals (i.e. identified regulation), because the activity fits their personality and overalllifestyle (i.e. integrated regulation) or for reasons of interest, enjoyment or challenge (i.e. intrinsic motivation). Autonomous motivation isself-initiated and therefore assumed to facilitate longer-term behavioral engagement than controlled motivation.
Furthermore, we evaluated whether, in accordance with the Self-Categorization Theory</>, integrating group processes and postulating social identity-based normative support for physical activity produce a more autonomous form of motivation, and consequently larger and longer-term increases in older adults physical activity than individually-tailored need-supportive counseling (Study 3</>). Given that both the Self-Determination Theory and the Self-Categorization Theory involve assumptions that are related tobehavior as well as to health, this doctoral thesis evaluated and compared the impact of the theoretically-grounded physical activity promotingstrategies not only on individuals behavioral persistence (i.e. over aperiod of one year) but also on their health perceptions.
The first intervention study</> aimed at examining the effectiveness of a four-month physical activity counseling based on the Self-Determination Theory amonguniversity employees who did not attain the physical activity recommendations for health (n = 126). Participants of the intervention condition</> (n = 92) received an individually-tailored need-supportive coaching from a bachelor in Kinesiology. Specifically, the coach facilitated participants physical activity behavior by supporting their need for autonomy (e.g., by exploring physical activity options rather than prescribing physical activities), their need for competence (e.g., by drafting a structured and appropriate physical activity plan or by providing positive feedback) and their need for interpersonal relatedness (e.g., by creating a warm relationship within an empathetic environment). Participants of the waiting-list control condition</> (n = 34) did not receive any physical activity adviceor coaching.
With respect to self-reported physical activity</>, results showed significantly different changes over time between the intervention and control condition. In particular, the intervention condition increased in moderate (+ 158%) and strenuous (+ 436%) physical activity from baseline to four-month follow-up and in mild (+ 81%), moderate (+ 215%) and strenuous (+ 386%) physical activity from baseline to one-year follow-up. In the control condition, no changes emerged in (the different intensities of) physical activity. Autonomous motivation and self-efficacy (i.e. the confidence one has to be physically active in adverse situations such as fatigue or bad weather conditions) significantly mediated the intervention effect on (strenuous) physical activity from baseline to four-month follow-up. Social support from significant others (e.g., friends) mediated the intervention effect from baseline to one-year follow-up.
With respect to physical well-being</>, results showed a significantly different change over time between the intervention and control condition. In particular, the intervention condition substantially improved in physical well-being from baseline to four-month follow-up and from baseline to one-year follow-up whereas no changes emerged in the control condition. The intervention effect on physical well-being was mediated by strenuous physical activity. With respect to psychological well-being, no significant changes were found in the intervention or control condition from baseline to four-month follow-up,but however, a significant decrease emerged in both conditions from baseline to one-year follow-up.
We concluded</> that an individually-tailored physical activity program based on the Self-Determination Theory can positively impact on employees physical activity behavior and their (physical) well-being, even after a one-year follow-up period. Moreover, the results underscored the importance of high quality motivation and social support in the adoption and maintenance of physical activity behavior.
The second intervention study</>aimed at examining and comparing the effectiveness of three physical activity programs varying in counseling procedure and intensity among adults aged 60 years or older who did not attain the physical activity recommendations for health (n = 442). The first strategy (i.e. referral condition</>; n = 146) consisted of a 15-minute contact in which a Health Fitness Specialist referred participants to local physical activityprograms. The second strategy (i.e. walking condition</>; n = 146) embraced a 15-minute contact in which a Health Fitness Specialist provided participants a structured program consisting of walking schemes that gradually increased in volume and intensity. The walking program wasassumed to inherently support participants need for competence. The third strategy (i.e. need-supportive coaching condition</>; n = 150) comprised a ten-week multiple-contact individually-tailored physical activity counseling in which a Health Fitness Specialist supported participants needs for autonomy, competence and relatedness, consistent withthe tenets of the Self-Determination Theory.
With respect to physical activity</>, each of the programs yielded significant and substantial increases in daily steps and self-reported physical activity from baseline to ten-week follow-up. However, significantly larger increases emerged in the walking condition (e.g., self-reported physical activity: + 104%) and the need-supportive coaching condition (e.g., self-reported physical activity: + 116%) compared with the referral condition (e.g., self-reported physical activity: + 65%). Similarly, each of the programs yielded significant increases in self-reported physical activity frombaseline to one-year follow-up, with larger increases in the walking condition (+ 131%) and the need-supportive coaching condition (+ 166%) than in the referral condition (+ 92%). With respect to daily steps from baseline to one-year follow-up, significant increases were found in the walking and the need-supportive coaching condition whereas no changes emerged in the referral condition, but however, no significant time by condition interaction effect emerged. Autonomous motivation mediated the relation between participants perceived need-support of the coach and theirphysical activity level, irrespective of intervention condition.
With respect to subjective health</>, results showed no significantly different changes over time between the referral condition, the walking condition and the need-supportive coaching condition. However, each of the programs yielded significant improvements in subjective well-beingand trait anxiety, from baseline to ten-week follow-up and from baseline to one-year follow-up. From baseline to two-year follow-up, no changesemerged in subjective well-being, indicating a relapse to baseline level two years after the intervention. Similarly, trait anxiety significantly increased from baseline to two-year follow-up. The improvements in participants health perception were significantly predicted by their increases in physical activity. Also a higher level of perceived need-support of the coach contributed to a better subjective health.
We concluded</> that physical activity promoting programs varying incounseling strategy and intensity can positively affect older adults physical activity and subjective health, even after a one-year follow-up period. However, an individualized and (partially) need-supportive physicalactivity program seemed to be more successful in producing long-term physical activity engagement than a referral to widespread opportunities. In this respect, and considering its one-contact character, providing a structured (walking) program appears to be a potentially effective strategy to implement at a large scale. Furthermore, the findings pointed out the key role of autonomous motivation in the transition from an inactive to regularly active lifestyle in older adults. At the same time, an increased physical activity level and satisfactory feelings of perceived need-support emerged as important determinants of older adults subjective health over a one-year follow-up period.
The third intervention study</> aimed at examining and comparing the effectiveness of three six-week identity-based physical activity counseling strategies among adults aged 55 to 70 years who did not attain the physical activity recommendations for health (n = 169). The first strategy (personal</> identity condition</>; n = 56) consisted of an individually-tailored need-supportive physical activity coaching based on the Self-Determination Theory. A Health Fitness Specialist targeted participants personal self, and thus their unique characteristics. Participants were encouraged to engage in physical activity for their own personally valued reasons (e.g., because of the health-related benefits, because of the social contact, in order to work off steam etc.). The second strategy (social identity condition</>; n = 57) embraced a socially-oriented physical activity promoting program based on the Self-Categorization Theory. A Health Fitness Specialist targeted participants social self and provided group-based normative support for physical activity. More specifically, physical activity behavior was proposed as prototypical for a relevant reference group within this population. Based on the results of a preliminary survey (n = 1340), sociallyengaged persons and independent persons were considered as the most appropriate reference groups to be used in the physical activity intervention. The third strategy (joined identity condition</>; n = 56)comprised a physical activity counseling procedure based on the Self-Determination and Self-Categorization Theory. A Health Fitness Specialist facilitated participants physical activity behavior by targeting both their personal and social self.
With respect to physical activity</>, each of the strategies yielded significant and substantial increases in daily steps, daily aerobic minutes and self-reported physical activity, from baseline to six-week follow-up (e.g., steps: personal identity condition: + 75%; social identity condition: + 68%; joined identity condition: + 71%) and from baseline to one-year follow-up (e.g., steps: personal identity condition: + 62%; social identity condition: + 56%; joined identity condition: + 69%). Changes over time did not significantlydiffer between the interventions, except for aerobic minutes, which increased significantly more in the social identity condition from baselineto six-week follow-up than in the personal identity condition. Consistent with the tenets of the Self-Determination Theory, the relation between perceived need-support and physical activity was mediated by identified regulation (i.e. being physically active because of its valued outcomes such as health benefits). Consistent with the Self-Categorization Theory, the relation between perceived normative support and physical activity was mediated by integrated regulation (i.e. being physically active because it fits your personality and your overall lifestyle and goals).
With respect to the self-rated health</>, significant increases emerged in the social identity condition and the joinedidentity condition from baseline to six-week follow-up and from baseline to one-year follow-up whereas no changes emerged in the personal identity condition. Physical well-being significantly increased in the joinedidentity condition from baseline to six-week follow-up and from baseline tot one-year follow-up whereas no changes occurred in the personal identity condition and the social identity condition. Finally, psychological well-being significantly improved in the joined identity condition from baseline to six-week follow-up whereas no changes emerged in the personal identity condition and the social identity condition. Participants self-rated health and physical well-being were positively related to their daily steps. In addition, participants degree of identificationwith a relevant social identity was significantly and positively related to each of the proposed dimensions of their subjective health.
We concluded</> that physical activity promoting strategies targeting individuals personal self, their social self or both their personal and social self are (equally) effective in increasing physical activity in the older adult population, even after a one-year follow-up period. However, the socially-oriented strategy that postulated group-based physical activity norms involved a non-individualized approach, and accordingly entailed relatively low costs. Therefore, a Self-Categorization Theory-based program appears to be particularly beneficial to implement in the wider community compared with individually-tailored Self-Determination Theory-based physical activity coaching. Moreover, the findings pointed out the importance of activating a highly qualitative behavioral regulation, either identified or integrated, to perform physical activity behavior in the short and the long term. With respect to perceived health, it was concluded that emphasizing older adults membership of a meaningful and positively valued group can positively affect their subjective health and well-being. In this respect, it seems that not only being but also perceiving oneself as a physically active person contributesto satisfactory health perceptions.
In conclusion</>, both the Self-Determination and Self-Categorization Theory have been demonstrated to be valuable frameworks within the domain of physical activity promotion. Specifically, various individually-tailored need-supportivestrategies as well as a socially-oriented procedure that postulated normative support yielded substantial and equal increases in (older) adults physical activity level, even after a one-year follow-up period. In this respect, the number of individuals who attained the physical activityrecommendations for health increased up to 50% after participation in one of the programs. In addition to facilitating behavioral changes, eachof these strategies has been shown to positively affect different dimensions of subjective health and well-being. However, it should be pointedout that both a one-contact need-supportive strategy and a group-based counseling are less time-consuming procedures than a multiple-contact personalized physical activity coaching. Therefore, these two strategies appear to be particularly beneficial to implement at a large scale, and accordingly impact on public health. Finally, both personally-oriented and socially-oriented physical activity programs should strive to facilitate highly qualitative forms of behavioral regulation, either identified,integrated or intrinsic, in order to successfully encourage individuals to perform physical behavior in the short and the long term. Physical activity promoting strategies should thus put emphasis on the valued outcomes of physical activity, on its harmony with individuals lifestyle or on the fun that is associated with it.
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Date:1 Oct 2009 → 12 Dec 2013
Keywords:Self-determination theory, Self-categorisation theory, Sedentary, Older adults, Physical activity, Intervention, Relatedness/belongingness
Disciplines:Public health care, Public health sciences, Public health services, Social psychology
Project type:PhD project