Motivation has been identified as an important variable in recovery. Self-efficacy, which is an individual's judgment of his or her capabilities to organize and execute courses of action to accomplish specific goals, is considered an essential component of motivation. This study used an experimental pretest-posttest design and qualitative design using a grounded theory approach to assess the impact of self-efficacy enhancing interventions on self-efficacy beliefs and functional outcomes of participants in a geriatric rehabilitation program. Participants were randomly assigned to one of two groups: (1) the experimental treatment group; and (2) the usual care control group. In addition to usual care, the treatment group received three self-efficacy enhancing interventions: (1) role modeling; (2) verbal persuasion; and (3) physiological feedback. The study sample consisted of 77 participants, 55 females (71%) and 22 males (29%), with a mean age of 78 (SD = 7.2). Admission performance was the only statistically significant predictor of self-efficacy and outcome expectancy beliefs in this sample. Based on repeated measures analyses there was a statistically significant difference between the two groups in regard to participation, self-efficacy and outcome expectancy for participation, and pain. The treatment group had stronger efficacy beliefs regarding participation, higher participation at discharge, and less pain than the control group. Although not statistically significant, the treatment group had higher self-efficacy for functional ability at discharge than the control group. There was no difference in the groups in regard to length of stay, however stronger efficacy beliefs on admission were correlated with shorter length of stay. Based on themes identified in the interviews, motivation was conceptualized as a wheel that moves. The spokes of the wheel incorporated the variables within the theory of self-efficacy and expanded on these variables to include: (1) personal expectations; (2) physical sensation; (3) individualized care; (4) social support; (5) self-determination; (6) spirituality; (7) goals; and (8) performance behavior. This conceptualization of motivation can be used to assess motivation in the older adult, and use interventions to strengthen motivation and help these individuals obtain and maintain their highest functional level.

Background. Ongoing adherence to exercise post hip fracture improves clinical outcomes. Unfortunately, older women post hip fracture do not continue to adhere to regular exercise. Understanding factors related to exercise behavior is critical so that interventions can be developed to increase exercise. Purpose. This study tested the impact of the Exercise Plus Program, a self-efficacy-based exercise intervention, on long-term adherence to regular exercise in older women post hip fracture who completed either of the two parent exercise interventions, Baltimore Hip Studies (BHS) 4 or 5 randomized-controlled trial. Methods. A descriptive, correlational study was conducted with 101 older women 14 to 48 months post hip fracture who completed a one-time telephone interview 2 to 36 months after completion of either parent study. Path analysis was used to test the hypothesized relationships among age, education, treatment group, time post parent study completion (TPPSC), pain, fear of falling, resilience, social support for exercise, stage of change, self-efficacy expectations for exercise (SEE), outcome expectations for exercise (OEE), and exercise behavior. Results. Participants were all female, mean age of 80 (SD 7.6), mainly white, and lived in the community. Approximately half were widowed, high school educated, and did not exercise at all. On average, they exercised 2 hours per week; had moderate SEE, resilience, and fear of falling; had high OEE; and had rarely no social support for exercise. Path analysis revealed 10 of the 37 hypothesized paths were statistically significant. SEE, pain, and social support for exercise explained 32% of the variance in exercise behavior. Education, resilience, fear of falling, and TPPSC explained 30% of the variance in SEE. The hypothesized model showed an excellent fit to the data (chi2m=36 (df=29, p=.20), chi 2m/dfm=1.2, CFI=.90, and RMSEA=.00) and model trimming showed no significant improvement in model fit. Conclusions. Older women post hip fracture did not meet the current national recommended exercise guidelines. The findings suggest that ongoing research is needed to test inoculation interventions that strengthen SEE, maintain social support for exercise, and alleviate pain after an exercise intervention is completed which may improve their long-term adherence to regular exercise.