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.
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