<p>This dissertation reports the development of a scale to measure childrens' and adolescents' self-perceptions regarding their involvement in those physical activities typical of youth. Self-efficacy theory is used as a perspective from which to view these perceptions. The test-retest reliability, and both the construct and predictive validity of this scale are investigated and established. The development and testing of a Participation Questionnaire and a Teacher's Evaluation form are also reported herein.</p> / Doctor of Philosophy (PhD)

Cardiovascular disease is currently the leading cause of death in Canada and other developed countries. Physical activity based cardiac rehabilitation programs have been shown to reduce the likelihood of subsequent cardiac events and even reverse the disease process. However, factors influencing physical activity in cardiac patients are still not clearly understood. The overall objective of this dissertation was therefore to better understand motivation and physical activity in a cardiac rehabilitation context. Specifically, theory-based motivational variables were studied as correlates of physical activity. To accomplish this objective, a two-purpose research approach was taken. First, two articles (Article-1 and Article-2) aimed to test and integrate concepts from two strong motivational theories: Self-Efficacy Theory (SET) and Self-Determination Theory (SDT) into one comprehensive model using the novel and rigorous approach of Noar and Zimmerman (2005). The second purpose of this dissertation was to extend the findings from the first purpose by investigating physical activity and motivational patterns over a 24-month period in cardiac patients (Article 3). With regards to the first purpose, Article-1 revealed that the integration of SDT and SET was feasible as the integrated model had good model fit, explained more variance in self-determined motivation, confidence, and physical activity and supported similar number of hypothesised links in a cross-sectional cardiac sample as well two other samples: primary care adults and university students. Due to the cross-sectional nature of Article-1, Article-2 tested the integrated SDT-SET model from cardiac patients with longitudinal data of patients following a cardiac rehabilitation program. Although no motivational variables predicted residual change in physical activity at 4-months, this longitudinal model was found to have good model fit. Across both articles, the integration of SDT and SET was found to be possible. However, more research is needed to further test the integration of these theories. As for the second purpose of this dissertation, Article-3 investigated physical activity and motivational patterns of cardiac rehabilitation participants over the course of 24 months. Distinct patterns were found for physical activity, self-determined motivation, barrier self-efficacy and outcome expectations. In addition, individuals in the higher patterns of the motivational/expectancy variables had greater probability of being in the maintenance physical activity pattern compared to individuals in the other motivational/expectancy patterns. Therefore, this article extended findings from the first purpose by linking SDT and SET variables to long-term physical activity behaviour. SDT and SET should continue to be investigated together in order to increase our understanding of the mechanisms leading to greater motivation and subsequent increases in physical activity levels. Having a theoretically supported pathway to build motivation is ideal to inform future interventions and cardiac rehabilitation programs.

Cardiovascular disease is currently the leading cause of death in Canada and other developed countries. Physical activity based cardiac rehabilitation programs have been shown to reduce the likelihood of subsequent cardiac events and even reverse the disease process. However, factors influencing physical activity in cardiac patients are still not clearly understood. The overall objective of this dissertation was therefore to better understand motivation and physical activity in a cardiac rehabilitation context. Specifically, theory-based motivational variables were studied as correlates of physical activity. To accomplish this objective, a two-purpose research approach was taken. First, two articles (Article-1 and Article-2) aimed to test and integrate concepts from two strong motivational theories: Self-Efficacy Theory (SET) and Self-Determination Theory (SDT) into one comprehensive model using the novel and rigorous approach of Noar and Zimmerman (2005). The second purpose of this dissertation was to extend the findings from the first purpose by investigating physical activity and motivational patterns over a 24-month period in cardiac patients (Article 3). With regards to the first purpose, Article-1 revealed that the integration of SDT and SET was feasible as the integrated model had good model fit, explained more variance in self-determined motivation, confidence, and physical activity and supported similar number of hypothesised links in a cross-sectional cardiac sample as well two other samples: primary care adults and university students. Due to the cross-sectional nature of Article-1, Article-2 tested the integrated SDT-SET model from cardiac patients with longitudinal data of patients following a cardiac rehabilitation program. Although no motivational variables predicted residual change in physical activity at 4-months, this longitudinal model was found to have good model fit. Across both articles, the integration of SDT and SET was found to be possible. However, more research is needed to further test the integration of these theories. As for the second purpose of this dissertation, Article-3 investigated physical activity and motivational patterns of cardiac rehabilitation participants over the course of 24 months. Distinct patterns were found for physical activity, self-determined motivation, barrier self-efficacy and outcome expectations. In addition, individuals in the higher patterns of the motivational/expectancy variables had greater probability of being in the maintenance physical activity pattern compared to individuals in the other motivational/expectancy patterns. Therefore, this article extended findings from the first purpose by linking SDT and SET variables to long-term physical activity behaviour. SDT and SET should continue to be investigated together in order to increase our understanding of the mechanisms leading to greater motivation and subsequent increases in physical activity levels. Having a theoretically supported pathway to build motivation is ideal to inform future interventions and cardiac rehabilitation programs.

Cardiovascular disease is currently the leading cause of death in Canada and other developed countries. Physical activity based cardiac rehabilitation programs have been shown to reduce the likelihood of subsequent cardiac events and even reverse the disease process. However, factors influencing physical activity in cardiac patients are still not clearly understood. The overall objective of this dissertation was therefore to better understand motivation and physical activity in a cardiac rehabilitation context. Specifically, theory-based motivational variables were studied as correlates of physical activity. To accomplish this objective, a two-purpose research approach was taken. First, two articles (Article-1 and Article-2) aimed to test and integrate concepts from two strong motivational theories: Self-Efficacy Theory (SET) and Self-Determination Theory (SDT) into one comprehensive model using the novel and rigorous approach of Noar and Zimmerman (2005). The second purpose of this dissertation was to extend the findings from the first purpose by investigating physical activity and motivational patterns over a 24-month period in cardiac patients (Article 3). With regards to the first purpose, Article-1 revealed that the integration of SDT and SET was feasible as the integrated model had good model fit, explained more variance in self-determined motivation, confidence, and physical activity and supported similar number of hypothesised links in a cross-sectional cardiac sample as well two other samples: primary care adults and university students. Due to the cross-sectional nature of Article-1, Article-2 tested the integrated SDT-SET model from cardiac patients with longitudinal data of patients following a cardiac rehabilitation program. Although no motivational variables predicted residual change in physical activity at 4-months, this longitudinal model was found to have good model fit. Across both articles, the integration of SDT and SET was found to be possible. However, more research is needed to further test the integration of these theories. As for the second purpose of this dissertation, Article-3 investigated physical activity and motivational patterns of cardiac rehabilitation participants over the course of 24 months. Distinct patterns were found for physical activity, self-determined motivation, barrier self-efficacy and outcome expectations. In addition, individuals in the higher patterns of the motivational/expectancy variables had greater probability of being in the maintenance physical activity pattern compared to individuals in the other motivational/expectancy patterns. Therefore, this article extended findings from the first purpose by linking SDT and SET variables to long-term physical activity behaviour. SDT and SET should continue to be investigated together in order to increase our understanding of the mechanisms leading to greater motivation and subsequent increases in physical activity levels. Having a theoretically supported pathway to build motivation is ideal to inform future interventions and cardiac rehabilitation programs.

Cardiovascular disease is currently the leading cause of death in Canada and other developed countries. Physical activity based cardiac rehabilitation programs have been shown to reduce the likelihood of subsequent cardiac events and even reverse the disease process. However, factors influencing physical activity in cardiac patients are still not clearly understood. The overall objective of this dissertation was therefore to better understand motivation and physical activity in a cardiac rehabilitation context. Specifically, theory-based motivational variables were studied as correlates of physical activity. To accomplish this objective, a two-purpose research approach was taken. First, two articles (Article-1 and Article-2) aimed to test and integrate concepts from two strong motivational theories: Self-Efficacy Theory (SET) and Self-Determination Theory (SDT) into one comprehensive model using the novel and rigorous approach of Noar and Zimmerman (2005). The second purpose of this dissertation was to extend the findings from the first purpose by investigating physical activity and motivational patterns over a 24-month period in cardiac patients (Article 3). With regards to the first purpose, Article-1 revealed that the integration of SDT and SET was feasible as the integrated model had good model fit, explained more variance in self-determined motivation, confidence, and physical activity and supported similar number of hypothesised links in a cross-sectional cardiac sample as well two other samples: primary care adults and university students. Due to the cross-sectional nature of Article-1, Article-2 tested the integrated SDT-SET model from cardiac patients with longitudinal data of patients following a cardiac rehabilitation program. Although no motivational variables predicted residual change in physical activity at 4-months, this longitudinal model was found to have good model fit. Across both articles, the integration of SDT and SET was found to be possible. However, more research is needed to further test the integration of these theories. As for the second purpose of this dissertation, Article-3 investigated physical activity and motivational patterns of cardiac rehabilitation participants over the course of 24 months. Distinct patterns were found for physical activity, self-determined motivation, barrier self-efficacy and outcome expectations. In addition, individuals in the higher patterns of the motivational/expectancy variables had greater probability of being in the maintenance physical activity pattern compared to individuals in the other motivational/expectancy patterns. Therefore, this article extended findings from the first purpose by linking SDT and SET variables to long-term physical activity behaviour. SDT and SET should continue to be investigated together in order to increase our understanding of the mechanisms leading to greater motivation and subsequent increases in physical activity levels. Having a theoretically supported pathway to build motivation is ideal to inform future interventions and cardiac rehabilitation programs.

In academia, research on feedback has been helpful and has enhanced awareness of students' and professors' perceptions, thereby promoting effective strategies for giving feedback to students. According to Boud (2015) and others, feedback is a significant component of the teaching and learning process. Quality teaching and evaluative processes give learners an advantage in becoming exceptional nurses. The current study aimed to research the perceptions of pre-licensure first- and second-year nursing students and their professors regarding clinical skills performance assessment feedback. A quantitative, cross-sectional, non-experimental design was utilized in this study. Convenience sampling was conducted with 163 nursing students either enrolled in the program's first year or second year of nursing education and those who completed the online survey entitled Students' Perceptions of Professor Feedback survey. In addition, nine professors who taught and assessed clinical skills in the first and second year of the nursing curriculum completed the Professors' Perceptions of Feedback survey. Data was analyzed using descriptive statistics and multiple linear regression. Based on the findings, it was reasonable to conclude that students generally felt that professor feedback was an effective teaching and evaluative strategy in nursing education. Specific content areas, such as the quality of the information given during feedback and the emotional impact of feedback, had a meaningful, significant effect on students' confidence levels. / Doctor of Philosophy / In academia, research on feedback has been helpful and has enhanced the awareness of students' and professors' perceptions, promoting effective strategies for giving feedback to students. According to Boud (2015) and others, feedback is a significant component of the teaching and learning process. Quality teaching and evaluative processes give learners an advantage in becoming exceptional nurses. The current study aimed to research the perceptions of pre-licensure first- and second-year nursing students and their professors regarding clinical skills performance assessment feedback. A quantitative, cross-sectional, non-experimental design was utilized in this study. Convenience sampling was conducted with 163 nursing students either enrolled in the program's first year or second year of nursing education and those who completed the online survey entitled Students' Perceptions of Professor Feedback survey. In addition, nine professors who taught and assessed clinical skills in the first and second year of the nursing curriculum completed the Professors' Perceptions of Feedback survey. Data was analyzed using descriptive statistics and multiple linear regression. Based on the findings, it was reasonable to conclude that students generally felt that professor feedback was an effective teaching and evaluative strategy in nursing education but there are opportunities to improve strategies used in nursing education. Specific content areas, such as the quality of the information given during feedback and the emotional impact of feedback, had a meaningful, significant effect on students' confidence levels involving clinical skills performance assessment.

The neighbourhood is an essential arena for adolescents’ health development and research suggests that perceived neighbourhood insecurity (PNI) is associated with socio-economic status and self-rated health. The present study explored the distribution of adolescents’ PNI and its association with psychosomatic health complaints across districts. It also examined gender differences and whether family socio-economic position, foreign background and previous exposure to crime could explain part of the association. Data came from classroom-surveys within Stockholm municipality’s 14 districts in 2010, 2012 and 2014 (n=10,291). Linear and logistic multilevel regression models were applied. Results showed that the average level of PNI varied considerably between districts and were strongly connected to its socio-demographic composition. However, individual characteristics in terms of family background and previous exposure to crime only explained a minor part of the variation in PNI across districts. Girls reported more insecurity than boys in all districts. Gender differences in PNI decreased in absolute numbers, but increased in relative numbers, as the overall ‘neighbourhood safety’ increased. Between-district differences in health were minor, but PNI was still a strong predictor of individual-level health, especially for boys. Furthermore, the predictive power of PNI on health was stronger in districts perceived as safer.

This preliminary investigation utilized both a top-down theory (Banduras Self-Efficacy Theory: SET, 1997) and a bottom-up theory (Leventhals Common Sense Model: CSM, 1980) to examine the cognitions and exercise behavior of novice cardiac rehabilitation (CR) participants engaged in 3 months of standard CR treatment. The primary purpose of this study was to investigate if the Illness Perception Questionnaire (IPQ,) as a reflection of the CSM, could classify CR novices relative to the strength of their illness perceptions. A further objective was to detect differences at baseline between the illness perception groups when evaluating SET variables and health-related outcomes that have been identified as important correlates of CR adherence. Additionally, the study proposed to determine differences between illness perception groups on adherence to recommended exercise therapy in CR. Lastly, differences between the groups on the assessed variables over the 3 month-rehabilitation period was examined. Forty-nine CR initiates were recruited. Participants were measured at 4 different time points over the 3-month initiation phase of CR. The IPQ, SF-36 (assessing health-related quality of life; HRQL,) and other social cognitive measures, including self-regulatory efficacy and positive and negative outcome expectations, were used to examine individuals. Participants completed measures at initiation of CR, after 2 weeks in CR, 6 weeks in CR and at the end of the 3-month initiate phase of CR. At onset of the program, cluster analysis successfully classified participants to weaker and stronger symptom-identity groups (i.e., illness perception groups). These groups were shown to be significantly different on the illness perceptions of identity, consequences and emotion. Upon initiation of CR, the classified groups were also significantly different on likelihood and value of negative outcome expectations, as well as physical and mental HRQL. At baseline, the group with stronger identity, consequences and emotion had higher negative outcome expectations and lower HRQL. In regards to adherence at the end of 3-months of CR, significant differences were found between the groups such that the group with stronger identity, consequences and emotion were less adherent to CR. This study was an initial exploration of the effectiveness of using the CSM along with SET. The findings offer insight into complementary use of top-down and bottom-up theoretical constructs to study psychological beliefs and adherence to exercise therapy in this rehabilitation setting.

Structured physical activity (SPA) is one type of physical activity in which preschool aged children participate (e.g., soccer programs). Given that SPA often occurs at community-based locations, such as at a field or hockey rink, primary caregivers, who are often times mothers, must transport their preschool aged children to the scheduled SPA. Although studies have examined social cognitions important to individuals participation in their own scheduled physical activity, no study to date has focused on the social cognitions of mothers that may be related to the transportation of their preschool aged children to SPA. The purpose of this two-study dissertation was to use self-efficacy theory to develop and examine the reliability and validity evidence of measures to assess mothers social cognitions (i.e., self-regulatory efficacy to overcome barriers and to schedule/plan; outcome expectations including likelihood and value) that may be related to transporting their children to SPA. A literature review, focus group elicitation with nine participants (Mean age = 35.25 years; SD = 3.57), and feedback from three expert judges and 10 participants were used to develop items for each of the measures in Study 1. The reliability of the measures was then investigated in Study 1 using data from 31 participants (Mean age= 33.50 years; SD = 5.79) to examine initial internal consistency and then 64 participants (Mean age= 32.87 years; SD = 4.48) to further examine internal consistency and temporal stability. Findings revealed some evidence for the content and construct validity, internal consistency, and temporal stability of the measures. To continue the construct validation of the measures, it was important to continue to examine the reliability evidence of the measures and other aspects of validity, including concurrent and predictive validity. In Study 2, data from 93 participants (Mean age= 34.88 years; SD = 5.04) were used to examine evidence of the criterion-related validity (i.e., concurrent and predictive) of the developed measures. Results revealed convergence of the measures that assessed similar constructs (i.e., self-regulatory efficacy to schedule/plan and to overcome barriers; outcome expectations: likelihood and value). However, evidence of the divergence of the self-regulatory efficacy measures from the outcome expectation measures was less consistent. Results also revealed that the self-regulatory efficacy beliefs and outcome expectations measures were not significant, independent predictors of transportation to SPA. These predictive validity findings as well as the divergence findings may have been due to the type of mothers who participated in the study (i.e., highly experienced in transporting children to SPA). Findings from the present series of studies suggest a need for continued exploration of the measures, including research with a more diverse sample. Collecting further reliability and validity evidence of these measures to compare it with the evidence from the present studies would contribute to the ongoing construct validation of these measures.

Structured physical activity (SPA) is one type of physical activity in which preschool aged children participate (e.g., soccer programs). Given that SPA often occurs at community-based locations, such as at a field or hockey rink, primary caregivers, who are often times mothers, must transport their preschool aged children to the scheduled SPA. Although studies have examined social cognitions important to individuals participation in their own scheduled physical activity, no study to date has focused on the social cognitions of mothers that may be related to the transportation of their preschool aged children to SPA. The purpose of this two-study dissertation was to use self-efficacy theory to develop and examine the reliability and validity evidence of measures to assess mothers social cognitions (i.e., self-regulatory efficacy to overcome barriers and to schedule/plan; outcome expectations including likelihood and value) that may be related to transporting their children to SPA. A literature review, focus group elicitation with nine participants (Mean age = 35.25 years; SD = 3.57), and feedback from three expert judges and 10 participants were used to develop items for each of the measures in Study 1. The reliability of the measures was then investigated in Study 1 using data from 31 participants (Mean age= 33.50 years; SD = 5.79) to examine initial internal consistency and then 64 participants (Mean age= 32.87 years; SD = 4.48) to further examine internal consistency and temporal stability. Findings revealed some evidence for the content and construct validity, internal consistency, and temporal stability of the measures. To continue the construct validation of the measures, it was important to continue to examine the reliability evidence of the measures and other aspects of validity, including concurrent and predictive validity. In Study 2, data from 93 participants (Mean age= 34.88 years; SD = 5.04) were used to examine evidence of the criterion-related validity (i.e., concurrent and predictive) of the developed measures. Results revealed convergence of the measures that assessed similar constructs (i.e., self-regulatory efficacy to schedule/plan and to overcome barriers; outcome expectations: likelihood and value). However, evidence of the divergence of the self-regulatory efficacy measures from the outcome expectation measures was less consistent. Results also revealed that the self-regulatory efficacy beliefs and outcome expectations measures were not significant, independent predictors of transportation to SPA. These predictive validity findings as well as the divergence findings may have been due to the type of mothers who participated in the study (i.e., highly experienced in transporting children to SPA). Findings from the present series of studies suggest a need for continued exploration of the measures, including research with a more diverse sample. Collecting further reliability and validity evidence of these measures to compare it with the evidence from the present studies would contribute to the ongoing construct validation of these measures.