OBJECTIVES: To study (i) the association of general self-efficacy (GSE) on the course of subjective (i.e. basic and instrumental activities of daily living (ADLs and IADLs) and objective physical performance outcomes (short physical performance battery (SPPB)) among older persons from discharge up to 3 months post-discharge and (ii) the extent to whether motivational factors such as depressive symptoms, apathy and fatigue mediate this association.METHODS: Prospective multi-centre cohort of acutely hospitalised patients aged ≥70 (Hospital-ADL study). Structural equation modelling was used to analyse the structural relationships.RESULTS: The analytic sample included 236 acutely hospitalised patients. GSE had a significant total effect on the course of subjective and objective performance outcomes (ADLs: β = -0.21, P < 0.001, IADLs: β = -0.24, P < 0.001 and SPPB: β = 0.17, P < 0.001). However, when motivational factors as mediator were included into the same model, motivational factors (IADLs: β = 0.51, P < 0.001; SPPB: β = 0.49, P < 0.001) but not GSE remained significantly associated with IADLs (β = -0.06, P = 0.16) and SPPB (β = 0.002, P = 0.97). Motivational factors partially mediated the relationship between GSE and ADLs (β = -0.09, P = 0.04). The percentage of mediation was 55, 74 and 99% for ADLs, IADLs and SPPB, respectively.CONCLUSIONS: Motivational factors and GSE are both associated with subjective and objective performance outcomes. However, the relationship between GSE and subjective and objective performance outcomes was highly mediated by motivational factors. Taken together, this suggests that GSE is important to being physically active but not sufficient to becoming more physical active in acutely hospitalised older patients; motivation is important to improving both subjective and objective performance.
Abstract The main purpose of this intervention was to measure student’s motivation in English Literature before and after an intervention based Zoltán Dörnyei’s Motivational Self System (2009) and Michael Magid’s (2011) application of the same theory in schools in Singapore. The present intervention was adapted to the students of the Dutch secondary school CLV (Christian Lyceum Veenendaal) in Veenendaal using fragments of English Literature (books, films, poems and songs). The intervention was carried out during eight lessons of fifty minutes where students had to participate in a variety of activities, all registered in a workbook assigned to each student at the beginning of the research project. Prior to and after the intervention, students filled in a questionnaire on motivation and English Literature. The results of these questionnaires were analysed with SPSS running descriptive statistical analysis. Along with these analyses, the timelines and life trees made by the students during the lessons and students’ answers given to the exercises on the workbooks were evaluated and compared. One of the most important conclusions of the intervention was that female students were more motivated, could make action plans and set goals easier and more detailed than male students. Another important result was that students in general had no interest in English Literature, although they realised it can be influential in their future life. The affective attitude of students to- wards the teacher and materials increased after the intervention, as well as students’ confidence in their own effort during class. However, the construct validity between the quantitative and qualitative data could not be established due to the fact that gender was not included as variable in the questionnaire. Gender relevancy became visible after the analyses of the workbooks. Therefore, future research will have to focus on including gender as a variable in the questionnaire in order to establish solid relations between quantitative and qualitative data. Another interesting research question for future interventions could be how to adapt English Literature and the materials that are being used in a way that both female and male students can tap into their own intrinsic motivational current.
Artikel proefschrift Jos Dobber verschenen in Frontiers in Psychiatry 24 maart 2020: Background: Trials studying Motivational Interviewing (MI) to improve medication adherence in patients with schizophrenia showed mixed results. Moreover, it is unknown which active MI-ingredients are associated with mechanisms of change in patients with schizophrenia. To enhance the effect of MI for patients with schizophrenia, we studied MI's active ingredients and its working mechanisms. Methods: First, based on MI literature, we developed a model of potential active ingredients and mechanisms of change of MI in patients with schizophrenia. We used this model in a qualitative multiple case study to analyze the application of the active ingredients and the occurrence of mechanisms of change. We studied the cases of fourteen patients with schizophrenia who participated in a study on the effect of MI on medication adherence. Second, we used the Generalized Sequential Querier (GSEQ 5.1) to perform a sequential analysis of the MI-conversations aiming to assess the transitional probabilities between therapist use of MI-techniques and subsequent patient reactions in terms of change talk and sustain talk. Results: We found the therapist factor “a trusting relationship and empathy” important to enable sufficient depth in the conversation to allow for the opportunity of triggering mechanisms of change. The most important conversational techniques we observed that shape the hypothesized active ingredients are reflections and questions addressing medication adherent behavior or intentions, which approximately 70% of the time was followed by “patient change talk”. Surprisingly, sequential MI-consistent therapist behavior like “affirmation” and “emphasizing control” was only about 6% of the time followed by patient change talk. If the active ingredients were embedded in more comprehensive MI-strategies they had more impact on the mechanisms of change. Conclusions: Mechanisms of change mostly occurred after an interaction of active ingredients contributed by both therapist and patient. Our model of active ingredients and mechanisms of change enabled us to see “MI at work” in the MI-sessions under study, and this model may help practitioners to shape their MI-strategies to a potentially more effective MI.
