Self-Management of Physical Activity in African Americans and Hispanics with Multiple Sclerosis: Mixed Methods
BACKGROUND: People with multiple sclerosis (MS) are prone to inactivity due to mobility impairments, which too often leads to obesity and other secondary conditions (e.g. depression, diabetes). Minorities with MS have health disparities when compared to Caucasians with MS, but the current health behavior theories were developed and validated mainly among the Caucasian population. There is a paucity of research considering multicultural perspectives for minorities with MS. The present study used the Health Action Process Approach (HAPA) as a theoretically driven framework to study how people with MS, specifically African Americans (AF) and Hispanics, self-manage their physical activity (PA). SUBJECTS: Eighteen AF (4 males, 14 females) with MS were recruited, ages 27-61 years old (M = 44.72, SD = 8.89). Three Hispanics (3 females) with MS were recruited, ages 27-54 years old (M = 38.33, SD = 14.01). They were all diagnosed with MS on average about 8 years prior (M = 7.83, SD = 5.58) and the majority of the participants (n = 18, 86%) lived in the Dallas-Forth Worth area. METHODS: Recruiting flyers were posted in the Multiple Sclerosis Clinic at UT Southwestern Medical Center, neurology clinics, churches in the community, and the National Multiple Sclerosis Society website. This study used a mixed methods research design. Qualitative data, used to gather minorities’ perspectives of their self-promotion of PA, was collected via focus groups and phone interviews; this data was transcribed verbatim and coded. For quantitative data, each participant filled out several HAPA surveys to assess severity of symptoms, self-efficacy, coping and planning, and PA engagement. RESULTS: An independent samples t-test was conducted to examine whether there was a significant difference between AF and Caucasians in self-evaluation of HAPA constructs, using an archived data of 170 Caucasians with MS as a norm for following comparisons. All measured HAPA constructs for PA were not significantly different between AF and Caucasians with MS. Interestingly, AF with MS had stronger intention to eat healthily (when comparing 18 Caucasians and 18 AF, t = -3.29, df = 34, p = 0.002; when comparing a norm database of 170 Caucasians and 18 AF, t = -2.31, df = 186, p = 0.02). However, Caucasians with MS had higher recovery self-efficacy for nutrition than the counterpart (comparing 170 Caucasians and 18 AF, t = 2.63, df = 186, p = 0.009). Qualitative analyses of transcriptions from six focus groups produced significant themes of self-motivated regulation of health promotion for minorities with MS. Significantly, modified item content on some HAPA-based measures is required to make the model more conducive to AF. For example, the study found that PA has been redefined for minorities with MS, self-efficacy is based on successful daily functional PA, it is not necessary to make a PA schedule because the course of MS is unpredictable, and self-defined PA goals vary according to daily MS course. DISCUSSION: Although many HAPA constructs were shared amongst AF, Hispanics, and Caucasians, this study discovered many new themes that were related to how minorities with MS approach PA. AF with MS redefined exercise as being any body movement costing physical energy. For AF, the fear of losing life roles and daily functioning was motivation to persevere and do any PA given the opportunity. In contrast to many studies on AF, this study showed AF with MS do not need social support from family or friends to do PA because they view it as self-responsibility and they have learned to be independent. For Hispanics, it appeared as though collective family thoughts regarding exercise were more influential on the intention to engage in PA. AF and Hispanics with MS agreed healthy eating habits had equal importance to PA for people with relatively severe MS status. Being AF commonly led to late treatment of MS among the focus group participants.