Stages of change in physical activity behavior in children and adolescents with cerebral palsy

Abstract

Purpose: To identify facilitators and barriers frequently experienced by families of children with cerebral palsy (CP) and associated with being at the pre-intention, intention and action stages for physical activity. Method: Qualitative study involving in-depth focus group interviews with 33 ambulatory children and adolescents with CP and their parents (n = 33). These interviews were followed by questionnaires to determine stage of behavior change (i.e. pre-intention, intention and action) related to the child’s participation in physical activity. Results: Families who were classified in the intention stage of behavioral change were more likely to identify environmental barriers related to the social environment and the facility or program than parents at the pre-intention stage. Families who were classified into intention and action stages were more likely to identify facilitators related to parental factors than families at the pre-intention stage. Moreover, at the action stage facilitators were related to the facility/program. Conclusions: The identified facilitators and barriers, organized according to three stages of change (pre-intention, intention and action), provide important theoretical insights into how and why children and adolescents with CP and their parents might change their physical activity behavior.

Implications for rehabilitation

• Understanding the barriers and facilitators of physical activity for children and adolescents with CP is essential for designing effective interventions to promote participation in this group.

• Using the three stages of change and the identified barriers and facilitators for participation can result in tailored advice to increase physical activity behavior.

• Adolescents
• cerebral palsy
• children
• exercise
• participation
• sport

Acknowledgements

The authors thank all participating children, adolescents with CP, and their parents. In addition, they thank Bernadette Verschuren for transcribing and Dominique Hermans for reading and analyzing all interviews. Karin Franken, Manon Bloemen, Femke Reijnders, Sabine de Hoop, Greet van der Bruggen and Marian Uppelschoten are being acknowledged for their enthusiasm and dedication to contacting families and organizing the focus groups. Bianca Nijhuis is being acknowledged for her input regarding the content of the focus groups. They also thank Mia Willems, Maureen Bult, Anne Kruijsen, Anka Michielsen, Wilma van de Kerk, Aniek Claassen, Carlijn van der Zee and Saskia Schokker for leading the focus groups. This study was supported by the Phelps Foundation, the Netherlands. The funding body did not participate in the design and execution of the study; collection, management, analysis and interpretation of the data; or preparation, review or approval of the article.