Physical Activity Intentions Research Articles

Motivational Pathways to Leisure-Time Physical Activity Participation in Urban Physical Education: A Cluster-Randomized Trial

Purpose: Grounded in the trans-contextual model of motivation framework, this cluster-randomized trial examined the effectiveness of an autonomy supportive physical education (PE) instruction on student motivation and physical activity (PA). Method: The study comprised six middle schools and 408 students (Mage = 12.29), with primary outcomes of students’ autonomous motivation in PE and exercise, PA intention, and self-report PA. Results: The path analysis showed that the intervention had a weak positive effect (γ = .11) on students’ perception of autonomy (R2 = .51), which in turn had a moderate positive effect (β = .29) on autonomous motivation in PE (R2 = .51). Students’ perception of autonomy during PE had a positive effect (β = .63) on their autonomous exercise motivation (R2 = .44) and autonomous exercise motivation had a positive effect (β = .37) on PA intentions (R2 = .34). Autonomous exercise motivation was an indirect link transferring PE autonomy to PA intentions and participation. Conclusion: T...

The Predictive Effects of Protection Motivation Theory on Intention and Behaviour of Physical Activity in Patients with Type 2 Diabetes.

INTRODUCTION:Theory-based education tailored to target behaviour and group can be effective in promoting physical activity.AIM:The purpose of this study was to examine the predictive power of Protection Motivation Theory on intent and behaviour of Physical Activity in Patients with Type 2 Diabetes.METHODS:This descriptive study was conducted on 250 patients in Rafsanjan, Iran. To examine the scores of protection motivation theory structures, a researcher-made questionnaire was used. Its validity and reliability were confirmed. The level of physical activity was also measured by the International Short - form Physical Activity Inventory. Its validity and reliability were also approved. Data were analysed by statistical tests including correlation coefficient, chi-square, logistic regression and linear regression.RESULTS:The results revealed that there was a significant correlation between all the protection motivation theory constructs and the intention to do physical activity. The results showed that the Theory structures were able to predict 60% of the variance of physical activity intention. The results of logistic regression demonstrated that increase in the score of physical activity intent and self - efficacy increased the chance of higher level of physical activity by 3.4 and 1.5 times, respectively OR = (3.39, 1.54).CONCLUSION:Considering the ability of protection motivation theory structures to explain the physical activity behaviour, interventional designs are suggested based on the structures of this theory, especially to improve self -efficacy as the most powerful factor in predicting physical activity intention and behaviour.

Abstract P278: Impaired Nighttime Sleep Negatively Effects Next-Day Physical Activity: Results From an Ecological Momentary Assessment Study

Introduction: Intention to engage in physical activity (PA) is an important concept in behavior change theories. However, age, body mass index (BMI), and sleep may influence one’s intention to engage in PA and intention might not predict actual activity. Purpose: This secondary analysis examined predictors of intention to engage in PA and if the factors associated with intention predicted objectively measured moderate-to-vigorous physical activity (MVPA) in adults who were overweight or obese and enrolled in a weight loss study. Methods: We used 6- and 12-mo data from the EMPOWER Study, an observational study examining triggers of lapse following intentional weight loss. Objective measures included up to 7 days of overlapping accelerometer and actigraphy data to assess daily MVPA and sleep. Self-report data included responses to the question “Do you intend to be physically active today?” hereafter called intention, collected at the beginning of each day via ecological momentary assessment. Analyses were performed examining: 1) the effects of subject-level covariates (e.g., age, sex, race, BMI) on intention, 2) the effects of objectively measured sleep characteristics (e.g., total sleep time [TST], number of awakenings, sleep fragmentation) on intention, and 3) the relationships between sleep, intention, and MVPA. Logistic regression using generalized estimating equations and linear mixed-effect models were used. Results: The analyses included 680 person-days at 6 mo and 678 person-days at 12 mo. Participants (N=136) were mostly female (89.8%) and white (81.8%) with a mean (± SD) age of 51.5 ± 9.9 years and BMI of 33.5 ± 4.6. At 6 mo, participants intended to engage in PA on 81.2% of days, had a mean TST of 408.9 ± 81.8 min/night, and a mean of 32.4 ± 14.7 awakenings/night. At 12 mo, PA intention decreased to 80.6% of days, TST increased to 416.5 ± 82.5 min/night, and awakenings increased to 34.0 ± 14.4 per night (p = .089 for TST; p = .043 for awakenings). Mean daily MVPA decreased from 19.0 ± 23.9 min at 6 mo to 17.3 ± 23.4 min at 12 mo (p = .185). Intention increased with increasing age (odds ratio [OR] = 1.04; 95% confidence interval [95% CI] = 1.02 -1.07). At 6 mo, sleep fragmentation, after adjusting for age, negatively affected intention (OR = 0.96; 95% CI = 0.94 - 0.98); however, it did not significantly affect intention at 12 mo. When comparing days with no PA intention to days in which participants intended to engage in PA, mean MVPA nearly tripled from 7.4 min (95% CI = 3.6 - 11.2) to 21.2 min (95% CI = 18.4 - 24.0). Furthermore, when controlling for age, time of assessment, and intention, participants engaged in an estimated 0.135 (95% CI = 0.241 - 0.029) fewer min of MVPA for each awakening. Conclusions: Based on these findings, future weight loss programs should include interventions that improve sleep quality by reducing fragmentation and strengthen the link between intention and engagement in PA.

Believability of messages about preventing breast cancer and heart disease through physical activity

BackgroundThe purpose of this research was to examine the relationships of self-reported physical activity to involvement with messages that discuss the prevention of heart disease and breast cancer through physical activity, the explicit believability of the messages, and agreement (or disagreement) with specific statements about the messages or disease beliefs in general.MethodsA within subjects’ design was used. Participants (N = 96) read either a breast cancer or heart disease message first, then completed a corresponding task that measured agreement or disagreement and confidence in the agreement or disagreement that 1) physical activity ‘reduces risk/does not reduce risk’ of breast cancer or heart disease, 2) that breast cancer or heart disease is a ‘real/not real risk for me’, 3) that women who get breast cancer or heart disease are ‘like/not like me’, and 4) that women who get breast cancer or heart disease are ‘to blame/not to blame’. This task was followed by a questionnaire measuring message involvement and explicit believability. They then read the other disease messages and completed the corresponding agreement and confidence task and questionnaire measures. Lastly, participants completed a questionnaire measuring physical activity related attitudes and intentions, and demographics.ResultsThere was no difference in message involvement or explicit believability of breast cancer compared to heart disease messages. Active participants had a higher confidence in their agreement that physical activity is preventive of heart disease compared to breast cancer. Multinomial regression models showed that, in addition to physical activity related attitudes and intentions, agreement that physical activity was preventive of heart disease and that women with heart disease are ‘like me’ were predictors of being more active compared to inactive. In the breast cancer model only attitudes and intentions predicted physical activity group.ConclusionsActive women likely internalized messages about heart disease prevention through physical activity, making the prevention messages more readily available within memory, and active women may therefore process such information differently. The study of how health-related beliefs are created and are related to perceptions of prevention messages is a rich area of study that may contribute to more effective health promotion.

The Association between Adolescent's Weight Perception and Health Behaviors: Analysis of National Health and Nutrition Examination Survey Data, 2011-2014.

The association between adolescents' weight perception and their physical activity (PA) and sedentary behaviors remains unclear. Therefore, these associations were explored using data from 2438 adolescents aged 12–19 years who participated in the National Health and Nutrition Examination 2011–2014 Survey. Respondents reported weight perception, and their weight perception accuracy was determined by examining whether the measured weight and perceived weight were concordant. Respondents also reported sedentary time (sitting time and screen time), PA, and intention to lose weight. Linear and logistic regression models were conducted to determine whether adolescents' PA, sedentary behaviors, and weight loss intention differed by weight perception and weight perception accuracy adjusted for demographic variables accounting for complex sampling. About one-quarter (21.4%) of the respondents had obesity. For respondents who perceived themselves as being overweight/fat, despite greater weight loss intention, males reported more sitting time (512.7 ± 16.3 versus 474.1 ± 10.2 minutes/day, p < 0.05) and females reported less PA (48.7 ± 5.0 versus 64.6 ± 3.3 minutes/day, p < 0.05) than respondents who perceived themselves as being normal weight. Similar patterns were observed for weight perception accuracy among individuals with obesity. Study results show that perceiving oneself as being overweight/fat regardless of accuracy was associated with more sedentary time for males or less PA for females despite higher weight loss intention.

Social antecedents in physical activity: Tracking the self‐determination theory sequence in adolescents

AbstractThe aim of the study was to test the self determination theory (SDT) sequence to predict physical activity (PA) and intention to be active during adolescence: social factors (father, mother, friends, and physical education teacher) → basic psychological needs (BPN) → types of motivation were assessed→ PA and intention to be active. Participants were 1,150 adolescents, Mage = 15.01 (1.55), who completed questionnaires. Structural equation modeling supports the SDT sequence model. Results revealed that intrinsic and extrinsic motivation positively predicted both PA and intention to be active while amotivation did so negatively. Moreover, social factors behaved differently with BPN, finding positive relationships between father, friends, and physical education teachers with competence, autonomy, and relatedness, whereas mother's support does not influence the sequence. The study shed light on the SDT theory to provide a better understanding of physical activity behaviors and intentions during adolescence.

Investigate the factors related to the intention to perform physical activity based on the theory of ‎planned behavior among high school female students of Ahvaz city

Background and Objective: Physical activity is one of the most important aspects of health promotion and one of the predictors of death and disability worldwide. In this study, we aimed to investigate the factors related to intention to perform physical activity based on the theory of planned behavior among high school female students of Ahvaz city, Iran. Materials and Methods: This descriptive analytical study was performed among 163 high school female students randomly selected from two girls' public schools in Ahvaz, Iran, in 2016. Data were gathered using a questionnaire including demographic characteristics and the theory of planned behavior constructs including attitude, subjective norms, perceived behavior control, and intention. To analyze the data, linear regression analysis and Pearson correlation coefficient were run in SPSS, version 23. Results: The mean age of the participants was 13.76±0.89 years. The regression model showed that the attitude (β=0.46, P<0.001) and perceived behavior control (β=0.15, P<0.05) constructs were predictors of physical activity intention. This model could explain 40% of the variance in physical activity intention. Subjective norms (P<0.057, β=0.14) were not significant predictors of the intention. Conclusion: We recommend using the theory of planned behavior and paying more attention to the attitude construct, as the strongest predictor of intention, in designing educational interventions to promote physical activity among female students.

Demographic, clinical, lifestyle-related, and social-cognitive correlates of physical activity in head and neck cancer survivors

PurposeThe purpose of the study is to identify demographic, clinical, lifestyle-related, and social-cognitive correlates of physical activity (PA) intention and behavior in head and neck cancer (HNC) survivors using the theory of planned behavior (TPB).MethodsData from two cross-sectional studies on correlates of PA in HNC survivors were pooled. Both studies used self-reports to assess PA and social-cognitive correlates. Potential correlates were collected via self-report or medical records. Univariable and multivariable multilevel linear mixed-effects models were built to identify correlates of PA intention and PA behavior (Z scores). Structural equation model analyses were conducted to study the full TPB model in one analysis, taking into account relevant covariates.ResultsIn total, 416 HNC survivors were surveyed. Their mean (SD) age was 66.6 (9.4) years; 64% were men, and 78% were diagnosed with laryngeal cancer. The structural equation model showed that PA intention was significantly higher in HNC survivors with a history of exercising, who had a more positive attitude, subjective norm, and perceived behavioral control. Patients with higher PA intention, higher PBC, a lower age, and without unintentional weight loss or comorbidities had higher PA behavior. The model explained 22.9% of the variance in PA intention and 16.1% of the variance in PA behavior.ConclusionsDespite significant pathways of the TPB model, the large proportion variance in PA intention and behavior remaining unexplained suggests the need for better PA behavior (change) models to guide the development of PA promotion programs, particularly for the elderly. Such programs should be tailored to comorbidities and nutritional status.

Age differences in physical activity intentions and implementation intention preferences.

This study aimed to examine older adults' physical activity intentions and preferred implementation intentions, and how intentions and preferred implementation intentions differ between older, middle aged and younger adults. A cross-sectional Australian wide telephone survey of 1217 respondents was conducted in 2016. Multiple and ordinal regression analyses were conducted to compare intentions and preferred implementation intentions between older (65+), middle aged (45-64) and younger adults (<45). A higher percentage of older adults had no intentions to engage in regular physical activity within the next 6months (60%) compared to younger adults (25%). Older adults' most popular preferences included being active at least once a day and for 30min or less and were more likely to prefer more frequent and shorter sessions compared to younger adults. Both older and middle aged adults were more likely to prefer slower paced physical activity compared to younger adults who preferred fast paced physical activity. Physical activity interventions for older adults should address the high percentage of older adults with no intentions and public health campaigns for older adults should promote 30min daily sessions of slow paced activity.

Health Behaviour Intentions and Barriers to Physical Activity among Health Science Students: Exploring General Self Efficacy as a Mediator

The objective of this study was to examine general self-efficacy as a mediator of the association between perceived barriers to physical activity(PA) and health behaviour intentions as well as moderate to vigorous physical activity(MVPA) among health science students. 205 Students completed the self-reported questionnaire. Mediation analysis revealed partial mediation of general self-efficacy on relationships between general barriers to PA and health behaviour intentions (b=0.812, p=0.001 reduced to b= 0.586, p=0.001). Mediation analysis also revealed that general self-efficacy fully mediated the association between barriers to physical activity and moderate to vigorous physical activity (b= 0.416, p=0.001 reduced to b= - 0.93, p=0.120).Pearson correlation was done and revealed that general self-efficacy was significantly correlated to moderate-to-vigorous physical activity r(205)=0.751, p. In view of the findings obtained from this research, participation in exercise has a positive effect on psychological effects like general self-efficacy, and general self-efficacy played a major role in predicting the health behaviour intention of health science students. This study suggests that, in the effort to encourage the student’s physical activity participation, university management should also plan and organize programmes to develop positive attitudes among students, because increasing their self-efficacy will have overall effect on their health behaviour habits.

Cognitive Determinants of Physical Activity Intention among Iranian Nurses : An Application of Integrative Model of Behavior Prediction

Cognitive Determinants of Physical Activity Intention among Iranian Nurses : An Application of Integrative Model of Behavior Prediction

Combining risk communication strategies to simultaneously convey the risks of four diseases associated with physical inactivity to socio-demographically diverse populations.

A single risk factor can increase the risk of developing multiple diseases, but most risk communication research has been conducted in the context of a single disease. We explored which combination of three recommended risk communication strategies is most effective in simultaneously conveying risk estimates of four diseases associated with physical inactivity: colon cancer, stroke, diabetes, and heart disease. Participants (N=1161, 50% no college experience, 50% racial/ethnic minority) were shown hypothetical risk estimates for each of the four diseases. All four diseases were placed at varying heights on 1 of 12 vertical bar charts (i.e., "risk ladders") to indicate their respective probabilities. The risk ladders varied in a 2 (risk reduction information: present/absent)×2 (numerical format: words/words and numbers)×3 (social comparison information: none/somewhat higher than average/much higher than average) full factorial design. Participants were randomly assigned to view one of the risk ladders and then completed a questionnaire assessing message comprehension, message acceptance, physical activity-related risk and efficacy beliefs, and physical activity intentions. Higher message acceptance was found among (1) people who received risk reduction information versus those who did not (p=.01), and (2) people who did not receive social comparison information versus those told that they were at higher than average risk (p=.03). Further, absolute cognitive perceived risk of developing "any of the diseases shown in the picture" was higher among people who did not receive social comparison information (p=.03). No other main effects and only very few interactions with demographic variables were found. Combining recommended risk communication strategies did not improve or impair key cognitive or affective precursors of health behavior change. It might not be necessary to provide people with extensive information when communicating risk estimates of multiple diseases.

SUN-P289: Understanding Behavioral Mechanisms for Physical Activity in Head and Neck Cancer Patients: A Qualitative Study

Rationale: Head and neck cancer (HNC) patients often have adverse changes in body composition. Loss of muscle mass and strength frequently occur, even when dietary intake is adequate. Nascent evidence suggests that a healthy lifestyle, including adequate physical activity (PA) and diet, may prevent muscle wasting. HNC patients often show suboptimal health behavior pre-diagnosis, and additional barriers to PA can arise from cancer treatment. Better understanding of the behavioral mechanisms of PA in this mostly sedentary group is needed to design effective individualized PA-supporting interventions. This qualitative study explored the perspective of HNC patients on PA. Methods: We conducted 9 semi-structured interviews in HNC patients, 6-8 weeks after treatment (surgery +/-(chemo)radiation). The interviews were guided by the Theory of Planned Behavior (TPB) key concepts, including: attitude; social norm (with emphasis on role of healthcare professionals); self-efficacy; intention; barriers/facilitators, knowledge/skills; and current PA behaviour. Interviews were analysed by directed content analysis. Results: Important themes identified for PA were: physical barriers, health as stimulus, role of habits, and lack of interest. While all themes could be fitted within the key concepts of TBP, there was little interaction between intention and other concepts. In fact, PA intention was not an explicit consideration for most patients. Conclusion: HNC patients perceived physical barriers, health, habits, and lack of interest as important themes with regard to PA. Our tentative results suggest that the TPB may not be the most appropriate model for explaining PA in HNC patients. For future research aiming to understand PA in HNC patients, theories less focused on rational reasoning and more on autonomy, such as Self Determination Theory, may be better suited.

The Utility of the Health Action Process Approach Model for Predicting Physical Activity Intentions and Behavior in Schizophrenia.

Research is needed to develop evidence-based behavioral interventions for preventing and treating obesity that are specific to the schizophrenia population. This study is the precursor to such intervention research where we examined the utility of the social cognitions outlined within the Health Action Process Approach (HAPA) model for predicting moderate to vigorous physical activity (MVPA) intentions and behavior among individuals with schizophrenia or schizoaffective disorder. A prospective cohort design [baseline (T1), week 2 (T2), and week 4 (T3)] was used to examine the HAPA constructs and MVPA across a sample of 101 adults (Mage = 41.5 ± 11.7 years; MBMI = 31.2 ± 7.8 kg/m2; 59% male). Two hierarchical regression analyses were conducted controlling for age, gender, BMI, and previous self-reported MVPA. In the first regression, intentions at T1 were regressed onto the T1 motivational HAPA constructs (risk perception, affective attitudes, task self-efficacy) and social support; MVPA status (meeting vs. not meeting the MVPA guidelines) assessed via accelerometry at T3 was regressed onto T1 social support and intentions followed by T2 action and coping planning, and maintenance self-efficacy in the second analysis. Overall, the motivational and social support variables accounted for 28% of the variance in intentions, with affective attitudes (β = 0.33, p < 0.01) and task self-efficacy (β = 0.25, p < 0.05) exhibiting significant, positive relationships. For MVPA status, the model as a whole explained 39% of the variance, with the volitional HAPA constructs explaining a non-significant 3% of this total variance. These findings suggest a need for interventions targeting self-efficacy and affective attitudes within this clinical population.

Executive Functions, Trait Self-Control, and the Intention-Behavior Gap in Physical Activity Behavior.

Many people fail to translate their physical activity intentions into behavior. This intention-behavior gap can be explained by (a)explicit trait self-control, (b)implicit executive functions, and (c)their interactions. In 118 participants, the intention-behavior gap was measured in a prospective design. Trait self-control was assessed via self-report questionnaires, whereas executive functioning was measured with test performance in inhibition, updating, and shifting at baseline. Regression analysis showed that (a)higher trait self-control predicts a smaller intention-behavior gap; (b)updating performance is related with this gap; and (c)behavior in tests on inhibition, updating, and shifting moderate the relation between the trait self-control and the intention-behavior gap. The present study showed that the complex pattern that modulates the relation between intended and realized physical activity behavior includes trait self-control, executive functions, as well as the combination of these cognitive components supporting dual-process approaches of self-control including implicit and explicit processing components.

고 3을 잘 견디는 법 : 고등학생의 신체활동과 학습동기 및 학교적응의 관계

This study investigates influences of leisure time physical activity (LPA), physical activity competence (PAC) and physical activity intention (PAI) on academic motivation and school adjustment in junior high school students who are having academic-centered school life for entering university. A total of 716 (male 359, female 357) 2nd year high school students from 6 high schools were surveyed with questionnaire of LPAtime, PAC, PAI, academic motivation and school adjustment. Data were utilized by internal consistency reliability, confirmatory factor analysis for validity and reliability of questionnaires. Bivariate correlation analysis, multivariate analysis of variance, and multiple regression analysis were also used. Results showed PAC had significantly influenced on peer-relationship factor of school adjustment. LPA had significantly negative influence on extrinsic academic motivation. PAI had significantly influenced on extrinsic academic motivation and all of school adjustment sub factors. Base on result, LPA participating students might have less dependent personality on academic performance. PAI was discussed with Theory of Planed Behavior (Ajzen, 1991) which considered academic-centered high school life in Korea.

고등학생의 신체활동 의도가 스트레스 대처양식 및 시험스트레스에 미치는 영향; 신체활동 참가여부와 성별 비교

고등학생의 신체활동 의도가 스트레스 대처양식 및 시험스트레스에 미치는 영향; 신체활동 참가여부와 성별 비교

Intention stability assessed using residual change scores moderates the intention-behaviour association: a prospective cohort study

Intention stability is considered to be one of the key pre-requisites for a strong association between intention and behaviour. It has been claimed, however, that studies examining the moderating impact of intention stability may be invalid, as they have relied on statistically inferior methods. Residual change scores have been suggested as a more appropriate method of measuring change (or lack thereof) in constructs. The aim of the current study, therefore, is to test whether intention stability, calculated using residual change scores, moderates the intention-physical activity behaviour association. A total of 163 participants (124 women, 39 men) completed questionnaires online at three time points separated by 14 day intervals. The moderating impact of intention stability was assessed using multiple linear regression followed up using simple slope analyses to identify the direction of any effect. The interaction of intention and intention stability was found to significantly improve the overall model fit. Intentions had a stronger positive association with behaviour when intentions were more stable than when they were more unstable. However, sensitivity analyses revealed that the association was not robust and reduced to non-significant with the removal of potential multivariate outliers. Future research should use residual change scores as the preferred method of assessing intention stability.

The Effects of Gain- versus Loss-Framed Messages Following Health Risk Information on Physical Activity in Individuals With Multiple Sclerosis

Few people with multiple sclerosis engage in physical activity. Messaging interventions may motivate more physical activity among these individuals. The purpose of this online study was to evaluate an intervention presenting participants with multiple sclerosis (N = 237) with risk information (i.e., information demonstrating people with multiple sclerosis are more likely to experience certain health issues) or no risk information followed by gain- or loss-framed physical activity messages. Participants completed questionnaires on Days 1, 6, and 28 and received information material on Days 2–5. The dependent variables were as follows: physical activity intentions and behavior, response and task efficacy, perceived threat (i.e., perception of threat to health issues relevant to people with multiple sclerosis), and avoidance (i.e., avoiding thinking about/doing something about the health issues presented in the messages). Analyses indicated physical activity and response efficacy increased over time. Also, participants receiving risk information had higher levels of physical activity and perceived threat. However, manipulation checks showed no differences between participants regarding perceptions of risk information or gain/loss-framed messages. Despite the lack of impact of the framing intervention, this study suggests that a brief informational intervention can positively influence physical activity and certain correlates of physical activity among people with multiple sclerosis.

Motivational Correlates of Physical Activity among Adults with Type 2 Diabetes

PURPOSE: About 61% of adults with type 2 diabetes are not meeting the current physical activity guidelines. This study examined the usefulness of the theory of planned behavior (TPB) for understanding physical activity intention and behavior in this population. METHODS: A link to an electronic survey that included a demographics questionnaire, a TPB questionnaire, and the Godin Leisure-Time Exercise Questionnaire (GLTEQ) was distributed through several social media outlets during an 8-week period. The TPB questionnaire used 7-point Likert-type scales to measure attitude, subjective norm, perceived behavioral control (PBC), and intention. The GLTEQ assessed weekly frequency of moderate and vigorous physical activity. RESULTS: Although 48 adults consented to participate in the research, only 23 adults (Mage = 56.18, SD = 11.41; MBMI = 29.55, SD = 7.65; 56.5% male; 78.3% White) reported having type 2 diabetes and provided complete survey data. Two hierarchical regression analyses with forced entry within each block were used to examine the predictors of physical activity intention and behavior. The final model that included attitude, subjective norm, and PBC explained 60.0% of the variance in intention, but PBC was the only significant predictor (β = .73; p < .001). For the prediction of physical activity, the model that included only intention (β = .45; p = .03) accounted for 20.5% of the variance. The addition of PBC did not add a significant amount of explained variance and was not a significant predictor of physical activity. CONCLUSION: These results are similar to previous research and suggest that the TPB is useful for understanding the physical activity intention and behavior of adults with type 2 diabetes. Further research with larger and more diverse samples are needed to inform intervention design.