Third, it is important to consider the role of work and employment seeking with regard to health promoting behaviors. Exercise and physical activity indeed inhibit secondary conditions and functional limitations, consequently, promoting job acquisition and retention. Thus, a focus on health promotion complements rehabilitation employment services aimed at promoting independence and functioning. Rehabilitation counselors have the opportunity to play a pivotal role in promoting health behaviors at the consumer level. Rehabilitation counselors can assist consumers with decision making, problem solving barriers, and negotiating a balance between time demands of work- related (or job-seeking) activities and physical exercise. Moreover, rehabilitation counselors may be useful in addressing
demand-side needs, such as assisting employers with developing inclusive health programs and initiatives for employees that ensures full inclusion and accessibility for workers with disabilities.
Finally, findings from this study suggest several areas for future research. There appears to be considerable overlap among the variables used in different health promotion models, and future research is needed to more clearly dis- tinguish differences among constructs. Such efforts will require the continued development of effective and efficient instruments. Measurement of physical activity and exercise for people with physical disabilities remains a challenge in research, as noted by Washburn et al. (2002), and move- ment toward a more uniform understanding of the constructs of physical activity and exercise and the subsequent development of sound measurement instruments will advance this line of study. In addition, the impact of cultural factors and motivation and volition of physical activity/ exercise behaviors may shed light on person–environment (P × E) interaction issues related to physical activity exer- cise behavior in people with SCI from racial and ethnic minority backgrounds. Adding P × E factors may be useful for validating HPM as a culturally sensitive health promo- tion model for people with SCI.
Conclusion
Overall, the findings for this study provide good support for variables in Pender’s HPM. Variables from the HPM model were found to predict physical activity/exercise participa- tion (the model accounted for 41% of the variance) and commitment to a plan for physical activity/exercise (the model accounted for 42% of the variance). All of the pre- dictor variables in the HPM were found to be significant in either predicting physical activity/exercise or predicting commitment to a plan for physical activity/exercise with the exception of normative beliefs, control beliefs, and perceived barriers. This provides support for the validation of the model as a predictor of physical activity/exercise participation for people with SCI and the use of this model in the development of health promotion interventions for people with SCI.
Authors’ Note
The contents of the article do not necessarily represent the policy of the U.S. Department of Education, and endorsement by the Federal Government should not be assumed.
Acknowledgments
The authors would like to thank the National Spinal Cord Injury Association (NSCIA), particularly K. Eric Larson, Executive Director, and Pat Maher, Managing Director of nAblement, for their generous assistance in recruiting individuals with Spinal Cord Injury (SCI) for this study. Their efforts to announce this study through online posting, mass emails, and including an arti- cle about the study in their member newsletter SCI Life are greatly appreciated.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The contents of this manuscript were developed with support through the Rehabilitation Research and Training Center on Effective Vocational Rehabilitation Service Delivery Practices established at the University of Wisconsin–Madison and the University of Wisconsin–Stout under a grant from the Department of Education, National Institute on Disability and Rehabilitation Research (NIDRR) grant number PR H133B100034.