Health Action Process Approach and Spinal Cord Injury: A Scoping Review

Research Objectives: People with spinal cord injury (PwSCI) are at increased risk of low physical activity and exercise, and as such experience increased risk for disease and premature death. The Health Action Process Approach (HAPA) is effective to explain modifiable health behaviors and guide intervention among the general population. As such, the current scoping review has two aims: (1) to investigate the application of HAPA among PwSCI, and (2) to make recommendations for rehabilitation research and practice.

Design: A scoping review.

Setting: A scoping review was conducted in community health and psycho-social well-being databases by an Applied Health Sciences Librarian at the authors’ university library.

Participants: The search resulted in 664 articles. After removing irrelevant/duplicate studies, 8 studies remained for analysis.

Interventions: HAPA is a social cognitive health behavior framework validated to explain modifiable health behaviors and is a means by which to identify behaviors for intervention. HAPA is a dual-phase model incorporating both determinants of initiating and maintaining a health behavior.

Main Outcome Measures: Not applicable.

Results: While research is limited, the HAPA framework is an acceptable model to explain physical activity/exercise and has good predictive ability among PwSCI. A strong predictor of physical activity/exercise is individual belief in capability to overcome barriers. Previous research indicates that barriers to physical activity/exercise exist across multiple levels of the ecological system for PwSCI. Individual level barriers (e.g., pain, lack of motivation), organizational barriers (e.g., expensive exercise facilities, lack of appropriate facilities), and environmental restrictions (e.g., missing or insufficient/inaccessible public places) result in diminished quality of life and worse health outcomes.

Conclusions: More attention is needed on HAPA-identified barriers for PwSCI. Both researchers and practitioners may utilize the HAPA framework to identify barriers to physical activity/exercise at multiple levels in the ecological system and create targeted interventions. To maximize the benefits of individual level intervention (e.g., self-efficacy), researchers and practitioners may like to advocate at organizational and environmental levels to advance affordability and availability of adaptive transportation and exercise equipment.

Author(s) Disclosures: There are no known conflicts.