Physical Activity Self-Efficacy - Adolescent Protocol
Protocol Id
151301
Version #
1
Description of
Protocol
The adolescent is asked to complete a set of eight questions about typical
situations in which he or she has free time and whether or not he or she
perceives they could be physically active during those times or receives
support from others to be physically active. The five response options appear
in a Likert-type scale.
Specific
Instructions
None
Protocol Text
Self-Efficacy Scale
For each statement below, select the response which best represents how
much you ’disagree’ or ’agree’ with the statement. Mark your response by
checking the box beside the number in the correct column.
Disagree Disagree Neither Agree a Agree a
a lot
a little
agree
little
lot
nor
disagree
1. I can be physically active
during my free time on most
days.
1
[]
2. I can ask my parent or other
adult to do physically active
things with me.
1
[]
2
[]
[]
4. I can be physically active
during my free time on most
1
days even if it is very hot or cold
outside.
[]
5. I can ask my best friend to be
physically active with me during 1
my free time on most days.
[]
6. I can be physically active
during my free time on most
days even if I have a lot of
homework.
[]
1
[]
2
3. I can be physically active
during my free time on most
1
days even if I could watch TV or
play video games instead.
[]
3
[]
3
[]
2
[]
[]
[]
5
[]
4
[]
3
[]
5
4
3
[]
2
[]
[]
[]
[]
5
4
3
2
[]
[]
[]
[]
5
4
3
2
[]
4
[]
5
[]
4
[]
5
7. I have the coordination I need
to be physically active during
1
my free time on most days.
[]
8. I can be physically active
during my free time on most
1
days no matter how busy my day
is.
[]
[]
2
[]
3
[]
2
[]
4
[]
3
[]
5
[]
4
[]
5
Scoring
The scale includes two types of self-efficacy questions, self-management and
social support. Self-management of physical activities is based on cognitive
and behavioral factors. Social support is based on support from family and
friends to do physical activities. The score is the sum of all values (1 through
5) for each question of the eight-question scale.
Selection
Rationale
This self-administered, eight-question scale has been successfully used in a
large study (~7,000 participants) of sixth- and eighth-grade girls with diverse
racial-ethnic backgrounds.
Source
Dishman, R. K., Hales, D. P., Sallis, J. F., Saunders, R., Dunn, A. L., BedimoRung, A. L., & Ring, K. B. (2010). Validity of social-cognitive measures for
physical activity in middle-school girls. Journal of Pediatric
Psychology, 35(1), 72–88.
Motl, R. W., Dishman, R. K., Trost, S. G., Saunders, R. P., Dowda, M., Felton,
G., Ward, D. S., & Pate, R. R. (2000). Factorial validity and invariance of
questionnaires measuring social-cognitive determinants of physical activity
among adolescent girls. Preventive Medicine, 31(5), 584–594.
Language
English
Participant
Ages 12-15 years
Personnel and
Training
Required
None
Equipment Needs None
Standards
Standard
Name
Common Data Elements
(CDE)
Adolescent Physical Activity 3107320 CDE Browser
Self-Efficacy Assessment
Score
Logical Observation
Phys act self efficacy adoles
Identifiers Names and Codes proto
(LOINC)
General
References
ID
Source
62844-6 LOINC
Dishman, R. K., Dunn, A. L., Sallis, J. F., Vandenberg, R. J., & Pratt, C. A.
(2010). Social-cognitive correlates of physical activity in a multi-ethnic
cohort of middle-school girls: Two-year prospective study. Journal of
Pediatric Psychology, 35(2), 188–198.
Dishman, R. K., Motl, R. W., Saunders, R. P., Dowda, M., Felton, G., Ward,
D. S., & Pate R. R. (2002). Factorial invariance and latent mean structure of
questionnaires measuring social-cognitive determinants of physical activity
among black and white adolescent girls. Preventive Medicine, 34(1), 100–
108.
Dishman, R. K., Motl, R. W., Saunders, R., Felton, G., Ward, D. S., Dowda,
M., & Pate, R. R. (2004). Self-efficacy partially mediates the effect of a
school-based physical-activity intervention among adolescent
girls. Preventive Medicine, 38(5), 628–636.
Dishman, R. K., Saunders, R. P., Motl, R. W., Dowda, M., & Pate, R. R.
(2009). Self-efficacy moderates the relation between declines in physical
activity and perceived social support in high school girls. Journal of Pediatric
Psychology, 34(4), 441–451.
Protocol Type
Self-administered questionnaire
Derived Variables None
Requirements
Requirement Category
Required
Average time of greater than 15 minutes in an unaffected individual
No
Average time of greater than 15 minutes in an unaffected
individual
Major equipment
No
This measure requires a specialized measurement device that
may not be readily available in every setting where genome wide
association studies are being conducted. Examples of specialized
equipment are DEXA, Echocardiography, and Spirometry
Specialized requirements for biospecimen collection
No
This protocol requires that blood, urine, etc. be collected from
the study participants.
Specialized training
This measure requires staff training in the protocol methodology
and/or in the conduct of the data analysis.
Physical Activity Self-Efficacy - Adult Protocol
Protocol Id
151302
No
Description of
Protocol
The participant is asked to complete a brief set of questions about his or her
perceived ability to exercise in the event that common barriers exist that
may impede participation in exercise on a regular basis. The participant is
asked to respond by circling a percentage on a scale of 0% to 100% that
relates to the confidence he or she has in performing exercise with an
existing barrier (e.g., bad weather).
Specific
Instructions
This questionnaire should be administered after individuals have experience
with the behavior (e.g., after they have been exercising for 1 week).
Protocol Text
The following items reflect situations that are listed as common reasons for
preventing individuals from participating in exercise sessions or, in some
cases, dropping out. Using the scales below please indicate how confident
you are that you could exercise in the event that any of the following
circumstances were to occur.
Please indicate the degree to which you are confident that you could
exercise in the event that any of the following circumstances were to occur
by circling the appropriate %. Select the response that most closely matches
your own, remembering that there are no right or wrong answers.
For example, in question #1 if you have complete confidence that you could
exercise even if "the weather was very bad," you would circle 100%. If,
however, you had no confidence at all that you could exercise, if you failed
to make or continue making progress (that is, confidence you would not
exercise), you would circle 0%.
0%
10%
20%
30%
40%
NOT AT ALL
CONFIDENT
50%
60%
70%
80%
MODERATELY
CONFIDENT
90%
100%
HIGHLY
CONFIDENT
I BELIEVE THAT I COULD EXERCISE 3 TIMES PER WEEK FOR THE NEXT 3
MONTHS IF:
1. The weather was very bad (hot, humid, rainy, cold).
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2. I was bored by the program or activity.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
40%
50%
60%
70%
80%
90%
100%
3. I was on vacation.
0%
10%
20%
30%
I BELIEVE THAT I COULD EXERCISE 3 TIMES PER WEEK FOR THE NEXT 3
MONTHS IF:
4. I was not interested in the activity.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
5. I felt pain or discomfort when exercising.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
50%
60%
70%
80%
90%
100%
50%
60%
70%
80%
90%
100%
90%
100%
6. I had to exercise alone.
0%
10%
20%
30%
40%
7. It was not fun or enjoyable.
0%
10%
20%
30%
40%
8. It became difficult to get to the exercise location.
0%
10%
20%
30%
40%
50%
60%
70%
80%
9. I didn’t like the particular activity program that I was involved in.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
I BELIEVE THAT I COULD EXERCISE 3 TIMES PER WEEK FOR THE NEXT 3
MONTHS IF:
10. My schedule conflicted with my exercise session.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
11. I felt self-conscious about my appearance when I exercised.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
12. An instructor does not offer me any encouragement.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
80%
90%
100%
13. I was under personal stress of some kind.
0%
10%
20%
30%
40%
50%
60%
70%
Scoring
Sum all items and divide by 13. Higher scores indicate greater exercise selfefficacy, or confidence in one’s ability to exercise although barriers exist.
Selection
Rationale
Exercise self-efficacy has been found to be a significant mediator in the
maintenance of exercise behavior. This protocol has been developed
following accepted methods of self-efficacy measure development, and it is
commonly used with older adults.
Source
McAuley, E. (1992). The role of efficacy cognitions in the prediction of
exercise behavior in middle-aged adults. Journal of Behavioral Medicine,
15, 65–88.
Language
English
Participant
Age 18+ years
Personnel and
Training
Required
None
Equipment Needs None
Standards
Standard
Name
ID
Source
Common Data Elements
(CDE)
Adult Physical Activity
Self-Efficacy Assessment
Score
3107324 CDE Browser
Logical Observation
Identifiers Names and Codes
(LOINC)
Phys act self efficacy adult
proto
62845-3 LOINC
General
References
Bandura, A. (2006). Guide for constructing self-efficacy scales. In F. Pajares
& T. Urdan (Eds.), Self-efficacy beliefs of adolescents (pp. 307–337).
Greenwich, CT: Information Age Publishing.
Protocol Type
Self-administered questionnaire
Derived Variables None
Requirements
Requirement Category
Required
Average time of greater than 15 minutes in an unaffected individual
No
Average time of greater than 15 minutes in an unaffected
individual
Major equipment
No
This measure requires a specialized measurement device that
may not be readily available in every setting where genome wide
association studies are being conducted. Examples of specialized
equipment are DEXA, Echocardiography, and Spirometry
Specialized requirements for biospecimen collection
This protocol requires that blood, urine, etc. be collected from
the study participants.
No
Specialized training
This measure requires staff training in the protocol methodology
and/or in the conduct of the data analysis.
No