Influence of Implementation Intentions on compliance when using the 'online bewegingscoach'.

Within the framework of the innovation centre and the related incoming money,
the paindivision has started the development of an on-line application which
will show home-exercises for patients (project "de online bewegingscoach"). The
importance of exercises for the health of the individual has been shown in a
lot of studies (Cooper, 2001; Plach, 2002; Saunders, Greig, Young & Mead,
2002). Physical activity is considered worldwide as a good preventative action
for a lot of chronic disorders (Warburton, Nicol & Bredin, 2006). Several
scientific studies have made it clear that the percentage of people that stops
doing exercises before the programme has expired, is considerable (Hartigan,
Rainville, Sobel & Hipona, 2000). When developing an application it is
therefore important to build in tools which can promote the compliance. With
the use of social cognition theories we can get better insight in underlying
factors that may influence the compliance. In social cognition theories such as
the TPB the individual intention is used as most important and best predicting
factor of behaviour (Azjen, 1991; Rogers, 1983). It appears however that, to
proceed from intention to effective behaviour there are more important factors
then one's intention alone (Orbell & Sheenan, 1998). It is valued that only 28%
of intentions are converted into behaviour (Sheeran, 2002). It became clear
from literature, how striking high the percentages were of patients who stuck
to the exercises in some studies which made use of Implementation Intentions
(Conner & Norman, 2005). In this experiment the theory behind Implementation
Intentions will be used to promote converting a positive intention into desired
behaviour.

The following research questions are answered in the research.
I. To what extent does filling out an Implementation Intentions form influence
the compliance when using `the online bewegingscoach'?
II To what extent can intention be explained by attitude, subjective norm and
self-efficacy when using `the online bewegingscoach'?
III To what extent do the HLOC, fear of movement and the degree of
catastrophizing have influence on intention and is this influence directly or
(as Azjen predict) by means of attitude, subjective norm and self-efficacy when
using ` the online bewegingscoach'?
IV How satisfied are patients with the use of 'the online bewegingscoach?

The main hypothesis in this research is, that filling in Implementation
Intentions by the users of the `online bewegingscoach ' leads to higher
compliance.

An experimental and a control group will be formed who both will use the
'online bewegingscoach' for four weeks when following their exercise program.
The experimental group fills out Implementation Intentions with respect to
place, time and type of exercises during the four weeks. At the end of every
week both groups have to fill out a self-evaluation questionnaire regarding the
compliance of the previous week.

The intervention has been set up as following. Both groups will be asked to
follow the exerciseprogramme. which can be found on the Internet site of
www.r-motion.nl, for four weeks. This exerciseprogramme is `tailor made' by
means of the loadibility estimation of the treating physical therapist of their
former group. The exercises consist of mobilizing, muscle strengthening and
conditional exercises. All these exercises have been done already once during
the rehabilitation period. The `tailor made' factor is present especially in
the individual intensity (number of recurrences and number of serials) and the
individual points of interest. Both the experimental and the control group
imposed exercise frequency is 3 time per week . The quantity of exercises for
both groups is equal. On mondays the experimental group will be asked to fill
out their Implementation Intentions and send these by mail to s.purmer@rrd.nl.
The Implementation Intentions must be formed with regard to time, place and
type of exercise (that is mobilizing, muscle strengthening and conditional
exercises). The Implementation Intentions are phrased as following: as....,
then I do...... Then the participants of the experimental group will be asked
to indicate on which day and at which time they do their exercises (Prestwick,
Lawton, Conner & Taylor, 2003rd Rise, Thompson & Verplanken, 2003). At the
beginning of the next week all participants in both groups will be asked to
evaluate the previous week by means of a questionnaire in which will be asked
if they have achieved their goals for the previous week, how much effort this
costed physically and regarding organisation, what the reasons were why they
have not (if so) reached their goals, and if they have done the
exerciseprogramme alone or with someone else. This questionnaire must be send
to s.purmer@rrd.nl. The participants in the experimental group also have to
fill out their new Implementation Intentions for the coming week and send these
to s.purmer@rrd.nl. If no mail has been received on Tuesday contact will be
made bij telephone . Beside this subjective information, objective data are
collected by collecting the inlogdata on the Internet site. This way it's
possible to determine how frequently the participants log in, how long they
have used their internet account and how many movements they have made through
the program.

Risk of overload has been limited by taking the loadibility level of the
participant at locking the policlinic rehabilitation program. The interval
between finishing the rehabilitation programme and start of the experiment
has been kept relatively short, so that the loadibility level is a good
indication. The exercises of `the online bewegingscoach' are the same as during
the policlinic rehabilitation period. The exercises which the participant must
carry out during 4 weeks are entirely tailor made, this means applied to the
complaints and loadibility level of the patient. The impact of the used
questionnaires on the daily functioning of the participants is negligible
small. We do not expect that the participants will experience more complaints
in the field of mental well-being due to the questionnaires. The risk of
developing mental complaints is being diminished by naming a trustworthy
contactperson in the name of Dr. Warmerdam (rehabilitation physician
paindivision) and taking an SLC larger than 179 as an exclusioncriterium.