{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T13:33:44Z","timestamp":1794058424205,"version":"4.8.0"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2024,3,28]],"date-time":"2024-03-28T00:00:00Z","timestamp":1711584000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Singapore Institute of Technology","award":["Ignition Grant"],"award-info":[{"award-number":["Ignition Grant"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Although the benefits of regular physical activity (PA) after stroke are well established, many stroke survivors do not achieve recommended PA levels. To date, studies exploring determinants to PA have not used a behaviour change theory and focused on stroke survivors with physical disabilities. As a precursor to an intervention development study, we aimed to use the Theoretical Domains Framework (TDF) to identify factors influencing PA in stroke survivors with physical disabilities in Singapore.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Between November 2021 and January 2022, we conducted interviews with 19 community-dwelling stroke survivors with a weak arm and\/or leg. An interview guide based on the TDF was developed. We analysed the data deductively by coding interview transcripts into the theoretical domains of the TDF, and then inductively by generating themes and belief statements. To identify relevant TDF domains, we prioritised the domains based on the frequencies of the belief statements, presence of conflicting belief statements and evidence of strong belief statements.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Eight of the 14 TDF domains were relevant, and included environmental context and resources, knowledge, social influences, emotion, reinforcement, behavioural regulation, skills and beliefs about capabilities. The lack of access, suitable equipment and skilled help often limited PA participation at public fitness spaces such as parks, gyms and swimming pools (environmental context and resources). While a few stroke survivors expressed that they had the skills to engage in regular PA, most expressed not knowing how much and how hard to work, which exercises to do, which equipment to use and how to adapt exercises and equipment (knowledge and skills). This often left them feeling afraid to try new activities or venture out to new places for fear of the unknown or adverse events (e.g., falls) (emotion). For some, doing the activities in a group encourage them to get out and engage in PA (social influences).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In stroke survivors with physical disabilities, environmental context and resources had a significant influence on PA participation, and this often had a spill over effect into other domains. Our results inform a complex behaviour change intervention to improve PA after stroke, and has implications for intervention design for people with physical disabilities.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0292442","type":"journal-article","created":{"date-parts":[[2024,3,28]],"date-time":"2024-03-28T17:27:39Z","timestamp":1711646859000},"page":"e0292442","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["What influences stroke survivors with physical disabilities to be physically active? A qualitative study informed by the Theoretical Domains Framework"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9809-9859","authenticated-orcid":true,"given":"L. K.","family":"Kwah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Doshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. A.","family":"De Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. M.","family":"Ng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Thilarajah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,3,28]]},"reference":[{"issue":"6","key":"pone.0292442.ref001","first-page":"e274","article-title":"How to address physical activity participation after stroke in research and clinical practice","volume":"52","author":"NA Fini","year":"2021","journal-title":"Stroke"},{"key":"pone.0292442.ref002","first-page":"1747493019840930","article-title":"Improving life after stroke needs global efforts to implement evidence-based physical activity pathways","author":"F van Wijck","year":"2019","journal-title":"International Journal of Stroke"},{"key":"pone.0292442.ref003","volume-title":"Physical activity","author":"WHO","year":"2020"},{"key":"pone.0292442.ref004","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1186\/1479-5868-8-80","article-title":"How many steps\/day are enough? For older adults and special populations","volume":"8","author":"C Tudor-Locke","year":"2011","journal-title":"International Journal of Behavioral Nutrition and Physical Activity"},{"issue":"7","key":"pone.0292442.ref005","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1093\/ptj\/pzx038","article-title":"How physically active are people following stroke? 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Bailey","year":"2020","journal-title":"Disability and Rehabilitation."},{"issue":"18","key":"pone.0292442.ref014","first-page":"407","article-title":"Vital signs: Disability and physical activity\u2014United States, 2009\u20132012","volume":"63","author":"DD Carroll","year":"2014","journal-title":"MMWR Morbidity and Mortality Weekly Report"},{"issue":"8","key":"pone.0292442.ref015","doi-asserted-by":"crossref","first-page":"e029954","DOI":"10.1136\/bmjopen-2019-029954","article-title":"Guidance on how to develop complex interventions to improve health and healthcare","volume":"9","author":"A O\u2019Cathain","year":"2019","journal-title":"BMJ Open"},{"key":"pone.0292442.ref016","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s40814-019-0425-6","article-title":"Taxonomy of approaches to developing interventions to improve health: a systematic methods overview.","volume":"5","author":"A O\u2019Cathain","year":"2019","journal-title":"Pilot and Feasibility Studies"},{"key":"pone.0292442.ref017","doi-asserted-by":"crossref","first-page":"a1655","DOI":"10.1136\/bmj.a1655","article-title":"Developing and evaluating complex interventions: the new Medical Research Council guidance","volume":"337","author":"P Craig","year":"2008","journal-title":"BMJ"},{"key":"pone.0292442.ref018","doi-asserted-by":"crossref","first-page":"n2061","DOI":"10.1136\/bmj.n2061","article-title":"A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance","volume":"374","author":"K Skivington","year":"2021","journal-title":"BMJ"},{"issue":"1","key":"pone.0292442.ref019","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/s13012-017-0605-9","article-title":"A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems","volume":"12","author":"L Atkins","year":"2017","journal-title":"Implementation Science"},{"issue":"6","key":"pone.0292442.ref020","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.","volume":"19","author":"A Tong","year":"2007","journal-title":"International Journal for Quality in Health Care"},{"issue":"9","key":"pone.0292442.ref021","doi-asserted-by":"crossref","first-page":"2243","DOI":"10.1161\/01.STR.0000027437.22450.BD","article-title":"Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the modified Rankin Scale","volume":"33","author":"JT Wilson","year":"2002","journal-title":"Stroke"},{"issue":"4","key":"pone.0292442.ref022","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1161\/01.STR.0000157596.13234.95","article-title":"Reliability of the modified Rankin Scale across multiple raters: benefits of a structured interview","volume":"36","author":"JT Wilson","year":"2005","journal-title":"Stroke"},{"key":"pone.0292442.ref023","article-title":"Physical activity and exercise recommendations for stroke survivors: A statement for healthcare professionals from the American Heart Association\/American Stroke Association","author":"SA Billinger","year":"2014","journal-title":"Stroke"},{"key":"pone.0292442.ref024","author":"L. 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