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doi: 10.2522/ptj.20110037

Originally published online July 19, 20122012; 92:1419-1436.PHYS THER.

Qu and Ronald GellishBeth Black, Beth C. Marcoux, Christine Stiller, XiangguiTherapist Students: A Cross-Sectional StudyAttitudes of Physical Therapists and PhysicalPersonal Health Behaviors and Role-Modeling

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Personal Health Behaviors and Role-Modeling Attitudes of PhysicalTherapists and Physical TherapistStudents: A Cross-Sectional StudyBeth Black, Beth C. Marcoux, Christine Stiller, Xianggui Qu, Ronald Gellish

Background. Physical therapists have been encouraged to engage in healthpromotion practice. Health professionals who engage in healthy behaviors them-

selves are more apt to recommend those behaviors, and patients are more motivatedto change their behaviors when their health care provider is a credible role model.

Objective. The purpose of this study was to describe the health behaviors androle-modeling attitudes of physical therapists and physical therapist students.

Design. This study was a descriptive cross-sectional survey.

Methods. A national sample of 405 physical therapists and 329 physical therapiststudents participated in the survey. Participants attitudes toward role modeling andbehaviors related to physical activity, fruit and vegetable consumption, abstentionfrom smoking, and maintenance of a healthy weight were measured. Wilcoxon ranksum tests were used to examine differences in attitudes and behaviors between

physical therapists and physical therapist students.

Results. A majority of the participants reported that they engage in regular phys-ical activity (80.8%), eat fruits and vegetables (60.3%), do not smoke (99.4%), andmaintain a healthy weight (78.7%). Although there were no differences in behaviors,physical therapist students were more likely to believe that role modeling is apowerful teaching tool, physical therapist professionals should practice what theypreach, physical activity is a desirable behavior, and physical therapist professionalsshould be role models for nonsmoking and maintaining a healthy weight.

Limitations. Limitations of this study include the potential for response bias andsocial desirability bias.

Conclusions. Physical therapists and physical therapist students engage in health-promoting behaviors at similarly high rates but differ in role-modeling attitudes.

B. Black, PT, DSc, Rocky MountainUniversity of Health Professions,Provo, Utah, and Physical TherapyProgram, School of Health Sci-

ences,Oakland University, 2200 NSquirrel Rd, Rochester, MI 48309-4401 (USA). Address all corre-spondence to Dr Black at:[email protected].

B.C. Marcoux, PT, DPT, PhD,Physical Therapy Program, Col-lege of Human Science and Ser-vices, University of Rhode Island,Kingston, Rhode Island.

C. Stiller, PT, PhD, Physical Ther-apy Program, School of HealthSciences, Oakland University.

X. Qu, PhD, Department of Math-ematics and Statistics, OaklandUniversity.

R. Gellish, MS, School of HealthSciences, Oakland University.

[Black B, Marcoux BC, Stiller C,et al. Personal health behaviorsand role-modeling attitudes ofphysical therapists and physicaltherapist students: a cross-sectional study. Phys Ther.2012;92:14191436.]

2012 American Physical Therapy

AssociationPublished Ahead of Print:

July 19, 2012Accepted: July 11, 2012Submitted: February 5, 2012

Research Report

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Despite being one of the

wealthiest countries in theworld,1 the United States

ranks only 31st in healthy life expec-tancy.2 There is mounting evidence

that personal behaviors contribute tothis disparity between the wealthand health of the nation.3 Behaviorsthat contribute to morbidity andmortality have been identified, andhealth professionals have beencalled on to help their patients adopthealthier lifestyles.4 The AmericanPhysical Therapy Association (APTA)has identified a role for physical ther-

apists in health promotion,5,6 andthere is evidence that physical ther-apists are beginning to include

health promotion in their patientmanagement programs.7,8

To be effective in health promotionpractice, therapists must understandthe factors associated with success-

ful interventions. Researchers havefound that health professionals aremore likely to engage in health pro-motion if they believe that they haveadequate knowledge and skills,810

time,911 environmental support,10,12

and remuneration.10 Researchersalso have found that health profes-sionals are more likely to promote

behaviors they practice them-selves.7,9,13,14 Patient-related factorsfound to be associated with success-ful health behavior change includepatients beliefs, attitudes, self-efficacy, readiness to change, andenvironmental support.15

An additional factor that may influ-

ence the success of a health promo-tion intervention is the credibility ofthe health professional. Role model-ing is a key construct in Bandurassocial cognitive theory of behaviorchange.16 The importance of healthprofessionals in role modelinghealthy behaviors has been demon-strated. Researchers have found that

patients of physicians who demon-strated healthy behaviors (were at ahealthy weight and participated in

regular exercise) were more moti-vated to change their own behaviorsand to have more confidence in thecounseling they received.17,18 Giventhis preliminary evidence that sug-

gests the importance of role model-ing, researchers in a number ofhealth and education professionshave begun to examine personalhealth behaviors1923 and role-modeling attitudes within their pro-fessions.19,21,24 Findings for healtheducators, osteopathic physicians,and health education, recreation,and dance professionals were simi-

lar, with a majority of respondents inthose studies reporting that they par-ticipate in regular exercise and

abstain from smoking.1923

Limited research has been publishedregarding the personal health behav-iors of physical therapists. In Good-golds survey of 257 physical thera-

pists, 81% of the participantsreported that they participated insports or fitness activities.7 In arecent study by Chevan andHaskvitz,25 67% of physical thera-pists, 63.8% of physical therapist

assistants, and 72.4% of physicaltherapist students reported that theyengage in physical activity at the

level recommended by the Centersfor Disease Control and Prevention(CDC).

Several researchers have studiedhealth, education, and fitness profes-sionals attitudes toward role model-ing.19,21,24 The majority of partici-pants in these studies indicated that

they believe that they should rolemodel healthy behaviors. No studywas found that reported on physicaltherapists attitudes toward rolemodeling.

The current study compared the per-sonal health behaviors of physicaltherapists and physical therapist stu-

dents to determine whether theyengage in the behaviors that wouldposition them to be role models and

examined their attitudes toward theprofessional responsibility to rolemodel healthy behaviors. From the

variety of health-promoting behav-iors that could have been chosen for

this study, those selected were con-sidered by Reeves and Rafferty26 tobe most indicative of a healthy life-style: engaging in regular physicalactivity, eating fruits and vegetables,maintaining a healthy weight, andabstaining from smoking. These 4behaviors also are behaviors thatphysical therapists have been shownto discuss with their patients.8

This study sought to answer the fol-lowing questions:

1. Do physical therapists and physi-cal therapist students engage inthe personal health behaviors ofregular physical activity, adequatedaily fruit and vegetable con-

sumption, maintaining a healthyweight, and abstaining fromsmoking?

2. Do physical therapists and physi-cal therapist students believe that

they have a professional responsi-bility to role model healthybehaviors?

3. Is there a difference betweenphysical therapists and physicaltherapist students in personalhealth behaviors or in attitudestoward the need to role modelhealthy behaviors?

4. Are sociodemographic variables

associated with personal healthbehaviors or attitudes toward rolemodeling?

The first 2 questions will beanswered through a description ofreported behaviors. The third ques-tion will be answered by comparingthe health behaviors and role-

modeling attitudes of physical thera-pists and physical therapist students.Based on the findings of the CDCs

Personal Health Behaviors and Role-Modeling Attitudes of Physical Therapists and Physical Therapist Students

1420 f Physical Therapy Volume 92 Number 11 November 2012



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Behavioral Risk Factor SurveillanceSystem (BRFSS), which has showndifferent health behaviors based onage and educational level,2734 wehypothesized that physical therapist

students would be more likely toengage in healthy behaviors thanwould physical therapists. We alsohypothesized that there would be adifference in attitudes toward rolemodeling with the increased empha-sis on theories of behavior change inhealth promotion courses in currentacademic programs. The final ques-tion examined the relationship

between sociodemographic vari-ables and both personal healthbehaviors and attitudes toward role

modeling. Currently, there is no lit-erature reporting on physical thera-pists and physical therapist stu-dents attitudes toward rolemodeling. In addition, there is lim-ited information about the health

behaviors of physical therapists andphysical therapist students. Resultsof this study will contribute to thisbody of literature.

Method

Study Design and SamplingThis study used a descriptive cross-sectional survey research design.35

The sample size necessary to be ableto detect a 10% difference in propor-

tions between physical therapistsand physical therapist students inboth health behaviors and agree-ment with role-modeling statements

was determined to be 413 partici-pants per group to achieve 95% con-fidence, an alpha level of .05, and

80% power. With a projectedresponse rate of only 33%, to ensure

a sufficient number of returned sur-veys, the names and addresses of arandom sample of 1,240 physicaltherapists (310 from each of the 4 UScensus regions) and 1,240 physicaltherapist students (310 from each ofthe 4 US census regions) wereobtained from APTA.

ParticipantsInclusion criteria included physicaltherapists or physical therapist stu-dents aged 18 years and older who

were members of APTA and cur-

rently residing in the United States.Physical therapists were excluded ifthey were not currently engaged in

either clinical practice or teaching.Physical therapist students wereexcluded if they were not currentlyenrolled in an accredited profes-sional (entry-level) physical therapisteducation program. A total of 759participants returned surveys, repre-senting a 30.60% return rate. The sur-

veys of 13 participants who did not

meet the inclusion criteria and thesurveys of 12 participants who didnot complete 1 or more of the healthbehaviors or role-modeling questions

were excluded, yielding a final sam-ple of 734 participants: 405 physicaltherapists and 329 students (Figure).The sociodemographic characteris-tics of the respondents are reported

in Table 1. The largest percentage ofphysical therapists (54.7%) workedin private or group outpatient prac-

tices or health system or hospitaloutpatient clinics. The 2010 APTAPhysical Therapist Member Demo-graphic Profile36 describes members

as 68.3% women, and the averageage of physical therapists was 43.5

years. In 2010, 54.5% of physical

therapists worked in private orgroup outpatient practices or healthsystem/hospital outpatient clinics.These statistics for physical thera-pists in 2010 are very similar to thosefor physical therapists in this sample,suggesting that this sample of physi-cal therapists is representative ofphysical therapist members of APTA.

SurveyThe survey consisted of 3 distinctquestionnaires (Appendix). The firstquestionnaire consisted of socio-demographic questions. The secondquestionnaire asked the participantsabout personal health behaviorsrelated to physical activity, fruit and

vegetable consumption, weight man-agement, and abstaining from smok-ing. The third questionnaire asked

13 individuals excluded due to notmeeting inclusion criteria

33 surveys returned asundeliverable

2,480 surveys mailed

759 respondents

411 PTs

6 excluded due to missing data 6 excluded due to missing data

335 SPTs

405 PTs in final sample 329 SPTs in final sample

Figure.Participant flow during the study. Participants were excluded if they did not answer 1or more questions on either the health behavior questionnaire or the role-modelingattitudes questionnaire. PTphysical therapist, SPTphysical therapist student.





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participants about their attitudestoward role modeling.

In the health behaviors question-naire, participants were asked if theyadhered to current recommenda-tions for regular exercise, adequate

fruit and vegetable consumption,abstaining from smoking, and main-taining a healthy weight, using ques-tions adapted from the BRFSS.37 In2008, the recommendation for phys-ical activity was Adults shouldengage in moderate-intensity physi-cal activities for at least 30 minuteson 5 or more days of the week or

engage in vigorous-intensity physicalactivity 3 or more days per week for20 or more minutes per occasion.38

Although adequate fruit and vegeta-ble consumption is individuallydetermined and based on personalfactors,39 adequate daily fruit and

vegetable consumption by the adultpopulation in the United States istracked and reported as the percent-

age of adults who consume 5 ormore servings per day,31 and, there-fore, was used as the operational def-inition of adequate consumptioninthis study. The behavior of maintain-ing a healthy weight was determinedby providing participants with abody mass index scale and askingthem if they maintained a healthy

weight. The behavior of smokingwas measured using the definition ofsmoking used in the BRFSS, which

defines smoking as smokingcigarettes.37

Rather than presenting a dichoto-mous choice for participants regard-

ing their current actions related toeach of the 4 behaviors, the healthbehavior questionnaire allowed par-ticipants to choose the answer thatbest represented their currentbehavior along a continuum ofchange for the behavior. The trans-theoretical model of behaviorchange40 identifies 5 stages ofchange for engaging in a specific

behavior: precontemplation, con-templation, preparation, action, andmaintenance. An individual is consid-

ered to be in the precontemplationstage when there is no intention totake action within the next 6 months

with respect to changing or engag-ing in a particular behavior. Individ-uals are in the contemplation stage if

they are seriously considering achange in their behavior within thenext 6 months but are not preparingto change the behavior at the pres-ent time. In the preparation stage,the individual intends to take action

within the next 30 days and hastaken some steps to change thebehavior. The action stage has been

identified as the stage when an indi-vidual has engaged in the behaviorfor less than 6 months. Individualsare in the maintenance stage if theyhave engaged in the behavior for 6months or more. These choices pro-

vided more detailed information tothe participants about current orintended behaviors. Stage of change

terminology was based on wordingused in previous studies for physicalactivity, smoking, and fruit and veg-etable consumption.4143 A newquestion was developed for thisstudy for the stage of change for thebehavior of maintaining a healthy

weight.

The third questionnaire was adaptedfrom Cardinal and colleagues Atti-tude Toward Role-Modeling Scale.44

Table 1.Sociodemographic Characteristics of Physical Therapists (PTs) and Physical TherapistStudents (SPTs)a

Sociodemograph ic Variable Total % (n) PTs % (n) SPTs % (n)

Age, y, X (SD) 34.5 (11.9) 42.0 (10.8) 25.2 (3.9)

Sex

Male 25.1 (184) 27.4 (111) 22.2 (73)

Female 74.9 (550) 72.6 (294) 77.8 (256)

Entry-level degree received or enrolled

Baccalaureate 24.8 (182) 44.9 (182)

Postbaccalaureate certificate 1.8 (13) 3.2 (13)

Masters 21.4 (157) 33.8 (137) 6.1 (20)

DPT 51.2 (376) 17.3 (70) 93.0 (306)

Other 0.8 (6) 0.7 (3) 0.9 (3)

Highest academic degree earnedb

Baccalaureate 58.9 (410) 28.4 (105) 93.6 (305)

Masters 23.1 (161) 40 (148) 4.0 (13)

t-DPT 3.9 (27) 7.3 (27)

Doctoral 13.2 (92) 24.3 (90) 0.6 (2)

Other 0.9 (6) 1.8 (6)

Took health promotion course 51.3 (351) 47.5 (170) 55.5 (181)

Region of current residence

Northeast 23.3 (171) 22.0 (89) 24.9 (82)

Midwest 25.9 (190) 23.7 (96) 28.6 (94)

South 26.0 (191) 27.2 (110) 24.6 (81)

West 24.8 (182) 27.2 (110) 21.9 (72)

a DPTDoctor of Physical Therapy, PTphysical therapist, SPTphysical therapist student,t-DPTTransitional Doctor of Physical Therapy.b Because of missing values, the data are based on 370 PTs and 326 SPTs.





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This questionnaire originally wasdeveloped for use with health, phys-ical education, recreation, and dance(HPERD) professionals and con-tained statements regarding model-

ing physical activity and a number offitness behaviors. This questionnairehas undergone psychometric testing,and the authors report a Cronbachcoefficient of .95 and a split-half reli-ability of .97 for their final version ofthe questionnaire.21 The question-naire was modified to change boththe terminology and questionsasked. For example, HPERD profes-

sionals was changed to physicaltherapist professionals. Items onthe original version related to

stretching and calisthenics wereremoved, and items related to fruitand vegetable consumption andsmoking were added. The survey,

with its 3-component question-naires, was reviewed by 3 content

experts and then pilot tested for facevalidity and test-retest reliability witha convenience sample of 10 physicaltherapists and 10 physical therapiststudents recruited from local physi-cal therapist clinics and entry-level

academic programs. In the pilotstudy, participants reported no prob-lems with understanding the ques-

tions or wording of the survey. Intest-retest reliability analyses, intra-class correlation coefficients of .944and .913 were found for the healthbehaviors questionnaire and role-modeling questionnaire, respec-tively. The Cronbach coefficient

was .979 for internal consistency ofthe role-modeling questionnaire. No

changes were made to the surveyafter the pilot study.

ProcedureThe study was approved by the insti-tutional review boards of the spon-soring agencies. Participants wereinformed that their names andresponses would be kept confiden-

tial and that only aggregate datawould be used for reporting pur-poses. Study participants were

mailed a package that included thefollowing: a consent form with infor-mation about the purpose of thestudy and the drawing for an incen-tive gift certificate, the survey, and a

stamped return envelope. Reminderpostcards were sent to participantswho did not return their surveyswithin 3 weeks. Data collectionoccurred from March 2009 to June2009.

Data AnalysisPredictive Analytics Software version17.0 (SPSS Inc, Chicago, Illinois) was

used to analyze the data. Descriptivestatistics were used to describe thesociodemographic characteristics of

the respondents. Frequencies foreach of the health behaviors werereported for the study sample as a

whole and separately for physicaltherapists and physical therapist stu-dents. Frequencies for agreement

with the role-modeling statementswere reported for the study popula-tion as a whole and separately forphysical therapists and physical ther-apist students. Nonparametric statis-tics were used to compare groups

and analyze associations. Wilcoxonrank sum tests were conducted toexamine differences between physi-

cal therapists and physical therapiststudents in health behaviors androle-modeling attitudes. Secondaryanalyses using logistic regression

were carried out to examine relation-ships between sociodemographiccharacteristics and both personalhealth behaviors and role-modelingattitudes. The stages of change for

engaging in the behavior weredichotomized by combining theaction and maintenance stage ofchange groups to represent theengages in the behavior group andcombining the preparation, contem-plation, and precontemplationgroups to represent the does notengage in the behavior group. Role-

modeling attitudes were dichoto-mized by combining agree andstrongly agree to represent the

agree group and combining theparticipants who were neutral, dis-agreed, or strongly disagreed to rep-resent the does not agree group.

Role of the Funding SourceThis study was supported by an Oak-land University Physical TherapyProgram research grant.

ResultsHealth BehaviorsThe results of the survey indicatethat both physical therapists andphysical therapist students engage

in health-promoting behaviors atvarying levels, depending on the spe-cific behavior (Tab. 2). An over-

whelming majority of the studysample reported that they were ineither the maintenance or actionstage of change for abstaining fromsmoking (99.4%). A majority of par-ticipants reported that they were in

either the maintenance or actionstage of change for engaging in reg-ular physical activity (80.8%) andmaintaining a healthy weight(78.7%). Only 60.3% of the studysample reported that they were in

the maintenance or action stages forconsuming sufficient fruits and veg-etables. No statistically significant

difference was found in the healthbehaviors of physical therapists andphysical therapist students (Tab. 2).

Binary logistic regression modelingwas applied to the survey responsedata to predict the odds of partici-pants engaging in health behaviors(Tab. 3) based on their sociodemo-

graphic characteristics. Due to miss-ing sociodemographic items forsome participants, the logisticregression modeling was based on672 participants: 352 physical thera-pists and 320 physical therapist stu-dents. For the behavior of engagingin regular physical activity, thoseparticipants with masters degrees

were less likely to engage in physicalactivity than participants holdingdegrees beyond a masters level





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(odds ratio [OR]0.48, 95% confi-dence interval [CI]0.240.93).One variable was related to fruit and

vegetable consumption; male partic-ipants were 37% less likely thanfemale participants to consume 5 or

more servings of fruits and vegeta-bles each day (OR0.63, 95%CI0.44 0.90). None of the vari-ables was related to the odds ofsmoking. Male participants were lesslikely than female participants tomaintain a healthy weight (OR0.63, 95% CI0.420.94).

Attitudes Toward Role ModelingThe majority of participants agreedor strongly agreed with all 10 state-

ments in the role-modeling question-naire (Tab. 4). The highest percent-age of participants (92.1%) agreed

with statement 6: Abstaining fromsmoking is a desirable and recom-mended behavior for physical thera-

pist professionals. The statementwith the next highest level of agree-ment (91.6%) was statement 5:Maintaining a healthy weight is adesirable and recommended behav-ior for physical therapist profession-als, followed closely by statement 3:Involvement in CDC-recommendedlevels of regular physical activity is a

desirable and recommended behav-ior for physical therapist profession-als (91.3%). The statement with the

lowest level of agreement was state-ment 9: It is important for physicaltherapist professionals to be rolemodels for eating 5 or more servingsof fruits and vegetables per day(73.2%).

Wilcoxon rank sum tests were car-ried out to analyze differencesbetween physical therapists andphysical therapist students in atti-tudes toward role modeling. Statisti-cally significant differences werefound between the groups in 5 state-ments on the role-modeling attitudes

questionnaire. Physical therapist stu-dents were more likely than physicaltherapists to agree with the follow-

Table 2.Health Behaviors of Physical Therapists (PTs) and Physical Therapist Students (SPTs)

Stage of Change for Behavior

Total %

(n)

PTs %

(n)

SPTs %

(n)

Differences in Health Behaviors

of PTs and SPTsa

Engage in regular physical activity P.275

Maintenance stage 69.9 (513) 72.6 (294) 66.6 (219)

Action stage 10.9 (80) 9.6 (39) 12.5 (41)

Preparation stage 10.9 (80) 8.4 (34) 14.0 (46)

Contemplation stage 5.4 (40) 5.7 (23) 5.2 (17)

Precontemplation stage 2.9 (21) 3.7 (15) 1.8 (6)

Abstain from smoking P.320


Action stage 0.5 (4) 0.5 (2) 0.6 (2)



Precontemplation stage

Consume fruits and vegetables P.835


Action stage 8.3 (61) 7.2 (29) 9.7 (32)




Maintain a healthy weight P.151


Action stage 3.0 (22) 2.2 (9) 4.0 (13)




aWilcoxon rank sum test,Pvalue (2-tailed) for engaging in the behavior (maintenance and action stages combined).





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ing statements: Role modeling is apowerful teaching tool for physicaltherapists (P.028); It is notenough to simply stay current in thefield; physical therapist professionals

also must practice what they preach(P.001); Involvement in CDC-recommended levels of regular phys-ical activity is a desirable and recom-mended behavior for physicaltherapist professionals (P.027);It is important for physical therapistprofessionals to role model non-smoking (P.013); and It is impor-tant for physical therapist profes-

sionals to role model maintaining ahealthy weight (P.005) (Tab. 4).Binary logistic regression modeling

was applied to the survey responsedata to predict the odds of partici-pants agreeing with the role-modeling statements (Tab. 5), basedon their sociodemographic charac-teristics. Men were less likely than

women to agree that eating 5 ormore daily servings of fruits and veg-etables is a desirable and recom-mended behavior for physical thera-pist professionals (OR0.61, 95%CI0.40 0.91). Male participants

also were 44% less likely thanfemale participants to agree that itis important for physical therapist

professionals to role model maintain-ing a healthy weight (OR0.66,CI0.450.97).

DiscussionHealth BehaviorsThe majority of physical therapistsand physical therapist studentsengage in regular physical activity,

eat sufficient fruits and vegetables,abstain from smoking, and maintaina healthy weight. Although cautionmust be taken in comparing theresults of this self-report survey withthe results of other self-report sur-

veys because of differences in boththe wording and format of the sur-

veys, it appears that physical thera-

pists and physical therapist studentsengage in all 4 behaviors at a higherlevel than the general adult popula-

tion in the United States4548 and atsimilar or higher levels than otherprofessional groups.1923

Physical activity. In this study,

80.8% of the participants reportedthat they engage in regular physicalactivity, a finding remarkably similarto the findings of a previous study ofphysical therapists7 but higher thanthe percentage found in a morerecent study of physical therapistprofessionals.25 The difference infindings between this study and the

study conducted by Chevan andHaskvitz25 could be due to different

wording and format of the surveys.

This study was a mailed survey, andit used terminology similar to that inthe BRFSS for physical activity, fruitand vegetable consumption, tobaccouse, and weight management to be

able to compare the findings withthe 2009 BRFSS findings for the gen-eral adult population for these 4behaviors. Chevan and Haskvitz25

used an online survey with wordingbased on the 2005 National HealthInterview Survey (NHIS) to be ableto compare their findings with the2005 NHIS findings of levels of phys-

ical activity for the general popula-tion. For example, the Chevan andHaskvitz25 survey included questions

Table 3.Logistic Regression Modeling of Respondents Health Behavior (Dependent Variable:Engage in the Activity Yes)a

Independent Predictor Variable OR 95% CI

Engage in regular physical activity

Respondent type (PT vs SPT) 1.187 0.7121.978

Sex (male vs female) 1.227 0.7771.937

Education

Bachelors vs post-masters 0.618 0.3091.232

Masters vs post-masters 0.481b 0.2470.934

Eat 5 servings/day of fruits and vegetables


Sex (male vs female) 0.636b 0.4460.906

Education


Masters vs post-masters 0.776 0.4691.283

Smoke cigarettes



Education


Masters vs post-masters

Maintain a healthy weight



Education



a PTphysical therapist, SPTphysical therapist student, 95% CI95% confidence interval for the oddsratio (OR) based on the coefficients value.b P.05;Pvalue (2-tailed) for the model coefficient associated with the indicated predictor.





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that asked respondents to identifyhow many days each week and forhow many minutes they engaged inmoderate activities and vigorousactivities. These more specific phys-

ical activity questions used by theNHIS may provide more reliable esti-mates of the percentage of the gen-eral population and the percentageof physical therapists and physicaltherapist students who engage inrecommended levels of physicalactivity.

In comparing the results of this studythat used BRFSS terminology withthe 2009 BRFSS results for physical

activity, only 50.9% of adults in theUnited States reported that theyengage in the level of physical activ-ity recommended by the CDC.45 Instudies conducted with other health,

fitness, and education professionalgroups,1921,49 the percentage of par-ticipants who reported that theyengage in regular physical activityranged from 41% to 88%. Given theresolution at the 2008 APTA AnnualSession of the House of Delegates50

that physical therapists adopthealthy lifestyle choices that include

meeting national guidelines for phys-ical activity, this high percentage ofphysical therapists and physical ther-

apist students who report that theycurrently engage in recommendedlevels of physical activity is hearten-ing, but more colleagues should beencouraged to meet the guidelines.

The first hypothesis of this study,that physical therapist students

would have healthier behaviors thanphysical therapists, was not sup-ported. There was no statistically sig-nificant difference between thephysical therapists and physical ther-apist students in any of the 4 behav-

iors, including physical activity. Inthe general population, a higher per-centage of younger adults than older

Table 4.Physical Therapists (PTs) and Physical Therapist Students (SPTs) Attitudes Toward Role Modeling

Role-Modeling Statement

% (n) of Respondents

Who Agree or

Strongly Agree

% (n) of PTs

Who Agree

or Strongly

Agree

% (n) of SPTs

Who Agree or

Strongly

Agree

Differences in

Role-Modeling

Attitudes of

PTs and SPTsa

1. Role-modeling is a powerful teaching tool for

physical therapist professionals

91.2 (669) 88.2 (357) 94.9 (312) .028b

2. It is not enough to simply stay current in the

field; physical therapy professionals also must

practice what they preach

90.3 (663) 86.9 (352) 94.5 (311) .001b

3. Involvement in CDCc-recommended levels of

regular physical activity is a desirable and

recommended behavior for physical therapy

professionals

91.3 (670) 88.4 (358) 94.9 (312) .027b

4. Eating 5 or more servings of fruits and

vegetables a day is a desirable and


professionals

77.9 (572) 78.7 (319) 76.9 (253) .459

5. Maintaining a healthy weight is a desirable and


professionals

91.6 (672) 89.3 (362) 94.2 (310) .116

6. Abstaining from smoking is a desirable and


professionals

92.1 (676) 90.4 (366) 94.2 (310) .141

7. It is important for physical therapy professionals

to role model CDC-recommended levels of

regular physical activity

87.6 (634) 85.4 (346) 90.3 (297) .052


to role model nonsmoking behavior

88.6 (651) 86.7 (351) 91.2 (300) .013b


to be role models for eating 5 or more servings

of fruits and vegetables a day

73.2 (537) 71.6 (290) 75.1 (247) .304

10. It is important for physical therapy professionalsto role model maintaining a healthy weight 89.6 (658) 87.2 (353) 92.7 (305) .005b

aWilcoxon rank sum test,Pvalue (2-tailed) for agreeing/strongly agreeing with statement.b Significant (P.05).c CDCCenters for Disease Control and Prevention.





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Table 5.Logistic Regression Modeling of Respondents Role-Modeling Attitudes (Dependent Variable: Agree With Statement)a

Independent Predictor Variable OR 95% CI

Role-modeling statement 1: Role modeling is a powerful teaching tool for PTs

Respondent type (PT vs SPT) 0.412b 0.1980.858


Education



Role-modeling statement 2: PTs must practice what they preach



Education



Role-modeling statement 3: Engaging in regular physical activity is desirable for PTs



Education



Role-modeling statement 4: Eating 5 servings/day of fruits and vegetables is desirable for PTs



Education



Role-modeling statement 5: Maintaining a healthy weight is desirable for PTs



Education



Role-modeling statement 6: Abstaining from smoking is desirable for PTs



Education



Role-modeling statement 7: It is important for PTs to role model regular physical activity



Education



(Continued)





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adults adhere to physical activity rec-ommendations.27 Piazza et al51 also

found that exercise behaviordecreased with age in their survey of300 female occupational health

nurses. Perhaps physical therapistsare a unique population who,through education and vocation, bet-ter understand the importance ofmaintaining an active lifestyle andhave developed strategies to ensurethat they maintain these healthybehaviors throughout their adultlives. If this is the case, physical ther-

apists are ideally suited to engage indiscussions with their patients aboutthe benefits of engaging in regularphysical activity.

The statistically significant differ-ence in physical activity behaviorfound on logistic regression betweenthose with a masters degree versus

those with a post-masters degree isdifficult to understand, especiallybecause there was no statistically sig-

nificant difference between thosewith a bachelors degree and those

with a post-masters degree. Thehigher end of the CI approaches 1.0,a value that indicates no difference

between these groups, and it is pos-sible that some associations foundbetween sociodemographic vari-ables and behaviors were primarilydue to the large sample size in thisstudy.

Smoking. More than 98% of par-ticipants in this study reported that

they do not smoke. In 2009, 82% ofthe adult population in the UnitedStates reported that they currentlydo not smoke.46 The high percent-age of nonsmokers in the physicaltherapy profession is similar to orhigher than the percentage of non-smokers found in other professionalgroups.12,13,19,20,23 There was no sta-

tistical difference between physicaltherapists and physical therapist stu-dents in this behavior. In the general

adult population, higher education isassociated with lower rates of smok-

ing.33 Perhaps the comparably highlevel of education of both physicaltherapist students and physical ther-

apists may explain why the groupsare similar in their high levels ofabstaining from smoking. Physicaltherapists and physical therapist stu-dents behaviors related to smokingplaces them in the position of beingexcellent role models for abstainingfrom smoking.

Healthy weight. In this study,21.3% of the physical therapists andphysical therapist students reportedthat they do not maintain a healthy

weight. Although there is evidencefrom previous studies that youngeradults are more likely to maintain ahealthy weight than older adults,28 inthis study there was no difference

found between physical therapistsand physical therapist students.Fewer men reported that they main-

Table 5.Continued

Role-modeling statement 8: It is important for PTs to role model nonsmoking behavior



Education



Role-modeling statement 9: It is important for PTs to role model eating 5 servings/day of fruits and vegetables



Education



Role-modeling statement 10: It is important for PTs to role model maintaining a healthy weight



Education



a PTphysical therapist, SPTphysical therapist student, 95% CI95% confidence interval for the odds ratio (OR) based on the coefficients value.b P.05;Pvalue (2-tailed) for the model coefficient associated with the indicated predictor.





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tain a healthy weight, and this find-ing is similar to findings at a nationallevel reporting more men than

women at an unhealthy weight.52 In2009, more than 63.1% of the gen-

eral adult population in the UnitedStates was either overweight orobese.47 The percentage of partici-pants reported to be overweight instudies conducted with other profes-sional groups1922 ranges from 29.7%to more than 56%. Although themajority of physical therapists andphysical therapist students maintaina healthy weight, there is room for

improvement.

Fruit and vegetable consumption.The health behavior with the lowestlevel of adherence to CDC recom-mendations for both the physicaltherapist group and the physicaltherapist student group was thebehavior of adequate fruit and vege-

table consumption. In this study,60.4% of participants reported thatthey eat 5 or more servings of fruitsand vegetables per day. Men werefound to have statistically significantlower odds of fruit and vegetable

consumption. National studies alsohave shown a lower level of fruit and

vegetable consumption by men.53

However, the percentage of partici-pants in this study who consume 5or more servings of fruits and vege-tables each day is much higher thanthe general adult populationsreported adherence of 23.3%.48 Fewresearch data are available to allowcomparison with other professionalgroups. In their study of female phy-

sicians, Frank et al22

found that onaverage, participants consumed 3.5servings of fruits and vegetables perday. Improvement in this behavior

would serve not only to improve thehealth of physical therapists andphysical therapist students but alsocould lead to physical therapistsbeing more apt to engage their

patients in discussions about healthyeating.

Attitudes Toward Role ModelingThe majority of physical therapistsand physical therapist studentsagreed with all 10 statements on therole-modeling attitudes question-

naire. More than 90% of respondentsagreed or strongly agreed with the 2general statements that role model-ing is a powerful teaching tool andthat physical therapists must prac-tice what they preach. Physicaltherapists and physical therapist stu-dents general attitudes toward rolemodeling are similar to the generalrole-modeling attitudes reported for

several other health and fitnessprofessionals.24,54

The role-modeling questionnaireincluded questions about howstrongly participants agreed that theparticular behavior was a desirablebehavior for physical therapist pro-fessionals. Participants believed it

was important for physical therapistprofessionals to abstain from smok-ing, manage their weight, engage inregular physical activity, and con-sume adequate fruits and vegetables,in that order. However, the ques-

tions on the role-modeling question-naire that asked which behaviorsphysical therapist professionals

should actually role model hadslightly different results. The behav-ior that respondents most stronglybelieved that it was important forphysical therapist professionals torole model was maintaining ahealthy weight (89.6%), followed byabstaining from smoking (88.6%).Role modeling physical activity was

third, at 87.6%. For a profession thathas as its brand motto Move For-ward. Physical Therapy BringsMotion to Life,55 it was surprisingthat respondents felt more stronglyabout the importance of physicaltherapist professionals maintainingand role modeling a healthy weightand abstaining from smoking than

engaging in and role modeling phys-ical activity, although the percentagedifferences were not large among

the 3 behaviors. It could be, as onerespondent suggested, in an unsolic-ited comment written underneaththe role-modeling questionnaire,that behaviors related to smoking

and weight management are morevisible to patients and, therefore, aremore important to role model thanthe behaviors of engaging in physicalactivity and consuming fruits and

vegetables. It also is possible thatthese responses reflect the respon-dents perceptions of the socialstigma associated with being over-

weight and smoking.56,57

Close to a quarter of physical thera-pists and physical therapist students

did not agree with the 2 fruit andvegetable consumption statementsneither the CDC recommendation,nor the need to role model thebehavior. Given that adequate fruitand vegetable consumption is asso-

ciated with weight management andprevention of disease, perhaps phys-ical therapists and physical therapiststudents should be made moreaware of the importance of engagingin this behavior and recommending

it to their patients.

The logistic regression identified a

statistically significant difference in 2role-modeling attitudes betweenmale participants and female partic-ipants. Both attitudes related to fruitand vegetable consumption, whichin turn may be related to the differ-ence found in the actual behavior ofmale and female participants in fruitand vegetable consumption.

The second hypothesis of this studywas supported: that there would bea statistically significant difference inrole-modeling attitudes of physicaltherapists and physical therapist stu-dents. The reasons for the differ-ences in role-modeling attitudesbetween physical therapists and

physical therapist students in thisstudy are unclear. As previously sug-gested, it is possible that different or





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increased content in health promo-tion and behavior change theory inthe academic curriculum is responsi-ble for this difference in attitudestoward role modeling. It also is pos-

sible that this difference is due todiscussions in class about profes-sional behaviors and professionalresponsibilities as they relate torecent professional association initia-tives and documents such as Vision20206 and Core Values.58 As previ-ous research has shown, patients

who are aware of the healthy behav-iors of their health professionals are

more motivated to change their ownbehaviors.17,18 With this greaterawareness of the importance of role

modeling, physical therapist stu-dents may be more likely to discusstheir personal health behaviors withtheir patients and may be more effec-tive in promoting healthy behaviorsamong their patients.

LimitationsThere are a number of limitations ofthis study. With self-report surveys,there is a potential for response biasand social desirability bias. Cause

and effect and temporality of thevariables of health behaviors androle-modeling attitudes cannot be

determined because of the cross-sectional study design. This studyincluded only members of APTA.Therefore, results cannot be general-ized to physical therapists and phys-ical therapist students who are notmembers of that professional associ-ation. The weight management ques-tion was developed specifically for

this study and may not have been avalid measure for this behavior. Therequired sample size to detect a 10%difference in proportions of physicaltherapists and physical therapist stu-dents engaging in the 4 behaviors

was 413 per group. This sample sizewas not achieved, and the actualpower of the study was 76%, raising

the possibility that a true differencebetween groups was not detected asthe result of inadequate power. The

CDC physical activity recommenda-tions have changed since 2008, witha strengthening exercise recommen-dation added to the aerobic exerciserecommendation, and this study did

not measure adherence to this addi-tional recommendation. Futureresearch should examine patientsattitudes toward physical therapistsdiscussing health behaviors withthem and the impact that role mod-eling may have on the success ofthese discussions.

SummaryA majority of physical therapists andphysical therapist students engage inregular physical activity, consume

sufficient fruits and vegetables,abstain from smoking, and maintaina healthy weight, although there isroom for improvement. The impor-tance of role modeling is understoodby physical therapists, but more so

by physical therapist students. Con-tinuing education in behaviorchange theory, role modeling, andpatient-related factors associated

with successful behavior changemay be beneficial to physical thera-

pists who did not have academicpreparation in this area in their pro-fessional program and are not aware

of the motivational benefit of dis-cussing their own behaviors withpatients. Physical therapists, as keymembers of the health professionalcommunity, should recognize thatthey have an important role in healthpromotion. Physical therapists havethe educational background, theopportunity, and the credibility, as

evidenced by their own behaviors,to successfully engage in discussionsabout healthy behaviors with theirpatients.

All authors provided concept/idea/researchdesign, data analysis, and consultation(including review of manuscript before sub-mission). Dr Black provided writing, data col-lection, project management, and fund pro-curement. Dr Black was a student at RockyMountain University of Health Professions,

Provo, Utah, at the time this research wascompleted in partial fulfillment of therequirements for her Doctor of Sciencedegree in Health Promotion and Wellness.

This study was supported by an OaklandUniversity Physical Therapy Program

research grant.

DOI: 10.2522/ptj.20110037

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2009&qkey_4396&state_UBhttp://apps.nccd.cdc.gov/brfss/display.asp?cat_TU&yr_2009&qkey_4396&state_UBhttp://apps.nccd.cdc.gov/brfss/display.asp?cat_TU&yr_2009&qkey_4396&state_UBhttp://apps.nccd.cdc.gov/brfss/display.asp?cat=PA&yr=2009&qkey=4418&state=UBhttp://apps.nccd.cdc.gov/brfss/display.asp?cat=PA&yr=2009&qkey=4418&state=UBhttp://apps.nccd.cdc.gov/brfss/display.asp?cat=PA&yr=2009&qkey=4418&state=UBhttp://www.ahrq.gov/ppip/manual/appende.htmhttp://www.ahrq.gov/ppip/manual/appende.htmhttp://www.mypyramid.gov/http://www.cdc.gov/physicalactivity/everyone/guidelines/index.htmlhttp://www.cdc.gov/physicalactivity/everyone/guidelines/index.htmlhttp://www.cdc.gov/brfss/http://www.cdc.gov/brfss/http://www.apta.org/http://www.apta.org/http://apps.nccd.cdc.gov/brfss/education.asp?cat_OB&yr_2008&qkey_4409&state_UBhttp://apps.nccd.cdc.gov/brfss/education.asp?cat_OB&yr_2008&qkey_4409&state_UBhttp://apps.nccd.cdc.gov/brfss/education.asp?cat_OB&yr_2008&qkey_4409&state_UBhttp://apps.nccd.cdc.gov/brfss/education.asp?cat=TU&yr=2007&qkey=4396&state=UBhttp://apps.nccd.cdc.gov/brfss/education.asp?cat=TU&yr=2007&qkey=4396&state=UBhttp://apps.nccd.cdc.gov/brfss/education.asp?cat=TU&yr=2007&qkey=4396&state=UBhttp://apps.nccd.cdc.gov/brfss/education.asp?cat=FV&yr=2007&qkey=4415&state=UBhttp://apps.nccd.cdc.gov/brfss/education.asp?cat=FV&yr=2007&qkey=4415&state=UBhttp://apps.nccd.cdc.gov/brfss/education.asp?cat=FV&yr=2007&qkey=4415&state=UBhttp://apps.nccd.cdc.gov/brfss/education.asp?cat_PA&yr_2007&qkey_4418&state_UBhttp://apps.nccd.cdc.gov/brfss/education.asp?cat_PA&yr_2007&qkey_4418&state_UBhttp://apps.nccd.cdc.gov/brfss/education.asp?cat_PA&yr_2007&qkey_4418&state_UBhttp://apps.nccd.cdc.gov/brfss/age.asp?cat_FV&yr_2007&qkey_4415&state_UBhttp://apps.nccd.cdc.gov/brfss/age.asp?cat_FV&yr_2007&qkey_4415&state_UBhttp://apps.nccd.cdc.gov/brfss/age.asp?cat_FV&yr_2007&qkey_4415&state_UBhttp://apps.nccd.cdc.gov/brfss/age.asp?cat_TU&yr_2007&qkey_4396&state_UBhttp://apps.nccd.cdc.gov/brfss/age.asp?cat_TU&yr_2007&qkey_4396&state_UBhttp://apps.nccd.cdc.gov/brfss/age.asp?cat_TU&yr_2007&qkey_4396&state_UBhttp://apps.nccd.cdc.gov/brfss/age.asp?cat=OB&yr=2007&qkey=4409&state=UShttp://apps.nccd.cdc.gov/brfss/age.asp?cat=OB&yr=2007&qkey=4409&state=UShttp://apps.nccd.cdc.gov/brfss/age.asp?cat=OB&yr=2007&qkey=4409&state=UShttp://apps.nccd.cdc.gov/brfss/age.asp?cat=PA&yr=2007&qkey=4418&state=UBhttp://apps.nccd.cdc.gov/brfss/age.asp?cat=PA&yr=2007&qkey=4418&state=UBhttp://apps.nccd.cdc.gov/brfss/age.asp?cat=PA&yr=2007&qkey=4418&state=UB


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http://apps.nccd.cdc.gov/brfss/sex.asp?cat=OB&yr=2009&qkey=4409&state=UShttp://apps.nccd.cdc.gov/brfss/sex.asp?cat=OB&yr=2009&qkey=4409&state=UShttp://apps.nccd.cdc.gov/brfss/sex.asp?cat=OB&yr=2009&qkey=4409&state=UShttp://apps.nccd.cdc.gov/brfss/sex.asp?cat=OB&yr=2009&qkey=4409&state=UShttp://apps.nccd.cdc.gov/brfss/sex.asp?cat=OB&yr=2009&qkey=4409&state=UShttp://apps.nccd.cdc.gov/brfss/sex.asp?cat=OB&yr=2009&qkey=4409&state=UShttp://apps.nccd.cdc.gov/brfss/sex.asp?cat=OB&yr=2009&qkey=4409&state=UShttp://apps.nccd.cdc.gov/brfss/sex.asp?cat=OB&yr=2009&qkey=4409&state=UShttp://apps.nccd.cdc.gov/brfss/sex.asp?cat=OB&yr=2009&qkey=4409&state=UShttp://apps.nccd.cdc.gov/brfss/sex.asp?cat=FV&yr=2009&qkey=4415&state=UShttp://apps.nccd.cdc.gov/brfss/sex.asp?cat=FV&yr=2009&qkey=4415&state=UShttp://apps.nccd.cdc.gov/brfss/sex.asp?cat=FV&yr=2009&qkey=4415&state=UShttp://apps.nccd.cdc.gov/brfss/sex.asp?cat=FV&yr=2009&qkey=4415&state=UShttp://apps.nccd.cdc.gov/brfss/sex.asp?cat=FV&yr=2009&qkey=4415&state=UShttp://apps.nccd.cdc.gov/brfss/sex.asp?cat=FV&yr=2009&qkey=4415&state=UShttp://apps.nccd.cdc.gov/brfss/sex.asp?cat=FV&yr=2009&qkey=4415&state=UShttp://apps.nccd.cdc.gov/brfss/sex.asp?cat=FV&yr=2009&qkey=4415&state=UShttp://apps.nccd.cdc.gov/brfss/sex.asp?cat=FV&yr=2009&qkey=4415&state=UShttp://apps.nccd.cdc.gov/brfss/sex.asp?cat=FV&yr=2009&qkey=4415&state=UShttp://www.moveforwardpt.com/http://www.moveforwardpt.com/http://www.moveforwardpt.com/http://www.moveforwardpt.com/http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/BoD/Judicial/ProfessionalisminPT.pdfhttp://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/BoD/Judicial/ProfessionalisminPT.pdfhttp://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/BoD/Judicial/ProfessionalisminPT.pdfhttp://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/BoD/Judicial/ProfessionalisminPT.pdfhttp://ptjournal.apta.org/http://ptjournal.apta.org/http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/BoD/Judicial/ProfessionalisminPT.pdfhttp://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/BoD/Judicial/ProfessionalisminPT.pdfhttp://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/BoD/Judicial/ProfessionalisminPT.pdfhttp://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/BoD/Judicial/ProfessionalisminPT.pdfhttp://www.moveforwardpt.com/http://www.moveforwardpt.com/http://apps.nccd.cdc.gov/brfss/sex.asp?cat=FV&yr=2009&qkey=4415&state=UShttp://apps.nccd.cdc.gov/brfss/sex.asp?cat=FV&yr=2009&qkey=4415&state=UShttp://apps.nccd.cdc.gov/brfss/sex.asp?cat=FV&yr=2009&qkey=4415&state=UShttp://apps.nccd.cdc.gov/brfss/sex.asp?cat=OB&yr=2009&qkey=4409&state=UShttp://apps.nccd.cdc.gov/brfss/sex.asp?cat=OB&yr=2009&qkey=4409&state=UShttp://apps.nccd.cdc.gov/brfss/sex.asp?cat=OB&yr=2009&qkey=4409&state=US


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Appendix.Survey Instrument Used in the Studya

(Continued)





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Appendix.Continued

(Continued)




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