Table 2 Barriers and facilitators relating to physical and psychological capability

Physical capability

Physical Skills

Individual mentions ability and proficiency for a physical skill acquired through practice impacting self-managing (symptoms, treatments, etc.) [an ability of proficiency acquired through practice]

19

17

4

Facilitators

Exercises were simple (13)

  “I liked that it was fairly simple to do…they weren’t real complicated” (10,272)

Tailored to patient’s abilities (3)

   “She, compensated my exercises so I didn’t have to use my neck as much or I supported my neck so that I didn’t get any pain.” (10,343)

Gaining new skills for future application (2)

   “[Name of Dr.] explained to me about preventing it, preventative maintenance for my lower back about…for example, when I do bend now, instead of just bending down, what I do is the golfer’s kick.” (14,953)

Barriers

Difficulty performing exercises (4)

   “I mean I couldn’t do the exercises” (13,246)

Psychological capability

Knowledge

individual mentions an awareness of the existence of something impacting self-managing (symptoms, treatments, etc.) [an awareness of the existence of something]

24

24

4

Facilitators

How to manage condition (11)

  “Too much bending or whatever. I mean, you know, bending over. So, but I’ve learned thr-through conversations with chiropractor and, and the physical therapist, I suppose it would be that gave me the exercises. I’ve learned how to do some things differently. So, you avoid some of those occurrences, so you didn’t have pain. So, and of course because of my age, I going ta, it’s not going to go a hundred percent, because of my age and I know that. But it certainly has helped me.” (13,097)

Understanding exercises (9)

  “Things that I can do to strengthen my um, I haven’t had any exercise programs that I liked, what exercise I should be doing to strengthen my back um, and I liked all the handouts they give me, I’m a visual person so I liked to have it with the reference. Once I’m done I have something to go back to that I can use. I think that was probably the manual or the three ring binder with the exercise I think was the biggest thing for me.” (15,047)

Being provided knowledge, general (8)

  “It’s more than I expected. I’m just amazed at how a little bit of good knowledge can make you take care of yourself and, and feel better. Cause’ I had completely stopped exercising.” (10,151)

Understanding condition (4)

  “Mmmh. Yes, I guess so, cause’ it did ultimately eliminate…do I have sciatica? No! And I can move on and hopefully… get treatments somewhere else for what, what is the problem.” (13,631)

Managing expectations (2)

  “There were a couple occasions when I was kind of sore afterwards…I think it’s kind of like opening a hornet’s nest, sometimes you work with muscles that maybe aren’t used to being worked with and so you know it, there are, there are a few occasions when I was pretty pain- you know, I was pretty painful afterwards, but that does goes away.” (13,751)

Barriers

Not knowing how to manage condition (3)

  “It was mostly the legs, that were giving me the most problems. I…you kind of know what to do for your back… if something annoys your back, you stop doing it. You know, you do things differently. But your legs, what do you do with your legs you know?…You got to use them.” (13,097)0

Not understanding exercises (1)

  “The reason for that is because, you know, although I have the picture there, I don't, it’s not necessarily, it’s not the same as a video or somebody standing there and correcting you, “Don’t go this far up, uh, don’t do this.” I was doing them wrong the first week or so” (10,140)

Cognitive and interpersonal skills

individual mentions an ability or proficiency in a cognitive skill acquired through practice impacting self-managing (symptoms, treatments, etc.) [an ability of proficiency acquired through practice]

6

5

2

Facilitators

Recognizing and communicating a need (3)

  “…and they’re, easy to follow and I think one thing that I would have liked and I kind of did on my own and stuff, I talked to [name of Dr.] about it but I started using like hand weights and stuff…going along with the exercises and stuff which I think helped me a little bit more…” (13,657)

Recognizing and reorganizing schedule for fitting in exercises (1)

  “I think it just made me, again I’m an organized person and it got me to be a little bit more organized because I knew what I had to do at a certain amount of, you know. Even though I got home late at night or whatever the case may be, I still had to get it done.” (10,014)

Recognizing correct performance of exercises (1)

  “Well, then I noticed I had been doing them wrong, because when I did it the way he told me to I didn’t feel the level of discomfort pain that I had been feeling.” (10,140)

Barriers

Not recognizing correct performance of exercises (1)

  “…I guess I never knew quite if I was engaging the right muscles (cleared throat).”

   Interviewer: “Ok. When you were doing…”

   Patient: “By myself.” (13,576)

Difficulty pacing exercises (1)

  “Well, I think at first I was over-exerting myself. And then I talked to the doctor and he took me off a couple of em’, and said, “Don’t over-exert” because I just thought they weren’t strenuous enough. So I had a misconception on, on the exercises and I think I did hurt myself the first couple weeks…” (10,014)

Memory, attention, and decision processes

Individual mentions retaining information, gaining or maintaining focus, or making decisions pertaining to self-managing (symptoms, treatments, etc.) [the ability to retain information, focus selectively on aspects of the environment and choose between 2 or more alternatives]

6

4

2

Facilitators

Awareness of when to incorporate self-management strategies (2)

  “I, um, was given instructions how to lift things and stoop and bend and, um…You know I keep them in mind now when I do those activities” (13,424)

Being disciplined (1)

  Interviewer 4a. “And what did you like best about the home exercise program you had in the study?”

  Patient: “The discipline of me just doing them. I said I, I think I’ve missed one day of exercise since I started. I mean one, one portion of the day” (10,151

Incorporating into routine (1)

  “That I was introduced to a few new exercises that seemed to help. That I was able to combine the recommended exercises with other exercises that I’d already been doing on a daily basis along with yoga and stretching…” (10,178)

Barriers

Difficulty deciding to exercise (2)

  “I’m not an exerciser so, I mean, that would, for me, it’s just the idea of exercising. It’s having to discipline yourself to do this on a regular basis. They weren’t strenuous, there were not, I mean so much that it was overwhelming. But it’s just the idea, I mean like for me, any type of exercise I just don’t like to do it.” (13,537)

Behavioral regulation

Individual mentions something pertaining to managing or changing self-managing behaviors [anything aimed at managing or changing objectively observed or measured actions]

4

2

2

Facilitators

Changing activity to reduce pain (2)

  “The…that how much it’s changed it’s just affected my life because, before I would just kind of like sit and wonder what was happening to me, I was getting older. Now, if it’s hurting I get up and do some stretches and I look forward to doing my exercises three times a day” (10,151)

Barriers

Choosing other activities over assigned exercises (2)

  “There near the end about week nine or so I started lacking, slacking off because I felt that my swim routine and my calisthenics and, what I was doing as far as pushups and chin ups and that kind of thing was contributing to about the same kind of exercise that was called for by the regime to get em’ in.” (10,307)