Cross-Cultural Adaptation of the Physical Activity Health-Care Packet among Chinese Adults with Type 2 Diabetes Mellitus

Thesis (Ph.D.)--University of Rochester. School of Nursing. Dept. of Nursing, 2012.Purpose: The purpose of this study was to (1) explore the cross-cultural adaptation of the Self-Determination Theory (SDT), and (2) examine the relationship of the SDT concepts and physical activity levels among Chinese adults with type 2 diabetes (T2DM). Methods: Participants: A total of 254 Chinese adults with T2DM were recruited from one diabetic institute in China. Instrumentation: (1) A SDT-framed questionnaire packet, the Physical Activity Health-Care Packet-Chinese (PAHCP-Chinese) with 25 items, was used to measure the SDT concepts. (2) The short international physical activity questionnaire-Chinese (IPAQ-C) was applied to examine physical activity levels in the last seven days. Procedure: The original English version PAHCP was translated and culturally adapted into Chinese using translation, backtranslation, expert committee review, and two times of pretesting. Each subject was interviewed with the PAHCP-Chinese and short IPAQ-C. One hundred subjects retested the PAHCP-Chinese two weeks after the first interview. Data analysis: Test-retest reliability, Cronbach’s alpha, content validity index, and exploratory factor analysis (EFA) were performed to examine the PAHCP-Chinese’s psychometric properties. Simple and multiple regression analyses and bootstrapping were conducted to explore the relationships of autonomy support, autonomous self-regulation, perceived competence, and physical activity levels. Results: The test-retest reliability of the three questionnaires of the PAHCP-Chinese ranged from 0.44 to 0.69. Internal consistency of the Perceived Competence Scale-Chinese (PCS-Chinese) and modified Health-Care Climate Questionnaire-Chinese (mHCCQ-Chinese) were respectively 0.91 and 0.94. The autonomous self-regulation subscale had good internal-consistency with the Cronbach’s alpha of 0.76. The controlled regulation and amotivation subscales showed low Cronbach’s alphas, 0.59 and 0.32. Autonomy support, autonomous self-regulation, controlled regulation, and perceived competence factors were extracted from the EFA results. After controlling for gender, Chinese patients’ autonomy support predicted their autonomous self-regulation and perceived competence, their autonomous self-regulation predicted perceived competence, and their perceived competence predicted physical activity levels. Conclusion: The mHCCQ-Chinese and PCS-Chinese appeared reliable and valid. The autonomous self-regulation subscale was acceptable. Autonomous self-regulation and perceived competence had mediation effects on the relationship between autonomy support and physical activity levels. Chinese females were more willing to be physically active than Chinese males