Developing and testing an E-learning program to increase physical activity among people with SCI

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Lay Summary by Matthew Ma

Edited by Rona Herzog

This is a summary of a research study by researchers at the University of Alabama. ICORD PI  Dr. Kathleen Martin Ginis is a co-author. Click here to access the original paper.


Despite reports showing that regular physical activity benefits both mental and physical health, most people with spinal cord injury (SCI) do not meet the recommended amount of  physical activity (PA). A possible reason is that people with SCI face many barriers towards PA, such as a lack of transportation to and from exercise facilities, lack of motivation, and fear of injury. In the past, long term interventions employing social cognitive theory (SCT) have been successful in increasing LTPA for people with neurological disabilities. However, there is a need for short term programs that can be used in settings such as clinics and hospital waiting rooms. 

What was the purpose of this study?

Previous research has suggested that using story-telling strategies to promote PA benefits may be especially effective. People with SCI tend to lean towards one of three different “narrative styles”, which refers to how they think physical activity impacts their lives: 

  • the “chaos narrative”, which views their SCI as preventing them from doing PA;
  • the “restitution/cure narrative”, which seeks to restore their pre-SCI self through LTPA;
  • the quest narrative, which views participating in LTPA as a means of enjoyment, socialization, and improving their health

The purpose of the study was to develop and test a brief interactive e-learning program that shares PA information in a way that can be tailored towards an individual’s preferred narrative style. The title of the e-learning program is e-STORIES (Exercise Strategies Through Optimized Relevant Interactive E-learning Storytelling).

How was this study conducted?

The study was conducted in four phases:

  1. In the first phase, the researchers created a storyboard outlining the flow of the program. This included designing the slides and determining the flow of the program based on how a user (e.g. people with SCI) would respond to survey questions.
  2. The second phase consisted of a national web-survey that aimed to gather information that would help refine the e-learning program. The information from the surveys included people’s current level of PA and the narrative style  they identified with.
  3. The third phase was a panel review of the e-learning program by four experts: an exercise physiologist, a rehabilitation scientist, an information specialist, and a clinician. Each expert gave a summary of their suggested revisions, which were taken into consideration when the program underwent subsequent revisions. 
  4. In the final phase, the program was tested by twelve people with SCI. The program’s usability was based on four different criteria: effectiveness, efficiency, usefulness, and satisfaction. Face-to-face interviews were conducted to inform the latter two criteria. 

What are the findings of the usability study? 

From the usability testing data, the researchers found that there were a few minor issues with program operation, including technical issues relating to the user interface. Consequently, the participants had slightly more trouble with the slides than was expected. However, the participants were still able to complete the program in a timely manner, on average. The general sentiment from participants was that the program made them think about PA in a more positive way, which was associated with motivation for goal setting and setting aside time for physical exercise. Interestingly, the study found no significant differences in the participants’ initial attitudes towards PA between the three narrative styles.

What do these findings mean for future e-learning program development, and the SCI community?

This study involved creating an evaluating a brief e-learning program aimed at increasing physical exercise in people with SCI.  had high perceived usability and great potential for improving self-efficacy and self-regulatory skills. Furthermore, the program can be implemented effectively and can be completed in a timely manner, both of which are important in clinical settings that are time-sensitive. Short duration programs such as the e-STORIES program are useful and could serve as alternatives to long term exercise programs/interventions, which can be costly and inflexible. Further research is needed to test the e-learning program’s feasibility in real-life settings, where more variables may be at play in determining the program’s practicality and effectiveness.

Definitions of article-specific terms: 

Effectiveness vs. Efficiency

Effectiveness: a measure of the program’s ease of use. This was calculated as the number of slides a user had problems with divided by the number of slides without any problems. The benchmark for acceptable effectiveness was set at 90%.

Efficiency: the time required to complete the program. The benchmark of acceptable efficiency was set to 30 minutes.

Self-efficacy: a personal judgment of how well one is able to perform a behaviour.

Self-regulation: the ability to adjust one’s thoughts, emotions, and behaviours to meet goals or to fit a certain situation.

Social Cognitive Theory: the psychological theory that people’s behaviours are influenced by their own experiences, the behaviours of others, and the environment.

Storyboard: a sequence of graphical images used to visualize the flow of the e-learning program.