Merits and Pitfalls of Social Media as a Platform for Recruitment of Study Participants

Psychometric Testing of the Revised Oncology Nurses Health Behaviors Determinants Scale

BACKGROUND

Chemotherapy exposure is an occupational risk that affects oncology nurses and is linked to several negative health consequences. Oncology nurses' adherence to chemotherapy handling guidelines is critical to protect themselves from this hazardous drug exposure. Several personal and workplace-related factors affect nurses' adherence to these guidelines.

OBJECTIVE

The purpose of this study was to test the psychometric properties of the revised Oncology Nurses Health Behaviors Determinants Scale (HBDS-ON) that measures factors affecting nurses' adherence to chemotherapy handling guidelines.

METHODS

A quantitative cross-sectional design was used. One hundred twenty-three oncology nurses were recruited through convenience sampling from 2 hospital settings in the Midwest United States and through social media. Participants completed 3 online surveys: (1) the Revised Hazardous Drugs Handling Questionnaire, (2) the revised HBDS-ON, and (3) a demographic questionnaire.

RESULTS

Exploratory factor analysis revealed a conceptually reasonable 7-subscale structure of the revised HBDS-ON. The psychometric properties of the scale were supported by convergence validity, regression model testing, and internal consistency reliability. Oncology nurses reported adherence to chemotherapy handling guidelines 55% of the time. The cues to action in the workplace, nurses' perceived barriers, institutional response to chemotherapy exposure incidents, and personal protective equipment availability and accessibility were associated with oncology nurses' adherence to chemotherapy handling guidelines.

CONCLUSION

The revised HBDS-ON demonstrates reliability and validity and can be used to measure factors at workplace and personal levels that affect nurses' adherence to chemotherapy handling guidelines.

User Perceptions of Behavioral Change Strategies in Diabetes Apps: Feedback From Online Support Groups

BACKGROUND

Behavioral change strategies are used in mobile health applications to help individuals manage chronic conditions like diabetes. However, there is limited research on user preferences and perceptions regarding these strategies in the context of diabetes management apps. This study aimed to investigate the preferences of individuals with diabetes and their relatives concerning behavioral intervention functions used in mobile health apps to enhance the design and effectiveness of future applications.

METHODS

An online survey was conducted to gather sociodemographic information, details about diabetes diagnoses, and the target group's preferences for the use of nine main behavioral change strategies, possible to include in mobile health apps. Participants were asked to rate their agreement with specific statements related to each of the nine strategies on a three-point scale: "Agree," "Don't know," or "Disagree." Recruitment efforts targeted 12 diabetes support groups on Facebook.

RESULTS

A total of 107 responses were received, all from Norwegian Facebook groups. The most valued behavior intervention function for diabetes apps was enablement, where 85% of the respondents wanted app functions based on this. Second, environmental restructuring received 70.1% votes, followed by incentivization and training, with 68.2% and 67.3%, respectively.

CONCLUSIONS

We identified that the users in this survey preferred more, and other behavior change strategies that were identified were used in a recent review. We conclude that more awareness is needed among app developers of preferences among end users.

Identifying and Managing Fraudulent Respondents in Online Stated Preferences Surveys: A Case Example from Best-Worst Scaling in Health Preferences Research

BACKGROUND

There is limited evidence and guidance in health preferences research to prevent, identify, and manage fraudulent respondents and data fraud, especially for best-worst scaling (BWS) and discrete choice experiments with nonordered attributes. Using an example from a BWS survey in which we experienced data fraud, we aimed to: (1) develop an approach to identify, verify, and categorize fraudulent respondents; (2) assess the impact of fraudulent respondents on data and results; and (3) identify variables associated with fraudulent respondents.

METHODS

An online BWS survey on healthcare services for inflammatory bowel disease (IBD) was administered to Canadian IBD patients. We used a three-step approach to identify, verify, and categorize respondents as likely fraudulent (LF), likely real (LR), and unsure. First, responses to 12 "red flag" variables (variables identified as indicators of fraud) were coded 0 (pass) or 1 (fail) then summed to generate a "fraudulent response score" (FRS; range: 0-12 (most likely fraudulent)) used to categorize respondents. Second, respondents categorized LR or unsure underwent age verification. Third, categorization was updated on the basis of age verification results. BWS data were analyzed using conditional logit and latent class analysis. Subgroup analysis was done by final categorization, FRS, and red flag variables.

RESULTS

Overall, n = 4334 respondents underwent initial categorization resulting in 24% (n = 1019) LF and 76% (n = 3315) needing further review. After review, 75% (n = 3258) were categorized as LF and n = 484 underwent age verification. Respondent categorization was updated on the basis of age verification, with final categorization of 76% (n = 3297) LF, 14% (n = 592) unsure, 10% (n = 442) LR, and < 1% (n = 3) duplicates of LR. BWS item rankings differed most by respondent category. Latent class analysis demonstrated final categorization was significantly associated with class membership; class 1 had characteristics consistent with LR respondents and item ranking order for class 1 closely aligned with LR respondent conditional logit results. Suspicious email was the most frequently failed red flag variable and was associated with fraudulent respondents.

CONCLUSIONS

Additional steps to review data and verify age resulted in better categorization than only FRS or single red flag variables. Email authentication, single use/unique survey links, and built-in identification verification may be most effective for fraud prevention. Guidance is needed on good research practices for most effective and efficient approaches for preventing, identifying, and managing fraudulent data in health preferences research, specifically in studies with nonordered attributes.

Using Social Media to Engage and Enroll Underrepresented Populations: Longitudinal Digital Health Research

BACKGROUND

Emerging digital health research poses roadblocks to the inclusion of historically marginalized populations in research. Exclusion of underresourced communities in digital health research is a result of multiple factors (eg, limited technology access, decreased digital literacy, language barriers, and historical mistrust of research and research institutions). Alternative methods of access and engagement may aid in achieving long-term sustainability of diversified participation in digital health research, ensuring that developed technologies and research outcomes are effective and equitable.

OBJECTIVE

This study aims to (1) characterize socioeconomic and demographic differences in individuals who enrolled and engaged with different remote, digital, and traditional recruitment methods in a digital health pregnancy study and (2) determine whether social media outreach is an efficient way of recruiting and retaining specific underrepresented populations (URPs) in digital health research.

METHODS

The Better Understanding the Metamorphosis of Pregnancy (BUMP) study was used as a case example. This is a prospective, observational, cohort study using digital health technology to increase understanding of pregnancy among 524 women, aged 18-40 years, in the United States. The study used different recruitment strategies: patient portal for genetic testing results, paid/unpaid social media ads, and a community health organization providing care to pregnant women (Moses/Weitzman Health System).

RESULTS

Social media as a recruitment tool to engage URPs in a digital health study was overall effective, with a 23.6% (140/594) enrollment rate of those completing study interest forms across 25 weeks. Community-based partnerships were less successful, however, resulting in 53.3% (57/107) engagement with recruitment material and only 8.8% (5/57) ultimately enrolling in the study. Paid social media ads provided access to and enrollment of a diverse potential participant pool of race- or ethnicity-based URPs in comparison to other digital recruitment channels. Of those that engaged with study materials, paid recruitment had the highest percentage of non-White (non-Hispanic) respondents (85/321, 26.5%), in comparison to unpaid ads (Facebook and Reddit; 37/167, 22.2%). Of the enrolled participants, paid ads also had the highest percentage of non-White (non-Hispanic) participants (14/70, 20%), compared to unpaid ads (8/52, 15.4%) and genetic testing service subscribers (72/384, 18.8%). Recruitment completed via paid ads (Instagram) had the highest study retention rate (52/70, 74.3%) across outreach methods, whereas recruitment via community-based partnerships had the lowest (2/5, 40%). Retention of non-White (non-Hispanic) participants was low across recruitment methods: paid (8/52, 15.4%), unpaid (3/35, 14.3%), and genetic testing service subscribers (50/281, 17.8%).

CONCLUSIONS

Social media recruitment (paid/unpaid) provides access to URPs and facilitates sustained retention similar to other methods, but with varying strengths and weaknesses. URPs showed lower retention rates than their White counterparts across outreach methods. Community-based recruitment showed lower engagement, enrollment, and retention. These findings highlight social media's potential for URP engagement and enrollment, illuminate potential roadblocks of traditional methods, and underscore the need for tailored research to improve URP enrollment and retention.

Methods and lessons from conducting a national study of primary care nurse practitioners

BACKGROUND

Researchers often rely on survey data to assess quality, cost, and outcomes of nurse practitioner (NP) care delivery. Achieving sufficient response rates with traditional survey methods (email, mail, phone calls) has become increasingly challenging. Moreover, survey data collection requires significant financial and labor resources, calling into question the efficiency of current approaches to survey data collection.

PURPOSE

This study aims to describe survey data collection from a national sample of primary care NPs caring for persons living with dementia and discuss the methods and response rate in the context of challenges conducting survey-based research.

METHODOLOGY

This was a cross-sectional survey conducted from November 2021 to October 2023 in 3 waves using a modified Dillman approach. The first wave was sent through physical mailings, and the second wave through email. After low response rates, the sampling frame was updated to include NPs not originally captured in the sampling frame.

RESULTS

The sampling frame included 11,518 NPs. Between 3 data collection waves, 3 survey mailings with 8 postcard reminders and 2 email surveys with 12 email reminders were sent. The response rate was 16.4% (N = 968).

CONCLUSION

Data collection took over 2 years as the approaches were modified due to low response. By the time addresses were obtained and surveys sent, it was likely that many addresses were no longer accurate. Our response rate is consistent with declining survey response rates among other health professions.

IMPLICATIONS

Survey research may require more efficient data collection methods, such as targeted social media advertisements.

Examining the Efficacy of the Telehealth Assessment and Skill-Building Kit (TASK III) Intervention for Stroke Caregivers: Protocol for a Randomized Controlled Clinical Trial

BACKGROUND

Stroke is a leading cause of serious, long-term disability and has a sudden onset. Upon discharge to the home setting, families are thrust into providing care, often without sufficient training from health care providers. Aligned with current patient and caregiver guidelines, the Telehealth Assessment and Skill-Building Kit (TASK III) is a nurse-led intervention designed to empower caregivers to address their own needs and those of the survivor using innovative skill-building strategies.

OBJECTIVE

This study aims to test the short-term (immediately after the intervention at 8 wk) and long-term (12, 24, and 52 wk) efficacy of the TASK III intervention, compared with an information, support, and referral (ISR) group, to improve caregiver life changes (ie, changes in physical health, physical functioning, emotional well-being, and general health) as a result of providing care.

METHODS

A randomized controlled clinical trial design will be used with baseline data collection from 296 family caregivers by telephone after the stroke survivor is discharged home. Caregivers randomly assigned to the ISR group (n=148, 50%) will receive information from the American Heart Association about stroke family caregiving. Caregivers randomly assigned to the TASK III group (n=148, 50%) will receive a TASK III resource guide and information from the American Heart Association. Both groups will receive 8 weekly calls from a nurse, with a booster call a month later. Outcomes will be assessed by blinded data collectors at 8, 12, 24, and 52 weeks. The primary outcome (at 8 wk) is caregiver life changes measured by the Bakas Caregiving Outcomes Scale. Secondary outcomes are depressive symptoms; other symptoms (eg, stress, fatigue, sleep, pain, and shortness of breath); unhealthy days; diet; exercise; and self-reported health care use. Mediators are task difficulty, threat appraisal, and self-efficacy. Program evaluation outcomes (satisfaction and technology ratings) will also be analyzed.

RESULTS

The trial was registered on March 10, 2022. Enrollment and random assignment of the first participant was on November 30, 2022, with an anticipated completion of recruitment by November 30, 2025. Completion of the primary end point data analysis is anticipated by August 31, 2026, with results expected to be reported on ClinicalTrials.gov by April 1, 2027. As of October 9, 2024, a total of 198 (66.9% of the proposed total sample of 296) family caregivers have been enrolled and randomly assigned to the TASK III group (n=98, 49.5%) or the ISR group (n=100, 50.5%). The last update was performed on January 25, 2024.

CONCLUSIONS

If the TASK III intervention is shown to be efficacious in the proposed randomized controlled clinical trial, our next goal will be to translate TASK III into ongoing stroke systems of care, providing a tremendous public health impact.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05304078; https://clinicaltrials.gov/study/NCT05304078.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/67219.

A Comparative Analysis of Recruitment Methods to Reach Emerging Adults Outside the Clinical Setting

BACKGROUND

Emerging adults are a hard-to-recruit population for health researchers, as many do not routinely access healthcare services and are best recruited outside clinical settings. Social media and research volunteer registries (e.g., ResearchMatch) offer great potential among this population, yet a comparison of these two recruitment methods has not been done.

OBJECTIVES

The aim of this study was to compare participant enrollment and completion rates, participant demographics, and recruitment costs between recruitment methods (social media advertisements compared to ResearchMatch) deployed with a sample of emerging adults assigned female at birth.

METHODS

Participants were recruited from October to November 2022 via ResearchMatch and social media (Instagram and Snapchat) advertisements. This analysis involves a subset of recruitment data from a larger institutional review board-approved study. Enrollment and survey completion rates were calculated using the number of individuals contacted and survey completion data from Qualtrics. Chi-square and independent t -test analyses were used to compare demographic data. Advertisement data collected included total cost, cost per click, link clicks, and paid impressions.

RESULTS

Two hundred forty-five emerging adults completed the survey, and 24 completed follow-up interviews. ResearchMatch and social media enrollment rates differed (58% and 39%, respectively). Survey completion rates for both methods were the same (~93%). Participants' ages and levels of education were significantly different. Social media resulted in recruitment of younger participants (18-21 years old), and ResearchMatch garnered participants with a higher level of education. Differences in race were also significant, as social media recruited higher numbers of White participants. Lastly, the researcher-incurred cost per survey was $0 for ResearchMatch versus $13 for social media.

DISCUSSION

Although social media and ResearchMatch are both successful tools for research recruitment, each provides distinct benefits for recruiting specific populations. ResearchMatch offers a lower-cost option and access to an older emerging adult population with higher education, whereas social media provides access to a younger emerging adult population. This knowledge can be imperative for deciding which recruitment methods best fit research study needs. Future research should explore differences in race by recruitment method to highlight potential sampling biases or recruitment opportunities.

The Factors Influencing Feeding Practices of Primary Caregivers of Preschoolers: A Theory-Based Cross-Sectional Study

BACKGROUND/OBJECTIVES

Primary caregivers play a pivotal role in shaping children's dietary behaviors, which are critical in preventing childhood obesity. This study aimed to examine the extent to which demographic characteristics and caregiver factors, including dietary beliefs and intentions to provide a healthy diet, influence feeding practices among primary caregivers of preschool-aged children.

METHODS

This study included a cross-sectional dataset comprising data collected from 146 primary caregivers of preschool-aged children (3-5 years). Participants were recruited using snowball and convenience sampling from Facebook and community settings in Cincinnati, Ohio. Feeding practices were assessed using the Comprehensive Feeding Practices Questionnaire (CFPQ), while caregiver demographic characteristics, dietary beliefs, and intentions were measured through self-administered surveys. Hierarchical multiple linear regression was employed to identify predictors of feeding practices.

RESULTS

The findings reveal that primary caregivers' feeding practices were shaped by multiple factors, including dietary beliefs (behavioral, normative, and control), intentions, and demographic characteristics. Each subscale of feeding practices was predicted by different factors, highlighting the unique influence of these factors on feeding behaviors.

CONCLUSIONS

This study underscores the complex interplay between caregiver cognitive (dietary beliefs and intentions) and demographic factors in shaping feeding practices. The findings highlight the importance of targeting caregiver beliefs and intentions in interventions aimed at promoting healthier feeding practices, contributing to the prevention of childhood obesity. Importantly, future research is needed to explore these factors in more diverse populations and validate cognitive measures for broader application.

Improving recruitment and retention of people with Parkinson's disease to clinical studies: A scoping review

BackgroundTimely recruitment and effective retention of participants are challenging for clinical Parkinson's disease (PD) research studies. Not achieving this can affect delivery costs and bias results.ObjectiveTo identify successful recruitment and retention methodologies for clinical research studies in PD.MethodsWe conducted a systematic scoping review using a Population, Intervention, Comparator, Outcome and Study design (PICOS) framework to search and screen literature within five databases for published quantitative and mixed methods studies evaluating recruitment and retention strategies of interventional and observational trials in PD.ResultsSearches identified 4608 records, of which six papers covering eight studies were included in the review following screening for eligibility. No papers on retention strategies were found that met eligibility criteria. Effective strategies for rapid recruitment included research registries and trial finders (n = 3), digital marketing campaigns (n = 3), site recruitment support (n = 1) and multiple referral sources (n = 1). Recruitment diversity was increased by online campaigns, mandatory 10% minority targets set by funders and supplemental site funding.ConclusionsThis scoping review has identified methods that can be used to increase the rate and diversity of recruitment to PD clinical studies. Retention methodologies are under-researched.

Theoretically Based Factors Affecting Diet Quality of Preschool Children: A Cross-Sectional Study

BACKGROUND/OBJECTIVES

Diet quality during early childhood significantly influences long-term health outcomes, including obesity and chronic disease risks. Parental feeding practices, dietary beliefs, and demographic factors have been shown to impact children's diet quality. This study aimed to determine the extent to which the demographic characteristics and the factors of primary caregivers (dietary beliefs, intention to provide a healthy diet, feeding practices) can explain the variance in the diet quality of preschoolers in the US Methods: This descriptive correlational cross-sectional study was guided by the Theory of Planned Behavior (TPB). A total of 146 primary caregivers of preschool children (aged 3-5) were recruited through convenience and snowball sampling. Data were collected using a self-reported questionnaire and a structured telephone interview. Diet quality was assessed using the Dietary Approaches to Stop Hypertension (DASH) score. Hierarchical multiple regression analyses were conducted to determine the factors associated with preschoolers' diet quality.

RESULTS

The mean DASH score was 40.5 (SD = 10.1), reflecting moderate to low diet quality. The results showed that 16% of the variance in diet quality was significantly explained by race (non-White) and three caregiver feeding practices (food as a reward, restriction food for health, and restriction for weight control). Of these, race (non-White) and restriction food for health were significant predictors and associated with lower diet quality in preschoolers.

CONCLUSIONS

These findings align with previous studies and suggest that the conceptual framework of this study might be further refined and tested in future studies.

Evaluating the representativeness of a cohort study of low back pain: Using electronic health record data to make direct comparisons of study participants with non-participants from the study population

Representativeness is an important component of generalizability. Few studies have rigorously examined the representativeness of randomized trials or observational studies of pain or musculoskeletal conditions with regards to a wide range of factors beyond age, sex, race, and ethnicity. We conducted the first study of a pain condition that uses individual-level data to directly compare the enrolled study sample to the population from which it was drawn. We used electronic health record data from the Veterans Affairs health system to compare participants in an observational study of low back pain (n = 417) with the study population of potentially eligible non-participants who were contacted about the study (n = 15,218). There were no statistically significant differences between participants and non-participants for most factors examined, and differences when present were of small or very small magnitude. Participants were more likely to be older (odds ratio [OR]=1.02 per each additional year of age [95 % CI 1.01-1.03], p < 0.001), women (OR=1.59 [95 % CI 1.26-2.01], p < 0.001), have had a prior diagnosis of lumbosacral radicular syndrome (OR=1.37 [95 % CI 1.08-1.74], p = 0.01), and report lower pain intensity (OR=0.96 per NRS point [95 % CI 0.93-1.00], p = 0.04). Current smokers (OR=0.54 [95 % CI 0.39-0.75], p < 0.001) and people of Asian descent (OR=0.62 [95 % CI 0.39-0.98], p < 0.001) were less likely to participate. This study illustrates an approach to directly compare research participants with non-participants from the study population. This approach can be considered as a standard method to examine the representativeness of study samples in pain research. PERSPECTIVE: This article illustrates how electronic health record data can be used to directly compare the representativeness of participants in a study of pain to the study population from which participants were selected. This approach should be considered as a standard method to examine the representativeness of study samples during reporting.

"Infantgram?" recruitment of infants to a clinical sleep study via social media

Study Objectives

This study aimed to outline the strategy and outcomes of a study team in recruiting participants for an infant sleep study via social media during the COVID-19 pandemic, to assess the feasibility of recruitment via social media, and to quantitatively and qualitatively explore parental satisfaction and perceptions of recruitment via social media.

Methods

The assessing sleep in infants with early-onset atopic dermatitis by longitudinal evaluation (SPINDLE) study recruited infants with and without atopic dermatitis for a longitudinal study assessing sleep. Infants were recruited via social media and their parents were interviewed to explore their experience of recruitment via social media.

Results

In total, 57 controls and 33 cases were recruited. Of the 45 controls recruited via social media, 43 (95.6%) were recruited via Instagram and 2 (4.4%) were recruited via Twitter. Of the seven cases recruited via social media, 6 (85.7%) were recruited via Facebook (via sharing of Instagram posts by third parties on Facebook) and 1 (14.3%) was recruited via Instagram. All (100%, n = 28) mothers recruited via social media who completed the full study were satisfied with this approach to recruitment. Specific reasons why mothers reported engaging following exposure to the social media posts included the benefit of additional health checks for their baby, the benefit to scientific advancement, and the opportunity for a stimulating outing following the COVID-19 lockdowns.

Conclusions

Our experience highlights parents' acceptance of recruitment via social media, the optimization of time and financial resources, and the benefit of using internet-based recruitment during a pandemic.

Low-Cost Recruitment Approach: Utilizing Facebook Groups to Recruit COVID-19 Long-Haulers

Introduction

The accessibility of social media (e.g., Facebook groups) presents long-haulers with the ability to connect with others with similar experiences and symptomology that are likely outside of their physical social networks. Social media sites may serve as promising platforms for research recruitment, public health campaigns, or interventions. The present study aims to assess, and comprehensively present, the effectiveness of a low-cost approach to recruitment through groups on Facebook within the context of a broader study of COVID-19 long-haulers.

Methods

Facebook groups were searched using a variety of COVID-related terminology and included if they were in English, COVID-19 specific, public, and have or were approaching 1,000 or more members. Group administrators were either contacted for permission to post recruitment materials or posts were made and left pending administrator approval, depending on group settings. Group members were able to follow a link to the online survey platform (i.e., RedCap) where they provided informed consent and completed an online assessment of their COVID-19 experiences and psychosocial wellbeing. Upon survey completion participants were able to opt-in to a raffle-based incentive. The characteristics of the Facebook groups and demographic background of participants were assessed.

Findings

Contacting administrators and posts made between January and March of 2022 within 17 COVID-19 specific groups yielded a sample size of 460 long-haulers. The groups relied upon for recruitment had a mean size of 21,022 (SD=45,645.3), most had three or more administrators (43%), and a majority were state specific (60%). The long-hauler participants enrolled from the posts had an average age of 32 years (SD=6.19), approximately split between men (48.91%) and women (50.22%), a majority white (70%), having earned a bachelor's or postgraduate degree (63.48%), and reporting an annual income between $50,000 and $100,000 (56.09%).

Discussion

The present study presents strengths and recommendations for survey recruitment through Facebook groups as a low-cost recruitment strategy that is easily targeted to populations with a specific health condition and allows users to complete online psycho-behavioral assessments off-site on a HIPPA compliant survey platform.

Exploring exercise adherence and quality of life among veteran, novice, and dropout trainees

Introduction

The purpose of this study was to identify and reveal the different contexts, variables, and factors that may influence adherence to physical activity among veteran, novice, and dropout trainees, such as the frequency of the weekly training units, the trainees preferred type of exercise, the purpose of the physical activity, and the relationship between support and supervision by fitness instructors and professionals. This study also examined the relationships between trainees, seniority and the strength of the habit and adherence to physical activity, the effects of personal variables such as age and gender on adherence to physical activity, and how the seniority and adherence of trainees may affect their quality of life.

Methods

A total of 460 participants drawn from the broader Israeli exercise community, which encompasses a diverse range of individuals within the general adult population, were engaged in this study. These participants included seasoned exercisers, individuals who had recently initiated exercise routines, and those who had previously engaged in physical activity. Each participant completed a comprehensive set of questionnaires, including the Self-Report Habit Index, the Exercise Adherence Rating Scale, and the World Health Organization (WHO) Quality of Life Scale. In addition to the questionnaire responses, demographic data and inquiries concerning their physical activity were also collected.

Results

The results show that the average frequency of the weekly training units of veteran trainees was significantly higher than that of novice trainees: 3.95 and 2.93, respectively (p < 0.0001). We found no significant differences between novice and veteran trainees regarding their training goal preferences (p = 0.07). Veteran trainees who had been in training for more than a year appeared to have higher self-efficacy since 31.16% reported receiving no supervision compared to 16.67% among novice trainees. In addition, people over 45 appear to have more health-related goals compared to their younger counterparts (p < 0.001). The quality of life scores of the trainees was related to their seniority in physical training, but only by a small magnitude (R2 = 0.06), p < .001). Those who trained in resistance training showed the greatest rate of adherence in relation to flexibility and aerobic training (p < 0.001), and women preferred more body toning and had more weight loss goals than men (p < 0.001).

Discussion

The results indicate that there are central and important factors that may affect adherence to physical activity, and that all these aspects must be taken into account when planning a training program or when there is a desire to maintain or increase adherence to physical activity. The research findings indicate that the main factors that can influence adherence to physical activity are identifying and increasing the trainee's self-efficacy, maintaining weekly training units with sufficient frequency to form a habit and incorporating resistance training into the training regime, as resistance training has shown high levels of adherence. Moreover, it seems that people with different degrees of experience in physical training have distinct and varied training goals, and there is no one goal that fits all. In addition, specific factors such as age and gender must also be taken into account, because the age and gender of the trainees may significantly affect the goals of physical training.