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Caring Rehabilitation Climate, the Tripartite Efficacy Framework, and Adherence to Rehabilitation Programs Among Individuals With Parkinson's Disease: A Multiple Mediation Analysis

Background and Purpose: Adherence to physical therapy (PT) and secondary prevention programs (SPPs) is particularly low for individuals with Parkinson's disease. Preliminary research has linked perceptions of caring climates as well as enhanced tripartite efficacy perceptions to adherence during rehabilitation programs. In light of such preliminary research, the purpose of this study was threefold: (1) to examine relationships between perceptions of a caring climate and the 3 efficacy constructs within the tripartite model, (2) to examine the relationship between the tripartite efficacy constructs and adherence to PT/SPP exercises, and (3) to determine whether tripartite efficacy beliefs mediated the relationship between caring climate perceptions and adherence. Method: A total of 77 individuals with Parkinson's disease who were currently or recently enrolled in PT or an SPP were recruited and surveyed about their perceptions of the caring climate of their rehabilitation clinic, their tripartite efficacy perceptions, and their adherence to rehabilitation. Correlations and a multiple mediation analysis were conducted to address the purposes of this study. Results and Discussion: Results showed significant positive associations between all variables; however, all paths within the proposed mediation model were not significant. Specifically, the c paths linking the tripartite efficacy constructs with adherence were not significant. A follow-up analysis was undertaken to address potential suppression effects within the mediating variables, and this analysis revealed a statistically significant model with relation-inferred self-efficacy (RISE) as a sole mediator of the relationship between caring perceptions and adherence to rehabilitation. Conclusions: Several practical implications can be gleaned from the current study. First, practitioners should strive to enhance the caring climate of their clinic by employing techniques reported in previous literature, such as creating a supportive atmosphere, displaying benevolence, and paying attention. In addition, the results suggest that individuals' RISE perceptions, in particular, could be a viable target for enhancing adherence.