Date of Award

Spring 2018

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research

Committee Director

Robert J. Cramer

Committee Member

Matthew C. Hoch

Committee Member

Ryan S. McCann


Lower extremity injuries are common among the physically active population. There are many negative consequences associated with these injuries which have led to a shift in clinical practice towards prevention. Exercise-related injury prevention programs (ERIPPs) were created to prevent musculoskeletal injuries that occur due to participation in physical activity. However, one of the major limitations to their effectiveness is the compliance of the users to complete the prescribed exercises. It is imperative to better understand the reasons why compliance is low to develop implementation strategies and improve compliance rates.

The overarching purpose of this dissertation was to gain a better understanding of why compliance with ERIPPs is low and to develop an intervention to improve attitudes towards ERIPPs. The first purpose of this dissertation was to perform a systematic review to identify the social or behavioral theoretical models or frameworks being used within ERIPP research and identify the level of theory implementation in study design (Project IA). The second purpose was to review the literature to determine how the Health Belief Model (HBM) and Theory of Planned Behavior (TPB) could be applied to ERIPP research (Project IB). The third purpose was to develop scales based on the HBM and TPB to assess behavioral determinants of ERIPP participation and pilot those scales (Project II). The fourth purpose was to confirm the psychometric properties of the HBM and TPB scales (Project III). The fifth purpose was to evaluate the effectiveness of an intervention based on the HBM to change attitudes towards ERIPP participation and functional performance (Project IV).

The systematic review (Project IA) determined that the HBM and TPB were the most commonly utilized theoretical models in ERIPP research. Project II determined the subscales of the HBM and TPB scales had mostly acceptable internal consistencies, but select subscales required further evaluation. Project III confirmed the psychometric properties of the HBM and TPB scales with all of the subscales having acceptable internal consistency. Project IV provided evidence that an intervention based on the HBM could improve individual and community led self-efficacy as well as lead to improvements in functional performance.