A Social Cognitive Approach to Understanding How the Marital Context Influences Physical Activity

Michel, K.L., Goodson, P., Pruitt, B.E. / Californian Journal of Health Promotion 2013, Volume 11, Issue 2, 73-85

Mr. & Mrs.: A Social Cognitive Approach to Understanding How the Marital Context Influences Physical Activity

Kacy L. Michel, Patricia Goodson, and B.E. Pruitt

Texas A&M University

Abstract Recent literature has demonstrated the power of marriage in influencing spousal physical activity behavior, yet the relationship between marriage and activity is not fully understood. The purpose of this qualitative study was to add to current literature by examining the mechanisms within the marital context that may influence physical activity. Employing constructs of Social Cognitive Theory to guide the inquiry, researchers used the qualitative techniques of in-depth interviews, photo elicitation and field notes to gather data in 2012 from twelve spousal pairs (n=24 participants). Results indicated verbal persuasion by husbands encouraged wives, yet verbal persuasion by wives was perceived as nagging by men. Verbal persuasion by husbands increased a few of wives’ sense of self-efficacy (25%), yet the majority of women (83%) felt that persuasion increased motivation, not necessarily confidence. Results also highlighted the power of modeling to increase husbands’ physical activity. Overwhelmingly, men reacted less positively to verbal persuasion than modeling (75%). This study demonstrated the utility of Social Cognitive Theory in advancing our understanding of spousal physical activity and underscored the need for health professionals to consider the marital dyad when designing health interventions.

Introduction extends to health behavior. Research has indicated a clear spousal influence on health, After saying “I do,” married individuals yet an ambiguous influence on physical begin tangibly and intangibly fusing their activity, specifically. In a study with newly lives together. This merging, along with the married couples, Craig (1990) found that close nature of the relationship, inevitably marriage coincided with decreasing exercise influences each spouse in a multitude of levels for both spouses. Yet, according to ways. Yet, spousal influence is often subtle the CDC (2004), married adults were more and varied. Is it what someone said (verbal likely to be physically active than persuasion) or what someone saw unmarrieds. Turner and Marino (1994) (modeling) or something else (e.g. concluded social support within marriage environmental factors) that influenced raised physical activity levels. behavior? Statement of Purpose A survey conducted by the Centers for Due to such varying reports, the influential Disease Control and Prevention [CDC] relationship between marriage and physical (2004) demonstrated a clear and striking activity is currently unclear. Why does association between marital status and physical activity increase in some marriages health. Falba and Sindelar (2008) and decrease in others? What are the investigated the power of marriage partners mechanisms influencing physical activity in and concluded the influence of marriage a marital context? Thus, the overarching

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purpose of this study was to answer the vicarious modeling. Thus, a spouse’s central question: How does the marital sustained persuasion could possibly alter the context influence physical activity in other person’s self-efficacy. However, if a spouses? husband continually persuaded his wife to exercise, might she view this as an indirect Since the previous research has been mixed, slight? Similarly, would a man tire of his we employed qualitative research methods wife’s cajoling to be more active? To to answer our central research question. answer these questions, the first objective of Specifically, we conducted individual this study was to: gain a better interviews and utilized photo-elicitation. understanding of how verbal persuasion Our desire was to elicit creative and visual influences physical activity self-efficacy in responses to our research questions by married individuals. asking participants to not only supply verbal responses to interview questions but also Along with persuasion, Bandura predicted visual data. Qualitative data gathered via the modeling of one spouse as influential in photo-elicitation and interviews is often altering the thoughts and actions of the other used to lay the groundwork for future (1989). If a man observed his wife quantitative studies. beginning to exercise consistently and simultaneously exhibiting a more energetic Theoretical Framwork disposition, he may begin to think he could Bandura’s Social Cognitive Theory (SCT) also exercise and enjoy similar outcomes. (1989) provided a theoretical lens through Therefore, our second objective was to: which the relationship between marriage and explore if/how modeling impacts spousal physical activity could be better understood. self-efficacy regarding physical activity. SCT was built under the assumption that people do not live as isolated individuals. While our research objectives and initial Bandura created the concept of reciprocal theoretical framework remained unchanged determinism by asserting a person’s throughout the course of this study, we did behavior both influences and is influenced leave room for other explanations. For by personal factors and the social instance, if participant data revealed a environment (Bandura, 1986). Bandura differing theoretical explanation, we were (1989) represented this “cognitive open to exploring alternate ways of “dialogue” as a triad in which the understanding the relationship between environment, behavior, and personal factors marriage and activity. To this end, our third all impact human behavior. objective was to investigate what other factors may influence physical activity for Self-Efficacy. The goal of this study was to married couples. better understand spousal influence on a specific behavior: physical activity. Along Methods with the personal factors and the social environment, Bandura (1986) stated Study Design behavior was largely dictated by self- To answer these objectives, we employed a efficacy or the belief in one’s confidence to basic qualitative research design by using perform a given behavior. SCT predicts individual interviews and photo-elicitation. spousal impact on his or her partner’s self- After receiving approval from the Texas efficacy in two ways: verbal persuasion and A&M University Institutional Review

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Board, we distributed flyers in College (United States Census, 2010). We came very Station, Texas to recruit participants. We close to maintaining these ratios in our then assigned participant pseudonyms in our sample with the exception of Asian interview transcripts to ensure Americans. 53% of our sample identified as confidentiality. Caucasian with Hispanic and African- American individuals comprising 33% and Participants 8% respectively. An example of our For participant selection, we utilized sampling frame can be found in Appendix snowball (or network) purposive sampling. A. One individual identified as Native The purpose of this sampling was to first American, and he represented 4% of the identify key informants who met criteria. total sample size. While no participants We then asked those participants for names identified as Asian American, we did of individuals who shared the phenomena of interview one Native American individual. interest (Merriam, 2009). Overall, 58 potential participants were contacted, and 24 Exclusion Criteria individuals consented and thus represented Couples were excluded from the study if our final sample. they were not married or had been previously married. While the influence of Inclusion Criteria cohabitating couples on physical activity We based selection criteria on the theoretical habits may be significant, empirical data framework and literature review. The first from a 2004 CDC survey revealed married criterion was marriage; specifically, and cohabiting couples do not share similar individuals who were both in their first health outcomes. Thus, we included only marriage. Second, we chose both partners married individuals. We also excluded for this sample due to the gender differences individuals in homosexual, bisexual or regarding how men and women perceive transgender partnerships. While there is verbal persuasion and modeling. If both certainly a need for more studies focused on spouses were not available for interview, the the various domestic partnerships, this study couple was excluded from our study. narrowed the focus to only heterosexual Findings from Fernandez-Ballesteros, Diez- couples. NA, Caprara, Barbaranelli, and Bandura (2002) indicated there is most likely a Measures gender and age difference regarding First introduced in 1967, Collier explained efficacious beliefs. Third, the sample photo elicitation as the process of asking included couples representing different participants to take photos of a phenomenon stages within marriage: early marriage prior to an interview, and then describe why (married 0-5 years), mid-marriage (married they chose to take certain photos. Clark- 6-20 years), and late marriage (married 21 or Ibanez (2004) stated photo elicitation more years). uniquely describes and communicates lived experiences. In order for the sample to be similar in racial makeup to the state of Texas, U. S. Census According to Erlandson et al. (1993), data guided the purposive sampling. qualitative researchers should use According to the 2010 Census, 70.4% of trustworthy documents to ensure the rigor, Texans were white, 37% Hispanic, 11.8% dependability and transferability of research Black or African American, and 3.8% Asian findings. We used several trustworthy

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documents and techniques. First, we both the photo itself and participant gathered data from three sources (notes, comments regarding each picture. Next, we interviews, and photos) for the purpose of placed the pieces of coded data from both triangulation. To ensure the credibility of the interviews and photos into potential findings, we created a peer-debriefing memo categories and subcategories. After that, the with a list of participant demographic analysis from the first interview guided the variables and potential categories. A full coding for the subsequent transcripts. We professor at Texas A&M University then conducted a round of axial coding to refine reviewed these categories to ensure validity categories. Axial coding is the process of of the data. Additionally, we organized relating categories to their subcategories by interview data into an audit trail to trace the identifying a central characteristic/ theme/ original data back to the extrapolated phenomenon (the axis) around which to categories so that the data would be aggregate data (Merriam, 2009). This type dependable. of coding was more reflective and conceptual than merely descriptive open Procedures coding (Lincoln & Guba, 1985). Axial Prior to the interview, we contacted coding helped create abstractions from the participants and asked each person to take data to ensure categories were interpretive two or three pictures representing how his or and reflexive. her marriage influences physical activity. All photographs were taken with the Results participants’ own digital cameras. Participants then emailed their photographs Overall, we coded forty-five photographs to the lead author. All photos were printed and seventy-eight pages of interview prior to the interviews. transcripts. The study sample consisted of twelve couples. To maintain confidentiality, Next, we conducted hour-long interviews in all participants’ names were changed, and participants’ homes. In order to reduce bias we used initials to identify participants in in responses, couples were interviewed text. The average length of marriage in the separately. To begin each interview, sample was 15.48 years, and the average age participants described the pictures they of participant was 40.6. Three couples had chose to take. We also collected data using no children, four had children under the age observational notes and photo elicitation. All of five, one couple had children ages 6-17, data was gathered in 2012. and four had children over the age of 17. Five couples were married five years or less, Analyses three couples were married 6-20 years, and After transcribing the interviews verbatim, four couples were married 21 or more years. we employed the constant comparative While number of children and years married method to guide our analysis (Glaser & were the same for each couple, ethnicity and Strauss, 1967). Specifically, we focused on education level varied within each dyad. comparing husbands’ and wives’ responses Thus, the individual data for ethnicity and in order to analyze the gender differences in education follows below. our sample. First, we reviewed each interview and photograph keeping in mind Regarding education, 25% held high school our research objectives. We then open coded diplomas, 37.5% had completed data for themes. For photographs, we coded undergraduate college degrees, and 37.5%

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had finished graduate programs. The confidence to be consistently active?” a relatively high number of those holding number of spouses claimed little influence. graduate degrees reflected the fact that the NA insisted, “There is little my wife could research was conducted in a community do to raise or lower my confidence to with a large research institution. exercise. I have always been active.” Thus, spousal modeling seemed to alter In keeping with the Social Cognitive motivation, more than confidence. framework and the idea of reciprocal determinism, the results of the first two “You Are Going to Feel Better” objectives corresponded to the behavioral Not only what spouses observed, but also component of the SCT reciprocal triad, what spouses heard impacted activity. The while additional results for the latter use of verbal persuasion by husbands objective corresponded to the other two emerged as the second most cited theme. points of the triangle, environmental and Ten of twelve wives said their spouses personal (e.g. social/cognitive) factors (see encouraged them to be active for emotional Appendix B). Additionally, the themes and psychological benefits. AR asserted, gleaned from participant data are presented “ER will suggest I go work out to take a in vivo or “in their own words.” We break from work.” However, not all wives organized themes according to the original perceived persuasion from husbands as study objectives (see Table 1). positive. RL said, “It is motivating when ML says I have more energy when I “When I See Her Exercising, I Take That exercise. But sometimes… (pause)… he will as a Sign to Get Off the Couch” tell me I need to work out to get a little more Seven spousal pairs and two other husbands toned (points to thigh) that does not always (n=16) commented on modeling, making it go over very well (rolls eyes).” RL said she the most cited theme (see Table 1). Spousal gets angry when her husband uses extrinsic pairs reported the mutually beneficial effect motivation (referencing her physique), and of modeling. WB expressed, “When I see his comments actually discourage her to be CB getting ready to go work out, I take that active. CB affirmed RL’s remarks, “If WB as a sign that it is time to go the gym.” CB told me I had to be active that would hurt indicated modeling as a motivating factor my feelings… (pause)... I would wonder if for her as well, “WB is always working out, he was saying I looked out of shape.” These so I see that, and want to keep up with him.” women perceived intrinsic motivation (i.e. MG and JG also referred to modeling. MG increased energy/ happiness) as stated, “My wife rides her bike all the time encouragement, and extrinsic motivation (a and when I see her, I usually want to go more toned appearance) as discouragement. too.” As one spouse observed the other exercise (or prepare to exercise), he or she In addition to an increase in motivation from was often motivated to engage in activity. husbands’ verbal persuasion, three wives [insert table] cited an increase in confidence or self- efficacy. OJ said her husband “definitely While modeling greatly influenced increased her confidence to be active” motivation and behavior, only a few because of his encouraging words. While participants indicated a change in only three wives reported an increase in self- confidence (i.e. self-efficacy). When asked efficacy, the majority of wives commented “How might your spouse influence your on an increase in motivation.

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While husbands tended to use the promise of environmental influence of media usage emotional and/or physical benefits to such as internet surfing (n=1) and television motivate wives to exercise, wives (n=6) viewing (n=2), participants most frequently often encouraged exercise in order to gain cited work (n=21) and children (n=15). quality time together. OJ said, “I like Those with children under 5 were especially walking, but I really like being with DJ.” likely to cite children as a distraction, while nearly all participants regardless of life- Husbands mentioned their wives used verbal stage cited work as a barrier. persuasion to increase quality time together, not necessarily to increase husbands’ “My Job Consumes Me” confidence to be physically active. In fact, Twenty-one individuals worked outside the when asked “what things might your wife do home, and 100% of those participants cited or say to influence your confidence to be work as a barrier to physical activity. Also, physically active,” several husbands said husbands and wives equally referenced work “very little” or “not much.” schedules and active jobs as barriers. RL used a photograph to tell the story of her Interestingly, participants said certain forms work demands. She explained: “I would like of verbal persuasion lowered spousal to exercise more, but I am exhausted from physical activity. Forceful, continuous work. I put my dress shoes in the middle and “encouragement” was often viewed as my tennis shoes to the side to represent my nagging by a participant’s spouse (especially priorities.” Her husband, ML, echoed her, by men). Half of the husbands spoke to this “…with my work schedule, I am too type of persuasion. JN said, “If she kept exhausted to exercise.” NA took a picture of asking and asking me about it, I probably a road sign to represent his lengthy would not like it.” JL said, “She can suggest commute. He added, “It is tough to be active I work out, but she sometimes crosses a line with having such a crazy schedule.” into nagging.” None of the wives reported this sense of nagging. Work hindered couples from being active individually and jointly; both husbands and Spouses also lowered partner physical wives in five spousal pairs mentioned the activity by discouraging overexertion. Every challenge of managing joint physical spouse in their forties, fifties, and sixties activity while working full time. SO stated, reported instances in which one partner “We use to be more active together but the discouraged activity due to injury or an biggest reason we quit was work existing health condition. DC told his wife commitments.” GO said, “SO’s work and MC to “slow down a little if [her] arthritis is mine have opposite schedules so we just can flaring up.” Similarly, JG often urged her not work out together.” husband to not exercise too much because of his existing health condition. This type of “My Child is My Activity” protective behavior was similar for both Children presented another environmental husbands and wives. influence on marital physical activity, especially for younger participants. “So Many Distractions” However, unlike the overwhelmingly The next theme captured the environmental negative impact of work, participants factors that enabled and/or hindered physical viewed having children as both positively activity. While a few spouses mentioned the and negatively impacting physical activity.

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Every mother (n=9) and a few fathers (n=3) MG’s photo depicted him and his wife at an mentioned an increase in activity area park and stated, “One of the things we immediately following the birth of their do together is walk. Many times that leads to children. BN said, “When my kids were deeper conversation.” little I was always chasing them.” Spouses Returning to SCT and the idea of reciprocal who reported low to moderate physical determinism, the comments of these activity before having children were participants demonstrated the mutual especially likely to perceive an increase in influence of personal cognitive factors (e.g. activity after kids (n=3). MA took a picture the desire for deeper conversation) on of her four year old and emphatically stated behavior. “He is my physical activity. I am much more active after having my son.” “It is More for Her” While quality time was a major social While frequency of activity increased, four motivator for spouses, eight participants wives and three husbands also noted a related husbands were often engaged in decline in intensity. This was particularly activity for their wives’ sake (not necessarily true for participants who claimed to have because they themselves enjoyed or been moderate to highly active before benefited from an activity). ML said, “When having children. BN lamented, “I still feel we exercise together, it is more for her than active, but I wish I could run as much as I me. I like to lift weights; she likes to do did.” Many of these participants had more low impact things. I love her, so I go children who were teenagers or young with her.” SM lamented, “CM will play adults. This decline may be due to aging tennis with me, but then will often run three more than the influence of children. miles afterwards. That bugs me.” CM said, “I usually need to do higher level activity.” “We Feed Off Each Other” Interestingly, no wives commented that they The final theme centered on cognitive and engage in this type of “sacrificial” exercise. social factors. How spouses related with one Also, the idea of sacrificial exercise was not another on an interpersonal level directly limited to a particular life-stage. Instead, the impacted the way participants thought about concept was shared by spouses of various activity and vice versa. The theme “It is a ages. head game” was broken down into two subthemes: “We enjoy the quality time” and Discussion “It is more for her.” The first two objectives of this study “We Enjoy the Quality Time” examined if and how verbal persuasion and Four husbands and seven wives indicated vicarious modeling influenced married the emotional benefit of being active individual’s self-efficacy to be physically together. CB said, “We work out together so active. The themes “You are going to feel we can have time together.” AR captured better” and “When I see her exercising, I this idea in a photo she took of her and her take that as a sign to get off the couch” husbands’ hands. She said, “The hands captured these thoughts. We divided the first represent being together. I enjoy walking part of our discussion into the following because I really like talking to ER.” subheadings: Verbal Persuasion, Motivation, Verbal Discouragement, and Modeling. Our third objective, to investigate how the other

79 Michel, K.L., Goodson, P., Pruitt, B.E. / Californian Journal of Health Promotion 2013, Volume 11, Issue 2, 73-85 two parts of the SCT triad (environmental Theory. Within the SCT framework, self- and social/cognitive factors) influenced efficacy and motivation are one in the same. behavior, was contained within the themes However, this sample differentiated between “So many distractions” and “It is a head these two concepts. game.” We explored these findings under the heading: Environmental Factors. In our sample, verbal persuasion impacted motivation that then altered behavior. Such a Verbal Persuasion departure from Bandura’s original theory no Regarding our first objective, verbal doubt signals a need for more research in persuasion (especially intrinsic motivation) this area. encouraged wives. While a few husbands alluded to external motivation such as an Motivation improved appearance, most husbands Ryan and Deci (2000) developed Self- encouraged their wives by referring to a Determination Theory by emphasizing the better emotional state. Wives perceived this power of motivation to alter behavior by type of persuasion as positive, and many influencing a person’s interest, excitement reported an increase in motivation. or confidence (i.e. self-efficacy). While self- Additionally, a small number of wives stated efficacy was defined as increased an increase in self-confidence from their confidence to perform an action in both SCT husbands’ use of persuasion. On the other and Self-Determination Theory, Ryan and hand, husbands perceived excessive verbal Deci’s theory referred to self-efficacy as one persuasion by wives as nagging and factor among many which may be influence counterproductive. A few husbands reported by motivation. Similar to Self- a slight increase in motivation if their wives Determination Theory, our findings used a small amount of persuasion; yet none concerning verbal persuasion pointed to an said persuasion alone increased confidence. increase in motivation (especially for Raglin (2001) reported similar findings after women), which then influenced self- interviewing thirty married individuals efficacy. Thus, motivation appeared to be enrolled in an exercise program. Men in that the mediator between what spouses said and study responded negatively to verbal consequent behavior change, not self- persuasion by wives because they felt it was efficacy. Again, this variation on how SCT nagging and disrespectful. These findings is theorized to operate represents a potential depart from Umberson (1992). Umberson direction for future research. found husbands perceived verbal persuasion by wives as protective and nurturing. Verbal Discouragement Interestingly, many older individuals in this Taken together, it appears that verbal study utilized verbal persuasion to persuasion in this sample increased discourage spouses from overexertion. motivation for wives and husbands (to a Couples instead encouraged age-appropriate lesser degree), yet had less impact on exercise. Beverly and Wray (2010) found confidence (i.e. self-efficacy). A few wives couples living with diabetes felt a collective reported increased confidence, but no responsibility to encourage one another to husbands felt that persuasion increased their engage in appropriate activity. Our findings, ability to be active. These results indicated a in conjunction with Beverly and Wray’s, departure from how verbal persuasion is suggest couples possess a responsibility for meant to operate within Social Cognitive

80 Michel, K.L., Goodson, P., Pruitt, B.E. / Californian Journal of Health Promotion 2013, Volume 11, Issue 2, 73-85 one another and this responsibility extends Lastly, participants noted the desire for to physical activity. quality time together as a strong social factor. While this is fairly intuitive, the Modeling existence of sacrificial exercise was The second objective, concerning the role of unexpected. At first glance, this appears modeling, was cited by three-fourths of positive, yet wives felt inadequate and study participants. Men, especially, reported frustrated that their husbands were the positive impact of modeling. Unlike participating in exercise yet were not really verbal persuasion which men often enjoying the activity for themselves. To the perceived as nagging or critical, nine of best of our knowledge, no study to date has twelve men said modeling spurred exercise focused on the concept of sacrificial or intention to exercise. While less exercise. More research is needed to influential for women, modeling motivated adequately investigate the long-term impact half of sampled wives to at least consider of this type of exercise. being active with their husbands (if not join them). These findings support Beverly and Implications for Practice Wray (2010). Husbands and wives from that Although generalizability in the statistical study indicated modeling as a strong sense is not possible in qualitative literature motivator for physical activity. Observing (Lincoln & Guba, 1985), our findings each other continue an exercise regime suggest the power of marriage to impact the motivated spouses to adhere. physical activity habits of both individuals. Thus, health professionals may need to Bandura (1986) theorized vicarious create programs specifically tailored to modeling alters behavior due to a model married couples. Incorporating both spouses being rewarded or punished. However, in a single intervention may yield greater spouses in this study mimicked one other’s results than engaging only one part of the actions due to close proximity and the desire marital dyad. Practitioners might also utilize for quality time, not only because one verbal persuasion and modeling. For spouse was rewarded or punished. Thus, instance, if women respond better to participants responded to modeling, not internally motivated persuasion (i.e. necessarily vicarious modeling. increased energy, lower stress), a health educator may emphasize to husbands the Environmental Factors need to use internal motivation instead of The last objective, to investigate other referencing external appearance. physical activity determinants, highlighted Additionally, health professionals may the idea of reciprocal determinism, or the encourage wives to employ modeling in notion that personal and environmental place of verbal persuasion in an effort to factors also dictate behavior (Bandura, positively influence husbands. 1986). Participants reported work as a unilateral negative influence, whereas Limitations children tended to increase frequency of One limitation of this study was the activity yet decrease exercise intensity. inclusion of only married, heterosexual These findings may give clues as to why unions. By excluding cohabitating and literature is unclear concerning whether homosexual couples, we failed to sample marriage increases or decreases physical individuals involved in every type of activity. intimate relationship. Additionally, our

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research was conducted in Texas. Due to exercise/physical activity. This sample regional and cultural differences, these reported limited verbal persuasion, research results are not generalizable to modeling, and having children (especially other areas. for younger couples) as positive determinants to behavior, while work Conclusion demands, nagging, and exercising for the While these limitations are noted, this study sake of the other partner as negative does make important contributions to the determinants. These results support the field of marital physical activity behavior. notion that marital influence is not Marriage is a complex, highly influential unidirectional, but rather a synergistic, relationship and this influence extends to reflexive dyad.

References Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall. Bandura, A. (1989). Human agency in social cognitive theory. American Psychologist, 44(2), 1175-1184. Bandura, A. (2000). Exercise of human agency through collective efficacy. Current Directions in Psychological Science, 9, 75-78. Beverly, E., & Wray, L. (2010). The role of collective efficacy in exercise adherence: A qualitative study of spousal support and Type 2 diabetes management. Health Education Research, 25(2), 211-223. Centers for Disease Control and Prevention (2004). Marital status and health: U.S. 1999- 2002. Retrieved from http://www.cdc.gov/nchs/data/ad/ad351.pdf. Clark-Ibanez, M. (2004). Framing the social world with photo-elicitation interviews. American Behavioral Scientist, 47, 1507-1527. Collier, J., Jr. (1967). Visual anthropology: Photography as a research method. Newbury Park, CA: Sage. Craig, L. (1990). Dynamics of food habits of newly married couples: Weight and exercise patterns. Australian Journal of Nutrition and Dietetics, 12, 42-46. Erlandson, D. A., Harris, E. L., Skipper, B. L., & Allen, S. D. (1993). Doing naturalistic inquiry. Thousand Oaks, CA: Sage. Falba, T., & Sindelar, J. (2008). Spousal concordance in health behavior change. Health Research and Educational Trust, 43(1), 96-115. Fernandez-Ballesteros, R., Diez-NA, J., Caprara, G. V., Barbaranelli, C., & Bandura, A. (2002). Determinants and structural relation of personal efficacy to collective efficacy. Applies Psychology, 51(1), 107-125. Glaser, B. G., & Strauss, A. (1967). The discovery of grounded theory. Chicago, IL: Aldine. Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Newbury Park, CA: Sage. Merriam, S. B. (2009). Qualitative research: A guide to design and implementation. San Francisco, CA: Josey-Bass. Raglin, J. S. (2001). Factors in exercise adherence: Influence of spouse participation. Quest (00336297), 53(3), 356-361. Ryan, R., & Deci, E. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68-78. Turner, R., & Marino, F. (1994). Social support and social structure: A descriptive epidemiology.

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Journal of Health and Social Behavior, 35(3), 193-212. Umberson, D. (1992). Gender, marital status and the social control of health behavior. Social Science Medicine, 34(8), 907-917. United States Census (2010). 2010 Census Demographic Profiles. Retrieved from http://2010.census.gov/2010census/data/. Wang, C., & Burris, M. (1994). Empowerment through photo novella: Portraits of participation. Health Education & Behavior, 21, 171-186.

Author Information *Kacy L. Michel, PhD Texas A&M University Department of Health and Kinesiology College Station, Texas 77843-4243 Email: [email protected] Telephone: 214-608-8299

Patricia Goodson, PhD Texas A&M University Department of Health and Kinesiology

B.E. Pruitt, EdD Texas A&M University Department of Health and Kinesiology

* corresponding author

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Appendix A Sampling Frame Matrix- Racial Distribution by Marriage and Children YEARS NO CHILDREN CHILDREN CHILDREN 6-17 CHILDREN MARRIED UNDER 5 OVER 17 0-5 yrs B, B, H, H, H, C H, H, H, H 6-20 yrs C, C, C, C C, C 21 + C, C, C, C, C, C, O, H Key: B- Black/ African-American, C- Caucasian, H- Hispanic, O-Other (Native American)

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Appendix B

Study Results as Related to Reciprocal Determinism & Reciprocal Triad

Environment Factors (Work, Children)

Bandura's Reciprocal Triad

Social & Behavior Cognitive Factors Factors (Persuasion, (Quality Time, Modeling) Sacrificial Exercise)