Theoretical framework and protocol for the evaluation of Strong Through Every Mile (STEM), a structured running program for survivors of intimate partner violence

Self-determination theory (SDT) explains human motivation and personality. SDT postulates that three key psychological needs (competence, relatedness, and autonomy) foster well-being [73]. Competence refers to the need to gain mastery of tasks, feel confident, and feel effective in task performance; relatedness or connection refers to the need to experience a sense of belonging, that one is cared for by others and, in turn, cares for others; lastly, autonomy refers to a need to feel in control of behaviors and goals. When these needs are met, growth, social development, and personal well-being are increased [74‐76]. Satisfying these needs is necessary for optimal wellness and performance; failure to satisfy these needs results in negative psychological outcomes [74‐76].

SDT proposes that these psychological needs are strongly associated with autonomous motivation [75]. Autonomous motivation describes behavior when individuals perceive themselves as having full choice, volition, interest, enjoyment, and value. When autonomously motivated, wellness, engagement, performance, and relationships are better. Self-direction, choice, and feelings of acknowledgement promote autonomous motivation [75]. In contrast, controlled motivation refers to doing something to gain a reward or avoid a punishment; performing due to feeling pressured or obliged to do so. Autonomous motivation is associated with increased persistence, greater vitality, and higher self-esteem, as well as general well-being compared to controlled motivation [75]. Autonomy orientation is associated with decreased negative impacts of stressful situations [73], greater psychological health [76], and increased general health [77]. Over the long term, fulfillment of the need for competence, relatedness, and autonomy leads to seeking out more situations that support these needs [73] thus supporting positive relationships and situations.

It is predicted that programs like STEM promote autonomous motivation by satisfying the basic needs described by self-determination theory (i.e., competence, relatedness, and autonomy) by offering a non-judgmental and voluntary framework which supports the development of autonomy orientation [73]. Participation in the STEM program is solely based on choice and there are little to no external rewards. Competence is gained by women gradually increasing their physical endurance (mastery experience) and thus confidence (self-efficacy) to successfully complete a 5 K road race. Mastering running techniques or even the ability to complete the course contributes to a sense of competence and increased confidence. The group format of the program provides a sense of connection and closeness, relatedness to others with similar life experiences. Survivors participate in the training and race together along with mentors and agency counselors; there is a sense of belonging and caring that grows over the course of the program. Lastly, autonomy is achieved through the program’s emphasis on non-judgemental support and participant self-direction. The program fosters behavior regulation based on one’s own goals, values, and interests rather than control orientation which involves coercion and pressure [73]. Participants are provided with a training plan but ultimately determine their own direction by choosing what they will do during each training session. Additionally, choosing to complete the 5 K is decided solely by the participant herself; she has complete and total control over the program’s completion.

Related to self-determination theory, self-efficacy theory is based in social learning theory [78] and focuses on the belief in one’s ability to accomplish a goal or task. Specifically, self-efficacy is the optimistic self-belief in competence and the prospect of successfully achieving or accomplishing a task. Mastery experience is one component of self-efficacy theory, and arguably the most powerful contributor to self-efficacy. Mastering a task or controlling an environment builds self-belief and provides the confidence to complete the same or similar task in the future. Self-efficacy is significantly impacted by participation in physical activity [79]. It is believed that the STEM program fosters a sense of mastery by offering participants the opportunity to train for and complete a 5 K race. The C25K format increases the run interval and decreases the walk interval in incremental fashion showing participants they can run for extended periods, gradually building on prior successes (a characteristic of mastery experience). Participants gain confidence in their ability to run. It is predicted that such confidence transfers to other aspect of their lives. While empowerment may be context specific, developing a sense of competence and control in one area of life may transfer to others as the actions to achieve goals are not as important as attempting to exert control [80].

Locus of control (LOC) [81] describes an individual’s belief system regarding the causes of, and factors that contribute to, successes and failures. An individual with a sense of personal control believes that he/she can master, control, and shape their destiny while individuals who perceive a lack of control believe that how they behave does not impact outcomes [82]. LOC is theorized to exist on a continuum, with several aspects that correspond to the extent to which individuals perceive outcomes in their lives as being within their control (internal locus of control) to being outside of their control (external locus of control). Perceptions of internal control are positively associated with empowerment [83], increased social action, lower psychological stress [80], and decreased depression [84].

Internal locus of control is central to survivors of intimate partner violence, particularly intimate terrorism, because of the nature of this type of violence. As discussed previously, intimate terrorists use economic control, intimidation, isolation, emotional abuse, and physical and sexual violence to gain and maintain control over their partner. Through entrapping a victim in the relationship, an intimate terrorist forces a sense of powerlessness upon the victim as he literally takes control of her life. Among survivors of intimate terrorism, trauma hinders perceptions of internal control and may subsequently lower perceptions of hope [85].

It is predicted that the STEM program will increase participants’ sense of accomplishment and internal control as participants are encouraged and empowered to set their own goals and create their own path to success. While the program determines the race, training schedule, and distance, the participants decide to join the program and control their training frequency and intensity. This type of control increases beliefs of personal control over one’s life and adoption of healthy behaviors [84].

Social capital refers to the available resources, either actual or potential, resulting from one’s social network or ties between individuals [86] and the ability to secure benefits and resources from these networks [87]. Unlike physical capital (e.g., property, wealth) or cultural capital (e.g., education, skill set), social capital is a function of who we know, who is in our social circles, and the extent to which we engage with these people.

The theory of social capital suggests that one’s position within a particular group or social network provides certain benefits. Findings indicate a positive correlation between social capital and psychological health [67, 88]. Moreover, studies have demonstrated empirically that participating in group activities is linked to increased social capital. Ottesen and colleagues (2010) found that previously inactive women who participated in a 16-week physical activity program report bonding with individuals who were unlike themselves and had improved social relations with significant persons in their lives [89]. Findings also suggest that team sports are more effective at fostering social capital compared to physical activities performed alone or outside of a group [89] potentially due to the sense of community, which is central to social capital [86]. It is predicted that STEM will increase participants’ social capital through group interaction and the increased engagement with other program participants and mentors.

Mindful individuals are aware of and pay attention to what is occurring in their internal and external environment [90] rather than performing in a habitual or automatic fashion [90, 91]. Mindfulness is related to increased relationship satisfaction [92], an improved ability to cope [90, 92, 93], increased well-being, and a positive view of stressful situations [93]. In addition to providing health benefits on its own, mindfulness promotes decision making that supports one’s own needs, values, and interests [90, 91]. Meta-analyses show that mindfulness, in addition to positively impacting psychological health, is related to increased subjective well-being [94] or happiness. Additionally, happiness is positively associated with physical activity [95‐97] and physical health [98]. It is anticipated that participation in the STEM program will positively impact mindfulness and happiness.