The Application of the Theory of Planned Behaviour to Diet in Carers of People with an Intellectual Disability

Development of a single-item physical activity intention measure for adults with intellectual disabilities: Evidence of validity and reliability

BACKGROUND

Physical activity (PA) is important for overall health and well-being, but adults with intellectual disabilities often struggle to achieve adequate levels of PA. Therefore, it is necessary to understand their PA behaviour.

OBJECTIVE

To develop a Single-Item Physical Activity Intention Measure (SPAIM) to assess PA intentions of adults with intellectual disabilities and preliminarily analyse its psychometric properties in terms of validity and reliability.

METHODS

The study had three phases: developing the SPAIM, assessing its validity and reliability evidence, and conducting a cross-sectional survey to analyse the relationship between PA intentions (measured by SPAIM) and PA levels. Participants were recruited between September 2016 and August 2017 from diverse settings in Oxford, UK, to ensure representation across the intellectual disability spectrum.

RESULTS

There were 82 participants aged 20-68 (mean age 36 ± 13) years who had mild-profound intellectual disabilities. The study provided evidence of content- and response processes-related validity to ensure respondents' understanding. Additionally, test-criterion evidence was provided, showing a predictive correlation between PA intention and sedentary hours/day (12 % of the explained variability). However, there was no correlation between PA intention and PA minutes/week. The study also provided adequate test-retest evidence (r = 0.78).

CONCLUSIONS

SPAIM may be a valuable tool for measuring PA intention in adults with intellectual disabilities. Modifying PA intentions could prove crucial in reducing sedentary behaviour and improving the health outcomes of this population. Future research and application of SPAIM in varied contexts will deepen our understanding of PA intentions and explore its predictive characteristics.

Supporting active engagement of adults with intellectual disabilities in lifestyle modification interventions: a realist evidence synthesis of what works, for whom, in what context and why

BACKGROUND

Lifestyle modification interventions for adults with intellectual disabilities have had, to date, mixed effectiveness. This study aimed to understand how lifestyle modification interventions for adults with intellectual disabilities work, for whom they work and in what circumstances.

METHODS

A realist evidence synthesis was conducted that incorporated input from adults with intellectual disabilities and expert researchers. Following the development of an initial programme theory based on key literature and input from people with lived experience and academics working in this field, five major databases (MEDLINE, EMBASE, CINAHL, PsycINFO and ASSIA) and clinical trial repositories were systematically searched. Data from 79 studies were synthesised to develop context, mechanism and outcome configurations (CMOCs).

RESULTS

The contexts and mechanisms identified related to the ability of adults with intellectual disabilities to actively take part in the intervention, which in turn contributes to what works, for whom and in what circumstances. The included CMOCs related to support involvement, negotiating the balance between autonomy and behaviour change, fostering social connectedness and fun, accessibility and suitability of intervention strategies and delivery and broader behavioural pathways to lifestyle change. It is also essential to work with people with lived experiences when developing and evaluating interventions.

CONCLUSIONS

Future lifestyle interventions research should be participatory in nature, and accessible data collection methods should also be explored as a way of including people with severe and profound intellectual disabilities in research. More emphasis should be given to the broader benefits of lifestyle change, such as opportunities for social interaction and connectedness.

Attitudes and perceptions of people with a learning disability, family carers, and paid care workers towards cancer screening programmes in the United Kingdom: A qualitative systematic review and meta-aggregation

OBJECTIVE

Evidence suggests that people with a learning disability (PwLD) are less likely to attend cancer screening than the general population in the United Kingdom. The aim of this systematic review was to identify and synthesise qualitative studies reporting the attitudes and opinions of PwLD, family carers, and paid care workers towards national cancer screening programmes.

METHODS

Five electronic and two grey literature databases were searched. Fourteen thousand eight hundred forty-six papers were reviewed against predetermined inclusion criteria. Included papers were critically appraised. Findings were synthesised using meta-aggregation.

RESULTS

Eleven papers met the inclusion criteria, all related to cervical and breast screening. No papers were related to colorectal cancer screening. Findings were clustered into four synthesised findings: (1) supporting women with a learning disability (WwLD) to attend screening, (2) WwLD's awareness of screening and their psychophysical experiences, 3) professional practice barriers including the need for multidisciplinary working and an understanding of the needs of WwLD, and (4) approaches to improve the uptake of cervical and breast cancer screening. The synthesis highlights the significance of WwLD having support to understand the importance of screening to be able to make an informed choice about attending.

CONCLUSIONS

WwLD may not attend cancer screening due to fear, concerns over pain, and the potential influence of family carers and paid care workers. The review identified practical mechanisms which could help WwLD attend screening. Future research should focus on identifying potential barriers and facilitators as a proactive measure to promote colorectal cancer screening.

Parental Intention to Support the Use of Computerized Cognitive Training for Children With Genetic Neurodevelopmental Disorders

Children with genetic neurodevelopmental disorders (NDDs) such as Down syndrome, Prader-Willi syndrome, and Fragile X syndrome may show a range of cognitive impairments, including impairments in executive functions (EF). EF are related to general intelligence, academic achievement, and literacy and mathematical skills. EF deficits are linked to a variety of clinically and socially important behaviors. Therefore, methods for improving EF in children with NDDs could be beneficial. One method for improving EF is through cognitive training. Research on commercial brain training programmes and video games suggests that EF can be improved through training, both in healthy adults and in children with NDDs. Computerized cognitive training (CCT) therefore represents a potentially viable intervention for children with NDDs. For training to be effective, it is important that an appropriate regimen is followed. Since children are likely to engage with training at home, the intentions of their parents to support them are therefore important. However, no research has investigated the attitudes of parents of children with NDDs to CCT. To address this, we developed a questionnaire based on the theory of planned behavior, which states that a person's intention to engage in a behavior is predicted by (1) their attitude toward the behavior, (2) their perception of subjective norms regarding the behavior (i.e., perceived social pressure), and (3) their perceived control over the behavior. The questionnaire was completed by parents of children with NDDs; 58 unique responses were retained for analyses. Parents reported low levels of knowledge of CCTs, and low levels of experience with CCTs (both their own experience and their child's experience). However, our results also show that parents of children with NDDs have positive beliefs about the potential of CCT to benefit their children and intend to support the use of CCT by their children. Linear modeling showed that, of the three constructs of the theory of planned behavior, only attitudes significantly predicted intention. Finally, parents' beliefs about the benefits of CCT correlated positively with positive attitudes toward such training. We also found limited evidence that parents of boys have more positive attitudes regarding CCT than parents of girls.

Gesundheitsförderung von Menschen mit intellektueller Behinderung

Zahlreiche Publikationen belegen, dass die Gesundheit von Menschen mit intellektueller Behinderung (IB) für Krankheiten und Störungen anfälliger ist als die der Allgemeinbevölkerung. Zudem sind bestimmte Risikoverhaltensweisen (z. B. schlechte Ernährung und wenig Bewegung) häufiger bei dieser Personengruppe zu finden. Trotz der sensibleren Gesundheitssituation steht die gesundheitspsychologische Forschung für Menschen mit IB noch am Anfang. Für diesen Überblicksartikel wurde Fachliteratur über Menschen mit IB nach gesundheitspsychologischen Konzeptionen durchsucht und bestehende Forschungsarbeiten analysiert. Des Weiteren wurden rezente Gesundheitsmodelle sowie Kontinuitäts- und Stadienmodelle für die Allgemeinbevölkerung und ihre einzelnen Bestandteile hinsichtlich ihrer Übertragbarkeit auf diese spezielle Population untersucht. Eine Generalisierung von Gesundheitsmodellen der Allgemeinbevölkerung auf die Gruppe von Menschen mit IB erscheint aus verschiedenen Gründen problematisch. So erweist sich z. B. die Erfassung einzelner Bestandteile durch ihre Abstraktheit als zu komplex für Menschen mit IB. Dieses und ähnliche Forschungshindernisse werden in diesem Artikel besprochen. Diese genaue Analyse hilft jedoch notwendige Kriterien für die Entwicklung eines theoretischen Gesundheitsmodells speziell für Menschen mit IB zu erstellen. Schlussendlich werden relevante Modellbausteine für Menschen mit IB, die auf den präsentierten Forschungsergebnissen aufbauen, vorgestellt und diskutiert. Schließlich werden zukünftige Forschungsfragen erörtert.

Care staff intentions to support adults with an intellectual disability to engage in physical activity: an application of the Theory of Planned Behaviour

Researchers suggest that people with an intellectual disability (ID) undertake less physical activity than the general population and many rely, to some extent, on others to help them to access activities. The Theory of Planned Behaviour (TPB) model was previously found to significantly predict the intention of care staff to facilitate a healthy diet in those they supported. The present study examined whether the TPB was useful in predicting the intentions of 78 Scottish care staff to support people with ID to engage in physical activity. Regression analyses indicated that perceived behavioural control was the most significant predictor of both care staff intention to facilitate physical activity and reported physical activity levels of the people they supported. Attitudes significantly predicted care staff intention to support physical activity, but this intention was not itself significantly predictive of reported activity levels. Increasing carers' sense of control over their ability to support clients' physical activity may be more effective in increasing physical activity than changing their attitudes towards promoting activity.