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Hatzikiriakidis K, Ayton D, O'Connor A, Cox R, MacRae A, Gulline H, Callaway L. Biopsychosocial determinants of physical activity and healthy eating for people with disability living in supported accommodation: A systematic review of qualitative research. Disabil Health J 2024; 17:101618. [PMID: 38548523 DOI: 10.1016/j.dhjo.2024.101618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND People with disability living in supported accommodation experience ongoing health disparities. Physical activity and dietary quality are factors that may minimise the risk of chronic disease, however this population may experience a range of biopsychosocial barriers to physical activity and healthy eating. OBJECTIVE The aim of this review was to synthesise the biopsychosocial determinants of physical activity and healthy eating for people with disability living in supported accommodation, as reported by existing qualitative research. METHODS A systematic review of qualitative evidence was conducted according to the JBI's methodological guidance. In September 2023, five academic databases were searched for relevant literature published since database inception. A secondary analysis of the results of included studies was guided by the International Framework for Functioning, Disability, and Health (ICF), using the ICF Linking Rules. RESULTS A total of 31 articles were included. The analysis identified 154 determinants of physical activity and 112 determinants of healthy eating. Determinants were most prominently representative of environmental factors that captured the health promoting role and attitudes of staff, alongside the influence of the organisational context. CONCLUSION This review provided evidence for the complex interactions between body functions and structures, activities and participation, personal factors, and the environment that influence physical activity and healthy eating within supported accommodation. Although there is a limited body of evidence to guide practice, the findings highlight the multifactorial nature of interventions that can be utilised by direct care professionals and adapted to the individual needs and interests of people with disability.
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Affiliation(s)
- Kostas Hatzikiriakidis
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Amanda O'Connor
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Rachael Cox
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Ann MacRae
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Hannah Gulline
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Libby Callaway
- Rehabilitation, Ageing, and Independent Living (RAIL) Research Centre, School of Allied Health and Primary Care, Monash University, Australia; Occupational Therapy Department, School of Primary and Allied Health Care, Monash University, Australia.
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Westrop SC, Rana D, Jaiswal N, Wu O, McGarty AM, Melville C, Ells L, Lally P, McEwan M, Harris L, Germeni E. 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. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:293-316. [PMID: 38379511 DOI: 10.1111/jir.13120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 11/10/2023] [Accepted: 12/19/2023] [Indexed: 02/22/2024]
Abstract
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.
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Affiliation(s)
- S C Westrop
- Mental Health and Wellbeing, School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - D Rana
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - N Jaiswal
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - O Wu
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - A M McGarty
- Mental Health and Wellbeing, School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - C Melville
- Mental Health and Wellbeing, School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - L Ells
- Obesity Institute, School of Health, Leeds Beckett University, City Campus, Leeds, UK
| | - P Lally
- UCL Institute of Epidemiology and Health Care, University College London, London, UK
- Department of Psychology, University of Surrey, Guildford, UK
| | - M McEwan
- People First (Scotland), Edinburgh, UK
| | - L Harris
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - E Germeni
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Røstad-Tollefsen HK, Kolset SO, Retterstøl K, Hesselberg H, Nordstrøm M. Weight reduction and dietary improvements in a cluster-randomised controlled trial for adults with intellectual disabilities. Food Nutr Res 2023; 67:9505. [PMID: 38187792 PMCID: PMC10770699 DOI: 10.29219/fnr.v67.9505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 01/09/2024] Open
Abstract
Background People with intellectual disabilities (IDs) have an increased risk of obesity and health concerns related to their nutritional status and dietary intake. Objective To assess the effectiveness of a multi-component intervention on weight, waist circumference (WC), clinical health parameters and dietary habits in a group of overweight and obese adults with mild-to-moderate ID. Design A 7-month cluster-randomised trial and a 7-month follow-up of the intervention group after the end of intervention when the group received usual care. The intervention consisted of monthly dietary-group courses tailored to the participants' cognitive abilities and practical skills, monthly nutritional courses for staff, use of behaviour change techniques and nudging. The control group received usual care during the intervention. Results There were 32 participants aged 22-61 years: 15 in the intervention group and 17 in the control group. After 7 months, a non-significant weight difference (median difference = -1.25 kg; 95% confidence interval [CI] = -2.00; 0.95 vs. +1.00 kg; CI = -1.15; 3.00, P = 0.08) and a significant WC difference were observed between the intervention and control groups (median difference = -3.75 cm; CI: -7.68; 0.11 vs. 0 cm; CI = -3.99; 1.00, P = 0.03), respectively. The median reduction in WC continued in the intervention group during the 7-month follow-up (median difference = -7.50 cm; CI: -13.57; -3.16, P = 0.002). A significant difference in frequency intake of fruit (P = 0.03) and berries (P = 0.004) was observed between the groups after 7 months, supported by a significant increase in measured serum-carotenoid levels in the intervention group after 7 months (median difference = 0.26 mmol/L; CI: -0.12; 0.52, P = 0.007). Conclusions A significant difference in WC was observed between the groups, accompanied by changes in blood parameters and dietary habits.
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Affiliation(s)
- Helen K. Røstad-Tollefsen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Baerum Municipality, Housing, Activity and Organized Work, Health, and Welfare, Baerum, Norway
| | - Svein O. Kolset
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Kjetil Retterstøl
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Lipid Clinic, Oslo University Hospital, Oslo, Norway
| | - Heidi Hesselberg
- Baerum Municipality, Housing, Activity and Organized Work, Health, and Welfare, Baerum, Norway
| | - Marianne Nordstrøm
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Frambu Resource Centre for Rare Disorders, Siggerud, Norway
- Unit for Inborn and Hereditary Neuromuscular Disorders, Department of Neurology, Oslo University Hospital, Oslo, Norway
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Hatzikiriakidis K, Ayton D, O'Connor A, Carmody S, Patitsas L, Skouteris H, Green R. The delivery of healthy lifestyle interventions for people with disability living in supported accommodation: a scoping review of intervention efficacy and consumer involvement. Disabil Health J 2023; 16:101444. [PMID: 36792486 DOI: 10.1016/j.dhjo.2023.101444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND People with disability living in supported accommodation experience health disparities that may be partly attributed to sedentary lifestyle behaviors and poor dietary quality. Healthy lifestyle interventions have been suggested as a method of health promotion for this population; however, a synthesis of their efficacy has not yet been conducted. OBJECTIVE The primary aims were to (1) identify healthy lifestyle interventions delivered to people with disability living in supported accommodation and (2) examine their efficacy in supporting health and well-being. A secondary aim was to explore whether people with disability have been involved in the codesign of these interventions. METHODS A scoping review was conducted following the Joanna Briggs Institute's guidance for conducting scoping reviews, and six databases were searched from January 2011 to November 2021. RESULTS Thirty-two studies were included. Identified intervention types included training and education, exercise programs, and multicomponent interventions. A broad range of outcomes were examined; however, findings regarding efficacy were overall mixed and limited due to significant heterogeneity and the underreporting of consistently measured outcomes. The codesign of interventions in consultation with people with disability was underexplored. CONCLUSIONS Health promotion training for staff and tailored education for people with disability hold promise in creating a care environment that supports a healthy lifestyle. The paucity of interventions developed in consultation with people with disability is concerning and highlights the importance of meaningful co-design. The development of a theoretically informed intervention that is codesigned and addresses the broader social determinants that influence health behavior is recommended.
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Affiliation(s)
- Kostas Hatzikiriakidis
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, UK.
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, UK
| | - Amanda O'Connor
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, UK
| | - Sarah Carmody
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, UK
| | - Luke Patitsas
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, UK
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, UK; Warwick Business School, Warwick University, UK
| | - Rachael Green
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, UK
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Barriers and enablers to the implementation of healthy lifestyle interventions for people with disability living in supported accommodation: A systematic review using the consolidated framework for implementation research. Disabil Health J 2023; 16:101442. [PMID: 36740546 DOI: 10.1016/j.dhjo.2023.101442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND People with disability living in supported accommodation often experience significant health disparities, despite the availability of additional support. Healthy lifestyle interventions have been identified as one key health promotion strategy. Implementation science offers an opportunity to explore the factors that influence the efficacy and sustainability of these interventions, yet its application in this context has been underutilized. OBJECTIVE This systematic review synthesized the barriers and enablers to the implementation of healthy lifestyle interventions delivered to people with disability living in supported accommodation settings. METHODS A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search for relevant literature published between January 2011 and November 2021 was conducted across six databases. The findings of included studies were coded and analyzed according to the domains and constructs of the Consolidated Framework for Implementation Research (CFIR) via deductive content analysis. RESULTS Five studies were included, and their findings were mapped to 21 out of 38 constructs under the CFIR. Interventions from each study delivered health promotion education and training to staff and/or people with disability. The most prominent determinants that influenced implementation success included an intervention's relevance and its flexibility to adapt to the needs of people with disability, alongside organizational resourcing, and stakeholder endorsement in supporting implementation. CONCLUSIONS The CFIR provided a systematic approach to explore the implementation of healthy lifestyle interventions. However, further research that is grounded in and guided by implementation science theories is warranted. Despite the scarcity of literature, several compelling, yet preliminary recommendations were drawn from the findings.
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Dean S, Marshall J, Whelan E, Watson J, Zorbas C, Cameron AJ. A Systematic Review of Health Promotion Programs to Improve Nutrition for People with Intellectual Disability. Curr Nutr Rep 2021; 10:255-266. [PMID: 34893970 DOI: 10.1007/s13668-021-00382-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW To investigate the type and effectiveness of health promotion programs designed to improve nutrition for people with intellectual disability. This review also sought to highlight gaps in the evidence by mapping interventions to the socio-ecological model. RECENT FINDINGS To date, reviews on health promotion programs for people with intellectual disability have focused on individualised weight management interventions and behaviour change techniques. No reviews have focused solely on nutrition or considered a broader range of interventions and policies targeted beyond the individual. This review found that health promotion interventions to date were predominantly at the individual level of the socio-ecological model and of varying effectiveness. Of the non-individually focused interventions, those targeting the physical environment or considering multiple socio-ecological levels achieved the greatest improvements in nutrition outcomes. Nutrition and obesity prevention research and policy need to include intellectual disability as part of equity considerations, while intellectual disability policy needs to consider the broader food environment.
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Affiliation(s)
- Sarah Dean
- Faculty of Health, School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, 3220, Australia
| | - Josephine Marshall
- Faculty of Health, School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, 3220, Australia
| | - Erin Whelan
- Faculty of Health, School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, 3220, Australia
| | - Jo Watson
- Faculty of Health, School of Health and Social Development, Deakin University, Geelong, 3220, Australia
| | - Christina Zorbas
- Faculty of Health, School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, 3220, Australia
| | - Adrian J Cameron
- Faculty of Health, School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, 3220, Australia.
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7
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Røstad-Tollefsen HK, Kolset SO, Retterstøl K, Hesselberg H, Nordstrøm M. Factors influencing the opportunities of supporting staff to promote a healthy diet in adults with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:733-741. [PMID: 33274594 DOI: 10.1111/jar.12846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/13/2020] [Accepted: 11/19/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Adults with intellectual disabilities living in residential houses have a high prevalence of obesity which is related to poor dietary habits. AIM The aim of this study was to assess supporting staff`s thoughts and experiences on factors influencing their opportunities to promote a healthy diet in adults with intellectual disabilities. METHODS 13 supporting staff members were recruited from 11 different residential houses in a community. Concept Mapping methodology was used, including group interviews, sorting, rating statement and analysing the results. RESULTS Seven clusters most accurately captured the ideas of the supporting staff`. 'Attitudes', 'Facilitating a healthy diet', 'Practical cooking skills' and 'Applied dietary knowledge' were the four most important. CONCLUSIONS Multiple factors influence the opportunities of supporting staff to promote a healthy diet. A holistic approach addressing all relevant factors is necessary when developing interventions to address this complex issue in persons with intellectual disabilities.
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Affiliation(s)
- Helen K Røstad-Tollefsen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Baerum Municipality, Health and Care Services, Community Housing and Services, Sandvika, Norway
| | - Svein O Kolset
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Kjetil Retterstøl
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Lipid Clinic, Oslo University Hospital, Oslo, Norway
| | - Heidi Hesselberg
- Baerum Municipality, Health and Care Services, Community Housing and Services, Sandvika, Norway
| | - Marianne Nordstrøm
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Frambu Resource Centre for Rare Disorders, Siggerud, Norway.,Department of Neurology, Unit for Inborn and Hereditary Neuromuscular Disorders, Oslo University Hospital, Oslo, Norway
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Janson AL, Moen A, Aure CF. Introducing a nutritional app in supervised residences for independent living: Experiences of individuals with intellectual disabilities and their caregivers. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:55-64. [PMID: 32700790 DOI: 10.1111/jar.12784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Dietary challenges are common among individuals with intellectual disability residing in supervised living in Norway, and this is a major risk factor for health problems. The aim of this study was to explore feasibility of the nutrition tablet app APPetitus, among persons with intellectual disability and their formal caregivers. METHOD Joint dyad interviews with residents and caregivers were conducted after five individuals with intellectual disability used APPetitus for eight weeks. Seven formal caregivers and managers participated in subsequent focus group interviews. Thematic analysis informed the data analysis. The study complies with the Consolidated Criteria for Reporting Qualitative Research (COREQ). RESULTS The findings were mapped into three themes: APPetitus mediating nutritional conversations, residents' strategies to control the conversation and caregiver support as a required prerequisite for overall user comprehension. CONCLUSIONS The study demonstrates that a nutritional app can contribute to and normalize nutritional conversations, and empower residents to participate.
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Affiliation(s)
- Astri Letnes Janson
- Department of Nursing Science, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Anne Moen
- Department of Nursing Science, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Caroline Farsjø Aure
- Department of Nursing Science, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
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Barnhart WR, Whalen Smith CN, Coleman E, Riddle IK, Havercamp SM. Living Independent From Tobacco reduces cigarette smoking and improves general health status among long-term tobacco users with disabilities. Disabil Health J 2019; 13:100882. [PMID: 31917121 DOI: 10.1016/j.dhjo.2019.100882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/12/2019] [Accepted: 12/09/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND People with disabilities disproportionately use tobacco and suffer associated negative health consequences. Research is needed to explore tobacco cessation programming for people with disabilities to counter these health disparities. OBJECTIVE We evaluated the impact of Living Independent From Tobacco on tobacco use, knowledge and attitudes about tobacco use, coping skills, and perceived health status among people with disabilities. We also assessed participants' subjective impressions at post-test. METHODS Living Independent From Tobacco was evaluated via train the trainer model at three Midwestern sites serving people with disabilities. Outcomes were assessed at four time points: pre- and post-test (n = 30), and again at 1-month (n = 26) and 6-months (n = 13). RESULTS Long-term tobacco users with disabilities significantly reduced tobacco use from pre-test to post-test (p = 0.003), and, compared to baseline, this reduction continued to be significant 1-month after the intervention (p = 0.02). From pre-test to post-test, perceived health status significantly improved (p = 0.0001). No significant changes were observed across time points for knowledge and attitudes about tobacco use nor for coping skills. Qualitative data revealed the importance of coping skills to mitigate the negative effects of nicotine withdrawal. Peer accountability was also noted as an important source of motivation for tobacco cessation. CONCLUSIONS Data from the present study provide evidence for the short-term effectiveness of Living Independent From Tobacco to reduce tobacco use and improve health status among people with disabilities. Qualitative data revealed the importance of coping skills and peer accountability to support tobacco cessation. Implications for tobacco cessation programming for people with disabilities are discussed.
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Affiliation(s)
| | | | - Erica Coleman
- University of Cincinnati, Center for Excellence in Developmental Disabilities, Cincinnati, USA
| | - Ilka K Riddle
- University of Cincinnati, Center for Excellence in Developmental Disabilities, Cincinnati, USA
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Stahlhut M, Esbensen BA, Larsen JL, Bisgaard AM, Downs J, Nordmark E. Facilitators and Barriers of Participation in "Uptime" Activities in Girls and Women With Rett Syndrome: Perspectives From Parents and Professionals. QUALITATIVE HEALTH RESEARCH 2019; 29:609-619. [PMID: 30304998 DOI: 10.1177/1049732318803358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Rett syndrome (RTT) is a rare neurodevelopmental disorder usually affecting females. It is associated with intellectual and multiple disabilities leading to a high level of dependency in all aspects of daily living including participation in physical activities. This study explored facilitators and barriers to "uptime" (non-sedentary) activities in Danish girls and women with RTT as perceived by parents and professionals using focus groups. Through thematic analysis, one central theme emerged: a constant balance to do the best thing for the girl or woman. Within the central theme, five subthemes of facilitators and barriers were identified relating to the individual and the physical, organizational, social, and attitudinal environments. Environmental barriers can be reduced through policy and management-level changes in health promotion and strong advocacy of physical activity by health professionals. Targeting both facilitators and barriers of "uptime" activities enables the planning and implementing of health-promoting interventions in individuals with RTT.
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Affiliation(s)
- Michelle Stahlhut
- 1 Center for Rett Syndrome, Rigshospitalet, Glostrup, Denmark
- 2 Health Sciences Center, Lund University, Lund, Sweden
| | - Bente Appel Esbensen
- 3 Copenhagen Center for Arthritis Research, Rigshospitalet, Glostrup, Denmark
- 4 Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Jenny Downs
- 4 Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- 5 Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Eva Nordmark
- 2 Health Sciences Center, Lund University, Lund, Sweden
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Elinder LS, Sundblom E, Zeebari Z, Bergström H. Effect and Process Evaluation of a Structural Health Intervention in Community Residences for Adults With Intellectual Disabilities. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2018. [DOI: 10.1111/jppi.12262] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Elinor Sundblom
- Department of Public Health Sciences; Karolinska Institutet; Solna Sweden
| | - Zangin Zeebari
- Department of Public Health Sciences; Karolinska Institutet; Solna Sweden
| | - Helena Bergström
- Department of Public Health Sciences; Karolinska Institutet; Solna Sweden
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12
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O'Leary L, Taggart L, Cousins W. Healthy lifestyle behaviours for people with intellectual disabilities: An exploration of organizational barriers and enablers. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31 Suppl 1:122-135. [DOI: 10.1111/jar.12396] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Lisa O'Leary
- Scottish Learning Disabilities Observatory, Academic Unit for Mental Health & Wellbeing; Gartnavel Royal Hospital, University of Glasgow; Glasgow UK
| | - Laurence Taggart
- Institute of Nursing and Health Research; School of Nursing, Ulster University, Jordanstown Campus; Newtownabbey Northern Ireland UK
| | - Wendy Cousins
- Institute of Nursing and Health Research; School of Nursing, Ulster University, Jordanstown Campus; Newtownabbey Northern Ireland UK
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Dixon-Ibarra A, Driver S, Nery-Hurwit M, VanVolkenburg H. Qualitative evaluation of a physical activity health promotion programme for people with intellectual disabilities in a group home setting. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31 Suppl 1:97-109. [PMID: 28833967 DOI: 10.1111/jar.12397] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a lack of health promotion programming designed to change the physical activity environment of the group home setting. The Menu-Choice programme assists staff in creating physical activity goals alongside residents with intellectual disabilities and provides strategies to incorporate activity into the group home schedule. The purpose of this study was to complete a process evaluation of Menu-Choice utilizing qualitative methods. METHODS Twelve participants, who completed a 10-week pilot intervention (n = 7 staff, mean age 42; n = 5 residents, mean age 52), participated in face-to-face interviews. Participants represented five group home sites involved in the intervention. RESULTS Meta-themes included: (i) Programme training, (ii) Programme implementation, (iii) Programme physical activity, (iv) Programme barriers, (v) Programme facilitators and (vi) Programme feedback. CONCLUSIONS Changes in programme training and simplified programme materials are needed to accommodate identified barriers for implementation. The importance of obtaining increased agency support and policy change is highlighted.
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Affiliation(s)
- A Dixon-Ibarra
- College of Public Health and Human Sciences: Adapted Physical Activity, Oregon State University, Corvallis, OR, USA
| | - S Driver
- Rehabilitation Research, Baylor Institute for Rehabilitation, Dallas, TX, USA
| | - M Nery-Hurwit
- Department of Kinesiology, Pacific Lutheran University, Tacoma, WA, USA
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14
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Roll AE. Health promotion for people with intellectual disabilities - A concept analysis. Scand J Caring Sci 2017; 32:422-429. [DOI: 10.1111/scs.12448] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/22/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Anne E. Roll
- University of Wisconsin-Madison School of Nursing; Madison WI USA
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15
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Sundblom E, Bergström H, Ellinder LS. Understanding the Implementation Process of a Multi-Component Health Promotion Intervention for Adults with Intellectual Disabilities in Sweden. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 28:296-306. [DOI: 10.1111/jar.12139] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Elinor Sundblom
- Centre for Epidemiology and Community Medicine; Solna Sweden
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16
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Hubbard KL, Bandini LG, Folta SC, Wansink B, Must A. The Adaptation of a School-based Health Promotion Programme for Youth with Intellectual and Developmental Disabilities: A Community-Engaged Research Process. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2014; 27:576-90. [DOI: 10.1111/jar.12104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Kristie L. Hubbard
- Friedman School of Nutrition Science and Policy; Tufts University; Boston MA USA
| | - Linda G. Bandini
- Eunice Kennedy Shriver Center; University of Massachusetts Medical School; Waltham MA USA
- Department of Health Sciences; Boston University; Boston MA USA
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy; Tufts University; Boston MA USA
| | - Brian Wansink
- Dyson School of Applied Economics and Management; Cornell University; Ithaca NY USA
| | - Aviva Must
- Department of Public Health and Community Medicine; Tufts University School of Medicine; Boston MA USA
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17
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Wahlström L, Bergström H, Marttila A. Promoting health of people with intellectual disabilities: Views of professionals working in group homes. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2014; 18:113-128. [PMID: 24595869 DOI: 10.1177/1744629514525133] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Deinstitutionalisation has influenced the life situation for people with intellectual disabilities, whilst the experiences of health promotion in group homes now are limited. This study aimed to explore aspects important to consider when promoting health amongst persons with intellectual disabilities in group homes, from the perspective of professionals. Semi-structured interviews were conducted with seven professionals and were analysed with thematic analysis. The overarching theme 'sense of security' was identified as a prerequisite for health promotion, together with the sub-themes 'resources in the organisation', for example, respectful treatment of the residents, and `resources of the residents', for example, meaningfulness and social connectedness. Findings were discussed from the perspective of health assets which is defined as the factors contributing to maintain and sustain health. The importance of strengthening external assets, that is, resources in the society and the organisation, to promote internal assets, that is, residents' individual resources, and ultimately their health, is emphasised.
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18
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Bergström H, Elinder LS, Wihlman U. Barriers and facilitators in health education for adults with intellectual disabilities--a qualitative study. HEALTH EDUCATION RESEARCH 2014; 29:259-271. [PMID: 24399263 DOI: 10.1093/her/cyt111] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The aim of this study was to explore barriers and facilitators in the implementation of a health course for adults with mild or moderate intellectual disabilities. An inductive qualitative design was used. Data were collected from a health course conducted in 16 study groups with 83 participants in Stockholm, Sweden by unstructured observations in course sessions, a group discussion with course leaders and evaluation notes from the course leaders. The data were analysed by qualitative content analysis. Four categories were identified: (i) 'individual characteristics', implying various needs, (ii) 'pedagogical strategies' used to meet those needs, (iii) 'interaction within the course', dealing with active and less active participation and (iv) 'structures', including learning climate and organizing. The overarching theme 'creating an individualized supportive context' describes the challenge of educating people with intellectual disabilities towards an empowered and well informed decision making regarding their own health. Therefore, there is a need for support not only within the course but also from the social and physical environment as well.
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Affiliation(s)
- H Bergström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 83 Huddinge, Sweden, Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden and Independent Researcher, Stockholm, Sweden
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19
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Bergström H, Hagströmer M, Hagberg J, Elinder LS. A multi-component universal intervention to improve diet and physical activity among adults with intellectual disabilities in community residences: a cluster randomised controlled trial. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:3847-3857. [PMID: 24021393 DOI: 10.1016/j.ridd.2013.07.019] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 07/10/2013] [Accepted: 07/10/2013] [Indexed: 06/02/2023]
Abstract
People with ID have an increased risk for unhealthy diets, physical inactivity and weight disturbances. The aim of the current study was to investigate the effectiveness of a novel and complex intervention to improve diet and physical activity, targeting both caregivers and residents, in community residences for people with ID. A three component intervention based on Social Cognitive Theory was developed, including: (1) appointment of a health ambassador in each community residence attending network meetings, (2) a study circle for caregivers, and (3) a health course for the residents. The intervention lasted for 12-16 months and allowed for some local tailoring. A cluster randomised controlled trial, randomised at residence level, was conducted to evaluate the effects of the intervention. Thirty community residences for people with mild or moderate ID in Stockholm County, Sweden, were included. A total of 130 participants, 74 women and 56 men aged 20-66 years, entered, and 129 participants completed the study. The primary outcome was physical activity, measured by pedometry. Secondary outcomes were BMI, waist circumference, dietary quality measured by digital photography, satisfaction with life assessed with a scale, and work routines assessed with a questionnaire. Outcomes were related to intervention fidelity. A positive intervention effect was found on physical activity, with an average increase of 1608 steps/day among participants in the intervention group (P=0.045). The effect size was 0.29 (Cohen's d). The type of residence was found to be an effect moderator. A positive intervention effect was found as well on work routines, with an average increase of 7.1 percentage points on a self-assessment scale among residences in the intervention group (P=0.016). No significant effects were found on BMI, waist circumference, dietary quality, or satisfaction with life. In conclusion, this innovative intervention was effective in improving physical activity and work routines. It is likely that even greater effects could be achieved by improvements in implementation strategies, leading to higher fidelity.
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Affiliation(s)
- Helena Bergström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels allé 3, 141 83 Huddinge, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 1497, 171 29 Solna, Sweden.
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