Top

BMC Public Health

Published in:

Open Access 01-12-2010 | Study protocol

Promoting a healthy diet and physical activity in adults with intellectual disabilities living in community residences: Design and evaluation of a cluster-randomized intervention

Authors: Liselotte Schäfer Elinder, Helena Bergström, Jan Hagberg, Ulla Wihlman, Maria Hagströmer

Published in: BMC Public Health | Issue 1/2010

Abstract

Background

Many adults with intellectual disabilities have poor dietary habits, low physical activity and weight disturbances. This study protocol describes the design and evaluation of a health intervention aiming to improve diet and physical activity in this target group. In Sweden, adults with intellectual disabilities often live in community residences where the staff has insufficient education regarding the special health needs of residents. No published lifestyle interventions have simultaneously targeted both residents and staff.

Methods/Design

The intervention is designed to suit the ordinary work routines of community residences. It is based on social cognitive theory and takes 12-15 months to complete. The intervention includes three components: 1) Ten health education sessions for residents in their homes; 2) the appointment of a health ambassador among the staff in each residence and formation of a network; and 3) a study circle for staff in each residence. The intervention is implemented by consultation with managers, training of health educators, and coaching of health ambassadors. Fidelity is assessed based on the participation of residents and staff in the intervention activities. The study design is a cluster-randomised trial with physical activity as primary outcome objectively assessed by pedometry. Secondary outcomes are dietary quality assessed by digital photography, measured weight, height and waist circumference, and quality of life assessed by a quality of life scale. Intermediate outcomes are changes in work routines in the residences assessed by a questionnaire to managers. Adults with mild to moderate intellectual disabilities living in community residences in Stockholm County are eligible for inclusion. Multilevel analysis is used to evaluate effects on primary and secondary outcomes. The impact of the intervention on work routines in community residences is analysed by ordinal regression analysis. Barriers and facilitators of implementation are identified in an explorative qualitative study through observations and semi-structured interviews.

Discussion

Despite several challenges it is our hope that the results from this intervention will lead to new and improved health promotion programs to the benefit of the target group.

Trial registration number

ISRCTN33749876

Available only for authorised users

Impact of obesity on health. The challenge of obesity in the WHO European Region and the strategies for response. Edited by: Branca F, Nikogosian H, Lobstein T. 2007, Copenhagen: World Health Organization, 20-27.

Adolfsson P, Sydner YM, Fjellstrom C, Lewin B, Andersson A: Observed dietary intake in adults with intellectual disability living in the community. Food Nutr Res. 2008, 52:

Draheim CC, Stanish HI, Williams DP, McCubbin JA: Dietary intake of adults with mental retardation who reside in community settings. Am J Ment Retard. 2007, 112 (5): 392-400. 10.1352/0895-8017(2007)112[0392:DIOAWM]2.0.CO;2.CrossRefPubMed

Emerson E: Underweight, obesity and exercise among adults with intellectual disabilities in supported accommodation in Northern England. J Intellect Disabil Res. 2005, 49 (Pt 2): 134-143. 10.1111/j.1365-2788.2004.00617.x.CrossRefPubMed

Robertson J, Emerson E, Gregory N, Hatto C, Turner S, Kessissoglou S, Hallam A: Lifestyle related risk factors for poor health in residential settings for people with intellectual disabilities. Res Dev Disabil. 2000, 21 (6): 469-486. 10.1016/S0891-4222(00)00053-6.CrossRefPubMed

Bhaumik S, Watson JM, Thorp CF, Tyrer F, McGrother CW: Body mass index in adults with intellectual disability: distribution, associations and service implications: a population-based prevalence study. J Intellect Disabil Res. 2008, 52 (Pt 4): 287-298. 10.1111/j.1365-2788.2007.01018.x.CrossRefPubMed

Moran R, Drane W, McDermott S, Dasari S, Scurry JB, Platt T: Obesity among people with and without mental retardation across adulthood. Obes Res. 2005, 13 (2): 342-349. 10.1038/oby.2005.46.CrossRefPubMed

Hove O: Weight survey on adult persons with mental retardation living in the community. Res Dev Disabil. 2004, 25 (1): 9-17. 10.1016/j.ridd.2003.04.004.CrossRefPubMed

Arnhoff Y: Onödig ohälsa. Hälsoläget för personer med funktionsnedsättning. [Unnecessary poor health. Health status for people with disabilities.]. 2008, Östersund: Swedish National Institute of Public Health

10.

Lägesrapport 2003. [Disability Care. Status report 2003]. 2003, Stockholm: The National Board of Health and Welfare, Handikappomsorg

11.

Elinder LS, Jansson M: Obesogenic environments--aspects on measurement and indicators. Public Health Nutr. 2009, 12 (3): 307-315.PubMed

12.

International Statistical Classification of Diseases and Related Health Problems. 2007, Geneva: WHO, 10

13.

Bazzano AT, Zeldin AS, Diab IR, Garro NM, Allevato NA, Lehrer D: The Healthy Lifestyle Change Program: a pilot of a community-based health promotion intervention for adults with developmental disabilities. Am J Prev Med. 2009, 37 (6 Suppl 1): S201-208. 10.1016/j.amepre.2009.08.005.CrossRefPubMed

14.

Chapman MJ, Craven MJ, Chadwick DD: Following up fighting fit: the long-term impact of health practitioner input on obesity and BMI amongst adults with intellectual disabilities. J Intellect Disabil. 2008, 12 (4): 309-323. 10.1177/1744629508100557.CrossRefPubMed

15.

Ewing G, McDermott S, Thomas-Koger M, Whitner W, Pierce K: Evaluation of a cardiovascular health program for participants with mental retardation and normal learners. Health Educ Behav. 2004, 31 (1): 77-87. 10.1177/1090198103259162.CrossRefPubMed

16.

Heller T, Hsieh K, Rimmer JH: Attitudinal and psychosocial outcomes of a fitness and health education program on adults with down syndrome. Am J Ment Retard. 2004, 109 (2): 175-185. 10.1352/0895-8017(2004)109<175:AAPOOA>2.0.CO;2.CrossRefPubMed

17.

Marshall D, McConkey R, Moore G: Obesity in people with intellectual disabilities: the impact of nurse-led health screenings and health promotion activities. J Adv Nurs. 2003, 41 (2): 147-153. 10.1046/j.1365-2648.2003.02522.x.CrossRefPubMed

18.

Kneringer MJ, Page TJ: Improving staff nutritional practices in community-based group homes: evaluation, training, and management. J Appl Behav Anal. 1999, 32 (2): 221-224. 10.1901/jaba.1999.32-221.CrossRefPubMedPubMedCentral

19.

Campbell MK, Elbourne DR, Altman DG: CONSORT statement: extension to cluster randomised trials. BMJ. 2004, 328 (7441): 702-708. 10.1136/bmj.328.7441.702.CrossRefPubMedPubMedCentral

20.

Fraser M, Richman J, Galinsky M, Day S: Intervention research. 2009, New York: Oxford University Press

21.

Baranowski TPC, Parcel GS: How individuals, environments, and health behavoir interact: Social cognitive theory. Health behaviour and health education Theory, research, and practice. Edited by: Glanz KRB, Lewis FM. 2002, San Francisco: Jossey-Bass, 3

22.

Wadoodi A, Crosby JR: Twelve tips for peer-assisted learning: a classic concept revisited. Med Teach. 2002, 24 (3): 241-244. 10.1080/01421590220134060.CrossRefPubMed

23.

Fixsen D, Naoom S, Blase K, Friedman R, Wallace F: Implementation research: a synthesis of the literature. 2005, Tampa, FA: University of South Florida

24.

Le Masurier GC, Tudor-Locke C: Comparison of pedometer and accelerometer accuracy under controlled conditions. Med Sci Sports Exerc. 2003, 35 (5): 867-871. 10.1249/01.MSS.0000064996.63632.10.CrossRefPubMed

25.

Tudor-Locke C, Ainsworth BE, Thompson RW, Matthews CE: Comparison of pedometer and accelerometer measures of free-living physical activity. Med Sci Sports Exerc. 2002, 34 (12): 2045-2051. 10.1097/00005768-200212000-00027.CrossRefPubMed

26.

Schneider PL, Crouter SE, Bassett DR: Pedometer measures of free-living physical activity: comparison of 13 models. Med Sci Sports Exerc. 2004, 36 (2): 331-335. 10.1249/01.MSS.0000113486.60548.E9.CrossRefPubMed

27.

Temple VA, Stanish HI: Pedometer-measured physical activity of adults with intellectual disability: predicting weekly step counts. Am J Intellect Dev Disabil. 2009, 114 (1): 15-22.CrossRefPubMed

28.

Camelon KM, Hadell K, Jamsen PT, Ketonen KJ, Kohtamaki HM, Makimatilla S, Tormala ML, Valve RH: The Plate Model: a visual method of teaching meal planning. DAIS Project Group. Diabetes Atherosclerosis Intervention Study. J Am Diet Assoc. 1998, 98 (10): 1155-1158. 10.1016/S0002-8223(98)00267-3.CrossRefPubMed

29.

Kline P: Handbook of psychological testing. 2000, London: Routledge

30.

Durlak JA, DuPre EP: Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol. 2008, 41 (3-4): 327-350. 10.1007/s10464-008-9165-0.CrossRefPubMed

31.

Peterson JJ, Janz KF, Lowe JB: Physical activity among adults with intellectual disabilities living in community settings. Prev Med. 2008, 47 (1): 101-106. 10.1016/j.ypmed.2008.01.007.CrossRefPubMed

32.

Campbell MK, Thomson S, Ramsay CR, MacLennan GS, Grimshaw JM: Sample size calculator for cluster randomized trials. Comput Biol Med. 2004, 34 (2): 113-125. 10.1016/S0010-4825(03)00039-8.CrossRefPubMed

33.

Bowling A: Research methods in health. 2002, New York: Open University Press, 2

34.

Patton M: Qualitative research and evaluation methods. (3rd edn.) Thousand Oaks: SAGE; 2002. 2002, London: Sage Publications, Inc, 3

35.

Mays N, Pope C: Qualitative research: Observational methods in health care settings. BMJ. 1995, 311 (6998): 182-184.CrossRefPubMedPubMedCentral

36.

Finlay WM, Lyons E: Methodological issues in interviewing and using self-report questionnaires with people with mental retardation. Psychol Assess. 2001, 13 (3): 319-335. 10.1037/1040-3590.13.3.319.CrossRefPubMed

37.

Kvale S, Brinkmann S: Den kvalitativa forskningsintervjun [The qualitative research interview]. 2009, Lund: Studentlitteratur, 2

38.

Malterud K: Kvalitativa metoder i medicinsk forskning [Qualitative methods in medical research]. 1998, Lund: Studentlitteratur

39.

Mays N, Pope C: Qualitative research in health care. 1996, London: BMJ Publishing Group

40.

Anderson LM, Quinn TA, Glanz K, Ramirez G, Kahwati LC, Johnson DB, Buchanan LR, Archer WR, Chattopadhyay S, Kalra GP, et al: The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: a systematic review. Am J Prev Med. 2009, 37 (4): 340-357. 10.1016/j.amepre.2009.07.003.CrossRefPubMed

41.

Wullink M, Widdershoven G, van Schrojenstein Lantman-de Valk H, Metsemakers J, Dinant GJ: Autonomy in relation to health among people with intellectual disability: a literature review. J Intellect Disabil Res. 2009, 53 (9): 816-826. 10.1111/j.1365-2788.2009.01196.x.CrossRefPubMed

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/10/761/prepub

Title: Promoting a healthy diet and physical activity in adults with intellectual disabilities living in community residences: Design and evaluation of a cluster-randomized intervention
Authors: Liselotte Schäfer Elinder
Helena Bergström
Jan Hagberg
Ulla Wihlman
Maria Hagströmer
Publication date: 01-12-2010
Publisher: BioMed Central
Published in: BMC Public Health / Issue 1/2010
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/1471-2458-10-761

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Promoting a healthy diet and physical activity in adults with intellectual disabilities living in community residences: Design and evaluation of a cluster-randomized intervention

Abstract

Background

Methods/Design

Discussion

Trial registration number

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods/Design

Discussion

Trial registration number

Please log in to get access to this content

Other articles of this Issue 1/2010

Abdominal obesity and other risk factors largely explain the high CRP in Indigenous Australians relative to the general population, but not gender differences: a cross-sectional study

Disparities in diabetes care: role of the patient's socio-demographic characteristics

What do first-time mothers worry about? A study of usage patterns and content of calls made to a postpartum support telephone hotline

Community-based prevention leads to an increase in condom use and a reduction in sexually transmitted infections (STIs) among men who have sex with men (MSM) and female sex workers (FSW): the Frontiers Prevention Project (FPP) evaluation results

Incarceration as a key variable in racial disparities of asthma prevalence

Facilitating access to pre-processed research evidence in public health