Parental perceptions of facilitators and barriers to physical activity for children with intellectual disabilities: A mixed methods systematic review

Background: There is a need increase our understanding of what factors affect physical activity participation in children with intellectual disabilities (ID) and develop effective methods to overcome barriers and increase activity levels. Aim: This study aimed to systematically review parental perceptions of facilitators and barriers to physical activity for children with ID. Methods: A systematic search of Embase, Medline, ERIC, Web of Science, and PsycINFO was conducted (up to and including August, 2017) to identify relevant papers. A meta-ethnography approach was used to synthesise qualitative and quantitative results through the generation of third-order themes and a theoretical model. Results: Ten studies were included, which ranged from weak to strong quality. Seventy-one second-order themes and 12 quantitative results were extracted. Five third-order themes were developed: family, child factors, inclusive programmes and facilities, social motivation, and child’s experiences of physical activity. It is theorised that these factors can be facilitators or barriers to physical activity, depending on the information and education of relevant others, e.g. parents and coaches. Conclusions: Parents have an important role in supporting activity in children with ID. Increasing the information and education given to relevant others could be an important method of turning barriers into facilitators

Use of behaviour change techniques in lifestyle change interventions for people with intellectual disabilities: A systematic review

Background: People with intellectual disabilities (ID) experience more health problems and have different lifestyle change needs, compared with the general population. Aims: To improve lifestyle change interventions for people with ID, this review examined how behaviour change techniques (BCTs) were applied in interventions aimed at physical activity, nutrition or physical activity and nutrition, and described their quality. Methods and procedures: After a broad search and detailed selection process, 45 studies were included in the review. For coding BCTs, the CALO-RE taxonomy was used. To assess the quality of the interventions, the Physiotherapy Evidence Database (PEDro) scale was used. Extracted data included general study characteristics and intervention characteristics. Outcomes and results: All interventions used BCTs, although theory-driven BCTs were rarely used. The most frequently used BCTs were ‘provide information on consequences of behaviour in general’ and ‘plan social support/social change’. Most studies were of low quality and a theoretical framework was often missing. Conclusion and implications: This review shows that BCTs are frequently applied in lifestyle change interventions. To further improve effectiveness, these lifestyle change interventions could benefit from using a theoretical framework, a detailed intervention description and an appropriate and reliable intervention design which is tailored to people with ID

A single-blind, pilot randomised trial of a weight management intervention for adults with intellectual disabilities and obesity: study protocol

Background: The prevalence of obesity in adults with intellectual disabilities has consistently been reported to be higher than the general population. Despite the negative impact of obesity on health, there is little evidence of the effectiveness of weight management interventions for adults with intellectual disabilities and obesity. Preliminary results from a single-stranded feasibility study of a multi-component weight management intervention specifically designed for adults with intellectual disabilities and obesity (TAKE 5) and that satisfied clinical recommendations reported that it was acceptable to adults with intellectual disabilities and their carers. This study aims to determine the feasibility of a full-scale clinical trial of TAKE 5.<p></p> Methods: This study will follow a pilot randomised trial design. Sixty-six obese participants (body mass index (BMI) ≥30 kg/m2) will be randomly allocated to the TAKE 5 multi-component weight management intervention or a health education ‘active’ control intervention (Waist Winners Too (WWToo)). Both interventions will be delivered over a 12-month period. Participants’ anthropometric measures (body weight, BMI, waist circumference, percentage body fat); indicators of activity (levels of physical activity and sedentary behaviour) and well-being will be measured at three time points: baseline, 6 and 12 months. The researcher collecting outcome measures will be blind to study group allocation.<p></p> Conclusions: The data from this study will generate pilot data on the acceptability of randomisation, attrition rates and the estimates of patient-centred outcomes of TAKE 5, which will help inform future research and the development of a full-scale randomised clinical trial

Correlates of objectively measured sedentary time in adults with intellectual disabilities

Sedentary behaviour is an independent risk factor for adverse health conditions. Adults with intellectual disabilities spend a high proportion of their day engaged in sedentary behaviour, however, there is limited evidence on potential correlates of objectively measured sedentary behaviour in this population group. In Glasgow, UK from July to September 2017, a secondary analysis of pooled baseline accelerometer data from two randomised controlled trials of lifestyle behaviour change programmes was conducted. Backwards linear regression was used to investigate the associations between demographic, biological, and environmental correlates and objective measure of sedentary behaviour (percentage of time spent sedentary). One-hundred and forty-three participants provided valid accelerometer data. Mean percentage time spent sedentary (adjusted for wear time) was 72.9% [Standard Deviation (SD) = 8.7] per day. In the final model, physical and mental health problems were significantly (p < 0.05) associated with increased percentage time spent sedentary. This is the first study to provide evidence on multi-level, demographic, biological, and environmental correlates of objectively measured sedentary behaviour in adults with intellectual disabilities. To inform the development of interventions to modify sedentary behaviours in adults with intellectual disabilities, further research is required including a wide range of socio-ecological correlates

Patterns of objectively measured sedentary behaviour in adults with intellectual disabilities

The purpose of this study was to investigate the patterns of objectively measured sedentary behaviour in adults with intellectual disabilities. Baseline accelerometer data were pooled from two randomized controlled trials of lifestyle behaviour change programmes for adults with intellectual disabilities. Patterns of sedentary behaviours were computed including total volume, number, and duration of bouts and breaks. Participants spent &gt;70% of the day sedentary (8 hr), which was generally accumulated in short sedentary bouts (&lt;10 min). Participants were engaged in significantly more sedentary time during the morning, although differences between time of day were small (mean bout duration range: 19.8-22.3 min). The findings add valuable insight into the patterns of sedentary behaviours among adults with intellectual disabilities. Further research investigating the patterns and context of sedentary behaviour is required to develop targeted interventions to reduce total sedentary time in adults with intellectual disabilities

Cultural adaptation of self-management of type 2 diabetes in Saudi Arabia (qualitative study)

Background: Saudi Arabia is continuously working on developing its health care system, however with the high prevalence of type 2 diabetes and comorbidities, such as cardiovascular diseases, self-management education programmes are essential. As part of a planned series of studies to develop a culturally sensitive type 2 diabetes self-management programme, this study explores the need versus barriers and facilitators relevant to implementing a national programme for type 2 diabetes self-management education within the community and health care system in Saudi Arabia. Methods: A qualitative methodology was used to explore the views of a multidisciplinary group of diabetes health professionals and adult patients with type 2 diabetes. The views of nine health professionals working at a specialised diabetes care centre were gathered at two focus groups (four and five) that included doctors, nutritionists, health educators and nurses. Individual interviews with 12 patients with type 2 diabetes (six females and six males) attending the centre were also carried out. Recurring themes through the translated transcripts were studied and treated by the research group under pre-set protocols. Results: Focus groups with health professionals revealed three main themes. 1. Resources: availability of resources and how they impacted on performance and patients’ care; 2.Familiarity with self-management education programmes: educating patients and raising awareness among them; and 3. Lifestyle: patients’ lifestyle and how it could affect their compliance with self-management programmes. Interviews with patients also revealed three main themes. 1. Habits: post diagnosis changes in patients’ attitudes and behaviours towards diet and physical activity; 2. Health education: awareness of managing type 2 diabetes through health centre advice or self-education; and 3. Culture and society: a lack of cultural or social support created by some social practices or conventions. Conclusion: The findings from this study highlight a gap in type 2 diabetes care system that can be breached through the development of a Saudi specific self-management programme for type 2 diabetes. The identified barriers and facilitators can be used for adapting a self-management programme to the Saudi context. However, initial training is needed for local health professionals to understand the mechanisms of self-management programmes. Such programmes will need to infiltrate to the society, and the patients’ families, in particular to tackle the rising prevalence of type 2 diabetes in Saudi Arabia and provide a friendlier, more supportive environment for the current patients to self-manage their diabetes

Individual, interpersonal, and environmental correlates of sedentary behaviours in adults with intellectual disabilities

Background: Sedentary behaviours have adverse health outcomes and adults with intellectual disabilities are at a higher risk of unhealthy lifestyle behaviours. The lack of knowledge relating to sedentary behaviours in adults with intellectual disabilities has impeded the development of effective interventions. This study aimed to investigate individual, interpersonal and environmental correlates that are associated with sedentary behaviours in adults with intellectual disabilities. Method: A secondary analysis of data from The UK Household Longitudinal Study (Understanding Society; collected 2011–2013) was conducted. Twenty-two predictor variables were included in a stepwise logistic regression, with TV hours during weekdays (≤3 and &gt;3 h/day) used as a proxy for sedentary behaviours. A sample of 266 adults, with mean age of 37.9 and range from 18 to 49 years old, with intellectual disabilities were identified. Because 63.9% were female, 62.4% had children and 28.2% were employed, the sample is likely to be most representative of more able adults with intellectual disabilities. Results: A significant interaction term between having children and neighbourhood status was found in the initial model so separate models for good and poor-quality neighbourhoods are reported. Having children only had a significant effect to lower the odds of high TV time among participants living in good quality neighbourhoods (OR 0.10, 95% CI 0.03, 0.25). However, for people living in poor quality neighbourhoods it was better quality leisure services that was associated with lower odds of high TV time (OR 0.48, 95% CI 0.23, 0.90). Being employed only significantly reduced the odds of high TV time in the good quality neighbourhood model (OR 0.35, 95% CI 0.12, 0.78). These effects highlight the importance of environmental effects on lifestyle behaviours of adults with intellectual disabilities. Conclusions: Future research should aim to expand our understanding of environmental effects on the sedentary behaviours and other lifestyle behaviours of adults with intellectual disabilities

"She is more about my illness than me": a qualitative study exploring social support in individuals with experiences of psychosis

Experiences of psychosis may increase isolation and stigma, increasing negative perceptions of oneself. Social networks can be a source of support and strain in dealing with these difficulties. This research explored how individuals with experiences of psychosis make sense of their social relationships. Interpretative Phenomenological Analysis guided the design and conduct of semi-structured interviews with seven Scottish mental health service-users with lived experience of psychosis, exploring positive and negative aspects of relationships and how they influenced personal recovery. Interviews were audio-recorded, transcribed and coded for subordinate and superordinate themes. The superordinate theme “She is more about my illness than me” highlighted normalisation of participants’ illness identity through family and support staff dominating social networks; their primary orientation being towards illness management. Subordinate themes; “without the service I wouldn’t know what to do”, “They wouldn’t talk, they will sort of control me in a way” and “She doesn’t see me as normal either with me getting help” evidenced benefits and tensions associated with these relationships. The composition and nature of social networks can prevent individuals with experiences of psychosis from exploring identities unrelated to illness. Further research must identify ways to empower individuals and promote connectedness independently from illness management

Correlates of type 2 diabetes and glycaemic control in adults in Saudi Arabia a secondary data analysis of the Saudi health interview survey

BACKGROUND:There is evidence that type 2 diabetes self-management programmes may have a positive impact on health outcomes of adults living in Gulf countries. However, none of the programmes evaluated were developed using evidence about the specific needs of adults with Type 2 diabetes living in the Gulf countries. This study is part of a wider programme of research, which uses a cultural adaptation framework to generate information on how to tailor type 2 diabetes self-management to the Saudi context. METHODS:Secondary data analysis of the Saudi Health Interview Survey (SHIS) (N = 10,821) was conducted. Bivariate and multivariate logistic regression modelling assessed factors associated with type 2 diabetes and its control / self-management including sociodemographic factors (e.g. age, gender), lifestyle (e.g. diet, physical activity), and health seeking behaviours (e.g. chronic illnesses, health services). RESULTS:7% (N = 808) of all participants had type 2 diabetes (59% male), however it represents 35% at or above 55 years. In multivariate analysis at older age, being overweight or obese, male, having hypertension, and reporting a reduction in health status in the 12 months prior to questionnaire completion, were significantly associated with having type 2 diabetes. Participants who reported walking for more than 10 min per day were less likely to report type 2 diabetes. Unexpectedly there was a significant association between type 2 diabetes and lower frequency of fast food intake, while increased fruit and vegetable intake was associated with poor glycaemic control. CONCLUSIONS:Being overweight and/or hypertensive are concomitant with type 2 diabetes in Saudi Arabia. Any self-management programmes for type 2 diabetes patients with either of these conditions should be tailored accordingly. Walking behaviours should be prioritised in Saudi self-management programmes. Prediabetes management programmes may be of special importance to the Saudi community

Systematic review: cultural adaptation and feasibility of screening for autism in non-English speaking countries

Aim: To explore the feasibility of screening for Autism spectrum disorder in Non-English-Speaking Countries, the cultural influences and the nurses' role in the screening process.Background: The prevalence Autism spectrum disorder (ASD) is rising worldwide, along with an increase in support for early intervention to improve outcomes. Increasingly, researchers investigated screening for autism in different health care settings to facilitate early detection for ASD. However, little is known about screening autism in non-English speaking countries, impact of culture and the nurse's role in the screening process.Design: Systematic Review Data source: Psych INFO, MEDLINE, CINAHL, EMBASE, ERIC databases and hand search were conducted from 1990 to March 2014.Review methods:PRISMA statement was used as a method to guide the discussion this review. Result: Five studies were identified from different geographical regions. In all studies children were screened with an adapted version of the Modified Checklist for Autism (M-CHAT) in different clinical settings of non-English speaking countries. Further investigation is required to validate the use of these instrumentinstruments within their general population. Nurses could be trained to undertake for the screening procedure.Conclusions: Screening for Autism spectrum disorder is challenging and requires knowledge, skills, as well as rigorous screening instrumentinstruments that are adapted to a specific nation`s culture. Although screening with the adapted Modified Checklist for Autism is viable in some healthcare settings of non-English speaking countries, using it in primary settings would necessitate further exploration. With proper training, nurses could screen children for Autism spectrum disorder