de Jong, Johan

Steenbergen, Rianne

van der Schans, Cees

van Wijck, R.

Waninge, Aly

AbstractBackground: Healthcare organizations supporting individuals with Intellectual Disabilities (ID) carry out a range of interventions to support and improve a healthy lifestyle. However, it is difficult to implement an active and healthy lifestyle into daily support. The presence of numerous intervention components, multiple levels of influence, and the explicit use of theory are factors that are considered to be essential for implementation in practice. A comprehensive written lifestyle policy provides for sustainability of a lifestyle approach. It is unknown to what extent these crucial factors for successful implementation are taken into consideration by healthcare organizations supporting this population. Aim: To analyze the intervention components, levels of influence, explicit use of theory, and conditions for sustainability of currently used lifestyle interventions within lifestyle approaches aiming at physical activity and nutrition in healthcare organizations supporting people with ID.Methods: In this descriptive multiple case study of nine healthcare organizations, qualitative data of the lifestyle approaches with accompanying interventions and their components were compiled with a newly developed online inventory form. Results: From nine healthcare organizations, 59 interventions were included of which 31% aimed to improve physical activity, 10% nutrition, and 59% a combination of both. Most (49%) interventions aimed at the educational component and less at daily (19%) and generic activities (16%) and the evaluation component (16%). Most interventions targeted individuals with ID and the professionals whereas social levels were underrepresented. Although 52% of the interventions were structurally embedded, only ten out of the 59 interventions were theory-driven. Conclusion: Healthcare organizations could improve their lifestyle approaches by using an explicit theoretical basis by expanding the current focus of the interventions that primarily concentrate on their clients and professionals towards also targeting the social and external environment as well as the introduction of a written lifestyle policy. This policy should encompass all interventions and should be the responsibility of those in the organization working with individuals with ID. In conclusion, comprehensive, integrated, and theory-driven approaches at multiple levels should be promoted. To analyze the intervention components, levels of influence, explicit use of theory, and conditions for sustainability of currently used lifestyle interventions within lifestyle approaches aiming at physical activity and nutrition in healthcare organizations supporting people with Intellectual Disabilities (ID)

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Aim To analyze the intervention components, levels of influence, explicit use of theory, and conditions for sustainability of currently used lifestyle interventions within lifestyle approaches aiming at physical activity and nutrition in healthcare organizations supporting people with Intellectual Disabilities (ID). Conclusion Comprehensive, integrated, and theory-driven approaches at multiple levels should be promoted in healthcare organizations for people with ID.  Background Healthcare organizations carry out a range of interventions to support and improve a healthy lifestyle.   However, it is difficult to implement and maintain active and healthy lifestyle into daily support.   It is unknown to what extent factors for implementation are taken into consideration by healthcare organizations.              Results Nine healthcare organizations, 59 interventions  • Aims (improve); 31% physical activity, 10% nutrition, 59% a combination of both.   • Aimed at; 49% educational component, 19% daily activities, 16% generic activities, 16% evaluation component  • Target groups; 38%  individuals with ID, 37% professionals, 25% social levels  • Structurally embedded;  52%  • Theory-driven: 17%  • Lifestyle policy; 44% clear vision, 67% policy on lifestyle, 67% employees , 56% individual lifestyle-plans  • Funding; between 33% and 100% funded by  own organizations, Methods Design: descriptive multiple case study  Research units:  9 healthcare organizations  Data collection: newly developed online inventory form (qualitative data).  Data procedure: analysis at four essential factors for implementation in practice: • Multiple intervention components1,2 • Multiple levels of influence3,1,2,4 • Explicit use of theory5,2,4 • Comprehensive written lifestyle policy3,6   References 1.Sallis, J. F., Cervero, R. B., Ascher, W., Henderson, K. A., Kraft, M. K., & Kerr, J. (2006). An ecological approach to creating active living communities. Annual Review of Public Health, 27, 297-322. doi:10.1146/annurev.publhealth.27.021405.102100. 2.Bartholomew L. K., Parcel G. S., Kok G., Gottlieb N. H. & Fernández M. E. (2011) Planning Health Promotion Programs; An Intervention Mapping Approach, Trans. Jossey-Bass, San Francisco, California.. 3. Glasgow RE, Vogt TM, Boles SM, (1999), Evaluating the Public Health Impact of Health Promotion Interventions: The RE-AIM Framework. American Joumal of Public Health. September 1999, Vol. 89, No. 9. 4. Naaldenberg, J., Kuijken, N., van Dooren, K., & de Valk, H. V. S. L. (2013). Topics, methods and challenges in health promotion for people with intellectual disabilities: A structured review of literature. Research in Developmental Disabilities, 34(12), 4534–4545.. 5. Gardner B, Whittington C, McAteer J, Eccles MP, Michie S: Using theory to synthesise evidence from behaviour change interventions: the example of audit and feedback. Soc Sci Med 2010, 70:1618–1625.. 6. Goodman RM, Steckler A (1989): A model for the institutionalization of health promotion programs. Fam Community Health 11:63-78.    Lifestyle approaches for people with intellectual disabilities: A systematic multiple case analysis   Steenbergen H.A1,5, Van der Schans C.P. 1,2,5, Van Wijck R. 4, De Jong J. 3, Waninge A.1 1. Hanze University of Applied Sciences Groningen, Groningen, the Netherlands 2. Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands 3. Hanze University of Applied Sciences Groningen, School of Sport Studies, Groningen, the Netherlands. 4. Center of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands 5. Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands Contact Details  Rianne Steenbergen h.a.steenbergen@pl.hanze.nl Healthy Ageing org Lifestyle policy physical activity nutrition both physical activity and nutrition Vision Policy employees plans education daily living additional activities inventory / evaluation education daily living additional activities inventory / evaluation education daily living additional activities inventory / evaluation         i p s i p s i p s i p s i p s i p s i p s i p s i p s i p s i p s i p s I Yes yes yes                                                                           II Yes yes   yes                                                                         III yes yes yes yes                                                                         IV     yes yes                                                                         V     yes                                                                           VI                                                                                 VII yes yes yes yes                                                                         VIII   yes yes                                                                           IX   yes yes yes                                                                          Table 1. The lifestyle policy, the currently used components targeting the individual, professional, and social level, horizontal, within each healthcare  organization, vertical. ( i = individuals ID, p = professional, s = social). The gray colored cells represent the presence of a vision and policy on lifestyle, the presence of employees responsible for the theme lifestyle, and the presence of individual lifestyle plans, monitoring of adherence,, as well as the presence of the components per level within the healthcare organization (to read by row). The organization with the most components is listed at the top; we listed the organization with the fewest components at the bottom. The second and third row depict the number of interventions, combined  strategies, and separate parts of interventions per healthcare organization.   

Lifestyle approaches for people with intellectual disabilities:a systematic multiple case analysis

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Lifestyle approaches for people with intellectual disabilities:a systematic multiple case analysis

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