Abstract: Combined lifestyle interventions (CLI) are focused on guiding clients with weight-related health risks into a healthy lifestyle. CLIs are most often delivered through face-to-face sessions with limited use of eHealth technologies. To integrate eHealth into existing CLIs, it is important to identify how behavior change techniques are being used by health professionals in the online and offline treatment of overweight clients. Therefore, we conducted online semi-structured interviews with providers of online and offline lifestyle interventions. Data were analyzed using an inductive thematic approach. Thirty-eight professionals with (n = 23) and without (n = 15) eHealth experience were interviewed. Professionals indicate that goal setting and action planning, providing feedback and monitoring, facilitating social support, and shaping knowledge are of high value to improve physical activity and eating behaviors. These findings suggest that it may be beneficial to use monitoring devices combined with video consultations to provide just-in-time feedback based on the client’s actual performance. In addition, it can be useful to incorporate specific social support functions allowing CLI clients to interact with each other. Lastly, our results indicate that online modules can be used to enhance knowledge about health consequences of unhealthy behavior in clients with weight-related health risks.
DOCUMENT
People with moderate to profound intellectual disabilities (ID) have a higher risk of health problems and, therefore, healthy living is of great importance for them. To achieve this, this group requires support from the people around them such as relatives and direct support professionals (DSPs). However, DSPs do not feel sufficiently equipped to provide this support. The objective of Annelies Overwijk’s research was to determine how to facilitate a healthy lifestyle for people with moderate to profound ID by improving the lifestyle support provided by DSPs. To this end, DSPs’ support needs were first explored after which a training and education program was developed, implemented, and evaluated. In this thesis, DSPs indicated that they need knowledge and skills to provide lifestyle support. One of the skills they can help use to stimulate people with ID is the use of behavioral change techniques. This thesis shows that, although a number of these techniques are used in daily practice, they are not yet consciously utilized to improve lifestyle support. Since the attitude of DSPs to support healthy nutrition is important, a practical questionnaire was also developed to measure this. Based on DSPs’ support needs for encouraging a healthy lifestyle, a training and education program was developed together with them and experts. This program consists of an e-learning and three in-person sessions that can be adapted to the support needs of the DSPs and the team and proved to be promising in an implementation study. The products are free and available on: www.dekrachtengebundeld.nl.
DOCUMENT
Background: Promotion of a healthy lifestyle for people with intellectual disabilities is important; however, the effectiveness of lifestyle change interventions is unclear.Aims: This research will examine the effectiveness of lifestyle change interventions for people with intellectual disabilities.Methods and Procedures: Randomized controlled trials (RCTs) of lifestyle changeinterventions for people with intellectual disabilities were included in a systematicreview and meta-analysis. Data on study and intervention characteristics were extracted, as well as data on outcome measures and results. Internal validity of the selected papers was assessed using the Cochrane Collaboration’s risk bias tool.Outcomes and Results: Eight RCTs were included. Multiple outcome measures were used, whereby outcome measures targeting environmental factors and participation were lacking and personal outcome measures were mostly used by a single study. Risks of bias were found for all studies. Meta-analysisshowed some effectiveness for lifestyle change interventions, and a statistically significant decrease was found for waist circumference.Conclusion and Implications: Some effectiveness was found for lifestyle change interventions for people with intellectual disabilities. However, the effects were only statistically significant for waist circumference, so current lifestyle change interventions may not be optimally tailored
DOCUMENT
Background: Professional caregivers are important in the daily support of lifestyle change for adults with mild intellectual disabilities; however, little is known about which behaviour change techniques (BCTs) are actually used. This study aims to gain insight in their use for lifestyle behaviour change using video observations.Methods: Professional caregivers (N = 14) were observed in daily work supporting adults with mild intellectual disabilities. Videos were analysed using the Coventry Aberdeen London Refined (CALO-RE-NL) taxonomy and BCTs utilised were coded.Results: Twenty one out of 40 BCTs were used by professional caregivers. The BCTs ‘Information about others' approval’, ‘Identification as role model’, ‘Rewards on successful behaviour’, ‘Review behavioural goals’ and ‘Instructions on how to perform the behaviour’ were most employed.Conclusion: Professional caregivers used BCTs to support healthier lifestyle behaviour of adults with mild intellectual disabilities. However, most promising of them as defined previous by professionals were rarely used by professional caregivers.
DOCUMENT
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.
DOCUMENT
BackgroundA healthy lifestyle is indispensable for the prevention of noncommunicable diseases. However, lifestyle medicine is hampered by time constraints and competing priorities of treating physicians. A dedicated lifestyle front office (LFO) in secondary/tertiary care may provide an important contribution to optimize patient-centred lifestyle care and connect to lifestyle initiatives from the community. The LOFIT study aims to gain insight into the (cost-)effectiveness of the LFO.MethodsTwo parallel pragmatic randomized controlled trials will be conducted for (cardio)vascular disorders (i.e. (at risk of) (cardio)vascular disease, diabetes) and musculoskeletal disorders (i.e. osteoarthritis, hip or knee prosthesis). Patients from three outpatient clinics in the Netherlands will be invited to participate in the study. Inclusion criteria are body mass index (BMI) ≥25 (kg/m2) and/or smoking. Participants will be randomly allocated to either the intervention group or a usual care control group. In total, we aim to include 552 patients, 276 in each trial divided over both treatment arms. Patients allocated to the intervention group will participate in a face-to-face motivational interviewing (MI) coaching session with a so-called lifestyle broker. The patient will be supported and guided towards suitable community-based lifestyle initiatives. A network communication platform will be used to communicate between the lifestyle broker, patient, referred community-based lifestyle initiative and/or other relevant stakeholders (e.g. general practitioner). The primary outcome measure is the adapted Fuster-BEWAT, a composite health risk and lifestyle score consisting of resting systolic and diastolic blood pressure, objectively measured physical activity and sitting time, BMI, fruit and vegetable consumption and smoking behaviour. Secondary outcomes include cardiometabolic markers, anthropometrics, health behaviours, psychological factors, patient-reported outcome measures (PROMs), cost-effectiveness measures and a mixed-method process evaluation. Data collection will be conducted at baseline, 3, 6, 9 and 12 months follow-up.DiscussionThis study will gain insight into the (cost-)effectiveness of a novel care model in which patients under treatment in secondary or tertiary care are referred to community-based lifestyle initiatives to change their lifestyle.Trial registrationISRCTN ISRCTN13046877. Registered 21 April 2022.
DOCUMENT
Background: Promotion of a healthy lifestyle for individuals with mild intellectualdisabilities is important. However, the suitability of behaviour change techniques(BCTs) for these individuals is still unclear.Methods: A Delphi study was performed using the Coventry, Aberdeen & LOndon –REfined (CALO‐RE) taxonomy of BCTs (n = 40). Health professionals (professional caregivers, behavioural scientists, health professionals, intellectual disability physicians) participated in an online survey to determine whether BCTs were suitable or unsuitable. Comments from participants were analysed qualitatively.Results: Consensus was reached for 25 BCTs out of 40.The most suitable BCTs were barrier identification (97%), set graded tasks (97%) and reward effort towards behaviour (95%). No significant differences were found for intergroup effects.Conclusion: Regardless of their position and education level, health professionalsreached consensus about the suitability of BCTs for individuals with mild intellectual disabilities. Increased use of these BCTs could result in more effective promotion of a healthy lifestyle.
DOCUMENT
Background: Behaviour change techniques (BCTs) can be employed to support a healthy lifestyle for people with intellectual disabilities. The aim of this study is to determine whether and which BCTs are used by direct support professionals (DSPs) for supporting healthy lifestyle behaviour of people with moderate to profound intellectual disabilities. Method: Direct support professionals (n = 18) were observed in their daily work using audio-visual recordings. To code BCTs, the Coventry Aberdeen London Refined (CALO-RE-NL) taxonomy was employed. Results: Direct support professionals used 33 BCTs out of 42. The most used BCTs were as follows: ‘feedback on performance’, ‘instructions on how to perform the behaviour’, ‘doing together’, ‘rewards on successful behaviour’, ‘reward effort towards behaviour’, ‘DSP changes environment’, ‘graded tasks’, ‘prompt practice’ and ‘model/demonstrate behaviour’. Conclusions: Although a variety of BCTs is used by DSPs in their support of people with moderate to profound intellectual disabilities when facilitating healthy lifestyle behaviour, they rely on nine of them.
DOCUMENT
Aim Direct Support Professionals (DSPs) provide important lifestyle behaviour support for people with intellectual disabilities (ID). They can use behaviour change techniques (BCTs) to do this. We aimed to evaluate which BCTs are used for supporting healthy lifestyle behaviour of people with moderate to profound ID by DSPs. Method 18 DSPs were observed in their daily work with audio-visual recordings. The Coventry Aberdeen London Refined (CALO-RE-NL) taxonomy was used for coding BCTs. Differences in the characteristics of people with ID and DSPs in relation to the used BCTs were evaluated.Results Most of the coded BCTs were used by DSPs (33 BCTs out of 42), but they rely heavily on nine of them. DSPs used ‘feedback on performance’, ‘instructions on how to perform the behaviour’, and ‘doing together’ mostly. No statistical differences were found for the characteristics of people with ID or DSPs for the top nine used BCTs.Conclusion DSPs mostly rely on nine BCTs. Although no statistical differences were found, DSPs use more BCTs for people with more severe ID. DSPs who support people with severe or profound ID are more aware of demonstrating, setting graded tasks and encouraging people with ID to practice healthy lifestyle.
LINK
Abstract Background: Multidimensional frailty, including physical, psychological, and social components, is associated to disability, lower quality of life, increased healthcare utilization, and mortality. In order to prevent or delay frailty, more knowledge of its determinants is necessary; one of these determinants is lifestyle. The aim of this study is to determine the association between lifestyle factors smoking, alcohol use, nutrition, physical activity, and multidimensional frailty. Methods: This cross-sectional study was conducted in two samples comprising in total 45,336 Dutch communitydwelling individuals aged 65 years or older. These samples completed a questionnaire including questions about smoking, alcohol use, physical activity, sociodemographic factors (both samples), and nutrition (one sample). Multidimensional frailty was assessed with the Tilburg Frailty Indicator (TFI). Results: Higher alcohol consumption, physical activity, healthy nutrition, and less smoking were associated with less total, physical, psychological and social frailty after controlling for effects of other lifestyle factors and sociodemographic characteristics of the participants (age, gender, marital status, education, income). Effects of physical activity on total and physical frailty were up to considerable, whereas the effects of other lifestyle factors on frailty were small. Conclusions: The four lifestyle factors were not only associated with physical frailty but also with psychological and social frailty. The different associations of frailty domains with lifestyle factors emphasize the importance of assessing frailty broadly and thus to pay attention to the multidimensional nature of this concept. The findings offer healthcare professionals starting points for interventions with the purpose to prevent or delay the onset of frailty, so communitydwelling older people have the possibility to aging in place accompanied by a good quality of life.
DOCUMENT
