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3To 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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Background: Health care organizations supporting individuals with intellectual disabilities (IDs) 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 health care 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 health care organizations supporting people with ID.
Methods: In this descriptive multiple case study of 9 health care organizations, qualitative data of the lifestyle approaches with accompanying interventions and their components were compiled with a newly developed online inventory form.
Results: From 9 health care 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 10 of the 59 interventions were theory-driven.
Conclusion: Health care 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 toward 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.
DOCUMENT
BACKGROUND: Health care organizations supporting individuals with intellectual disabilities (IDs) 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 health care 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 health care organizations supporting people with ID.
METHODS: In this descriptive multiple case study of 9 health care organizations, qualitative data of the lifestyle approaches with accompanying interventions and their components were compiled with a newly developed online inventory form.
RESULTS: From 9 health care 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 10 of the 59 interventions were theory-driven.
CONCLUSION: Health care 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 toward 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.
DOCUMENT
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
Lifestyle management is the cornerstone of both primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) and the importance of lifestyle management is emphasised by all major guidelines. Despite this, actual implementation of lifestyle management is poor. Lifestyle modification includes smoking cessation, weight loss, dietary change, increasing physical inactivity, and stress management. This review summarises evidence-based opportunities and challenges for healthcare professionals to promote healthy lifestyles at an individual level for the prevention of ASCVD.
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Background: Cancer survivors face various short- and long-term consequences of their disease and treatment, which may negatively impact their quality of life. Healthy lifestyle changes can have a positive effect on these consequences but current counselling does not sufficiently meet their needs. This study explores the experiences and needs of cancer survivors regarding lifestyle counselling. Methods: A qualitative design comprising semi-structured interviews was used. We conducted 18 interviews with Dutch adult cancer survivors with various types of cancer, including people with limited health literacy. The data were analysed using reflexive thematic analysis. This study is part of the GLINK project, which aims to develop and evaluate an integrated lifestyle intervention for cancer survivors. Results: Dutch cancer survivors experienced current lifestyle counselling as fragmented and not structurally embedded, which requires them to be proactive in seeking support. Participants expressed a desire for stronger integration of lifestyle counselling within oncological (after)care, with clear information on available options and improved accessibility in terms of location, contact with professionals, and referral pathways. They reported a need for personalised, flexible support from professionals specialized in oncology, focusing on individual needs to ensure that patients feel seen and heard. Conclusions: This study provides insights into how lifestyle counselling for cancer survivors can be improved from the patients’ perspective. These findings can enhance the initiation of lifestyle conversations and referral processes and serve as a foundation for developing an integrated lifestyle intervention for cancer survivors.
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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.
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Maintaining a proper lifestyle is important for chronic kidney disease patients. This study investigates whether an online lifestyle diary supplementary to the support received in the outpatient clinic can help patients to get to such a lifestyle. A total of 33 participants expressed their willingness to participate in the study. However, 11 of them did not start actually. The remaining 22 participants used an online lifestyle diary. They received limited support regarding practical issues and feedback on lifestyle issues only when they asked explicitly. Questionnaires were used to determine the change in self-efficacy and self-management with regard to lifestyle after four months. Only five participants used the website successfully. They had already developed a good self-efficacy and self-management. A disappointingly large group hardly used the website. The effectiveness of using the website regarding self-efficacy and self-management was therefore limited in this particular situation. Insights of the outpatient clinic’s caregivers and information from the participants partly clarify the factors involved in lifestyle management and coaching. Motivation of the participant appears to be an important factor as well as setting realistic goals. If a patient were to receive feedback on lifestyle issues regularly while working with the website, more satisfactory results might be obtained. Finally, the participant’s (computer) skills and practical support played an important role. Taking these factors into account, the already comprehensive task of lifestyle coaching would be extended with specific new tasks, requiring the necessary skills and motivation of the caregiver.
MULTIFILE
Abstract Background: Cardiovascular disease is the leading cause of the estimated 11–25 years reduced life expectancy for persons with serious mental illness (SMI). This excess cardiovascular mortality is primarily attributable to obesity, diabetes, hypertension, and dyslipidaemia. Obesity is associated with a sedentary lifestyle, limited physical activity and an unhealthy diet. Lifestyle interventions for persons with SMI seem promising in reducing weight and cardiovascular risk. The aim of this study is to evaluate the effectiveness and cost-effectiveness of a lifestyle intervention among persons with SMI in an outpatient treatment setting. Methods: The Serious Mental Illness Lifestyle Evaluation (SMILE) study is a cluster-randomized controlled trial including an economic evaluation in approximately 18 Flexible Assertive Community Treatment (FACT) teams in the Netherlands. The intervention aims at a healthy diet and increased physical activity. Randomisation takes place at the level of participating FACT-teams. We aim to include 260 outpatients with SMI and a body mass index of 27 or higher who will either receive the lifestyle intervention or usual care. The intervention will last 12 months and consists of weekly 2-h group meetings delivered over the first 6 months. The next 6 months will include monthly group meetings, supplemented with regular individual contacts. Primary outcome is weight loss. Secondary outcomes are metabolic parameters (waist circumference, lipids, blood pressure, glucose), quality of life and health related self-efficacy. Costs will be measured from a societal perspective and include costs of the lifestyle program, health care utilization, medication and lost productivity. Measurements will be performed at baseline and 3, 6 and 12 months. Discussion: The SMILE intervention for persons with SMI will provide important information on the effectiveness, cost-effectiveness, feasibility and delivery of a group-based lifestyle intervention in a Dutch outpatient treatment setting. Trial registration: Dutch Trial Registration NL6660, registration date: 16 November 2017.
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