Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels allé 3, 141 83 Huddinge, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 1497, 171 29 Solna, Sweden.
Res Dev Disabil. 2013 Nov;34(11):3847-57. doi: 10.1016/j.ridd.2013.07.019. Epub 2013 Sep 7.
People with ID have an increased risk for unhealthy diets, physical inactivity and weight disturbances. The aim of the current study was to investigate the effectiveness of a novel and complex intervention to improve diet and physical activity, targeting both caregivers and residents, in community residences for people with ID. A three component intervention based on Social Cognitive Theory was developed, including: (1) appointment of a health ambassador in each community residence attending network meetings, (2) a study circle for caregivers, and (3) a health course for the residents. The intervention lasted for 12-16 months and allowed for some local tailoring. A cluster randomised controlled trial, randomised at residence level, was conducted to evaluate the effects of the intervention. Thirty community residences for people with mild or moderate ID in Stockholm County, Sweden, were included. A total of 130 participants, 74 women and 56 men aged 20-66 years, entered, and 129 participants completed the study. The primary outcome was physical activity, measured by pedometry. Secondary outcomes were BMI, waist circumference, dietary quality measured by digital photography, satisfaction with life assessed with a scale, and work routines assessed with a questionnaire. Outcomes were related to intervention fidelity. A positive intervention effect was found on physical activity, with an average increase of 1608 steps/day among participants in the intervention group (P=0.045). The effect size was 0.29 (Cohen's d). The type of residence was found to be an effect moderator. A positive intervention effect was found as well on work routines, with an average increase of 7.1 percentage points on a self-assessment scale among residences in the intervention group (P=0.016). No significant effects were found on BMI, waist circumference, dietary quality, or satisfaction with life. In conclusion, this innovative intervention was effective in improving physical activity and work routines. It is likely that even greater effects could be achieved by improvements in implementation strategies, leading to higher fidelity.
具有智力障碍的人群饮食不健康、身体活动不足和体重紊乱的风险增加。本研究的目的是调查一种针对社区居住的智力障碍人士的护理人员和居民的新型复杂干预措施对改善饮食和身体活动的效果。该干预措施基于社会认知理论，包括三个部分：（1）在每个社区居住场所任命一名健康大使参加网络会议，（2）为护理人员开设一个学习圈，（3）为居民开设一门健康课程。干预持续 12-16 个月，并允许进行一些地方调整。采用集群随机对照试验，在居住场所层面进行随机分组，以评估干预措施的效果。该研究纳入了瑞典斯德哥尔摩县的 30 个社区居住场所，共 130 名参与者，其中 74 名女性和 56 名男性，年龄在 20-66 岁之间，共有 129 名参与者完成了研究。主要结局指标是身体活动，通过计步器测量。次要结局指标包括 BMI、腰围、通过数字摄影测量的饮食质量、使用量表评估的生活满意度和使用问卷评估的工作常规。这些结果与干预的忠实度有关。干预组参与者的身体活动平均增加了 1608 步/天（P=0.045），干预效果为正。效应大小为 0.29（Cohen's d）。研究发现居住场所的类型是一个效应调节因素。干预组居住场所的工作常规也有积极的干预效果，自我评估量表上的平均得分增加了 7.1 个百分点（P=0.016）。干预对 BMI、腰围、饮食质量或生活满意度没有显著影响。总之，这项创新性的干预措施在提高身体活动和工作常规方面是有效的。通过改进实施策略，提高忠实度，可能会取得更大的效果。
