UTHealth School of Public Health, 5323 Harry Hines Blvd., Dallas, TX 75390-9066, USA.
Baylor Institute for Rehabilitation, 909 N. Washington Ave. Ste. 232, Dallas, TX 75246, USA.
Disabil Health J. 2018 Apr;11(2):315-323. doi: 10.1016/j.dhjo.2017.10.008. Epub 2017 Oct 27.
People with impaired mobility (IM) disabilities have a higher prevalence of obesity and obesity-related chronic conditions; however, lifestyle interventions that address the unique needs of people with IM are lacking.
This paper describes an adapted evidence-based lifestyle intervention developed through community-based participatory research (CBPR).
Individuals with IM, health professionals, disability group representatives, and researchers formed an advisory board to guide the process of thoroughly adapting the Diabetes Prevention Program Group Lifestyle Balance (DPP GLB) intervention after a successful pilot in people with IM. The process involved two phases: 1) planned adaptations to DPP GLB content and delivery, and 2) responsive adaptations to address issues that emerged during intervention delivery.
Planned adaptations included combining in-person sessions with conference calls, providing arm-based activity trackers, and adding content on adaptive cooking, adaptive physical activity, injury prevention, unique health considerations, self-advocacy, and caregiver support. During the intervention, participants encountered numerous barriers, including health and mental health issues, transportation, caregivers, employment, adjusting to disability, and functional limitations. We addressed barriers with responsive adaptations, such as supporting electronic self-monitoring, offering make up sessions, and adding content and activities on goal setting, problem solving, planning, peer support, reflection, and motivation.
Given the lack of evidence on lifestyle change in people with disabilities, it is critical to involve the community in intervention planning and respond to real-time barriers as participants engage in change. A randomized controlled trial (RCT) is underway to examine the usability, feasibility, and preliminary effectiveness of the adapted intervention.
行动不便（IM）残疾人肥胖和肥胖相关慢性疾病的患病率更高；然而，针对 IM 人群的独特需求的生活方式干预措施却缺乏。
本文描述了一种通过社区参与性研究（CBPR）开发的适应性循证生活方式干预措施。
行动不便者、健康专业人员、残疾群体代表和研究人员组成了一个顾问委员会，在对行动不便者进行成功的试点后，指导彻底适应糖尿病预防计划小组生活方式平衡（DPP GLB）干预的过程。该过程涉及两个阶段：1）对 DPP GLB 内容和交付方式进行计划适应性调整，2）对在干预实施过程中出现的问题进行响应性适应性调整。
计划的适应性调整包括将面对面会议与电话会议相结合，提供臂带式活动追踪器，并增加关于适应性烹饪、适应性体育活动、伤害预防、独特的健康考虑因素、自我倡导和照顾者支持的内容。在干预过程中，参与者遇到了许多障碍，包括健康和心理健康问题、交通、照顾者、就业、适应残疾和功能限制。我们通过响应性调整来解决这些障碍，例如支持电子自我监测、提供补课、增加目标设定、解决问题、计划、同伴支持、反思和动机方面的内容和活动。
鉴于残疾人群中缺乏生活方式改变的证据，让社区参与干预计划并在参与者参与改变时及时应对实时障碍至关重要。正在进行一项随机对照试验（RCT），以检验适应性干预措施的可用性、可行性和初步效果。
