School of Health and Related Research, Sheffield University, Sheffield, UK.
Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
Int J Equity Health. 2018 Oct 22;17(1):159. doi: 10.1186/s12939-018-0871-4.
People with intellectual disabilities (ID) may not be able to access and respond to uniformly delivered health interventions. Public bodies have a legal duty to make 'reasonable adjustments' to policies and practices to provide fair access and treatment for people with ID. This study aimed to identify adjustments to the Slimming World weight management programme to improve accessibility and assess acceptability and feasibility for this population.
This user-centred qualitative study was carried out with a steering group of people with ID (n = 4). Barriers and facilitators to using Slimming World were identified through interviews and focus groups with people with ID (n = 54), carers (n = 12) current members with ID (n = 8) and Slimming World group leaders (n = 11). Adjustments were made and their feasibility and acceptability were explored in a before-and-after mixed methods study where people with ID attended Slimming World for eight weeks. Participants (n = 9), carers (n = 7) and Slimming World group leaders (n = 4) were interviewed to explore their experiences of the adjustments. Participants were weighed at baseline then each week.
Four key adjustments were identified and addressed by Slimming World who developed prototype Easy Read materials and a letter for carers. Six of the nine participants attended Slimming World for eight weeks and lost weight (1.4 kg to 6.6 kg, reduction in BMI between 0.5 and 1.7 kg/m2), indicating that the adjustments were feasible and acceptable. Two participants dropped out because they felt uncomfortable in a mainstream group and another left because they lacked control over food choice in their residential setting.
This user-centred approach identified reasonable adjustments that were feasible to implement. In a small uncontrolled feasibility study, people with ID were positive about the adjustments and lost weight. However, issues in the wider context of people's lives, such as obesogenic environments and concerns about joining mainstream groups, limited the acceptability of Slimming World even with these adjustments. These findings have important implications for policy and suggest that environmental and organisational level interventions are needed alongside those targeting individual behaviour to tackle the obesogenic environment in which many people with ID spend their time, in order to reduce inequalities associated with the consequences of obesity.
智力障碍人士（ID）可能无法获得和响应统一提供的健康干预措施。公共机构有法律义务对政策和实践进行“合理调整”，为 ID 人士提供公平的机会和待遇。本研究旨在确定对 Slimming World 体重管理计划进行调整，以提高可及性，并评估其对该人群的可接受性和可行性。
本项以用户为中心的定性研究与一个 ID 人士指导小组（n=4）合作开展。通过对 ID 人士（n=54）、照顾者（n=12）、当前 ID 成员（n=8）和 Slimming World 小组领导（n=11）进行访谈和焦点小组讨论，确定使用 Slimming World 的障碍和促进因素。在一项前后混合方法研究中对调整措施进行了调整，并在 8 周内对 ID 人士参加 Slimming World 的情况进行了可行性和可接受性探索。研究人员对 9 名参与者、7 名照顾者和 4 名 Slimming World 小组领导进行了访谈，以探讨他们对调整措施的体验。参与者在基线时称重，然后每周称重一次。
Slimming World 确定并解决了四个关键调整，他们为此开发了简易读物材料和给照顾者的一封信。9 名参与者中有 6 名参加了 Slimming World 8 周，体重减轻（1.4 公斤至 6.6 公斤，BMI 降低 0.5 至 1.7 公斤/平方米），表明调整措施是可行和可接受的。有两名参与者因在主流群体中感到不适而退出，另一名参与者因在居住环境中无法控制食物选择而离开。
本项以用户为中心的方法确定了可行的合理调整。在一项小型非控制可行性研究中，ID 人士对调整措施持积极态度并减轻了体重。然而，在更广泛的背景下，如肥胖环境和对加入主流群体的担忧，这些调整措施限制了 Slimming World 的可接受性。这些发现对政策具有重要意义，并表明需要针对个体行为以外的环境和组织层面的干预措施，以解决 ID 人士所处的肥胖环境，从而减少与肥胖相关的不平等。
