Adults with mild-moderate learning disabilities tend to eat less healthily and engage in lower levels of physical activity and higher levels of sedentary behaviour than adults in the general population which contributes to higher levels of overweight, obesity and underweight in this cohort (Dunkley et al., 2017; Melville et al., 2017). This can be at least in part due to their greater independence in making choices in relation to diet and the activities they participate in (de Winter et al., 2017).
Yet a significant proportion of this group rely on the guidance and support of a carer for day to day activities to some extent and this can also involve shopping, cooking and other pursuits such as recreational physical activity in the local environment (Smyth & Bell, 2006). The support they receive can be crucial, yet carers can struggle between perceived moral dilemmas around enabling a person to make their own choices and providing duty of care to promote their health (Spanos et al., 2013). They may need training to increase their knowledge on healthy eating, cooking, physical activity and reducing sedentary behaviour. Additionally, adults with learning disabilities may need to increase their self-efficacy in trying out novel foods and activities (particularly if they have co-occurring food sensitivities and physical impairments, (Bergstrom, Elinder, & Wihlman, 2014)) and carers may need this to cope effectively with behaviour that may challenge when assisting with health promotion and behaviour change.
Research in progress
For these reasons social cognitive theory (Bandura, 2001) was chosen to underpin health promotion workshops for a group of adults with mild-moderate learning disabilities, and staff training in a social care context. These aim to increase knowledge and positive outcome expectancies of both groups of participants, so they could provide peer support to each other. Teaching will be experiential for adults with learning disabilities as they may struggle with memory and understanding (e.g., Bergstrom et al., 2014; McDermott et al., 2012). We will use role plays to help adults with learning disabilities provide each other with positive emotional support. We plan to create easy read recipes and cooking videos with adults with learning disabilities and physical impairments as a knowledge resource and so they act as role models for their peers and staff to improve self-efficacy for both groups. Staff will also have workshops to explore nuances around informed decision making, exploring the roles of decision complexity, familiarity and working within tight resource constraints (Smyth & Bell, 2006), to support them to persuade clients to engage with these behaviours whilst respecting their right to self-determination. They will also be supported to reflect on their own role in enabling healthier choices within the relationship they have with their clients.
Adults with mild-moderate learning disabilities need support to eat healthily, be more active and reduce sedentary behaviour. A social cognitive theory-based approach to training could be useful with adults with learning disabilities and staff working with them. This work aims to improve knowledge, positive outcome expectancies, engender positive social support and create resources that enable adults with learning disabilities to improve self-efficacy for themselves and staff on cooking healthy dishes.
Bandura, A. (2001). Social cognitive theory: An agentic perspective. Annual Review of Psychology, 52(1), 1-26. doi:10.1146/annurev.psych.52.1.1
Bergstrom, H., Elinder, L. S., & Wihlman, U. (2014). Barriers and facilitators in health education for adults with intellectual disabilities-a qualitative study. Health Education Research, 29(2), 259-271. doi:10.1093/her/cyt111
de Winter, C. F., Bastiaanse, L. P., Hilgenkamp, T. I. M., Evenhuis, H. M., & Echteld, M. A. (2012). Cardiovascular risk factors (diabetes, hypertension, hypercholesterolemia and metabolic syndrome) in older people with intellectual disability: Results of the HA-ID study doi://0-dx.doi.org.wam.city.ac.uk/10.1016/j.ridd.2012.04.010
Dunkley, A. J., Tyrer, F., Gray, L. J., Bhaumik, S., Spong, R., Chudasama, Y., . . . Khunti, K. (2017). Type 2 diabetes and glucose intolerance in a population with intellectual disabilities: The STOP diabetes cross-sectional screening study. Journal of Intellectual Disability Research, 61(7), 668-681. doi:10.1111/jir.12380
McDermott, S., Whitner, W., Thomas-Koger, M., Mann, J. R., Clarkson, J., Barnes, T. L., . . . Meriwether, R. A. (2012). An efficacy trial of 'steps to your health', a health promotion programme for adults with intellectual disability. Health Education Journal, 71(3), 278-290. doi:10.1177/0017896912441240
Melville, C. A., Oppewal, A., Elinder, L. S., Freiberger, E., Guerra-Balic, M., Hilgenkamp, T. I. M., . . . Gine-Garriga, M. (2017). Definitions, measurement and prevalence of sedentary behaviour in adults with intellectual disabilities - A systematic review. Preventive Medicine, 97, 62-71. doi:10.1016/j.ypmed.2016.12.052
Smyth, C. M., & Bell, D. (2006). From biscuits to boyfriends: The ramifications of choice for people with learning disabilities. British Journal of Learning Disabilities, 34(4), 227-236. doi:10.1111/j.1468-3156.2006.00402.x
Spanos, D., Hankey, C. R., Boyle, S., Koshy, P., Macmillan, S., Matthews, L., . . . Melville, C. A. (2013). Carers' perspectives of a weight loss intervention for adults with intellectual disabilities and obesity: A qualitative study. Journal of Intellectual Disability Research, 57(1), 90-102. doi:10.1111/j.1365-2788.2011.01530.x
Kiran Bains, Trainee Health Psychologist, City University
Opening Doors project.
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