Development and testing of a school-based multi-component walking intervention for children with intellectual disabilities

Abstract

Background: It is established that people with intellectual disabilities (ID) have an increased risk of poorer health than the general population. This population are more likely to experience obesity, type 2 diabetes, coronary heart disease and premature death. The risks of obesity and associated co-morbidities can be alleviated by meeting the recommended physical activity guidelines. People with ID, and especially children and adolescents with ID are not sufficiently physically active to produce health enhancing benefits. It is well reported that walking is the most natural form of physical activity and the most common type of physical activity among people with ID. Given that children and adolescents with ID spend the majority of their day either travelling to or in school, this setting may provide the best opportunity for sustainable behaviour change in this population.

Aim: The aim of this doctoral thesis was to develop and test a school-based multicomponent walking intervention for children with ID.

Method: There were 5 phases involved in this thesis. Phase 1 involved a systematic review of interventions aimed at increasing physical activity in children and adolescents with ID to synthesise the evidence base. Phase 2 involved conducting focus groups and interviews with children with ID, adolescents with ID, teachers, classroom assistants and principals to identify themes to aid in the development of the intervention. Phase 3 involved co-production of the walking intervention with stakeholders through a series of workshops. Individual and systems change theories were used to form a coherent theoretical underpinning to the intervention. During phase 4, the feasibility trial was conducted to assess the appropriateness and the acceptability of the intervention for this population and setting. Finally, phase 5 involved the process evaluation to determine the acceptability of the intervention from the perspective of the participants.

Results: The results from the systematic review highlighted the dearth of physical activity interventions aimed at increasing physical activity in children and adolescents with ID and the poor quality and design of existing interventions. Four core themes were identified from focus groups (social support, organisational structure, rewards and incentives and reasons for participation/non-participation). These themes were mapped to COM-B (Capability, opportunity, motivation and behaviour) and the socio-ecological model to develop the intervention. The iterative process of workshops allowed stakeholders to tailor the intervention for their school, this involved making changes to walk routes, frequency and duration of walks, pairing of participants and walk diaries. The feasibility trial showed that attrition rate was low (6.7%) and drop outs were within the intervention group. Adherence to the prescribed frequency and duration of walks across the 12-week intervention was acceptable. Compliance to accelerometer wear time was low and declined from baseline to end of intervention. In relation to the effect of the intervention, there were consistent trends for decreases in sedentary behaviour and increases in moderate and vigorous physical activity in the intervention group, whilst the control group showed consistent trends for increases in sedentary behaviour and decreases in light and moderate physical activity. There was a consistent trend for improvement in physical fitness in the children with ID and peer role models with ID intervention group and a decrease in physical fitness in both the children and peer role model control groups. Strengths and difficulties questionnaire (SDQ) scores showed a reduction in total difficulties in both children and peer role model groups in the intervention group and in the control group. Findings from the process evaluation showed the school setting is an appropriate environment for physical activity interventions aimed at this population however challenges exist with logistics, staffing, objective measurement of physical activity and engagement of parents.

Conclusion: The work comprised in this thesis demonstrates that it is feasible to develop and test a school-based walking intervention for children with ID. This work contributes to the evidence base for physical activity interventions in this population and highlights key intervention components, methodological challenges and recommendations to inform future research in this field.

Date of Award	Nov 2018
Original language	English
Sponsors	DEL
Supervisor	Marie Murphy (Supervisor) & Laurence Taggart (Supervisor)