title: Promoting a healthy diet and physical activity in adults with intellectual disabilities living in community residences: design and evaluation of a cluster-randomized intervention.
abstract: BACKGROUND
  Many adults with intellectual disabilities have poor dietary habits, low physical activity and weight disturbances. This study protocol describes the design and evaluation of a health intervention aiming to improve diet and physical activity in this target group. In Sweden, adults with intellectual disabilities often live in community residences where the staff has insufficient education regarding the special health needs of residents. No published lifestyle interventions have simultaneously targeted both residents and staff.
  
  
  METHODS
  The intervention is designed to suit the ordinary work routines of community residences. It is based on social cognitive theory and takes 12-15 months to complete. The intervention includes three components: 1) Ten health education sessions for residents in their homes; 2) the appointment of a health ambassador among the staff in each residence and formation of a network; and 3) a study circle for staff in each residence. The intervention is implemented by consultation with managers, training of health educators, and coaching of health ambassadors. Fidelity is assessed based on the participation of residents and staff in the intervention activities. The study design is a cluster-randomised trial with physical activity as primary outcome objectively assessed by pedometry. Secondary outcomes are dietary quality assessed by digital photography, measured weight, height and waist circumference, and quality of life assessed by a quality of life scale. Intermediate outcomes are changes in work routines in the residences assessed by a questionnaire to managers. Adults with mild to moderate intellectual disabilities living in community residences in Stockholm County are eligible for inclusion. Multilevel analysis is used to evaluate effects on primary and secondary outcomes. The impact of the intervention on work routines in community residences is analysed by ordinal regression analysis. Barriers and facilitators of implementation are identified in an explorative qualitative study through observations and semi-structured interviews.
  
  
  CONCLUSIONS
  Despite several challenges it is our hope that the results from this intervention will lead to new and improved health promotion programs to the benefit of the target group.
  
  
  BACKGROUND
  ISRCTN33749876.
authors.affiliation: Division of Intervention and Implementation Research, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. liselotte.schafer-elinder@ki.se
authors.forename: Liselotte Schäfer
authors.initials: LS
authors.lastname: Elinder
authors.forename: Helena
authors.initials: H
authors.lastname: Bergström
authors.forename: Jan
authors.initials: J
authors.lastname: Hagberg
authors.forename: Ulla
authors.initials: U
authors.lastname: Wihlman
authors.forename: Maria
authors.initials: M
authors.lastname: Hagströmer
mesh_terms: D000328:Adult; D004032:Diet; D015444:Exercise; D005260:Female; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D057187:Independent Living; D008607:Intellectual Disability / Q000503:physiopathology*; D007407:Interviews as Topic; D008297:Male; D011582:Psychological Theory; D012107:Research Design