An exploration of lifestyle/obesity programmes for adults with intellectual disabilities through a realist lens: Impact of a ‘context, mechanism and outcome’ evaluation

Abstract

Background Obesity is higher in people with intellectual disabilities. Aims There are two aims of this explorative paper. Firstly, using a realist lens, to go beyond ‘what works’ and examine the ‘context, mechanisms and outcomes’ (CMO) of lifestyle/obesity programmes for this population. Second, using a logic model framework to inform how these programmes could be implemented within practice. Method We explored six‐review papers and the individual lifestyle/obesity programmes that these papers reviewed using the CMO framework. Results There were few theoretically underpinned, multi‐component programmes that were effective in the short to long‐term and many failed to explore the ‘context and mechanisms’. We developed a logic model and engaged in two co‐production workshops to refine this model. Discussion Using a realist approach, programmes need to be underpinned by both individual and systems change theories, be multi‐component, have a closer understanding of the interplay of the ‘context and mechanisms’, and co‐designed using a logic model framework.

Improving access to primary care and annual health checks for people who have a learning disability: a multistakeholder qualitative study

“…A care coordinator or learning disability nurse may be required, for example, to support hospital admission, so people with learning disabilities do not get lost to follow-up. In accordance with previous research on preventative healthcare, 23 bridging agencies and providers onwards from primary care requires a proactive organisational-level approach.…”

“…Other barriers in primary care for people with learning disabilities, include fear, carer unawareness of health problems 22 and lack of evidence-based lifestyle interventions (eg, obesity prevention). 23 People with learning disabilities may lack assertiveness, communication skills and carers to support primary care attendance, and have difficulties self-managing health needs. 17 22 24 25 In the USA, adults with learning disabilities living unsupported had more emergency hospital visits compared with other residency types.…”

Supporting active engagement of adults with intellectual disabilities in lifestyle modification interventions: a realist evidence synthesis of what works, for whom, in what context and why

“…One realist synthesis has previously explored lifestyle interventions relating to obesity among adults with intellectual disabilities, with a focus on physical activity and diet (Taggart et al 2021). However, the synthesis included studies identified from reference lists of six review articles, and only included 14 studies, which all reported on intervention effectiveness (Taggart et al 2021). Failure to incorporate broader qualitative and mixed-methods literature potentially reduced understanding of complex CMOCs.…”

“…However, the synthesis included studies identified from reference lists of six review articles, and only included 14 studies, which all reported on intervention effectiveness (Taggart et al . 2021). Failure to incorporate broader qualitative and mixed‐methods literature potentially reduced understanding of complex CMOCs.…”

Barriers and facilitators of physical activity in adolescents with intellectual disabilities: An analysis informed by the COM‐B model

“…In addition, they enable researchers to clearly replicate and evaluate their utility in changing behaviour (Hackman & Knowlden, 2014 ). Complex interventions are strengthened through utilisation of both individual and system changes theories, and by working in co‐production with key stakeholders, to develop and refine such programmes (Moore et al, 2019 ; Taggart et al, 2021 ). Historically, a noted limitation within health behaviour research, is that interventions often do not explicitly state the application of a theoretical framework guiding development (Michie et al, 2009 ).…”