Determinants of dietary behaviour in wheelchair users with spinal cord injury or lower limb amputation: Perspectives of rehabilitation professionals and wheelchair users

Health providers often focus on secondary conditions and spend less time prioritising overweight/obesity care. Informal caregivers are well positioned to facilitate health-promoting behaviours of healthy eating and physical activity among community-dwelling care recipients with spinal cord injury (SCI) for prevention and management of overweight/obesity. Literature has typically focused on caregiver adjustment post-injury and burden related to their roles in secondary condition care. The novel objective of this study was to describe informal caregivers' perspectives of their roles in facilitating health-promoting weight management behaviours, healthy eating and physical activity, for care recipients with SCI. This was a qualitative study that used semi-structured interviews with informal caregivers for data collection in 2019. Braun & Clarke's established thematic phases were used for analysis.Participants included informal caregivers of individuals with SCI living in the community (n = 24). Caregivers identified eight themes to describe their role in facilitating weight management for care recipients. Themes included: (1) meal planning/shopping, (2) meal preparation/cooking, (3) using portion control, (4) serving/feeding, (5) helping the care recipient with physical activity and/or leisure activities, (6) mutually participating in weight management activities, (7) providing motivation and encouragement and ( 8) being an information liaison. In summary, informal caregivers have an intimate understanding of care recipients' needs and have insights on obstacles and enablers to health-promoting behaviours, making their involvement in facilitating weight management in individuals with SCI vital. Caregivers self-identified several significant roles for promoting weight management. This is especially valuable for conditions such as overweight/obesity for which prevention and treatment involve health-promoting behaviours that need consistent attention in the community setting. It is important to ensure that informal caregivers and care recipients have the information required in order to facilitate healthy eating and physical activity in persons with SCI and have opportunities for mutual dyadic participation when both partners are interested. e1586 | LAVELA Et AL.

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“…This is significant because Holla et al. (2020) reported that boredom had a negative influence on dietary behaviour in wheelchair users with SCI.…”

Section: Discussionmentioning

confidence: 99%

“…In the current study, caregivers focused on keeping individuals with higher cervical injuries active and busy so that they did not sleep all day or eat out of boredom. This is significant becauseHolla et al (2020) reported that boredom had a negative influence on dietary behaviour in wheelchair users with SCI.…”

mentioning

confidence: 99%

Informal caregivers’ self‐identified roles in facilitating health‐promoting behaviours for weight management in community‐dwelling care recipients living with spinal cord injury in the United States

LaVela

Pedersen

Ehrlich-Jones

et al. 2021

Health Social Care Comm

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“…Participants also highlighted that as a result of the injury and subsequent bodily changes, these individuals have fewer opportunities to participate in leisure physical activities or exercise and more challenges in shopping and preparing meals. Similarly, among wheelchair users, function impairments and unadjusted kitchens were found to influence dietary behaviors [ 19 ], suggesting that the inability to prepare a healthy meal, due to either physical ability or not having an accessible kitchen, may lead this population to resort to unhealthier options. Future weight management studies may want to focus on identifying strategies to address the negative impacts that physical ability and mobility limitations have on both exercise and healthy eating.…”

Section: Discussionmentioning

confidence: 99%

Health provider identified barriers and facilitators to weight management for individuals with spinal cord injury

et al. 2021

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Study Design: Qualitative descriptive study using semi-structured interviews Objective: The purpose of this study was to examine the barriers and facilitators of weight management in individuals with spinal cord injury (SCI) from the perspective of SCI health care providers. Setting: Veterans Health Administration and Midwest Regional SCI Care Systems Methods: Health care providers (n=25) who care for individuals with SCI completed semi-structured interviews. Thematic analysis methodology was used to identify emergent themes around barriers and facilitators to weight management in SCI. Results: Sixteen subthemes emerged for barriers and 7 subthemes emerged for facilitators for weight management in SCI. Barriers included individual-level factors (e.g., physical ability/mobility limitations, lack of interest, psychological obstacles, lack of knowledge, poor dietary strategies), socio-environmental factors (e.g., challenges with family support, lack of access to weight management resources, dependency on others, difficulties obtaining weight measurement), and organizational factors (e.g., lack of integration/ inconsistent weight management support from healthcare systems, pushing calorie intake early post-injury). Facilitators included individual-level factors (e.g., motivation, education/knowledge, participation in exercise and physical activity) and socio-environmental factors (e.g., positive support network, access to/use of healthy dietary strategies, access to exercise facilities/adaptive equipment, participating in weight management with others). Conclusions: Healthcare providers identified individual-level, socio-environmental, and organizational barriers and facilitators that influence weight management efforts in individuals with SCI. Future weight management resources and programs should consider addressing common barriers identified by healthcare providers, individuals with SCI, and their caregivers, and develop strategies to promote facilitators to enhance weight management in this population.

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“…It is possible that individuals feel restricted in healthy eating goals because they experience challenges independently cooking for themselves. Holla et al (2020) identified multiple barriers that complicate healthy eating behaviors, including inaccessible kitchens and challenges shopping for and cooking healthy meals, for example, demands on both time and energy consumption. Another reason for not focusing on healthy eating goals may be that food is a remaining source of enjoyment after injury and individuals with SCI do not want to give up this pleasure of food (Ehrlich-Jones et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Motivators, goal setting, and helpful feedback for weight management among individuals with spinal cord injury.

LaVela¹,

Jones²,

Heinemann³

et al. 2021

Rehabilitation Psychology

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Objective: To gain a fuller understanding, in the context of biopsychoecological factors, of drivers/motivators, goal setting, and feedback, individuals with spinal cord injury (SCI) find helpful to gauge their weight management progress. Research Method/Design: We conducted in-depth interviews around weight management in SCI. Participants included veterans and civilians with SCI. Thematic analysis methodology was used to categorize data into relevant recurrent and/or conceptually significant themes. Results: Twenty-five individuals identified three primary reasons they wanted to participate in weight management, including overall health and wellness, appearance, and functional mobility. Their self-identified weight management goals included reaching/maintaining a specific body weight and/or trimming a focused body part; engaging in any or more physical activity/exercise; gaining strength and endurance; participating in life and activities; and alleviating weight-related health symptoms (e.g., pain). Individuals identified progress assessments, recognition, regular check-ins, and encouragement as helpful feedback toward weight management achievement. Conclusions/Implications: Our work identified what drives weight management in individuals with SCI, what is important to them in terms of goal setting, and what feedback they would find helpful. These findings may be used in intervention planning and program development to facilitate participation and behavior modification. Weight management efforts and interventions are needed that 1) incorporate motivators for weight management that are important to individuals with SCI; 2) help them identify actionable process and performance goals to facilitate achievement of self-identified meaningful outcome goals; and 3) provide person-centered weight management progress feedback such as those identified in this study (progress assessments, recognition, regular check-ins, and encouragement).

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Determinants of dietary behaviour in wheelchair users with spinal cord injury or lower limb amputation: Perspectives of rehabilitation professionals and wheelchair users

Abstract: ¶ Membership of the WHEELS-study group is provided in the Acknowledgments.

Cited by 19 publications

References 50 publications

Informal caregivers’ self‐identified roles in facilitating health‐promoting behaviours for weight management in community‐dwelling care recipients living with spinal cord injury in the United States

Informal caregivers’ self‐identified roles in facilitating health‐promoting behaviours for weight management in community‐dwelling care recipients living with spinal cord injury in the United States

Health provider identified barriers and facilitators to weight management for individuals with spinal cord injury

Motivators, goal setting, and helpful feedback for weight management among individuals with spinal cord injury.

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