Title of
Health Intervention
Let's make a healthy choice:
Healthy eating and Exercise
Intended
Audience
Adults with intellectual
disabilities (ID), their caregivers, and the staff, who live in community
facilities in Denton, Texas, are eligible to the health promotion program. The
participants who are identified as severe to profound ID are required to have a
company to facilitate the engagement of the proposed activities.
Proposed Program
Within the proposed
program, five units are developed in accordance with the five stages
(precontemplation, contemplation, preparation, action, and maintenance) of the
Thanstheoretical Model of Behavior Change. Each unit has 6 lesson plans (90 minute
per lesson) includes exercise, nutrition, and health promotion components in a
total of 30 lessons in the 15-week program. Three lessons per week are
scheduled on every Monday and Wednesday night to encourage caregivers to regularly
participate the lessons.
The goal of the
intervention program is a) to increase the understanding of health-related
behaviors such as regular exercise habits, nutrition education embedded in activities;
b) to teach staff, caregivers, and friends to support participants with ID to
achieve their goals. In the sample lesson plan, we focus on Unit 2
(Contemplation) to highlight the perceived need of making changes in one’s
particular health behaviors.
Need for
this Health Topic
Individuals with ID are
considered as a “vulnerable” population due to a high risk of obesity, tobacco
use, and poorer nutrition intake in their daily life (Robertson, Emerson,
Baines, & Hatton, 2014). In a review article by Heller, McCubbin, Drum,
& Peterson (2011) investigating the detriments of health promotion
interventions in adults with ID, a combined intervention of physical activity
and nutrition education may facilitate their health behaviors and in some cases,
the improvement of weight status was reported.
Older adults with ID are
more likely to be physically inactive when compared to young adults with ID and
older adults without ID (Dixon-Ibarra, Lee, & Dugala, 2013). Specifically,
only 6% of older adults with ID met the physical activity recommendation with
150 minutes of moderate or 75 minutes of vigorous intensity per week
(Dixon-Ibarra et al., 2013). Barnes and his colleagues (2013) pointed out that
approximately 80% (235 participants) of adults with ID (aged 18-65 years) were
overweight or obese. Of these, 26% (76 participants) of adults with ID reported
there was no exercise habit. The most common activities were walking (53.7%)
and house work (42.5%). The findings of the study are in accord with other results,
indicating adults with ID have a sedentary lifestyle and may have higher
incidences of health conditions compared to the general population (e.g,
obesity; Haveman et al., 2010; Hsieh, Rimmer, & Heller, 2014).
With regard to the
nutrition aspects, unhealthy dietary pattern or unbalanced intake in individuals
with ID has been documented (Ball et al., 2012; Marin & Graupera, 2011; Wong,
Dwyer, & Holland, 2014; Robertson et al., 2014). Take Marin and Graupera’s
study for example. Overconsumptions of protein and under consumption of carb
were found among participants with ID. The same dietary pattern was also
reported in those with the obese group. In addition to cholesterol and fiber
intake, the former was above the recommendations; the latter appeared to be
below (Marin & Graupera, 2011). Another study examining the obesity and
health behaviors between adults with ID and those without disabilities, showed that
higher obesity rate and unhealthier dietary habits were found in the ID group.
For example, 65.5% of participants with ID ate fruit less than 4 days in a
typical week while there were 41.5% of those without ID doing so. Meanwhile, based
on the results of BMI measurement, over 41% of participants with ID were obese
in comparison with those (26%) without disabilities (Robertson et al., 2014). For
these reason, there is a need of health promotion for the “vulnerable”
population. Thus, multiple components (e.g., exercise and dietary habits) of
intervention used in the proposed program are needed to ensure the promotion of
healthy lifestyle in adults with ID (Bodde, Seo, Frey, Van Puymbroeck,
&
Lohrmann, 2012; Marks, Sisirak, Heller, 2011; Spanos, Melville,
& Hankey, 2013).
Setting
A community facility in
Denton, Texas
Multiple - Purpose Room.
Maximum occupancy = 30
people, including participants with ID, staff, and caregivers.
6 people in one group,
including at least one staff or caregiver.
A total of 15 week, every Monday
and Wednesday night, 7:00 – 8:30 pm.
Procedures and Estimated
Timeline (Unit 2, the 4th class)
1. Review
(4 minutes)
The reason
causes dehydration or loss of water in one’s body.
(vomiting,
sweating, fevers )
How
could we make sure that we drink enough water during the day.
2. Introduce
the lesson ( 5 minutes)
What
food do we like to eat?
Discuss the
eating habits.
Things to
do before exercise
3. Ask
& Discuss # 1(18 minutes)
Ask: a) When we ate food even though we were not
hungry. Why do you suppose we did that? (Video: https://www.youtube.com/watch?v=KgDeeMfh3HY, https://www.youtube.com/watch?v=5Jlv1c-3JeM
)
Possible answer: solicit responses. People may eat
food that are not nutritious because they value the company of friends more
than food.
Discuss: In choosing what we eat, we should make
sure that we select different kinds of food so we get the nutrients we need.
4. Activity
# 1 (18 minutes)
Handouts:
Foods and beverage I like to eat and drink (See Appendix A), Putting foods I
like to eat in the food pyramid (See Appendix B).
Show your pictures to the class and discuss the
pros and cons of the foods they selected. (The staff or caregivers assist one
or two persons with ID to share their eating habits)
(5-minute break)
5. Ask
& Discuss # 2 (18 minutes)
Ask: Things to do before exercise.
Discuss: Use the handout (See Appendix C) to discuss it
(The staff or caregivers assist one or two persons
with ID to share their experiences; appendix D)
6. Activity
# 2 (18 minutes)
Practice the warm-up activities
Let everyone know that the warm-up activity session
(10 minutes) will be performed when staring a class to shape one of the daily
exercise habits.
7. Summarize
(4 minutes)
Review
participants’ responses and the handout.
Summarize
the importance of nutrition on exercise/physical activity, and physical and
emotional well-being, and long-tern exercise/physical activity.
Materials
Needed
7 Tables, 35 chairs, 35
sweat towels, 35 pencils
Projection equipment set
(laptop, projection screen, speakers, laser pointer, and remote clicker)
35 handouts of PPT
presentation, 35 handouts of each “Foods and beverage I like to eat and drink”,
“Putting foods I like to eat in the food pyramid”.
Guiding
Health Education Theory or Model
Social Cognitive Theory and
Transtheoretical Model of Behavior Change will be employed in the present
intervention program. The descriptions of the reason are depicted as follow:
Social
Cognitive Theory (SCT): Bandura’s SCT is defined as social
learning of individuals, environment, and health behaviors interact (Glanz, Rimer, & Viswanath, 2008). In other words, the process of learning outcomes emphasizes the dynamic and
reciprocal experiences between personal, behavioral, and environmental factors.
Observational learning and collective efficacy are the two important components
of the constructs in SCT. In the intervention program, goal setting and
expectation for behavior change are based on personally valued since
participants are personally capable of adopting new health-promotion behaviors
(self-efficacy). In addition, by the exposure of peer modeling, the
observational learning is expected to facilitate one’s positive attitude toward
a lifestyle change.
Thanstheoretical
Model (TTM): Based on TTM, the establishment of health
behavior undergoes five stages (precontemplation, contemplation, preparation,
action, and maintenance). It is the continuum of progress for a person who
needs a health behavior change. In the proposed intervention program, lessons
are designed based on the features of each stage.
Stages
|
Definition
|
Goals of the Lessons
|
Precontemplation
|
People
are unaware of the need of behavior change.
|
To
increase the understanding of health, exercise, and nutrition, along with
making appropriate decisions about one’s health.
|
Contemplation
|
People
are increasingly aware of the importance of a healthy lifestyle and intend to
take action.
|
To
consider life change and evaluate their physical activity habits and
nutrition behaviors.
|
Preparation
|
People
make a commitment and have taken some initial steps to change a particular
behavior.
|
To set
up goals and to plan to move out the barriers which impede their healthy behavior
change.
|
Action
|
The particular
behavior change is in action.
|
To
reinforce the changed behavior and make ongoing physical exercise habits and
healthy dietary patterns maintained.
|
Maintenance
|
People take
account of strategies to prevent relapse.
|
To
strengthen the efficacy of the behavior change as a lifelong habit and to
keep engaging regular physical activities and making healthy food choices.
|
By the use of SCT and TTM,
persons who participate the proposed program will experience the process of
assessing personal’s health behavior, adopting new health behavior patterns,
maintaining a healthy lifestyle such as regular exercises and healthy food
choices. However, this will be a dynamic process as relapse, in which people
with ID may have different present levels, at different stages or rates. For
example, they may move back and forth between stages before the health behavior
appears to be maintained in a period of time. In the lesson plan example, we
are assuming participants in the same activities (or lessons) are at the same
stage. Instructors are encouraged to modify the activities to meet the current
level of participants if necessary. The lesson plan is set up at the second
stage (Contemplation) of behavior change. Participants are considering making a
lifestyle modification and encouraged to assess their focused health behaviors
(physical activity and food intake habits).
Goal
Participants will
a) Review
benefits of good nutrition on their health.
b) Identify
favorite foods and discuss their eating habits.
c) Describe
the things they need to do in order to do exercise
d) Perform
warm up activities.
Objectives
80% of participants will evaluate
the foods they prefer to eat daily as reflected through hand-on activity and
discussion (Cognitive).
-
To know they usually eat even they
do not feel hungry?
-
To assess their understanding of
what types of foods are they based on the food pyramid.
80% of participants will be
able to perceive their needs of a lifestyle change based on evaluation of foods
they prefers daily as reflected through hand-on activity and discussion
(Affective).
-
To share the experiences of how
they think of their eating habits based on the food pyramid.
-
To share the reflection if they
are willing to change the eating habits if necessary.
90% of participants will be
able to perform the at least 7 movements of the chair exercise (10 totally) or
warm-up activities during class (Psychomotor).
-
To engage in the warm-up exercise.
Procedure/Outcome Objective
Evaluation Measures:
Items
|
Procedure
|
Outcome
|
Can
participants state the benefits of good nutrition on their health?
|
Oral
responses (40%), discussion (40%) paper, and pencil response (20%) in class. (Appendix
F)
|
Follow-up
food preference (50%) and discussion (50%) by staff or caregivers.
(Appendix
E)
|
Did
participants identify their favorite foods
|
Oral
responses (40%), discussion (40%) paper, and pencil response (20%) in class.
(Appendix F)
|
Follow-up
observation (50%) and discussion (50%) by staff or caregivers. (Appendix E)
|
Did
Participants identify healthy foods and unhealthy foods based on the food
pyramid??
|
Oral
responses (40%), discussion (30%) paper and pencil response (30%) in class.
(Appendix F)
|
Self-checklist
by the participants.
|
Are the
participants able to describe the things that they need to do before they
exercise?
|
Oral
responses (30%)/ discussion (20%) paper and pencil response (20%), and in
class. (Appendix F)
|
Follow-up
observation (50%) and discussion (50%) by staff or caregivers.
|
Are the participants
able to perform at least 6 movements of the chair exercise or warm-up
activities?
|
Performance
test.
(Appendix
F)
|
Follow-up
observation if the participants perform it at least 5 minute twice per day
(e.g., before the class or bedtime).
(Appendix
E)
|
Are the participants
able to attend each scheduled class of the intervention program?
|
N/A
|
Use of attendance
record to evaluate the participation engagement.
|
Anticipated
Problem(s) and Solution(s)
Potential
problem
|
Solutions
|
Participants
with moderate to severe ID may have difficulties of understanding the
materials in class.
|
Modified
(i.e., simplified) the handout to the particular individuals. Let the company
(e.g., staff, caregiver, participants with high functioning) assist him/her
in class.
Use of
short videos (i.e., audio/visual clips) may motivate the participation.
|
The
pictures of the foods used in the handout or the PowerPoint presentation may
not 100% reflect what an individual eat daily.
|
To
encourage participants to share the personal preferences to narrow the gap
between the contents.
|
Projection
equipment set may not work.
|
Make
sure the handout is clear to verbally and visually present. For example, use
of pages or pictures (combined texts together) may facilitate the
learning.
Prepare
another laptop or portable protector.
|
Because
of physical disabilities or severe cognitive limitation, some participants
with ID may not follow the recommended movements.
|
An
instructor may provide alternative movements or simplified physical activities.
|
References
Ball,
S. L., Panter, S. G., Redley, M., Proctor, C. A., Byrne, K., Clare, I. C. H.,
& Holland, A. J. (2012). The extent and nature of need for mealtime support
among adults with intellectual disabilities. Journal of Intellectual
Disability Research, 56(4), 382-401. doi: 10.1111/j.1365-2788.2011.01488.x
Barnes, T. L., Howie, E. K., McDermott, S., & Mann, J. R. (2013).
Physical activity in a large sample of adults with intellectual disabilities. Journal
of Physical Activity & Health, 10(7), 1048-1056.
Bodde, A. E.,
Seo, D.-C., Frey, G. C., Van Puymbroeck, M., & Lohrmann, D. K. (2012). The
Effect of a designed health education intervention on physical activity
knowledge and participation of adults with intellectual disabilities. American
Journal of Health Promotion, 26(5), 313-316.
Dixon-Ibarra,
A., Lee, M., & Dugala, A. (2013). Physical activity and sedentary behavior
in older adults with intellectual disabilities: A comparative study. Adapted
Physical Activity Quarterly, 30(1), 1-19.
Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Health Behavior and Health Education – Theory, Research, and Practice (4th ed.). San Francisco, CA: Jossey-Bass.
Haveman,
M., Heller, T., Lee, L., Maaskant, M., Shooshtari, S., & Strydom, A.
(2010). Major health risks in aging persons with intellectual disabilities: An
overview of recent studies. Journal of Policy & Practice in Intellectual
Disabilities, 7(1), 59-69. doi: 10.1111/j.1741-1130.2010.00248.x
Heller, T., McCubbin, J. A., Drum,
C., & Peterson, J. (2011). Physical activity and nutrition health promotion
interventions: What is working for people with intellectual disabilities? Intellectual
and Developmental Disabilities, 49(1), 26-36.
Hsieh,
K., Rimmer, J. H., & Heller, T. (2014). Obesity and associated factors in
adults with intellectual disability. Journal of Intellectual Disability Research,
58(9), 851-863. doi: 10.1111/jir.12100
Marin,
A. S., & Graupera, J. M. X. (2011). Nutritional status of intellectual
disabled persons with Down syndrome. Nutrición Hospitalaria, 26(5),
1059-1066. doi: 10.3305/nh.2011.26.5.5233
Marks,
B., Sisirak, J. & Heller, T. (2011). Health
matters: The exercise and nutrition health education curriculum for people with
development disabilities. East Peoria, Illinois: Brookes.
Spanos,
D., Melville, C. A., & Hankey, C. R. (2013). Weight management
interventions in adults with intellectual disabilities and obesity: a
systematic review of the evidence. Nutrition Journal, 12(1), 1-16. doi:
10.1186/1475-2891-12-132
Wong,
C., Dwyer, J., & Holland, M. (2014). Overcoming weight problems in adults with
Down syndrome. Nutrition Today, 49(3), 109-121. doi:
10.1097/nt.0000000000000029
Yilmaz, M., Sari, H. Y.,
Serin, G. E. Ç., Kisa, S. S., & Aydin, Ö. (2014). The effectiveness of
nutrition and activity programmes for young adults with intellectual
disabilities. International Journal of Caring Sciences, 7(2), 449-459.
Please email me for the details of Appendix A~F.
Appendix A: Foods and beverage I like to eat and drink
Appendix B: Putting foods I like to eat in the food pyramid
Appendix C: Food pyramid
Appendix D: Things to do before exercise
Appendix E: Follow-up Checklist
Appendix F: Evaluation Form
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