Abstract
ObjectiveThis study aims to identify determinants of dietary behaviour in wheelchair users with spinal cord injury or lower limb amputation, from the perspectives of both wheelchair users and rehabilitation professionals. The findings should contribute to the field of health promotion programs for wheelchair users.MethodsFive focus groups were held with wheelchair users (n = 25), and two with rehabilitation professionals (n = 11). A thematic approach was used for data analysis in which the determinants were categorized using an integrated International Classification of Functioning, Disability and Health and Attitude, Social influence and self-Efficacy model.ResultsReported personal factors influencing dietary behaviour in wheelchair users were knowledge, boredom, fatigue, stage of life, habits, appetite, self-control, multiple lifestyle problems, intrinsic motivation, goal setting, monitoring, risk perception, positive experiences, suffering, action planning, health condition, function impairments, attitude and self-efficacy. Reported environmental factors influencing dietary behaviour in wheelchair users were unadjusted kitchens, monitoring difficulties, eating out, costs, unfavourable food supply, nutrition education/counselling, access to simple healthy recipes, eating together, cooking for others, and awareness and support of family and friends.ConclusionsImportant modifiable determinants of dietary behaviour in wheelchair users that might be influenced in lifestyle interventions are knowledge, fatigue, habits, self-control, intrinsic motivation, risk perception, attitude and self-efficacy. It is recommended to involve relatives, since they appear to significantly influence dietary behaviour.
Highlights
Overweight and obesity affect approximately 58% of men and 49% of women in developed countries [1], and are even more frequent in adults with disabilities
Important modifiable determinants of dietary behaviour in wheelchair users that might be influenced in lifestyle interventions are knowledge, fatigue, habits, self-control, intrinsic motivation, risk perception, attitude and self-efficacy
As a first step in the development of this intervention, the present study aims to identify determinants of dietary behaviour in wheelchair users with spinal cord injury (SCI) or lower limb amputation (LLA) living in the Netherlands, from the perspectives of both wheelchair users and rehabilitation professionals
Summary
Overweight and obesity affect approximately 58% of men and 49% of women in developed countries [1], and are even more frequent in adults with disabilities. People with mild or severe lower extremity mobility difficulties have the greatest risk of obesity, about 2.5 times greater compared to those without lower extremity mobility difficulties [2] This increased risk is related to a decreased resting energy expenditure due to muscle atrophy and physical inactivity [3,4,5,6,7,8]. A high BMI can hinder physical functioning and independence in the short and longer term, because it leads to high loads on the upper extremities during transfers and wheelchair propulsion, and negatively affects prosthetic device use and fit [22,23,24,25] This increases the risk of overuse injuries, upper extremity pain and increased wheelchair use [25,26,27]. Research has shown that a third of people with SCI experience increasing weight as a major health problem [28]
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