Effect and Process Evaluation of a Structural Health Intervention in Community Residences for Adults With Intellectual Disabilities

Abstract

AbstractInterventions to improve health among adults with intellectual disabilities (ID) living in community residences are needed as unhealthy behaviors, obesity, and chronic diseases are more common in this group than in the general population. This study evaluated effectiveness of a structural health intervention, a study circle for paid carers aiming to improve health promotion work routines for residents, and explored barriers and facilitators in the implementation process. A quasi‐experimental design was used. Eight municipalities with 84 community residences agreed to participate with 70 of these completing the study. A 26‐item questionnaire was used regarding staff work routines in three domains (general health promotion, food and meals, physical activity) and a total score to evaluate effectiveness. An inductive qualitative method was used to explore barriers and facilitators in the implementation process. The intervention group (n = 42 residences) improved their health promoting work routines significantly more than the comparison group (n = 28 residences) in the domains of general health promotion (p = .05), physical activity (p = .02), and for the total score (p = .002), but no significant change was found in the food and meal domain (p = .11). Regarding barriers and facilitators in the implementation process, a “Need for a supportive structure and key persons with a mandate to act,” was identified as an overarching theme. Barriers and facilitators were identified within four categories: (1) characteristics of the study circle, (2) staff capacity, (3) organizational capacity, and (4) external support. This study provides evidence that a structural intervention targeting staff in community residences for people with ID can improve health promoting work routines and that the results might be generalizable. If disseminated on a wider scale, this intervention has the potential of improving health and preventing obesity and other chronic diseases in adults with ID.