Developing a health promotion tool for people with a learning disability or their carersfamily

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Developing a health promotion tool for people
with a learning disability or their carers/family
Unit for Development in Intellectual Disabilities

• Louise Mellen March 04
• Farrah Owen Sept 04
• Venessa Thorpe Sept 04

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Module assessment

• Students are required to develop a health
  promotion tool for a group or individual with
  learning disabilities or their family/carers.
• Identify a priority area for health promotion
• Plan a strategy
• Develop a tool (leaflet, game, poster, CDROM,
  etc.)
• Evaluation of tool

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Previous health promotion tools

• Dementia
• Testicular and breast cancer
• Exercise
• Healthy eating
• Epilepsy
• Positive image

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TRAC - Service user group

• TRAC is a service user group who advise, teach
  and work with students and staff at the
  University of Glamorgan.

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Interventions to promote oral hygiene needs in
people who have a learning disability.

• By Venessa Thorpe Louise Mellen Student
  Learning Disability Nurses

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Aims of the HP Tools

• To improve the oral hygiene of people with
  learning disabilities
• To improve the knowledge of clients, carers and
  family regarding oral hygiene

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Background information

• Good oral health is to be free from pain and
  disease (DoH, 1994)
• Fulfilling the Promise (WAG, 2001)
• Valuing people (DoH, 2001)
• Oral Health Guidelines (BSDH, RCS, 2001)
• Role of the LD nurse (DoH, 1996)
• Why this topic?

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Epidemiological data

• Compared to the general population, people with
  learning disabilities have an higher incidence of
  unmet oral health needs.
• (Scott et al., 1998 Cumella et al., 2000)
• Clinical pathways for oral health care of people
  with learning disabilities
• (BSDH, RCS, 2001)
• 
  

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Risk factors

• Medication
• Down Syndrome - dry mouth
• (BSDH RCS, 2001 Gates, 2004)
• Communication deficits
• Lack of skills/knowledge (both client and carer)
• Oral hygiene not viewed as a priority
• Carers give oral health care a low priority
• (Cumella et al., 2000 Rawlinson, 2001
  Tiller et al., 2001 and Stanfield et al., 2003)

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Target population

• Considering the barriers found.
• Target group - carers.
• Aim - raise awareness

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Intervention

• Educational approach
• Secondary intervention (Tones and Green, 2004)
• leaflets are suggested to be effective in raising
  awareness (Humphris et al., 1999 Andermann et
  al., 2002)

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Producing a leaflet

• Following the recommendations of the audit of
  health promotion leaflets
• 
  (RPSGB, 1998)
• Actively provided
• Contain some pictures
• SMOG readability test (Basic skills Agency)
• Larger text for easier reading

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Evaluation

• Resources.
• Evaluation team.
• Action plan.
• Questionnaires.
• Ethics.
• Recommendations for future.

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References

• Andermann AAJ, Austoker J, Watson EK. Lucassen AM
  and Mackay J (2002) Development and evaluation of
  a general information leaflet for women with a
  family history of breast cancer, Journal of
  cancer education, 17 (3) 155-60.
• BSDH and RCS (2001) Clinical Guidelines and
  Integrated Care Pathways For The Oral Health care
  Of People With Learning Disabilities, British
  society For Disability and oral Health, The Royal
  College of Surgeons of England.
• Cumella S, Ransford N, Lyons J, Burnham H (2000)
  Needs for oral care among people with
  intellectual disability not in contact with
  community dental services Journal of Intellectual
  Disabilities 44, 1, 45-52.
• DoH (1996) Continuing the commitment The report
  of the learning disability nursing project,
  London, HMSO.
• DoH (2001) Valuing People A New Strategy for
  Learning Disability in the 21st Century,
  Department of health.
• DoH (2005) Oral Health strategy Group Department
  of Health.
• Gates B (2004) Learning disabilities Towards
  Inclusion 4th Ed London, Elsvier.
• Humphris GM, Duncalf M, Holt D and Field EA
  (1999) The experimental evaluation of an oral
  cancer leaflet, Oral Oncology, 35 (6) 575-82.
• RPSGB (1998) Audit of Health Promotion Leaflets
  The Royal Pharmaceutical Society of Great
  Britain, on line at www.rpsgb.org.uk/pds/leaflet.p
  df accessed on 11.12.05.
• Scott A, March L and Stokes ML (1998) A survey of
  oral health in a population of adults with
  developmental disabilities Comparison with a
  National Health survey of the general population,
  Australian Dental Journal, 43 (4) 257-61.

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Healthy eating and keeping fitin Children
withLearning Disabilities

• By Farrah Owen

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Objectives

• Obesity
• Explore the evidence that shows the need for my
  health tool
• Aims of the health tool and how I will meet them
• Limitations
• Evaluating my health tool

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Obesity

• Sharkey (1990) stated that
• Obesity is an excessive accumulation of fat
  beyond that considered normal for the age, sex
  and body type.

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Obesity 2

• The main reasons for an Increase in obesity are
  documented by Drummond (2002)-
• a high fat diet and a lack of habitual physical
  activity
• A diet high in fat and energy combined with low
  levels of physical activity promote a positive
  energy balance (energy intake exceeds energy
  expenditure)
• RESULTING IN WEIGHT GAIN.

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Evidence behind the health need.

• People with learning disabilities are at a high
  risk of obesity and consequent health risks.
• Adults with learning disabilities are more likely
  to be inactive for a variety of reasons,
  including barriers to leisure and exercise
  facilities, and the impact of physical and
  intellectual impairments on their ability to take
  part in traditional exercise.
• Chapman et al. (2005)

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Barriers

• Primary barriers
• unclear policy guidelines in residential and day
  service provision
• Leisure opportunities
• Resourcing
• Transport
• Staffing constraints
• Income
• Expenditure

• Secondary barriers
• individuals motivation
• Support and encouragement
• Overprotection
• Underestimating persons ability
• Staffs interpretations of ordinary living
  principles

Chapman et al. (2005)
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My aims

• To give children with Learning disabilities a
  knowledge of healthy eating.
• To produce a video that will not only help reduce
  weight and help with cardiovascular fitness, but
  will be enjoyable.
• To make children more aware of the reasons why
  its important to eat healthy.

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Who am I aiming my health tool towards?

• I aimed my tool towards children with mild
  learning disabilities from around the age of 12
  to 15.
• I did this because
• Children are our future (please dont sing)
• Children are becoming more obese
• Children eat a lot of junk food
• Overweight kids usually grow up to be overweight
  adults with high risk of heart disease, diabetes
  and cancer. (www.healthyeating.net/he_4-01.htm)

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Also

• During my school placement, I took part in the
  P.E. classes, and found that the children were
  bored of the same type of exercise every week.
  When I spoke to some of them about the dance
  classes that I teach, they were very interested.
• Also I feel that children with learning
  disabilities have more knowledge and potential
  than people give them credit for.

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How to meet the need.

• Leaflet
• The leaflet shows good food and bad food to eat
  with clear diagrams and words.
• It also explains why we need to eat healthy,
  again with diagrams and simple words.
• The leaflet is bright and colourful to catch
  their eye and some words are in bright colours
  too, to help exaggerate important points.

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• Video
• 20 minutes long
• consists of a warm up, main dance and a cool down
• pictures to show what they should wear
• and to insure that the children remember its
  important to wash and drink plenty of water after
  exercise there are pictures at the end
• The music was chosen after spending a lot of time
  with the children in my school placement, and
  listening to the types of music they liked.

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Why its important to warm up and cool down

• Warm up
• increases body temperature
• Increase respiration and heart rate
• Guard against muscle, tendon and ligament strains

• Cool down
• just as important
• Abrupt cessation of vigorous activity leads to
  pooling of blood, sluggish circulation and slow
  removal of waste products
• To stop cramping, soreness or more serious
  problems
• Lowers body temperature

Sharkey (1990)
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Why I chose a leaflet and a video

• The video can be played over and over
• The leaflet gives just enough information
• I felt that to meet the health need I could not
  do one without the other as if you dont eat the
  right diet, physical activity will not be
  effective and vice versa.
• You need to balance energy input and energy
  output.

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Fact!

• 300 Kcals in a chocolate bar take only 30
  seconds to consume but 30 minutes to exercise
  away
• Carr and Decheemaeker (2002)

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Limitations

• Leaflet
• Limited on the information I could give
• Making them aware without scaring them
• Video
• Background noise
• Room- lighting and background
• Not an expert on making videos and editing them
• Teaching a camera how to dance!

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Evaluation and Recommendations

• The tool is yet to be evaluated but I intend to
• Send out the leaflet and video to schools to
  either do in P.E. lessons or for the children to
  take home
• Also send out a simple evaluation form to gain
  feedback from the teachers and the pupils.

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References

• Chapman M.J. Craven M.J. and Chadwick D.D. (2005)
  Fighting fit? An evaluation of health
  practitioner input to improve healthy living and
  reduce obesity for adults with learning
  disabilities, Journal of intellectual
  disabilities, 9 (2), pp131-144.
• Drummond S. (2002) The management of obesity,
  Nursing Standard, 16 (48), pp 47-52
• Fox K.R. (2002) Physical activity, exercise and
  weight control movement for management? In Carr
  T. Descheemaeker K. (2002) Nutrition and Health,
  London, Blackwell science, p 55.
• Lllingworth K. Moore K.A. McGillivray J. (2003)
  The development of the nutrition and activity
  knowledge scale for use with people with an
  intellectual disability, Journal of applied
  research in intellectual disabilities, Australia,
  BILD publications, vol.16, pp 159-166.
• Sharkey B.J. (1990) Physiology of fitness, 3rd
  Ed., Leeds, Human Kinetics.
• BILD (1998) Worcestershire, BILD publications.
• www.healthyeating.net/he_4-01.htm

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Thank you for listening, now dance your way out!!
Any Questions????