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Commentary on: Examining sedentary behaviours of adults with intellectual disabilities: A qualitative analysis - Safi et al.
Implications for practice and research
The high prevalence of sedentary behaviour (SB) in individuals with intellectual disability (ID) contributes to poorer mental health outcomes, increased morbidity and mortality.
Individuals with ID can and should be direct participants in research, which can then identify modifiable policy and environmental factors that can reduce SB.
Context
Sedentary behaviour (SB) is different from physical inactivity1 and is correlated with poorer mental health outcomes and multiple comorbidities. Individuals with intellectual disability (ID) are more sedentary than those without (85% of waking time vs 65–80%), and experience unique challenges related to economic, environmental, physical and personal barriers which further increases the risks of poor health outcomes.2 Previous studies have shown that screen time is common in this population, which correlates with negative mental and physical health.3 Those with ID also experience social isolation due to a lack of access, transportation, motivation and support to participate in physical activities. Poverty, discrimination and lack of self-esteem additionally contribute.2 Quantitative studies have identified factors associated with SB in individuals with ID,4 5 but there has been very limited qualitative research in this domain.
Methods
A qualitative research methodology, Critical Incident Technique (CIT), was used to collect information from English-speaking subjects, aged between 18 and 65 years, residing in Ontario, Canada. CIT is defined as an inductive process of collecting critical factors and facts regarding a specific behaviour in a defined condition. No specific sample size is required, and data saturation is reached when no new categories are found, or 50–100 incidents are obtained. Sampling was purposive and subjects were interviewed for 2 hours via two virtual interviews. The study was conducted during the COVID-19 pandemic.
Findings
Analysis of 102 CITs from five subjects identified some of the most common SBs as screen time (television/gaming, texting, online browsing), hobbies (knitting, reading, music, art) and napping. Low income contributed to SB followed by feeling unsafe/unsuitable environment, perceived stigmatisation, weather, pandemic lockdown (unable to be vaccinated) and physical disability. Walking was identified as being an accessible and helpful way to increase physical activity, as was the use of fitness devices (Fitbit), sports and camping (not during the pandemic) and housekeeping. Personal support workers increased physical activity by accompanying individuals with ID. Participants suggested that increased education and resources (financial, physical accessibility) and incentives would encourage activity. Communities can play a role in putting on events like walking groups or park meet-ups. Small breaks in SB make a substantial difference.
Commentary
There is limited research into SB in individuals with ID, and while there are similar factors operating in the general population, for example, poverty, this study engaged individuals with ID and sought to understand their perspectives. The use of CIT allowed their voices to be heard (instead of their caregivers) and provided in-depth data. However, the very small and selected sample (younger, mild ID, computer literate, predominantly female, completed post-secondary, responding to social media advertisement, Zoom interview) significantly limits generalisability. Identifying potentially modifiable factors and addressing these through targeted and individualised interventions is clinically relevant. These may range from education to advocating for disability-friendly health policy for the creation of safe and inclusive spaces with activities, support, transportation, and funding available.
Ethics approval
Not applicable.
Footnotes
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests PC has no conflicts or disclosures to report. MT is enrolled in a nurse practitioner programme at Athabasca University.
Provenance and peer review Commissioned; internally peer reviewed.