Westrop, Sophie ORCID: https://orcid.org/0000-0002-3776-0543, Rana, Dikshyanta, Jaiswal, Nishant, Wu, Olivia, McGarty, Arlene M., Melville, Craig, Ells, Louisa, Lally, Phillippa, McEwan, Michael, Harris, Leanne and Germeni, Evi (2024) Supporting active engagement of adults with intellectual disabilities in lifestyle modification interventions: a realist evidence synthesis of what works, for whom, in what context and why. Journal of Intellectual Disability Research.

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Abstract

Background
Lifestyle modification interventions for adults with intellectual disabilities have had, to date, mixed effectiveness. This study aimed to understand how lifestyle modification interventions for adults with intellectual disabilities work, for whom they work, and in what circumstances.

Methods
A realist evidence synthesis was conducted that incorporated input from adults with intellectual disabilities and expert researchers. Following the development of an initial programme theory based on key literature and input from people with lived experience and academics working in this field, five major databases (MEDLINE, EMBASE, CINAHL, PsycINFO, and ASSIA) and clinical trial repositories were systematically searched. Data from 79 studies were synthesised to develop context, mechanism, and outcome configurations (CMOCs).

Results
The contexts and mechanisms identified related to the ability of adults with intellectual disabilities to actively take part in the intervention, which in turn contributes to what works, for whom, and in what circumstances. The included CMOCs related to support involvement, negotiating the balance between autonomy and behaviour change, fostering social connectedness and fun, accessibility and suitability of intervention strategies and delivery, and broader behavioural pathways to lifestyle change. It is also essential to work with people with lived experiences when developing and evaluating interventions.

Conclusions
Future lifestyle interventions research should be participatory in nature and accessible data collection methods should also be explored as a way of including people with severe and profound intellectual disabilities in research. More emphasis should be given to the broader benefits of lifestyle change, such as opportunities for social interaction and connectedness.

Item Type:	Article
Status:	Published
DOI:	https://doi.org/10.1111/jir.13120
Subjects:	H Social Sciences > H Social Sciences (General) R Medicine > R Medicine (General)
School/Department:	School of Education, Language and Psychology
Institutes:	Institute for Social Justice
URI:	https://ray.yorksj.ac.uk/id/eprint/9606

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