The efficacy of the Duke of Edinburgh award scheme on the psychological and physical health of adolescents with intellectual disabilities.Ben Fitzpatrick

Supervisors: Dr Laurence TaggartDr Wendy CousinsDr Gavin Breslin

Outline

• Background

• Justification

• The Duke of Edinburgh award

• Theoretical Framework

• Aim and Objectives

• Phase 1 - Pilot study

• Pilot study informed work

• Phase 2 – Main study

• Conclusion / Questions

Background• People with intellectual disabilities (ID) have significantly poorer

health than their non-disabled peers (Emerson & Glover, 2011).• People with ID have a greater variety of health care needs due to

increased risk of congenital diseases and a higher rate of comorbidity factors such as obesity that often leads to type 2 diabetes (Oullette-Kuntz, 2005).

• Small number of health intervention programmes with small sample sizes

• This is especially the case in children and adolescents (Allerton et al., 2011)

Background• There is a significant positive relationship between an individual’s

physical activity levels and their psychological health, particularly how psychological health can affect long term adherence to physical activity (Biddle & Mutrie 2008, Hardy et al., 1999).

• However, few studies on how a particular intervention affects psychological factors in young people with ID (Paterson et al., 2011).

• Tendency to measure psychological measures as secondary outcome measures to physical health measures (Carmeli et al., 2008, Oriel et al., 2008)

• Or make a direct comparison between people with and people without ID without intervention. For example, Nthangase et al., (2008)

• While there are studies investigating the effects that a physical activity intervention has on physical activity levels and fitness these tend to be short intervention programmes with no long term follow up.

Justification• This proposed study offers a unique opportunity to investigate the

longitudinal effects of a programme that potentially enhances:• 1. Self-esteem and self-efficacy which have shown to be

determinants and facilitators of healthier physical activity levels. • 2. Self-determination that can enhance determination, motivation

and autonomy. • 3. Physical activity levels and fitness levels that can enhance physical

health by reducing comorbidity factors such as obesity and type 2 diabetes.

• 4. Emotional well-being that can enhance relationships and community connectedness.

Duke of Edinburgh award scheme

The DofE’s core principles are to improve young people’s: • Leadership and communication skills • Resilience and independence • Physical activity• Teamwork and compassion• Enhancing sense of community belonging

• Little robust research into efficacy of the award (Campbell 2009)• Campbell (2009): No use of robust, validated instruments• No study undertaken to investigate effects on people with ID

• Belfast Activity Centre

Theoretical Framework• The DofE award scheme was not designed based on a

particular psychological framework. • However, due to the nature of its core objectives and those

that are going to be explored within this proposed study there are two theoretical frameworks that can be applied.

• Social Cognitive Theory (SCT, Bandura, 1986)• Self-Determination Theory (SDT, Deci and Ryan, 1985).• In addition to psychological factors there is a strong

relationship between these two theories and physical activity

Aim

Examine the efficacy of the Duke of Edinburgh award scheme on the psychological and physical health of adolescents with ID aged between 14-19 years.

Objectives• 1) To complete a pilot study that will indicate the feasibility of

the study design, instruments and compliance of the wearing of the accelerometers measuring physical activity.

• 2) To compare and contrast the psychological (i.e. self-efficacy, self-esteem, and self-determination), emotional and physical (i.e. BMI, physical activity level, physical fitness) health of teenagers with and without ID.

• 3) To investigate the efficacy of the DofE for teenagers with ID targeting psychological, emotional and physical health at baseline, mid-intervention and two follow-up periods.

Objectives (Cont.)4) To compare and contrast the efficacy of the DofE for teenagers with ID with two control groups: a) teenagers without ID taking part in the DofE, and b) teenagers with ID not taking part in the DofE at baseline, mid intervention and two follow-up periods.

5) To examine parental and teacher perceptions of the emotional wellbeing changes of the young people with and without ID who participate in the DofE in comparison to teenagers with ID not engaged in the programme. Measures of emotional well-being will be taken at baseline and one follow-up period.

Objective 1 will be met in phase 1 of the study and objectives 2,3,4,5 in phase 2

Phase 1- Pilot Study

Group 1

Adolescents with ID n=127 male

5 femaleMean age 16.7yrs

Group 2

Adolescents non-ID n=165 male

11 femaleMean age 16.1yrs

Outcome measures

Self-efficacySelf-esteem

Self-determinationEmotional wellbeing

Physical FitnessPhysical activity level

Focus group

Pilot study - Psychological measures

• The following were presented in an A5 size booklet to each student:• Self Efficacy (SEQ-C Muris, 2001)• Self-determination (ARC questionnaire Wehmeyer et al., ‘95)• Self Esteem (Rosenberg scale, Paterson et al., 2011)

• The following was sent to parents and handed out to classroom teachers• SDQ questionnaire (Goodman 1997)

Pilot study – Physical measures

• Physical fitness – adapted Presidential fitness test• Shuttle Run (cardio endurance), Sit-up (muscle endurance) , Sit

and Reach (flexibility).• Incorporated into ‘Circuit training’ session within PE lesson

Station 4Shuttle Run

Pilot study - Physical measures (cont.)

• Physical activity level• Measured using Actigraph Accelerometer (‘The Red Box’)

Good Morning!!!

DON’T FORGET YOUR RED BOX !!

Phase 1 – Considerations and issues for main study

Small focus group (n=5) with non-ID group revealed:

• Circuit session was ‘fun’ alternative to normal PE lesson‘Quality control’ check will take place between PE teachers and doctoral student to ensure uniformity of observational data from fitness tests.

• Questionnaire booklet was not too time consuming and was user friendly

Phase 1 – Considerations and issues for main study

•Some boredom associated with wearing accelerometersSome accelerometers (n=5) returned with no dataPhysical activity questionnaire has been added to questionnaire

bookletIncentive for returning data and more demonstration time

•Some parents felt suspicious of demographic sheet and SDQ questionnaire Despite information sheet and explanation given

• There were no issues regarding time constraints in collecting data within time allocated within each school

• Therefore confident main study will be manageable

NB: Statistical analysis ongoing: (Small sample size but comparable to previously published work in this area)

Pilot Study results (summary)

Psychological measures:

No statistical significant difference between groups in self-efficacy, self-esteem or self-determination

Physiological measures:

No difference in physical activity between groups – no individual across groups achieved recommended PA levels

Statistical difference (p= <0.05) in all elements of the PFT

Pilot study – Subsequent work

• Currently writing study protocol paper to:

• Discuss the use of accelerometers with people with intellectual disabilities

• Describe the methodology of accelerometer and PFT elements with this population

• Report the results of focus group discussions with

participants of pilot study

• Main study undertaken

Phase 2 – Main study design overview

Psychological measures

Physiological measures

Self-efficacySelf-determinationSelf-esteem

Emotional wellbeing

•All adolescents within the study will be measured (n=3x100)

•Measures take place at the BAC or within schools

•Lead by student researcher and assisted by BAC staff and/or P.E. Teachers / classroom assistants

•All adolescents within the study (n=3x100)

•Questionnaires completed in schools

•Facilitated by teachers and classroom assistants and BAC staff

Parents and teachers of all participants (n=300)

Measured pre and post intervention only

BMIFitness testPhysical activity

Phase 2 – Main study tools

As Phase 1 with additional:

• Demographic sheet will be included to record social data

• Attendance registers of DofE sessions to be kept by teachers across groups

Statistics

• Substantial quantitative study design (3x4 analysis)

• Data will be analysed using latent growth curve analysis

Conclusion

Thank you

Questions

Ben FitzpatrickFitzpatrick-b1@email.ulster.ac.uk