Tobacco and alcohol-related interventions for people with mild/moderate intellectual disabilities: a systematic review of the literature
Tobacco and alcohol-related interventions for people with mild/moderate intellectual disabilities: a systematic review of the literature
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DOI：
10.1111/j.1365-2788.2012.01543.x
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发表时间：
2013-05-01
影响因子：
3.6
通讯作者：
Fitzsimmons, L.
中科院分区：
文献类型：
--
作者：
Kerr, S.;Lawrence, M.;Fitzsimmons, L.
背景轻、中度智力障碍(ID)患者的健康行为决定因素日益受到关注。随着长住机构的关闭，更多的ID患者住进了社区。随着他们过着更普通和更少限制的生活，ID患者可能会暴露在社会和环境压力下，这些压力鼓励他们采取对其健康产生负面影响的行为。这一客户群体的吸烟和饮酒水平尤其令人担忧。方法采用混合方法对文献进行综述，旨在评估针对轻、中度ID患者使用烟草和/或酒精的干预措施的可行性、适当性、意义和有效性(FAME)。检索1996-2011年间的电子数据库(如Medline、Cochrane临床对照试验登记表、心理信息库)。搜索是使用适当的主题标题和关键字(例如，智力残疾、烟草使用、饮酒、健康促进)进行的。在完成数据库搜索后，根据PICO框架的适应情况(人口、干预、比较、结果)应用了纳入/排除标准。方法质量采用7分评分表进行评估。结果数据库搜索确定了501条独特记录，其中9条符合纳入标准。其中四人关注烟草，三人关注酒精，两人同时关注烟草和酒精。这项研究位于英国、美国和澳大利亚，旨在提高知识水平和/或改变行为(例如鼓励戒烟)。一项是随机对照试验，一项是准实验，其他的是研究和/或病例研究前后的。方法学质量较差或中等。合并后的研究样本规模为341人，年龄从14岁到54岁不等。这些干预措施由专业人员(例如，保健、社会护理、教育)在为期三周至一学年的会议期间进行。研究强调了与这一客户群体干预措施的适当性有关的一些重要问题(例如，使用图片、测验、角色扮演、激励)；然而，在大多数情况下，干预措施似乎缺乏理论框架(例如，行为改变理论)。结果衡量标准是否适用于这一客户群体并未进行测试。一项研究讨论了可行性(教师讲授有关酒精和烟草的课程)，只有一项研究在有效性方面是有益的，即增加对吸烟和过度饮酒的健康和社会危害的认识。结论该综述首次系统地整理了与烟酒相关的针对ID患者的干预措施的证据。虽然目前几乎没有证据来指导实践，但这项综述为干预措施的发展提供了明确的见解，并为更有力的研究方法提供了强有力的证据。特别是，需要在大规模、设计良好的试验中测试干预措施的有效性，并确保为这一客户群体制定/定制适当的结果衡量标准。
Background The behavioural determinants of health among people with mild/moderate intellectual disabilities (ID) are of increasing concern. With the closure of long-stay institutions, more people with ID are living in the community. As they lead more ordinary and less restricted lives, people with ID may be exposed to social and environmental pressures that encourage them to adopt behaviours that impact negatively on their health. Levels of smoking and alcohol consumption in this client group are of particular concern. Methods We undertook a mixed method review of the literature, aiming to assess the Feasibility, Appropriateness, Meaningfulness and Effectiveness (FAME) of interventions designed to address the use of tobacco and/or alcohol in people with mild/moderate ID. Key electronic databases were searched (e.g. Medline, Cochrane Register of Controlled Trials, PsycINFO) from 1996 to 2011. The search was developed using appropriate subject headings and key words (e.g. intellectual disability, tobacco use, alcohol drinking, health promotion). On completion of the database searches, inclusion/exclusion criteria, based on an adaptation of the PICO framework (Population, Intervention, Comparison, Outcomes), were applied. Methodological quality was assessed using a seven-point rating scale. Results Database searches identified 501 unique records, of which nine satisfied the inclusion criteria. Four focused on tobacco, three on alcohol and two on both tobacco and alcohol. Located in the UK, the USA and Australia, the studies aimed to increase knowledge levels and/or change behaviour (e.g. to encourage smoking cessation). One was a randomised controlled trial, one a quasi-experiment and the others were before and after studies and/or case studies. Methodological quality was poor or moderate. The combined studies had a sample size of 341, with ages ranging from 14 to 54 years. The interventions were delivered by professionals (e.g. in health, social care, education) during sessions that spanned a period of three weeks to one academic year. The studies highlighted a number of important issues linked to the appropriateness of interventions for this client group (e.g. use of pictures, quizzes, role play, incentives); however, in the majority of cases the interventions appeared to lack a theoretical framework (e.g. behaviour change theory). The appropriateness of the outcome measures for use with this client group was not tested. One study discussed feasibility (teachers delivering lessons on alcohol and tobacco) and only one was informative in terms of effectiveness i.e. increasing knowledge of the health and social dangers of smoking and excessive alcohol consumption. Conclusions This review is the first to systematically collate evidence on tobacco and alcohol-related interventions for people with ID. While there is currently little evidence to guide practice, the review delivers clear insights for the development of interventions and presents a strong case for more robust research methods. In particular there is a need to test the effectiveness of interventions in large-scale, well-designed trials and to ensure that outcome measures are developed/tailored appropriately for this client group.