Increasing physical activity among people with visual impairment:intervention design

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For some older people who have developed problems with their vision, getting enough exercise can be difficult. In fact, disabled people (including people with visual impairment) are twice as likely to be inactive than non-disabled people, and therefore have a higher risk of health problems such as coronary heart disease. Challenges experienced by some people with visual impairment, particularly older people, include unsuitable paths and walking routes, difficulties obtaining transport, feeling vulnerable, and fear of falling or injury. Despite this, we know that most people with visual impairment want to do more physical activity, including walking. The benefits of walking are well establised, and include improvements in both physical and mental health. Hence, we want to develop an intervention which will help people with visual impairment to overcome these barriers and to engage in more walking. We will design the intervention alongside people with visual impairment so that we know that it is acceptable to them. The design will involve 5 stages:Stage 1 - we will find out what needs to change to enable people with visual impairment to do more walking. We will do this by asking people with visual impairment to tell us about their experience while walking (using 'walking interviews'), and by discussion in focus groups. We will also review what is already known about barriers and facilitators to walking by reviewing existing research literature.Stage 2 - we will summarise, using evidence from other research, ways in which these barriers might be overcome. Then, during workshop discussions we will ask people with visual impairment, their family members, and relevant healthcare professionals, to discuss these various options for overcoming barriers to walking. We will ask all workshop participants to decide whether they think these options are feasible and acceptable, and whether they think each option can be used to help older people with visual impairment to walk more. Each workshop participant will 'rate' the options described.Stage 3 - we will examine those options which were rated as acceptable, and likely to be useful for helping people with visual impairment to walk more, and we will incorporate these options in a 'draft' intervention, or package of techniques, which can be used to increase walking. These techniques might involve ways of improving motivation and confidence, and reducing fear. The techniques might also include the help of volunteer 'buddy walkers' to provide social and practical support for people trying to walk more (particularly in the early days). In a further workshop, people with visual impairment, and others, will discuss this 'package of techniques, and provide feedback. Stage 4 - the research team, and people with visual impairment will use information from the previous stages to design intervention resources that can be used by older people with visual impairment to walk more. These resources are likely to tackle problems around motivation, confidence and fear of falling - in a guided and manageable way that can be adapted depending upon the person's needs and abilities. Stage 5 - some of the barriers that prevent or deter people from walking may involve characteristics of the built environment (paths, roads, parks), transport options, or wider societal issues. It may be necessary, in order to change these barriers, to engage with a wide range of different local and regional agencies, and government departments. Changing these barriers may require more time and additional investment than is available to us at the minute. However, we will bring these agencies together during a workshop to talk about this goal of improving access to, and promoting walking for people with visual impairment. This discussion will also help us to identify who we need to involve if we want our intervention to be successful, and to secure further investment to test the effectiveness of our intervention.