Increasing physical activity among people with visual impairment:intervention design

对于一些视力出现问题的老年人来说，进行足够的锻炼可能很困难。事实上，残疾人（包括有视力障碍的人）不运动的可能性是非残疾人的两倍，因此患冠心病等健康问题的风险更高。一些视力障碍者，特别是老年人面临的挑战包括不合适的路径和步行路线、难以获得交通工具、感觉脆弱以及害怕跌倒或受伤。尽管如此，我们知道大多数有视力障碍的人都想做更多的体育活动，包括散步。散步的好处是众所周知的，包括改善身心健康。因此，我们希望开发一种干预方法，帮助视力受损的人克服这些障碍，多走路。我们将与视力受损的人一起设计干预措施，这样我们就知道他们是可以接受的。设计将包括5个阶段：第一阶段——我们将找出需要做出哪些改变，以使视力受损的人能够更多地行走。我们将通过让有视力障碍的人告诉我们他们走路时的经历（使用“走路采访”），以及通过焦点小组讨论来做到这一点。我们还将通过回顾现有的研究文献来回顾已经知道的行走障碍和促进因素。第二阶段-我们将利用其他研究的证据，总结这些障碍可能被克服的方法。然后，在研讨会讨论期间，我们将要求视障人士、他们的家庭成员和相关的医疗保健专业人员讨论这些克服行走障碍的各种选择。我们将要求所有的研讨会参与者决定他们是否认为这些选择是可行和可接受的，以及他们是否认为每个选择都可以用来帮助有视力障碍的老年人走更多的路。每个研讨会参与者将对所描述的选项进行“评分”。第三阶段-我们将检查那些被评为可接受的选项，并且可能对帮助有视力障碍的人更多地行走有用，我们将把这些选项纳入“草案”干预或一揽子技术，可用于增加行走。这些技巧可能包括提高动机和信心，减少恐惧的方法。这些技术可能还包括志愿者“伙伴步行者”的帮助，为那些试图多走路的人提供社会和实际支持（尤其是在早期）。在进一步的研讨会上，有视力障碍的人和其他人将讨论这个“一揽子技术”，并提供反馈。第四阶段——研究团队和视障人士将利用前几个阶段的信息来设计干预资源，这些资源可以帮助有视障的老年人多走路。这些资源可能会以一种可根据个人需求和能力进行调整的指导和管理的方式，解决与动力、自信和害怕跌倒有关的问题。第五阶段：阻碍人们行走的一些障碍可能涉及建筑环境的特征（路径、道路、公园）、交通选择或更广泛的社会问题。为了改变这些障碍，可能有必要与各种不同的地方和区域机构以及政府部门进行接触。改变这些障碍可能需要更多的时间和额外的投资，而不是我们现在所能做到的。然而，我们将把这些机构聚集在一起，在一个研讨会上讨论这个目标，即改善视力障碍人士的行走机会，并促进他们的行走。这种讨论还将帮助我们确定，如果我们希望干预措施取得成功，我们需要让谁参与进来，并确保进一步的投资，以测试我们干预措施的有效性。

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.