Title: Understanding the effectiveness and underlying mechanisms of lifestyle modification interventions in adults with learning disabilities.
Funder: Chief Scientist Office, Scotland

Abstract: Unhealthy behaviours can lead to serious health problems such as heart disease, diabetes, and cancer. Adults with learning disabilities are more likely to participate in unhealthy behaviours such as eating an unhealthy diet, smoking, and a lack of physical activity. Supporting adults with learning disabilities to make positive choices can lead to improvements in health. We would like to know how to support adults with learning disabilities to change unhealthy lifestyle behaviours. To do this, we need to understand what works and how best to adapt lifestyle behaviour change programmes to make them accessible and effective for adults with learning disabilities. This research project will look at all available studies of lifestyle behaviour change programmes for adults with learning disabilities. We will use research methods to understand how the programmes work, why they work in some situations and not others, and what health outcomes they can improve. To inform this research we will work together with a group of people with different skills and experience in this area including; adults with learning disabilities, health professionals, and researchers to bring together the research findings. We will use the information to help healthcare services decide how they might help people with learning disabilities to improve their health and wellbeing. We will also provide recommendations on what research is needed in the future to make lifestyle behaviour change programmes that work available for adults with learning disabilities. The involvement of people with lived experience of learning disabilities is central to this application and adults with learning disabilities will be involved in every stage of the study.

Lay abstract: Research question and objectives_x000D_ _x000D_ What is the effectiveness and underlying mechanisms of lifestyle modification interventions (focussed on physical inactivity, sedentary behaviour, unhealthy diet, smoking and alcohol) in adults with learning disabilities? To address the research question, the specific objectives of the study include: _x000D_ 1) To assess the effectiveness of different lifestyle modification interventions simultaneously, in adults with learning disabilities_x000D_ 2) To assess the effectiveness of interventions and the components that contribute to improvements in modifiable health risk factors in adults with learning disabilities_x000D_ 3) To understand how, why, and in what context interventions can be designed to promote healthy lifestyle behaviours in adults with learning disabilities _x000D_ 4) To identify future research priorities to develop lifestyle modification interventions for the NHS and social care services to improve the health of adults with learning disabilities._x000D_ _x000D_ Methods_x000D_ _x000D_ We will systematically review relevant literature and conduct two interlinked evidence syntheses: a network meta-analysis (NMA) of quantitative studies to establish if lifestyle interventions are effective in improving the health of adults with learning disabilities, and a realist synthesis to complement and explain the results of the NMA by identifying key mechanisms within different interventions that are likely to improve the health of adults with learning disabilities. _x000D_ _x000D_ Systematic review and NMA - we will include comparative effectiveness studies (e.g. randomised controlled trials and observational studies). The quality of the studies will be assessed using accepted contemporary standards appropriate to the study design and using the GRADE methodology. NMA at both the intervention level and the component level will be performed. Systematic review and realist synthesis - realist logic of analysis will be applied to build context–mechanism–outcome configurations which will allow us to understand how, why, for whom, and in what contexts an intervention produces the outcomes. We will include a diverse body of literature including quantitative, qualitative, and mixed-methods studies. Studies will be selected based on their relevance to programme theory development and rigour and trustworthiness of findings. Overarching synthesis - to integrate the findings from the two syntheses we will develop a logic model. This will allow us to map out the relationship between intervention components and outcomes, identify important mediators and moderators of effects, explore heterogeneity in the findings, and identify the gaps in the evidence-base which need to be addressed. Finally, we will use priority setting methodology to generate a list of research questions/recommendations informed by the treatment uncertainties identified in the evidence syntheses. _x000D_ _x000D_ Anticipated impact and dissemination_x000D_ _x000D_ Outputs from this study will allow us to make clear recommendations for future research focussed on improving the health and wellbeing of adults with learning disabilities. Our findings will be communicated to a range of audiences (e.g. adults with learning disabilities, community organisations, health and social care services, and policy makers). We will use appropriate and acceptable methods for each group including journals, conference presentations, social media, videos, and health events (involving workshops and a role play performance, performed by adults with learning disabilities).

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: MENTAL HEALTH