Increasing physical activity among people with visual impairment:intervention design

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.

One fifth of older adults experience visual impairment (VI). Adjusting to VI after a lifetime as a sighted person is difficult, and negatively impacts upon health inequalities, in part due to low levels of physical activity. Most people with VI want to engage in more physical activity, but barriers include disabling environments, difficulties obtaining transportation, lack of assertiveness, and feelings of vulnerability, fear of falling/injury. Hence, we seek to develop a multi-component intervention to increase walking among older people with VI, informed by the Behaviour Change Wheel. Development will progress in 5 stages, with significant and meaningful input from end-users throughout: Stage 1 - identification of barriers to walking (personal, social, and physical/environmental) via rapid reviews, ethnographic walking interviews with older people with VI, focus groups and standard interviews. Stage 2 - the components (barriers / facilitators) identified in stage 1 will be mapped onto the 'intervention functions' specified by the Behaviour Change Wheel (BCW). Rapid reviews will be conducted to extract behaviour change techniques (BCTs) relevant to each function. These will be synthesised and presented to stakeholders in a series of workshops. Using the RAND/UCLA Appropriateness Method and criteria (based on APEASE) defined a-priori, each BCT will be rated by stakeholders. Stage 3- compilation of a draft intervention logic model and theory of change, including contextual contingencies, using the BCTs identified in stage 2, and review of the logic model in a further stakeholder workshop. Stage 4 - intervention resources will be co-designed by the research team and people with VI, in an appropriate medium for the end-users. Stage 5 - systems mapping workshop to situate the intervention in the broader socio-ecological system, and to identify important contextual contingences relevant to the effectiveness, and implementation of the intervention.

Older people with visual impairment, and their families will benefit from the research.
Some older people living with a visual impairment face many challenges when trying to engage in physical activity. As a consequence of this, and other factors, they are at a higher risk of health problems including coronary heart disease. There is no existing, research informed intervention that specifically targets the multiple challenges faced by this group of people, particularly the vicious cycle of fear (of falling/ injury) and activity restriction experienced by people with visual impairment. Our research will result in an intervention that will help older people with visual impairment to meet the recommended 150 minutes a week moderate intensity physical activity needed for substantial health gain. Ultimately we expect that use of our intervention will also produce benefits to physical health and mental wellbeing for older people with visual impairment. It may also reduce social isolation and feelings of loneliness, and improve quality of life. By improving physical and psychological outcomes for people with visual impairment, the intervention will also impact positively upon the wellbeing of family members who help to support older people with visual impairment.
By bringing together a broad range of stakeholders, including local and regional agencies and departments involved with transport, the built environment, parks and outdoor spaces, healthcare, communities, and advocacy groups) to discuss the goal of increasing walking among older people with visual impairment, the research might contribute to increased awareness, future strategy, activities and investment in this area by these agencies, and to increased public awareness.