Dilemma between self-determination and duty of care


A Swedish report by R&D-Södertörn suggests that dilemmas may arise between staff and adults with developmental inhibitions, especially when the adult with developmental inhibition eats or drinks too much and at the same time must be supported in his right to self-determination and conduct his own choices (Assadi, 2012).

The R&D-Södertörn report highlights in particular the conflict between the individual’s right to self-determination on the one hand and the need for care on the other, which can end in doubt and conflict in practice. The trade-off between trying to influence the actions of the individual while respecting the individual’s own choices when it comes to diet, alcohol and exercise is often difficult (Assadi, 2012).

In order to meet this dilemma, the R&D-Södertörn report emphasizes that the employee must support and motivate the individual adult with developmental inhibition, rather than controlling and addressing the individual. A health-promoting care must focus on the individual, so that he or she experiences everyday life and the demands that are made, as manageable, comprehensible and meaningful. If the individual has an experience of coherence, it can lift control, motivation, create a change in behaviour and meet the dilemma between self-determination and duty of care (Assadi, 2012).

Interventions combining diet and physical activity are seen to lead to some improvement in health. At the same time, studies show that support from carers and close relatives, as well as from the health service, is important for people with developmental inhibition to maintain physical activity (Bergström et al., 2013; Blomqvist&Börje, 2015; CFK, 2015).

  • Body and food

Danish and international research shows that people with developmental inhibition have a greater risk of both overweight and underweight than the rest of the population. This is largely due to inappropriate diets that have a negative impact on physical and mental well-being.self-determination

Dorte From | National Board of Health

Overweight and obesity, but also underweight, occur to a greater extent in people with developmental inhibition than in the rest of the population. While in the normal population there are generally 50 per cent who are normal weighted, 27 per cent are normal weighted in the group of citizens with developmental inhibition. Thus, there is a large group of citizens with developmental inhibition who are either overweight or underweight (Region Midtjylland, u.å.).

  • Overweight and obesity have consequences for physical and mental well-being

In recent years, several Danish and international studies have identified obesity and overweight as major risk factors in relation to physical health for people with developmental inhibition. Obesity and overweight have an impact on the person’s physical and mental well-being in everyday life. A consequence of being overweight can be difficulties in performing tasks in everyday life, and this can increase the risk of further loss of function and thus an increased need for care and support. Another consequence may be social isolation. Overweight and obesity also lead in the long term to an increased risk of cardiovascular disease and diabetes (Bergström et al., 2013; Wallén, 2014; Dry rice et al., 2015).

self-determinationMaking good dietary choices is about having the right skills to plan, shop for, produce and eat good meals. It’s also about an understanding of what’s good diet and why it’s important to eat healthily. Ultimately, it’s about being motivated to eat good diets (Dehn et al., 2018).

Due to cognitive impairment, people with developmental impairment often find it difficult to understand and understand the need for healthy eating. Therefore, it is an essential premise of dietary planning that one not only has an eye on the person’s own resources and competences, but also includes the total resources around the person, including the professional staff responsible for supporting the person (Adolfsson, 2010; Wallén, 2014; Dehn et al., 2018; Bergström et al., 2013).

  • Self-determination and participation have an impact on dietary choices

Danish and international studies have shown that it is important for people with developmental inhibition to eat healthily that they experience self-determination in relation to dietary choices. The motivation to eat healthily increases significantly when the person is supported in making good dietary choices themselves and experiences it is meaningful. That is, the experience of the good meal is individual and therefore must always be customized individually (Køhler, 2010; Adolfsson et al., 2012; Furesø Municipality, 2014; Johansen et al., 2017; Sørensen& Rasmussen, 2020).

Within a number of years, several Danish and Nordic projects have been carried out with a focus on healthy eating, where a thorough focus has been self-determination and participation. The involvement of citizens’ own resources and mastery has been a common part of the projects, which has had a major impact on the fact that participants with developmental disabilities have experienced meaningfulness and motivation to make healthy dietary choices (Dehn et al., 2018; Dønnestad&Dale-Western, 2018; CFK, 2015; Bergström et al., 2013).

self-determinationAmong other things, the projects have developed models for cooperation between residents and employees in residential areas on purchasing, choosing a diet and making meals. Several of the projects have also developed concrete tools for residents, such as easily accessible cookbooks. Finally, some projects have included joint health education for residents and employees (Dehn et al., 2018; Dønnestad&Dale-Western, 2018; CFK, 2015; Bergström et al., 2013).

It is obvious that interventions that combine diet and physical activity provide some improvement in health. The studies also show that support from carers and close relatives as well as health care is important for outcomes (Blomqvist&Börje, 2015).

In Denmark the National Board of Health and Welfare in Denmark has developed, published and operated a Knowledge portal in Social area.

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Bergström H. et al. (2013). Hälsofrämjande gruppbostad: Planering, genomförande och utvärdering av ett hälsofrämjande program. Rapport 2013: 5. Stockholm: Centrum för epidemiologi och samhällsmedicin.

Blomqvist, Sven & Rehn, Börje (2015). Fysisk aktivitet och hälsa för personer med utvecklingsstörning. Fysioterapi, (1): 26-31.

CFK (2015). Indflydelse på egen sundhed. Aarhus: CFK – Folkesundhed og Kvalitetsudvikling.

Elnan, I. (2010). Idrett for alle? Studie av funksjonshemmedes idrettsdeltagelse og fysiske aktivitet. Trondheim: NTNU Samfunnsforskning AS, Senter for Idrettsforskning.

Furesø Kommune (2014). Slutevaluering af ’Sundhedsfremmeprojekt på bosteder for psykisk udviklingshæmmede’. Furesø Kommune.

Socialpædagogen Online (2014). Det skal være sjovt at slå dovenskabSocialpædagogen Online, Vol. 71(20): 14-17.

Sveriges Kommuner och Landsting (2018). Hur skapar vi bättre hälsa för personer med funktionsnedsättning? Beskrivning av ojämlikheter idag samt förslag på förändrade arbetssätt.Stockholm: Sveriges Kommuner och Landsting.

Sørensen, J. et al. (2013). Barrierer for lige adgang til det primære sundhedsvæsen: For personer med en intellektuel eller psykisk funktionsnedsættelse. Taastrup: Danske Handicaporganisationer.

Wallén, Eva Flygare (2014). Betydelsen av hälsomma kost- och motionsvanor hos personer med utvecklingsstörning: En sammanställning av evidens. Evidensrapport nr. 5. Stockholm: Habilitering & Hälsa. Stockholms Läns Landsting.

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