• Mastery and self-determination in relation to health promotion

Meaningful, manageable and comprehensible activities promote mastery and control in the individual adult with developmental inhibition. The focus on health promotion activities requires committed and motivated employees, who through the promotion of the individual’s right to self-determination can pave the way to a health-promoting everyday life.

Anne Kirstine Bjerrum Flor | Socialstyrelsen

• Control

Adults with developmental inhibition have historically only been involved to a limited extent in decisions that affect themselves (Owren&Linde, 2017). However, adults with developmental inhibition have as much need to have control over their own lives as people without developmental inhibition (Jensen, 2012).

Gaining control of one’s own life is closely linked to the ability to master new situations e.g. health promotion activities, where the adult with developmental inhibition must go out into the garden for new activities with water, bonfire or dance (From, 2013; Andersen, 2019).

• Mastering and the experience of coherence

The Israeli-American professor of medical sociology Aron Antonowski uses the term “experience of context”. An individual achieves an experience of context, if a new situation is meaningful, can be understood and handled by the individual adult with developmental inhibition. The experience of coherence is closely linked to the ability to master a new situation, increase control and promote health. If the individual finds that a new situation is unpredictable or meaningless, for example, the ability to master the situation has deteriorated (Johansson &Roslund, 2017; From, 2013).

Therefore, it is essential that all health promotion activities are organised on the basis that the individual adult with developmental inhibition should be able to achieve an experience of coherence (From, 2013).

Health promotion activities must therefore be organised so that:

1. activity can be predicted and understood by the individual
2. the requirements of the activity are balanced with the individual’s resources;
3. the individual is involved in the planning and execution of the activity so that it becomes as meaningful to the individual as possible (From, 2013).

If one of the three parameters is not present, there is a risk that the individual adult with developmental inhibition will have difficulty mastering the situation, which may result in the risk of impotence, envy, unhealthy behavior and increased morbidity (UCC et al., 2015; Johansson &Roslund, 2017).

• Self-determination and motivation

Self-determination is the right to make your own decisions, which increases the experience of control over one’s own life (Jensen, 2012).

Control over one’s own life is based on the understanding that life must be comprehensible, manageable and meaningful (From, 2013).

If the individual does not experience control, it may result in the individual opting out of participating in health promotion initiatives and activities (Elvén, 2011).

Some studies show that there is still a big difference between the ideal of how self-determination should be practised and what is actually happening in practice. Practice can continue to be characterised by extensive institutionalisation, where the right of self-determination is linked to competence, including when the individual adult with developmental inhibition is formally competent to exercise self-determination. Therefore, it is essential to focus on the individual’s right to self-determination in practice in order to move from speech to action (Jensen, 2012).

In order to promote control and participation in health promotion activities, the National Association of Social Educators states that social education efforts must be based more on the wishes and participation of the individual (Jensen, 2012).

The effort must also promote motivation through relationships, fun and involvement and provide individuals with a choice of health promotion activities. The pedagogical reflection must therefore be about what is offered and how it is offered (Molbæk-Steensig, 2019).

• Committed and active employees are contagious

It requires committed employees to put health on the agenda and motivate both adults with developmental inhibition and employees to participate in health promotion activities on a daily basis. Engagement grows through the employees’ common approach and common language on health promotion activities and behaviour. At the same time, it facilitates cooperation between employees and citizens and thereby strengthens the individual health promotion efforts (Brinck et al., 2010).

In particular, the motivational interview has proven to be a useful tool in connection with the motivational work, which can be used in practice. Active employee participation in health promotion activities has also shown a particularly beneficial effect on motivation for health promotion activities in adults with developmental inhibition (Brinck et al., 2010), according to the health project in Gladsaxe municipality. In the activity, it is particularly important that employees provide verbal support and are mindful of recognising the efforts of the individual adults with developmental inhibition (Molbæk-Steensig, 2019).

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

Sources

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 dovenskab. Socialpædagogen 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.