Health Promotion and Intellectual disability- Never More Important

Sheelagh Wickham and Joanne Anderson write for Frontline....

  • How staff that support individuals with Intellectual Disabilities implement Health Promotion practice
  • Social care managers see health promotion as a priority for individuals with Intellectual Disabilities,
  • However health promotion needs to be tailored to meet individuals’ needs
  • More training and education is seen as a requirement for social care managers in the area of health promotion


The World Health Organisation states that disability is a global public health issue, because individuals with disability throughout the life course face widespread barriers in accessing health and related services, such as those for healthcare, education, employment and social services (WHO, 2014).  Health Promotion can help in addressing the needs of individuals with Intellectual Disabilities. The World Health Organisation (WHO) define health promotion as “The process of enabling people to increase control over and improve their health”.

The WHO consider health  a resource for everyday life (1986). Recognised the need for a ‘charter of action’, this orients health services to be inclusive for all people (WHO, 1986).  When considering people with disability this can be a challenge. Now in the current climate with Covid 19 the need for the intellectual disability population to full access to health services and follow good health practices, such as hand hygiene, is evermore essential.  This paper explores understanding and role of one cohort of staff who interact, support and advocate for individuals on a daily basis.

The participants who informed this work were six social care managers working in an organisation supporting individuals with intellectual disabilities in both residential and day service settings. The six managers were interviewed and the information generated was analysed.  Three themes were generated.

  • Understanding and experience of HP by social care managers
  • Social care managers’ perceptions of their role in promoting HP
  • Enablers and barriers to promoting HP

Understanding and experience of HP by social care managers

The SCM highlighted the importance of awareness of health issues.  For example ageing concerns for people with ID was commonly mentioned with mobility an example of the growing problem for many. While there are some supports such as the public health nurse etc available, there is limited availability of physiotherapy, occupational and speech therapy.  Health Promotion is being practiced, but there may be some health promotion areas are not being addressed.

Social care managers’ perceptions of their role in promoting HP

Social Care Managers’ acknowledged that their role was about supporting the service users along with supporting the staff to be able to support the service users. However many said their roles have changed and that as managers they now have more responsibility in relation to documentation, ensuring it is reviewed and updated. They also spoke of their responsibility for managing staff, particularly staff shortages and sick leave. The impact of this element in the current healthcare pandemic and the reduction in staff numbers due illness and the need to self-isolate further takes from the time needed for health promotion.

Enablers and barriers to promoting health promotion.

Organisational-led initiatives such as mental health well-being days and the lunchtime walks were perceived positively by the managers. Another enabler experienced has been access to nursing staff; particular mention was made about recently appointed Clinical Nurse Specialists (CNS) posts, for example one acute liaison nurse for hospital admissions. This all lend to supporting health and health promotion.

Social care manager indicate that individuals with intellectual disabilities are perceived to experience barriers in accessing healthcare, for example screening an important part of health promotion. The managers believe at times it appears that individuals with intellectual disabilities are often not seen as a priority due to their disability.  While the managers saw they had an important role in health promotion they were concerned about their lack of training and education believing a strong need for more preparation or training for the HP role is indicated.


It is clear throughout that caring for an individual with intellectual disabilities has its challenges, and they may have to deal with ethical dilemmas. Staffs are required to balance the need to respect the independent decisions of individuals with intellectual disabilities on the one hand and try to encourage healthy eating on the other.   Social care managers their role in health promotion, but they were concerned about their lack of training and education. Nevertheless, they undertake actions to promote HP in their units, many as a result of their own initiative. There was a focus on changing health behaviour of individuals with ID, and in particular a focus on healthy lifestyle choices and physical activity. The importance of tailored programmes to individuals’ needs was highlighted. However some barriers to health promotion were identified. It was perceived that health services failed to accommodate the needs of individuals with intellectual disabilities adequately, and that in some cases healthcare professionals’ skills are inadequate.

Health promotion has gained increased recognition within Ireland since the publication of Health Ireland (2013). This was reflected in in the social care managers’ identification of the importance of health promotion in their role the need to enable individuals to have control over their own health.  In the current pandemic the ability of people to contribute to the maintenance of their own good health has never been more important.  Health promotion can contribute to this good health. With support and individualisation from the social care managers’’ the people of the intellectual disability community can each achieve this, to their own individual level.

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Joanne Anderson. RNID, MSc in nursing practice Certificate in Applied management.  The author has over 10years + experience within the field of ID and providing holistic care to individuals with ID. Current role is managing (CNM2) a respite house for both adults and children. Particular areas of interest are improving the overall wellbeing of these individuals, providing a person centred service and enhancing their quality of life.

Dr. Sheelagh Wickham,  RGN. RM. RNT. FFNMRCSI. MSc Ed. DrNSci.    Currently Asst Professor School of Nursing, Psychotherapy and Community Health Her research interests are chronic illness, particularly diabetes, preventive medicine and education. Sheelagh Wickham is a registered nurse midwife.  She achieved MSc Ed Sci from TCD and registered as a nurse tutor.  She completed the fellowship in the Faculty of Nursing in RCSI in 2000 and her Doctorate in the Science of Nursing from the University of Wales, Swansea. Her research interests are chronic illness, particularly diabetes, health promotion/preventive medicine and education. She lectures in DCU and conducts research in education, preventive medicine and chronic illness