Determinants of dietary behaviour in wheelchair users with spinal cord injury or lower limb amputation: Perspectives of rehabilitation professionals and wheelchair users

Objective
This study aims to identify determinants of dietary behaviour in wheelchair users with spinal cord injury or lower limb amputation, from the perspectives of both wheelchair users and rehabilitation professionals. The findings should contribute to the field of health promotion programs for wheelchair users.
Methods
Five focus groups were held with wheelchair users (n = 25), and two with rehabilitation professionals (n = 11). A thematic approach was used for data analysis in which the determinants were categorized using an integrated International Classification of Functioning, Disability and Health and Attitude, Social influence and self-Efficacy model.
Results
Reported personal factors influencing dietary behaviour in wheelchair users were knowledge, boredom, fatigue, stage of life, habits, appetite, self-control, multiple lifestyle problems, intrinsic motivation, goal setting, monitoring, risk perception, positive experiences, suffering, action planning, health condition, function impairments, attitude and self-efficacy. Reported environmental factors influencing dietary behaviour in wheelchair users were unadjusted kitchens, monitoring difficulties, eating out, costs, unfavourable food supply, nutrition education/counselling, access to simple healthy recipes, eating together, cooking for others, and awareness and support of family and friends.
Conclusions
Important modifiable determinants of dietary behaviour in wheelchair users that might be influenced in lifestyle interventions are knowledge, fatigue, habits, self-control, intrinsic motivation, risk perception, attitude and self-efficacy. It is recommended to involve relatives, since they appear to significantly influence dietary behaviour.

研究目的：本研究旨在从轮椅使用者及康复专业人员双重视角出发，识别脊髓损伤或下肢截肢轮椅群体饮食行为的影响因素，研究成果可为轮椅使用者健康促进项目相关领域提供理论支撑。
研究方法：本研究共开展5场轮椅使用者焦点小组访谈（n=25）、2场康复专业人员焦点小组访谈（n=11）。数据分析采用主题分析法，结合《国际功能、残疾和健康分类》（International Classification of Functioning, Disability and Health, ICF）与态度-社会影响-自我效能模型（Attitude, Social Influence and Self-Efficacy Model）对影响因素进行归类。
研究结果：研究发现，影响轮椅使用者饮食行为的个人因素包括知识水平、无聊感、疲劳程度、人生阶段、行为习惯、食欲、自我控制能力、多重生活方式问题、内在动机、目标设定、行为监测、风险感知、正向体验、痛苦感受、行动规划、健康状况、功能障碍、态度及自我效能。影响其饮食行为的环境因素包括未适配厨房、饮食监测困难、外出就餐、经济成本、不利的食物供给条件、营养教育/咨询服务、简易健康食谱获取途径、共同进餐、为他人烹饪，以及亲友的认知与支持。
研究结论：可通过生活方式干预加以调节的轮椅使用者饮食行为关键可改变影响因素包括知识水平、疲劳程度、行为习惯、自我控制能力、内在动机、风险感知、态度及自我效能。鉴于亲友对饮食行为具有显著影响，建议在干预实践中纳入亲属群体参与。