Assessing the capabilities of care networks of people with limited executive functions in supporting health-promoting behaviors. A conceptual framework

Background: Programs that address the promotion of health-related behaviors of people with intellectual or developmental disabilities, mental disorders or impaired cognitive functioning typically focus on health-related knowledge and health literacy. These approaches overlook the fact that a significant proportion of these people are affected by more or less severe forms of executive dysfunction. These people have particular difficulties with motivation, following plans, taking responsibility, self-efficacy and self-regulation, all of which are essential for changes in behavior. These people have a particular need for support with regard to their health-promoting behavior, which is often provided by their informal caregivers. Methods: We conducted systematic reviews to identify theories, models and concepts related to predictors of health promoting behavior, domains of health promotion and collaboration between formal and informal care. Based on the identified concepts we developed a conceptual framework using a theoretical integration approach. Findings: In the context of nutrition, physical activity, stress and addiction, we integrated concepts from Nutbeam’s model of health literacy and concepts on intrapersonal skills related to executive functions (taking responsibility, self-perception, self-regulation, self-control) as self-care capabilities of the clients and embedded these into Pender’s health promotion model. We adapted concepts of Orem’s self-care-deficit theory and Taylor’s theory of dependent care to conceptualize caregivers’ helping actions and intrapersonal skills of the caregivers as prerequisites for providing effective support. Conclusions: Based on this framework, we currently develop measurement scales using rasch analysis. The scales to be developed can be used by health care professionals to assess the capabilities to support health promoting behavior in informal care networks.