The World Health Organization’s recent Global report on health equity for persons with disabilities estimated that approximately 16% of the global population experience disability.1 Although gradual progress across health and social care has been made to reduce inequity for this population, people with disability1 continue to experience significant health disparities and unmet health needs.2 In examining the determinants of health, physical activity and dietary quality are among many of the factors that influence health and wellbeing. However, research indicates that participation in physical activity and healthy eating among people with disability may be low due to a broad range of functional and environmental barriers.1,3,4 Human rights perspectives, most notably the United Nations Convention on the Rights of Persons with Disabilities, recognise that people with disability maintain a universal right to the highest attainable standard of health.5 Further investment in accessible, inclusive, and empowering health promotion initiatives that target physical activity and healthy eating are therefore needed.6 Importantly, research that intends to inform the development of health promotion initiatives must be inclusive and seek meaningful participation from those who have lived experience to target relevant barriers based on their own perceived needs.7

Researchers have increasingly advocated for a biopsychosocial perspective that recognises the interaction of both individual characteristics and environmental factors that contribute to disability and health.8,9 The World Health Organization’s International Classification of Functioning, Disability, and Health (ICF) is one of the most prominent biopsychosocial frameworks used to conceptualise the experience of disability (see Fig. 1).10 The ICF received endorsement from the World Health Assembly in 2001,11 and now provides a standard approach to “understanding and studying health and health-related states, outcomes and determinants” (pp.5).10 The ICF positions that the concepts of disability and health arise as a product of the interaction between the person and their environment, addressing criticisms of both medical and social models of disability.12 While the medical model attributes the experience of adversity to the person and views disability as a “problem” that can be resolved solely through medical intervention, the social model highlights the role of barriers in the social, political, economic, and attitudinal environment that limit accessibility and inclusiveness.13,14 The ICF integrates these two perspectives and offers a holistic view of disability as a multifaceted concept that arises from the interaction between body functions and impairments, activity limitations and participation restrictions, and contextual factors.10

As illustrated in Fig. 1, the ICF classifies health information into one of two parts, each consisting of several components.10 The first part relates to Functioning and Disability and encompasses: (1) Body Functions and Structures, relating to differences or impairments in physiological functions and anatomical structures; and (2) Activities and Participation, referring to the execution of tasks or involvement in everyday life situations. The second part embodies Contextual Factors, including: (3) external physical, social, economic, or attitudinal Environmental Factors; and (4) Personal Factors that relate to an individual’s background. The ICF further classifies information according to a series of chapters, and uses an alphanumeric coding system to categorise determinants of health as they relate to each chapter. As indicated within a recent global overview of the ICF’s utilisation, the framework has been applied across a broad range of disciplines to inform clinical practice, policy development, and education.15 In the realm of public health, the ICF provides an opportunity to explore the determinants that contribute to health outcomes, including physical activity engagement and nutrition.16, 17, 18

The health-promoting features of supported living environments have been recognised as one social determinant of health for this population.19 Following the deinstitutionalisation movement which commenced in the 1970s,20 supported accommodation2 settings have encompassed community-based models of housing where people with disability may live either by themselves or within shared residences and receive individualised 24-h support from staff.21 Research indicates that outcomes in supported accommodation are heavily influenced by care practices that can promote self-determination and autonomy through the successful implementation of person-centered ‘active support’.22, 23, 24 Through the consistent application of active support, staff utilise an enabling relationship that facilitates the meaningful participation and engagement of people with disability, with the goal of increasing choice and control.22 Given that supported accommodation settings are managed by disability service providers, broader organisational factors inevitably impact the quality of care.25 In particular, the concept of ‘practice leadership’ describes the elements of managerial support that sustain workforce capacity and capability in enabling the meaningful engagement of people with disability.22 Effective practice leadership reflects a frontline manager’s commitment to improving quality of life by allocating staff support according to the needs and interests of people with disability, coaching and modelling examples of good practice, and reviewing staff practices through individual and shared supervision.

In conceptualising quality of life domains for people with disability, physical activity and nutrition have been identified as key contributors to health and wellbeing.26,27 However, evidence suggests that people with disability living in supported accommodation may primarily participate in sedentary daily routines, and dietary quality within these settings may be poor.28, 29, 30, 31, 32, 33, 34, 35 Service providers are therefore encouraged to direct attention towards the development of health promotion policies and initiatives that support greater opportunities for physical activity and healthy eating. In an Australian report prepared for the NDIS Quality and Safeguards Commission, Bigby recognised that supporting participation in healthy lifestyles is a foundational component of best practice in supported accommodation.36 Certainly, frontline staff provide support that encompasses lifestyle-related tasks, such as providing mealtime support (e.g., meal preparation, texture modification, feeding routines),37, 38, 39 and encouraging regular participation in physical activity and providing practical support to exercise (e.g., offering physical activities as part of daily programs, transport to local community-based exercise facilities, mutual participation).40,41 Following this, a recent scoping review of health promotion interventions delivered within supported accommodation settings identified education and training as a prominent method of building workforce capacity in providing such support.42 However, conclusions regarding the impact of these interventions were limited due to heterogeneity in methodological quality and the underreporting of outcomes. Evidence also indicates that service providers and researchers may encounter several challenges during the implementation process that determine whether the intervention will be sustained in long-term practice.43

Intervention development must therefore consider the factors that influence health behaviours to inform effective implementation and address a key gap in service provision. Furthering our understanding of the determinants of health that are experienced by people with disability will help identify modifiable risk factors that can be targeted through intervention development.8 This review synthesised the determinants of physical activity and healthy eating, according to the experiences of people with disability living in supported accommodation and the perspectives of staff. These determinants were examined from a biopsychosocial perspective, using the ICF as a guiding framework.