Barriers and Best Practices: Marketing Health Promotion for People with Disabilities

Health promotion for people with disabilities attracts a diverse audience: people with disabilities themselves, policymakers, service providers and others. This Guideline discusses our research on effective strategies for marketing and promoting RTC: Rural’s two health promotion programs: Living Well with a Disability (an eight-week workshop) and the New Directions physical activity program. It also describes the barriers people with disabilities anticipate when they consider participating in a health promotion program. If marketing strategies address these barriers, more people with disabilities may participate in health promotion activities. Secondary conditions are the medical and psycho-social conditions people with disabilities often experience following the onset of a disabling injury or disease. Chapter 6 of Healthy People 2010 focuses on increasing the proportion of people who engage in healthy behaviors that may prevent and/or manage secondary conditions. There are many approaches to changing health behavior, but health education continues to be the standard strategy to teach people how to prevent health problems, and how to maintain and even improve their health. Health promotion programs often include structured classes that target behaviors such as healthy eating and exercise. Living Well with a Disability aims to effect lifestyle changes that may reduce the incidence and severity of secondary conditions. Although our research indicated that Living Well works for people with disabilities, we knew that to reach our audience we would need to package and promote the program effectively

Rural Independent Living and Physical Therapy: Exploring Collaborations

Traditional rehabilitation services are often assumed to be incompatible with independent living (IL) philosophy, but perhaps rural individuals with disabilities might benefit from a collaboration between Centers for independent living (CILs) and rehabilitation services providers. IL philosophy emphasizes improving opportunities for community participation by people with disabilities.1,2 Ecological models of disability emphasize that community participation results when the environment interacts with a person’s capacity to access that environment.3 Participation may increase if environmental accessibility improves, and/or if the individual’s capacity increases. For people with mobility impairments, technology (e.g. wheelchairs) frequently improves individual capacity. Less frequently, changes in a person’s health behavior, such as increased physical activity, can reduce limitation due to secondary conditions and increase personal capacity.4-8 Unfortunately in rural environments people with disabilities rarely have access to opportunities for physical activity, and often lack basic sidewalks and curb cuts to encourage daily physical activity. Centers for independent living provide IL skills training to teach individuals to change their behavior and increase their participation. However, most centers do not have the staff or facilities to help individuals increase their physical capacity. In rural areas, collaboration between physical therapists (PTs) and CILs promises to increase the availability of physical activity for people with disabilities. RTC: Rural researchers interviewed rural physical therapists to explore that possible solution

Marketing Health Promotion for People with Disabilities

Healthy People 2010 is the blueprint for improving the health and well being of all Americans. Its overall focus is to decrease health risks and to increase the proportion of people engaging in healthy behaviors. For the first time, Healthy People includes a chapter on the health of people with disabilities. Chapter Six specifically addresses secondary conditions as a public health concern. Secondary conditions are medical and psycho-social conditions people often experience following the onset of disabilities or chronic illnesses. Our research suggests people with disabilities annually experience 14 secondary conditions that limit their health and independence

The Prevalence and Treatment of Pain Among Rural Medicaid Beneficiaries with Disabilities

Pain has an enormous impact on the lives of many people with disabilities. Recent research suggests that nearly 80% of people whose primary disability is not a pain disorder are still limited by pain as a secondary condition. As many as half of those people report that their pain is ongoing, intractable and limiting (Ehde, Jensen, Engel, Turner, Hoffman & Cardenas, 2003). Our research suggests strong associations between an individual’s pain and his or her quality of life, depression and the number of hours worked

Meaningful Activity and Adaptation to Spinal Cord Injury: An Empirical Investigation of a Cognitive-Existential Measure

Objective: To examine a measure of meaningful activity and purpose attributions for predicting disability outcome in adults with spinal cord injury (SCI). Study Design: Cross-sectional survey correlational design using multiple regression to examine the relationship between the meaningful activity scale and other disability outcome measures. Participants: Adults with spinal cord injury living independently in a community setting (n = 73). Main Outcome Measures: Sense of Coherence, the Centers for Epidemiological Studies of Depression Scale, the Hope Scale, the Health Promoting Lifestyle Inventory and the Life Satisfaction Scale. Results: Significant and substantial variation in each of the outcome measures was attributable to the purpose attribution subscale of the meaningful activity scale. Concurrent validity with both the Sense of Coherence Meaningfulness subscale and the Health Promoting Lifestyle Inventory Personal Growth Orientation subscale was good. Conclusions: The Meaningful Activity Scale provides an alternative approach to assessing disability outcome and quality of life. The cognitive existential conceptual model for the measurement instrument may be useful for developing interventions to help adults with SCI improve their long-term adaptation and outcome following injury

Is teaching skills for independent living to disabled adults associated with change in self-determination?

The purpose of this study was to examine the effect of teaching people with disabilities independent living skills on the basic human needs specified in Self-Determination Theory (Ryan & Deci, 2000). Nine Centers for Independent Living (CILs) recruited 160 disabled adults with disabilities to participate in weekly group sessions to go through the Community Living Skills curriculum (CLS). The CLS curriculum includes 10 sessions that cover basic independent living skills. Groups of participants met weekly to go through the curriculum with a CIL staff member trained in workshop facilitation. We used the Basic Needs Satisfaction General Scale (Gagne, 2003) to assess within subject change pre- and post-intervention. Results indicated participants’ overall needs satisfaction increased after the intervention. This result was driven by a statistically significant change in needs for autonomy and non-significant changes in the positive direction for competence and relatedness needs. Results are discussed in terms of recent literature that highlight intervention characteristics associated with change in satisfaction for each of these basic needs

Tele-Health Promotion for Rural People with Disabilities: Toward a Technology Assisted Peer Support Model

There are relatively few health promotion programs for people with disabilities who live in rural areas. An exception is Living Well with a Disability, a health promotion program for people with disabilities developed by researchers at the RTC: Rural (Ravesloot & Seekins et al.,1994). The Living Well program was originally designed to be delivered in-person by peer-support staff of Centers for Independent Living (CILs) to groups of participants with disabilities. For many rural people with disabilities, however, the distances and travel difficulties inherent in their environment make onsite group programs impractical or inaccessible. Limited funding for programs such as Living Well with a Disability is an additional barrier to health promotion dissemination

Pain as a Secondary Condition Experienced byRural Medicaid Beneficiaries with Disabilities

Secondary conditions are disability-related problems that further limit a person’s ability to engage in daily activities. People who live independently in the community and who have mobility impairments consistently report being limited by 14 secondary conditions annually

Living Well and Medicaid: Better Health for Consumers -- Lower Costs for States

The United States has the world’s most expensive healthcare system. In 2002, health spending rose to nearly 15 percent of U.S. Gross Domestic Product. Healthcare policymakers charged with balancing cost containment with quality healthcare for consumers are desperate for solutions (Levit, Smith, Cowan, Sensenig, and Catlin, 2004)

Peer Support in Managing Psychiatric Symptoms of Rural Adults with Mobility and Sensory Impairments

Little is known about the mental health of people with disabilities who live in rural America or the potential benefit of providing peer support services for these individuals. Stress diathesis models of psychiatric disorders suggest the challenges of living with a disability in rural areas may predispose individuals to higher rates of psychiatric disorders (Monroe & Simons, 1991). In addition, rural mental health service providers struggle to meet the needs of rural individuals with primary psychiatric diagnoses, and they may not be trained to assist people with disabilities who have secondary mental health conditions (New Freedom Commission on Mental Health, 2003). Peer support provided by Center for Independent Living (CIL) staff may help rural adults with disabilities reduce the impact of psychiatric symptoms. Peer support was pioneered by “the rolling quads” who supported each other in advocating for service and support access. Recognizing the importance and role of peer support in living with a disability, the IL movement formalized peer support as a core service with original funding through the 1978 amendments to the Rehabilitation Act of 1973. The purpose of this study was to examine the utility of peer support for supporting the needs of rural adults with mobility an