Health Program Plan
Kristin Pridgen
HLTH 634-B01
March 7, 2014
Title of Project: Disabled ≠ Unable Health Promotion Initiative
Author: Kristin Pridgen
Problem/Need Statement:
In the United States, there are 37 to 56 million people with a disability, ranging from physical and mental to developmental.1 The number of people affected by a disability has increased over the years, as the term disability was more accurately defined. Thirteen percent of North Carolina’s population has a disability.2 The Americans with Disabilities Act (ADA) was enacted in 1990 to prohibit any discrimination against persons with disabilities. The act is to ensure equal opportunities in employment, public accommodations, transportation, and government services.3 Despite the growing need for improved health services for this population and the ADA of 1990, there are only 16 health promotion programs in the nation targeting the millions of people with disabilities.2
Goal:
Disabled ≠ Unable Health Promotion Program is a group that calls for better and equal health care services for people with disabilities and their inclusion in community activities in North Carolina. The overall goal of this health promotion program is to create a successful health promotion program for people with disabilities in Wake County. The underlying goal is to increase the acceptance and frequency of social interaction between people with and without disabilities.
Objectives:
For Goal 1:
- Emphasize the importance of preventive screenings
- Provide education on basic health conditions and alarms
- Encourage advocacy of more health promotion programs
For Goal 2:
- Highlight the importance of social inclusion and participation
- Increase level of comfort of people with and without disabilities while interacting together
Sponsoring Agency/Contact person:
Disabled ≠ Unable Health Promotion Program is partnered by The Arc of North Carolina. The Arc is a non-profit agency established in 1950 whose mission is to “promote and protect the human rights of people with intellectual and developmental disabilities and actively support their full inclusion and participation in the community throughout their lifetimes.”4 Currently, the Arc is present in all 50 states and provides services to children and adults with disabilities through housing services, government assistance, health education and assessment services.
For more information on the Disabled ≠ Unable Health Promotion Program and ways to become involved, contact Kristin Pridgen at kbadger6@liberty.edu or visit the website at www.disablednotunable.wordpress.com.
Primary target audience:
The primary target audience of this intervention is adults with disabilities residing in Wake County, North Carolina. More details on this population are provided below:
- Behavioral
- Potentially have higher rates in risky health behaviors (smoking, physical inactivity, poor diet)5
- 34% North Carolina adults engage in regular physical activity2
- Cultural
- 56,028 American adults living in congregate care facilities6
- Demographic
- 37% Americans in competitive employment2
- Physical
- Developmental disabilities can produce premature aging5
- Comorbidities are usually present (obesity, high blood pressure, additional disability, etc.)5
- Psychographic
- 70% of adults with disabilities claim to have emotional/social support6
- 32% adults have negative feelings affecting their activities2
Primary target key strategies:
The health communication will target adults with disabilities residing in Wake County, North Carolina; primary focus will be on adults living independently or with family, not supportive accommodations (group homes, rehabilitation centers), but people from this group will be accepted into the program. From the given health communication, the intended audience should feel inclined to utilize the health promotion program. Self-efficacy should increase, as the intended audience will feel motivated to receive these health services.
A potential barrier to the intended audience utilizing lower self-efficacy may not motivate the intended audience to participate in the program. Chronic conditions and co-morbidity can hinder some of the intended audience from utilizing the program. Some members of this group may not engage in the community or their external environment, due to the stigma placed on disabilities; leaving their homes in order to participate in a health program may produce fear and feeling uncomfortable.
One benefit that adults with disabilities will experience from receiving the communication will be awareness of an accessible program that is designed to specifically assist them in their health needs. This is important, since there is a lack of health promotion programs for people with disabilities. The benefit outweighs the barriers, because the importance of healthy living will be successfully promoted to the intended audience. By highlighting healthy habits in a welcoming setting, the intended audience will feel inclined to participate in healthy behaviors. This could lead to people with disabilities comfortably engaging in their community’s activities and social gatherings, therefore advocating the ADA of 1990.
The communication will use television advertisements to promote the new program; this will reach people with and without disabilities. Flyers will be mailed to homes in Wake County that house persons with disabilities; flyers will be mailed to inform residents of the new program. Internet advertisements will be placed on Wake County’s health department website and the North Carolina Department of Health and Human Services website.
Secondary target audience:
The secondary target audience of this intervention is the direct support professionals and medical professionals that work with adults with disabilities. A large number of people with disabilities reside in assisted living homes with support staff that decide their daily activities. Including this group in the program through education and providing available resources will promote a greater chance that people with disabilities with supportive housing and accommodations can participate in the program and receive its benefits. Health professionals, as mentioned earlier, do not feel comfortable assisting people with disabilities; this group must be targeted in order to change their mentality on working with disabilities and emphasize the need for these people to receive optimal healthcare.
Secondary target key strategies:
The message that will be presented to the secondary audience will be awareness of the grave health risks people with disabilities face when not receiving proper health care. The message will also challenge direct support professionals to address any medical conditions and needs of this population and for medical staff to seek education on the best ways to serve this population and to actually provide services to them. “Disabled does not equal unable” will be the emphasized motto during this message.
Barriers may be lack of education that is available to medical staff to provide health services to people with disabilities. Direct support professionals receive substantial amounts of education and training on working with people with disabilities; a barrier in this audience may be the sense of urgency they hold when attending to people with disabilities. Benefits for both groups are a sense of satisfaction with ensuring that individuals’ have good health, maintaining their current employment, and receiving increased business (medical professionals). By encouraging people with disabilities to connect with the community, networking and the establishment of connections with other supportive people and companies in the area will benefit this audience.
The secondary audience will be reached via representatives visiting medical offices, health seminars/continuing education units and promotion through health professional and direct support professional organization chapters in Wake County. Having a representative from the program speak to this group will be a strong method of conveying the need for health equity and social inclusion for people with disabilities and the importance of this program.
Pretest strategy:
Pretesting the intended audience will be performed by surveys and a baseline knowledge exam. The surveys will provide both quantitative and qualitative data, as it will ask participants about the number of times they engage in their community and why they do or do not engage in their community. Quantitative data will be measured through the health knowledge examination; the exam will measure what health facts participants know prior to starting the program. The survey and examination will have various ways of being administered (enlarged screen, American Sign Language, orally presented, simple wording, etc.) in order to accommodate the participant’s disabilities.
Theoretical foundation:
The Social Cognitive Theory will be a strong theory to use for this program. SCT focuses on behavior being influenced by personal factors and the environment7; using this premise will allow the program to address the intended audience’s level of self-efficacy towards healthy living and having the community’s role addressed through observational learning. SCT can be used within the PRECEDE-PROCEED framework, which focuses on the predisposing, enabling, and reinforcing factors that affect behavior change.7
Management chart:
Timetable: The following tasks are to be completed within this estimated timeframe
| Task | Completed Time |
| Receive grant to fund program | 1 year before program start |
| Secure location for sessions | 6 months before program start |
| Train representatives | 6 months before program start |
| Pretest a sample to edit program topics | 3 months before program start |
| Design final program session schedule and topics | 3 months before program start |
| Address primary and secondary audience | 2 months before program start |
| Advertise program | 2 months before program start |
| Enroll 20 participants | 2 months before program start |
| Pretest evaluations for participants | 2 months to 2 weeks before program start |
| Health Education portion | 12 sessions |
| Social Inclusion portion | 12 sessions |
| Process Evaluation | During 4th and 8th session |
| Outcome and Impact Evaluations | 1 month after program, 3 months after program |
Tasks include each of the items mentioned in the table above. These tasks will be completed by the program representatives and administrators.
Budget:
The projected amount to fund the Disabled ≠ Unable Health Promotion Program is as follows:
- Advertising and promotion: $1,000
- Training of health educators: $1,000
- Health education course materials: $1,000
- Space rental: $5,000
- Salary of health educators: $100,000
Advertising and promotions will not be as expensive as many health programs, since most of the promoting will be through presentations at community organizations and the use of social media. Advertising on social media is relatively reasonable in cost. Creating and submitting a public service announcement for radio will cost approximately $300 dollars. Placing a commercial on the local news channel will cost approximately $500 dollars. The remaining funds will be for printing flyers and for traveling.
Health educators will be trained extensively for this program. Many training sessions will be comparable to continuing education unit courses, which will cost around $1,000 for five health educators. The program will also need health educators who are fluent in American Sign Language and can write Braille to accommodate for participants with hearing or vision loss. Renting a space to hold the meetings will cost no more than $5,000 for 12 sessions; the space should be accommodating to people with disabilities, which may be more expensive. The program will be a seasonal, part-time employment for the health educators, each receiving $20,000 for their work, which includes networking with health professionals in the area to create a list of medical resources and educating the program participants.
Issues of concern:
Possible issues of concern are accommodating the various disabilities represented by the participants. The location for the sessions must be accommodating, including ramps, elevators, and open space. Other issues may arise for accommodating people with vision or hearing loss; Braille writing, closed captioning, or sign interpreters may be needed. Any other issues could be with the general public at community events—ensuring the event is accommodating for people with disabilities and advocating for the community to welcome and support people with disabilities as equal people.
Evaluation strategies:
Qualitative and quantitative research will be useful to evaluate this program. Quantitative research is incorporated by receiving the percentages on participants who had a behavior change in their health and interacting in their community; qualitative research retrieved from the participants will give insight on their perspectives about the program and better explain the quantitative data. Various evaluation designs are possible for evaluating this program. Some of the better options are to do a randomized control trial (RCT) to compare the effects on the program on an experimental group to a control group, before and after studies, and time series analysis. RCT can be time-consuming and expensive, and the time series analysis requires utilizing a governmental database such as the BRFSS.8 Before and after studies will allow the participants’ knowledge, perceptions, and behaviors to be recorded and compared prior to and following their engagement in the program.
Another way to evaluate the health communication program is to use the health theory as a guideline towards measuring effectiveness. For this particular health communication program, Social Cognitive Theory (SCT) was selected due to its reciprocal nature of cognitive, environmental and interpersonal factors; all three factors affect one’s behavior and are believed to affect each other.7 SCT also uses observational learning to introduce a behavior change; in this program, introducing the benefits of having adequate health services and maintaining your health can be illustrated to participants through the testimony of fellow individuals with disabilities via video or in person. Self-efficacy, emotional coping responses, and self-regulatory capacity are three other SCT components that can be utilized for this program.7 Evaluating the program through SCT will measure if the participants’ level of those 3 components had increased from engaging in the program, and if the observational learning was beneficial. Using outcome evaluation methods is the key towards properly creating a successful health communication program.
References
- CDC. Disability and health: data and statistics. CDC. http://www.cdc.gov/ncbddd/disabilityandhealth/data.html. Published December 16, 2011. Accessed March 4, 2014.
- Centers for Disease Control and Prevention (CDC). DATA 2010. http://wonder.cdc.gov/data2010/focus.htm. Accessed March 4, 2014.
- ADA. The Americans with Disabilities Act of 1990 and revised ADA regulations implementing Title II and Title III. ADA. http://www.ada.gov/2010_regs.htm. Accessed March 4, 2014.
- The Arc. Who we are. The Arc. http://www.thearc.org/page.aspx?pid=2530. Accessed March 5, 2014.
- World Health Organization (WHO). Disability and health. WHO. http://www.who.int/mediacentre/factsheets/fs352/en/. Published September 2013. Accessed March 4, 2014.
- Healthy People 2020. Disability and health. Healthy People 2020. http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicId=9. Updated November 13, 2013. Accessed March 5, 2014.
- National Cancer Institute (NCI). Appendix B: selected planning frameworks, social science theories and models of change. NCI. http://www.cancer.gov/cancertopics/cancerlibrary/pinkbook/page11. Accessed March 5, 2014.
- National Cancer Institute (NCI). Stage 5: Accessing effectiveness and making refinements. http://www.cancer.gov/cancertopics/cancerlibrary/pinkbook/page8#3. Accessed March 5, 2014
Disabled ≠ Unable 