Health Program Plan

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

1. CDC. Disability and health: data and statistics. CDC. http://www.cdc.gov/ncbddd/disabilityandhealth/data.html. Published December 16, 2011. Accessed March 4, 2014.
2. Centers for Disease Control and Prevention (CDC). DATA 2010. http://wonder.cdc.gov/data2010/focus.htm. Accessed March 4, 2014.
3. 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.
4. The Arc. Who we are. The Arc.  http://www.thearc.org/page.aspx?pid=2530. Accessed March 5, 2014.
5. World Health Organization (WHO). Disability and health. WHO. http://www.who.int/mediacentre/factsheets/fs352/en/. Published September 2013. Accessed March 4, 2014.
6. 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.
7. 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.
8. National Cancer Institute (NCI). Stage 5: Accessing effectiveness and making refinements. http://www.cancer.gov/cancertopics/cancerlibrary/pinkbook/page8#3. Accessed March 5, 2014

Brief Marketing Plan

Brief Marketing Plan

Kristin Pridgen

HLTH 634-B01

March 2, 2014

Executive Overview

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 program is comprised of public health professionals who are certified health education specialists and devoted towards the advocacy of equal health services of people with disabilities. All representatives of this program hold at least 5 years of experience working with people with various disabilities and possess at minimum, a Masters’ degree in Public Health or related field.

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. 13% of North Carolina’s population has a disability.² Services have been provided for children with disabilities—integrated school services, specialized education plans, frequent medical attention etc.; however, there is a lack of services provided to adults with disabilities. More than half of American adults with a disability do not engage in physical activity, and 39% of people with disabilities have a reported poor state of health, compared to 9% of the nondisabled population.² Other studies have shown a higher rate of people with disabilities developing chronic diseases such as cardiovascular disease, gum disease, high cholesterol and high blood pressure. Despite the growing need for improved health services for this population, there are only 16 health promotion programs in the nation targeting the millions of people with disabilities.²

The lack of health care services for people with disabilities is greatly affecting the overall health of this population. Women with disabilities are significantly less likely than nondisabled women to receive an annual mammogram and Pap smear test.³ Similarly, only 39% of people with disabilities received an annual dental examination.² A survey of doctors revealed the lack of comfort and confidence health professionals have with working with people with disabilities. This leads to lack of services, an increased number of emergency room visits, and overall poor health by this population. Adults with disabilities need to receive proper medical care and health education in order to pursue and maintain a healthy lifestyle.

The proposed intervention is to create a health promotion program for adults with disabilities residing in Wake County, North Carolina, titled “Disabled ≠ Unable Health Promotion Program.” The overall goal of this health promotion program is to create a successful health promotion program for people with disabilities in Wake County. Objectives are the following:

• Emphasize the importance of preventive screenings
• Provide education on basic health conditions and alarms
• Encourage advocacy of more health promotion programs
• Highlight the importance of social inclusion and participation

Outcomes of the Disabled ≠ Unable Health Promotion Program are divided according to the amount of time required to achieve them. Short-term goals that should be achieved within a year of the program’s conception are the following:

• At least 60% of participants in program will actively and consistently receive preventive screenings
• At the end of the program, at least 70% of participants will be adequate in health education, as determined by pre and post tests
• At the end of the program, at least 65% of participants will report engaging in their community’s social activities

Long-term goals that will occur after 1 year are the following:

• 70% of participants will retain their health education
• 80% of participants will report consistently engaging in their community’s social activities
• At least 1 other successful health promotion program for people with disabilities has been created within North Carolina

Market Review

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)⁴; 34% North Carolina adults engage in regular physical activity²
•      Cultural: 56,028 American adults living in congregate care facilities³
•     Demographic: 37% Americans in competitive employment⁵ 
•      Physical: developmental disabilities can produce premature aging¹; comorbidities are usually present (obesity, high blood pressure, additional disability, etc.)⁴
•      Psychographic: 70% of adults with disabilities claim to have emotional/social support⁵; 32% adults have negative feelings affecting their activities²

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, there is a greater chance that this group of people with disabilities 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.

Product Review

This intervention will provide a health education course to participants, educating them on the importance of having good health and on ways to achieve good health (physical activity, healthy eating habits, annual exams and screenings). The program will also offer a list of resources for the participants to utilize to maintain great health; this includes a list of medical care facilities, fitness centers, and ways to engage in physical activity, healthy recipes and foods. This program will differ from other health promotion programs by its advocacy of social inclusion of people with disabilities in main society. The program will encourage the acceptance of all people interacting with each other through visits to community events.

Strategies

Position: The Disabled ≠ Unable Health Promotion Program will use imaging as a unique way to draw awareness and attention to this issue. The logo will be a picture of a handicap sign (stick figure person in a wheelchair) with the words “disability is more than this.” The image portrays the significance of this program: changing your mentality and realizing that people with disabilities are people and are capable of doing many things. The name of the program is a distinct facet of the program. The use of the not equal sign (≠) is a way to catch the reader’s eye and potentially draw the reader into learning about the program. The program will also be distinct in its objectives of increasing optimal health of people with disabilities, and the advocacy of social inclusion in community activities.

Product: Emphasis will be placed on health education and social inclusion advocacy. Both topics are of large importance to the target audience. The percentages of people with disabilities in poor health and engaging in unhealthy behaviors are higher than the percentages of people without disabilities. Additionally, many people with disabilities do not engage in their community’s activities, such as speaking with neighbors and going to events.

Price: Since such a small percentage of people with disabilities are employed, participation in the program will be free. There will be a fee for direct support professionals who participate in the program; the cost will be $30 for the entire program (12 weeks), a reasonable fee for a start-up program. The program will rely on grants to fund the services provided. The program will provide health education and resources to maintain optimal health and social inclusion; this service will not be costly.

Promotion: The Disabled ≠ Unable Health Promotion Program will be promoted online via Wake County Human Services’ website and through social media (Facebook and Twitter). Large promotion will be accomplished by posting flyers in the health department and throughout various assisted living homes in Wake County. Utilizing community organizations such as churches, local recreation centers, and rotary clubs are also strong ways to promote the program. Libraries and radio stations can be used for posting flyers and reading public service announcements. The flyers and advertisements will include information about the number of people in the United States and North Carolina with a disability, the lack of good health in this population and lack of strong healthcare services and health promotion programs, and the need to include this population in main society.

Budget

The projected amount to fund the Disabled ≠ Unable Health Promotion Program is as follows:

• Advertising and promotion: $500
• 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. 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. 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.

References

1. CDC. Disability and health: data and statistics. CDC. http://www.cdc.gov/ncbddd/disabilityandhealth/data.html. Published December 16, 2011. Accessed February 27, 2014.
2. Centers for Disease Control and Prevention (CDC). DATA 2010. http://wonder.cdc.gov/data2010/focus.htm. Accessed February 27, 2014.
3. Smith DL, Ruiz MS. Perceived disparities in access to health care due to cost for women with disabilities. Journal of Rehabilitation. 2009;75(4):3-10.
4. World Health Organization (WHO). Disability and health. WHO. http://www.who.int/mediacentre/factsheets/fs352/en/. Published September 2013. Accessed February 27, 2014.
5. Healthy People 2020. Disability and health. Healthy People 2020. http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicId=9. Updated November 13, 2013. Accessed February 27, 2014.

Brochure & Pretest

Brochure for social inclusion of people with disabilities: Brochure

 

Pretest results for the brochure are provided as well.

Brochure Topic: Social Inclusion of People with Disabilities

Five adults were asked to read the brochure and provide their feedback on its message, presentation, and appeal. Three women and two men were selected to participate. The participants read the brochure and were asked for their input individually as opposed to a focus group approach. The participants were asked to name the first thing about the brochure that caught their eye. Half of the participants named the photo on the cover of the brochure, while the other half mentioned the color and background design of the brochure.  The participants were asked to identify the brochure’s message; all participants said that people with disabilities should not be excluded from main society and that they are able to do things that non-disabled people are. All participants stated that the brochure did raise their interest in the subject; the majority of the participants mentioned never hearing about this topic prior to reading the brochure. Every participant claimed the wording was appropriate for the general public and was compatible for the general public’s reading level. Two participants suggested some adjustments to the brochure’s formatting (creating a new paragraph, font size) and sentence structure. One participant mentioned the order of information presented on the brochure might be confusing to some readers. All participants agreed that the brochure is a good channel to disseminate information about people with disabilities and health. Overall, this pretest of this brochure presented quantitative and qualitative data that suggest a promising outcome from using this brochure.

News Release

K.Pridgen_News.Release

FOR IMMEDIATE RELEASE:                                                                                             Contact: Kristin Pridgen

February 17, 2014                                                                                                            Email: kbadger6@liberty.edu

                                                                                                                 Website:  https://disablednotunable.wordpress.com/  

 

Disabled Doesn’t Equal Unable

Program Addresses Need for Health Promotion Programs for People with Disabilities

(Flesch-Kincaid Reading Level – 9.9)

 

(RALEIGH, NC) Wake County Human Services will work with the new program, Disabled ≠ Unable Program to bring more services for people with special needs in the county.

There are up to fifty-six million Americans who have special needs, and in North Carolina, there are around thirteen percent of citizens with special needs.  There are a large number of people in this country who have special needs, but they do not get the best health care services. In the United States, there are only sixteen programs that promote health and wellness to people with special needs. Poor health services are given to people with special needs. Studies show that people with special needs do not get check-ups to test for cancer, high blood pressure, or high cholesterol on a regular basis.

The Disabled ≠ Unable Program calls for the making of health programs for people with special needs and for them to be included in main society. This program is key, because these people receive poor health care services. Less than half of people with special needs have poor health. Health care workers have said that they do not feel at ease or educated enough to work with people with special needs. The workers’ lack of education and comfort cause many people with special needs to go to the hospital for health problems instead of seeing a regular doctor. People with special needs go to the emergency room up to nineteen times a year.

There is a big need for equal health care services, but not all health centers are able to give better care to people with special needs. The Centers for Disease Control and Prevention (CDC) held a forum about health for people with handicaps. Monika Mitra, Assistant Professor at the University of Massachusetts Medical School put stress on the importance of including people with special needs in main society: “We need to move towards a barrier free environment so that people with disabilities can access medical offices, diagnostic equipment, gyms, and the community at large.”

Mitra’s comment and the facts on poor health services show how important the need is for better health services and social acceptance for people with special needs. In the United States, only one in three adults with special needs say they join in their community’s activities, and the majority of adults with special needs say that they are pleased with their lives. Yet, minorities who have special needs are less content with their lives and do not engage in their community. Equal services are needed for all people with special needs. More health promotion programs and social inclusion for people with special needs can boost this group of people to become driven to have good health and to feel at ease in their community.

For more information on the Disabled ≠ Unable Program and ways to become involved, contact Kristin Pridgen at kbadger6@liberty.edu or visit the website at www.disablednotunable.wordpress.com.

Disabled ≠ Unable Program calls for better and equal health care services for people with special needs and their inclusion in the community activities in North Carolina. Disabled ≠ Unable Health Promotion Program is partnered by The Arc of North Carolina.

###

Literature Review: Why Health Promotion Programs are Needed

Health promotion programs for people with disabilities: a literature review

Kristin Pridgen

Health 634: Health Communication & Advocacy

February 1, 2014

Introduction

Individuals with disabilities face heavy challenges with acceptance in their social environment, and they are often ostracized from main society through accessibility of infrastructure and health care services. In the disabled population, maintaining a healthy lifestyle is essential towards an increased quality of life; 39% of American adults with disabilities reported having a fair to poor health status, when 9% of adults without disabilities claim the same level of health.¹ Comorbidity due to cardiovascular issues, respiratory disease, and obesity are more likely in people with disabilities, increasing their risk of mortality.

While the statistics of risk are alarming, the number of American citizens with disabilities is even more startling; between 37 and 56 million Americans have some type of disability (physical, intellectual, developmental) with the chance of having a disability increasing along with age.² These findings emphasize the need to provide optimal health care services to this population.

Efforts were made in the past to equalize rights and opportunities for persons with disabilities. The Americans with Disabilities Act of 1990 (ADA) protected people with disabilities against any discriminating acts in employment, public accommodations, transportation, and government services, including health and wellness programs³; however the number of health and wellness programs specifically for persons with disabilities has not increased since the 1990s. In 1999, there were 14 documented health promotion programs targeting people with disabilities; 10 years later in 2009, there were 16 programs.⁴ On the one hand, it is possible for people with disabilities to engage in non-specific health programs and health services (this is what the ADA advocated); however, data portrays the lack of utilization of non-specific health care systems by the disabled population.

An intervention is much needed in order to address the lack of health promotion and preventive services for people with disabilities, particularly not residing in supportive housing and receiving their program’s services. The proposed intervention will be the creation of a health promotion program specifically targeting individuals with disabilities. It will be initiated by including persons with disabilities as stakeholders in the program and assisting in creating a program that will meet their needs and preferences; upon the intervention’s effectiveness, a framework can be created to help produce more successful programs for people with disabilities. This review will further endorse the importance of this intervention by addressing the need for health promotion programs and services for individuals with disabilities.

This literature review is comprised of 3 sections: the introduction above briefly describing the current issue; the body of evidence (health trends of persons with disabilities, lack of health services, and healthcare costs) supporting the need for a health promotion intervention; and a summary of presented information and conclusions connecting the intervention’s purpose with the need of health promotion programs for people with disabilities.

 

 

Body of Evidence

Health needs:

As previously mentioned, the percentage of persons with disabilities who reported a poor health status is considerably high (39%) compared to persons without disabilities (9%).¹ The Healthy People 2010 Database has provided health data of American adults with and without disabilities. Physical activity is something of great importance; by engaging in physical activity, muscles are strengthened, balance and stability can increase, body weight can decrease, and risk of developing chronic diseases decreases. Data shows that 54% of adults with disabilities do not engage in any type of physical activity, compared to 32% of non-disabled adults who are consistently physically inactive.⁴ Increased body mass is associated with physical inactivity and poor diet; obesity was measured in 41% of persons with disabilities and in 33% of persons without disabilities.⁴ A study of poor healthy habits in people with intellectual disabilities determined that less than 10% of adults living in supported housing consumed a diet with recommended daily intake of fruits and vegetables.⁵ If the adults with disabilities within supportive housing are consuming unhealthy diets, it is difficult to imagine what type of dietary habits people with disabilities have who live on their own or with family.

In addition to physical inactivity and higher percentages of obesity, persons with disabilities have greater risks of developing cardiovascular disease, respiratory disease, and dental disease. People with Down syndrome and other types of intellectual disabilities have a high incidence of lung disease and injuries.⁵ Furthermore, cardiovascular health of people with disabilities is needing attention; the Healthy People 2010 Database reported 39% of individuals with disabilities and only 29% of non-disabled people having high blood pressure, but similar percentages between the two groups in measures of coronary heart disease and checking blood pressure.⁴ Although the numbers may be comparable in various measures of cardiovascular health, there is still a need to provide education and services towards the disabled population in regards to this topic. Lastly, studies have suggested an association between intellectual disabilities and poor oral health. These findings were consistent even though the participants in the study brushed their teeth daily; the study also found a higher prevalence of dental disease in people with severe intellectual disabilities and residing in deprived areas.⁵   Outside of these illnesses, people with disabilities have a greater rate of having comorbidities, or additional debilitating illnesses, such as arthritis, depression, and diabetes. Out of the 23 million individuals who reported having a disability that did not interfere with performing activities of daily living (ADLs) or instrumental activities of daily living (IADLs), around half of them reported having at least 2 chronic conditions; around 70% of people with disabilities that do affect their ADLs and IADLs reported having at least 2 chronic conditions.⁶  Overall, these statistics of chronic diseases emphasize the caliber of health care needs for people with disabilities.

Lack of services:

Despite the alarming need for addressing the health conditions of persons with disabilities, there is an overwhelming lack of services provided to this population. Several of the chronic diseases mentioned above can be averted through preventive services. Regular blood pressure checks, physical and dental exams are ways to address minor issues in advance before they become substantial debilities. Although the ADA of 1990 enforced health services to people with disabilities, a growing number of health professionals “perceive that they lack the necessary skills, resources, and training to provide adequate primary care”⁷⁽¹⁵⁶⁾ to this population. In regards to preventive services, only 38% of people with disabilities reported receiving annual dental visits.⁴ Furthermore, preventive screenings according to gender are also low; a study concluded that women with disabilities had less access to health care services than men with disabilities and women without disabilities.⁸ These services include Pap smears and mammograms, two preventive services that can detect abnormal or cancerous cells before they can progress. A particular study used the Behavioral Risk Factor Surveillance System (BRFSS), a randomized telephone survey, to compare women with disabilities’ access to health care to the access of men with disabilities and women without disabilities; while women from both groups reported to have had a mammogram, women with disabilities were less likely to have had a mammogram within the last year (59.5%) compared to women without disabilities (65.1%).  Similar results were measured for Pap smear tests between the women with and without disabilities. (64.3% and 71.4% respectively).⁸

Lack of preventive services and access to a personal doctor can increase the number of ambulatory visits by persons with disabilities. One particular study on access to health services for people with disabilities and chronic conditions measured 11 to 19 emergency care visits for individuals with disabilities within the sample, while people without disabilities had around 4 ambulatory visits.⁶ Additionally, preventive screenings and annual visits can educate patients on knowing key symptoms of illnesses such as a lump in a breast, chest pain, or slurred speech. The Healthy People 2010 Database lists 37% of American adults (regardless of disability) recognizing a heart attack and the importance of immediately calling for help, and 49% of people with disabilities are aware of early warning signs of a stroke.⁴ These percentages emphasize the need to not only provide preventive services to the disabled population but to also provide education to promote self-advocacy in health.

Cost of healthcare services:

Numerous surveys and focus groups have indicated that healthcare costs and limited insurances are hindrances to people with disabilities seeking health care services. The Surgeon General priced the annual costs of disability to be more than $300 billion dollars.³ While federal and state monies do fund the bulk of the costs, people with disabilities and their families typically pay $34 billion dollars for health services.³ These numbers are generally startling, but they are a significant problem to many people with disabilities who only have a high school education and are unemployed or underemployed. One study compared the health care expenditures of people with and without physical disabilities; the average health care spending of people with disabilities was 6 times higher than people without disabilities.⁹ Health insurance (private and Medicaid) does provide for most health services and can allow people with disabilities to spend less money out of pocket—Medicaid paid $72.7 billion dollars in 2011,³ particularly to help fill prescriptions and address behavioral health.¹⁰ Despite these initiatives to provide affordable healthcare, accessing healthcare is difficult, as the rate of unmet physical health needs was 41% in one study.¹⁰ For this reason, 27.5% of adults with disabilities claim health care costs to be a barrier to receiving health care services.¹¹ Overall, affordability to all health care services needs to be addressed.

 

 

Summary & Conclusions

The body of evidence addressed the poor health status associated with disability, lack of health services and the expensive nature of such services. Rates of obesity, physical inactivity, comorbidity, and lack of preventive screenings illustrate the health disparity this population suffers. Despite the large disparity, health professionals do not target educating this population on healthy living, and there are only 16 reported health promotion programs for this group in the US.

All the studies mentioned in this literature review do have limitations, such as sample size, source of the samples (people living at home), and methods used to collect data (telephone and mail surveys). Additionally, there is not a large health database on persons with disabilities, a limitation towards creating an effective intervention.

People with disabilities are people and deserve equal services as the rest of the US population. The ADA of 1990 initiated the nationwide acceptance and accommodations for the disabled population, but more work is needed, particularly in the health care sector. This intervention of creating a health promotion program tailored to people with disabilities will aim to effectively educate and promote healthy living among this population and produce a framework for future programs.

 

References

1. CDC. Disability and Health Data System (DHDS). CDC. Available at http://dhds.cdc.gov. Published 2010. Accessed January 31, 2014.
2. CDC. Disability and health: data and statistics. CDC. http://www.cdc.gov/ncbddd/disabilityandhealth/data.html. Published December 16, 2011. Accessed January 31, 2014.
3. Surgeon General. The Surgeon General’s call to action to improve the health and wellness of persons with disabilities. Surgeon General. http://www.surgeongeneral.gov/library/calls/disabilities/understanding.html. Updated January 10, 2008. Accessed January 31, 2014.
4. Centers for Disease Control and Prevention (CDC). DATA 2010. http://wonder.cdc.gov/data2010/focus.htm. Accessed January 31, 2014.
5. McCarthy J, O’Hara J. Ill-health and intellectual disabilities. Curr Opin Psychiatry. 2011;24(5):382-386.
6. Gulley SP, Rasch EK, Chan L. The complex web of health: relationships among chronic conditions, disability, and health services. Public Health Reports. 2011;126(4):495-507.
7. Iacono T, Sutherland G. Health screening and developmental disabilities. Journal of Policy and Practice in Intellectual Disabilities. 2006;3(3):155-163.
8. Smith DL, Ruiz MS. Perceived disparities in access to health care due to cost for women with disabilities. Journal of Rehabilitation. 2009;75(4):3-10.
9. Pumkam C, Probst JC, Bennett KJ, Hardin J, Xirasagar S. Health care expenditures among working-age adults with physical disabilities: variations by disability spans. Disability and Health Journal. 2013;6(4):287-296.

10. Henry AD, Long-Bellil L, Zhang J, Himmelstein J. Unmet need for disability-related health care services and employment status among adults with disabilities in the Massachusetts Medicaid program. Disability and Health Journal. 2011;4(4):209-218.

11. CDC. Cost as a barrier to care for people with disabilities. CDC. http://www.cdc.gov/ncbddd/documents/cost_barrier-tip-sheet–_phpa_1.pdf. Accessed January 31, 2014.

Introduction

The United States has been considered the land of freedom and opportunity—a place where all have the chance to pursue their dreams and live happily. Well, this American Dream has certainly not been attainable to all. Throughout America’s history, equal rights have been advocated for various groups: racial minorities, women, LGBT individuals, and persons with disabilities. While rights have been enacted to help each of these groups (on state and federal levels), there are still persistent issues that arise, particularly for persons with disabilities. The Americans with Disabilities Act 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.¹

But all too often, individuals with disabilities are not given employment opportunities and equal government services. My current job is with a non-profit agency offering services to people with disabilities in order for them to gain their highest level of independence. I serve as an employment specialist, assisting people in finding, applying, and maintaining a job that is right for them. While the job description sounds simple, the truth is, several of candidates with disabilities are overlooked in the work field or are given minimum wage jobs (cart pusher, grocery bagger, etc.). Unemployment and underemployment remain issues for people with disabilities.

Additionally, health services given to people with disabilities is substandard; folks with disabilities are more likely to have delays in receiving health care, not have annual dental visits, pap smears or mammograms, be overweight, receive less emotional support, and not engage in physical activity, as opposed to individuals without disabilities.² More alarming is the number of health promotion programs for people with disabilities in the United States from 1999 to 2009 only increased from 14 to 16.³  There is a great need to include this population in health promotion services, social interactions, employment opportunities, and emergency preparedness.

This blog is designed to bring awareness to American health professionals and to others who have an interest in health equity about the short-comings of health services to persons with disabilities, Healthy People 2020’s objectives to combat these issues, and individual ways to meet these goals. Partnership with an organization will also be essential in meeting the Healthy People 2020’s objectives. 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.⁴ Partnering with the Arc’s mission to provide health education and services to persons with disabilities will be a useful asset to promote health equity.

People with disabilities are people; they are not “the disabled/handicapped” or less than anyone else. I hope this blog will bring about awareness and change.

 

References

1. 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 January 18, 2014.
2. Healthy People 2020. Disability and health. Healthy People 2020. http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicId=9. Updated November 13, 2013. Accessed January 18, 2014.
3. Centers for Disease Control and Prevention (CDC). DATA 2010. http://wonder.cdc.gov/data2010/focus.htm. Accessed January 18, 2014.
4. The Arc. Who we are. The Arc.  http://www.thearc.org/page.aspx?pid=2530. Accessed January 18, 2014.
5. Malamantra. Handicapped. http://www.everystockphoto.com/photo.php?imageId=6758712&searchId=28ba1672245d7ddc101ce99594ba35bf&npos=78. Accessed January 18, 2014.