Health Promotion

ADA compliance and the accessibility of physical activity facilities in western Oregon.

Cardinal BJ, Spaziani MD. Am J Health Promot. 2003 Jan-Feb;17(3):197-201.
Department of Exercise and Sport Science, 220 Langton Hall, Oregon State University, Corvallis, OR 97331-3303, USA.

Objective: One of the mandates of Title III of the Americans With Disabilities Act (ADA) is to address the accessibility of public facilities for all people. The aim of this study was to determine how compliant physical activity facilities in western Oregon were with regard to Title III of the ADA. Comparisons were also made with the findings of a study conducted 5 years prior in a different geographic region.

Methods: On the basis of direct observations and physical measurements taken during on-site visits to 50 physical activity facilities located in western Oregon during 2000-2001, facility compliance with Title III of the ADA was characterized in terms of 10 structural domains.

Results: No facility was found to be 100% ADA-compliant. Exterior entrance/doors (90%) and telephone accessibility (88%) were the areas where compliance was highest, whereas accessibility to and around exercise equipment (8%) and customer service desk (37%) were areas lowest in compliance. Relative to a previously published study, the facilities in western Oregon showed greater rates of ADA compliance in six of the 10 structural domains evaluated.

Conclusion: There is an on-going need and legal mandate for increasing the accessibility of physical activity facilities. Furthermore, from a social-ecological perspective, the environmental constraints identified in this study might be limiting factors in efforts aimed at increasing individuals with disabilities’ physical activity involvement.

 

What makes it so hard? Barriers to health promotion experienced by people with multiple sclerosis and polio.

Becker H, Stuifbergen A. Fam Community Health. 2004 Jan-Mar;27(1):75-85.
School of Nursing, University of Texas at Austin 78701, USA.

Perceptions of barriers to health promotion were examined in three groups of individuals with disabilities: (1) those with multiple sclerosis, (2) those with postpolio syndrome, and (3) polio survivors without postpolio syndrome. While there were small statistically significant differences among the three groups, all rated fatigue and impairment as their most frequent problems. For all groups, financial and interpersonal resources contributed significantly to the prediction of barriers, after accounting for perceived impairment. The findings suggest that health professionals should explore thoroughly the nature of individuals’ perceived barriers to staying healthy, so that they can target their health-promoting interventions most effectively.

 

Bridging the equity gap: health promotion for adults with intellectual and developmental disabilities.

Marks BA, Heller T. Nurs Clin North Am. 2003 Jun;38(2):205-28. Department of Disability and Human Development (DHD), University of Illinois at Chicago (UIC), 1640 West Roosevelt Road, Chicago, IL 60608, USA. bmarks1@uic.edu

Health is influenced by political, economic, social, cultural, environmental, behavioral and biological conditions—either positively or negatively. Health promotion aims to make these factors more favorable through health advocacy. Advocating for physical, mental, and social health requires that individuals with I/DD have opportunities to identify and realize their aspirations, develop the capacity to satisfy their needs, and possess the ability to adapt and/or cope with the environment. Because health is both an individual and a social responsibility, effective health promotion strategies must incorporate linkages between health and development, particularly for vulnerable and disadvantaged groups where deprivation in health and economic resources exist simultaneously and reinforce each other [6]. Incorporating health and development at the core of health promotion activities addresses issues of poverty, poor health, and unemployment, while accounting for social, cultural and economic differences. Health promotion enables people with I/DD to achieve their health goals by ensuring equal opportunities and resources. This includes having supportive environments, access to information, and life skills and opportunities to make healthy choices. People cannot achieve their health goals unless they can control health determinants. Health promotion efforts require coordinated action from all interested groups (e.g., government entities, health and other social and economic sectors, nongovernmental and voluntary organizations, local authorities, industry and media), including individuals, families and communities. Community-based health promotion emphasizes community participation, along with empowerment of community members to address inequities and increase control over their health [3]. Individual satisfaction and participation are critical components in community coalitions that are providing health promotion programs. Moreover, community leadership, shared decision-making, linkages with other organizations, and organizational climate can predict satisfaction, participation, and planning. Health becomes a resource for everyday life when individuals with I/DD are empowered and can participate in health promotion activities that are based in their community.

 

Community health and nutrition screening for Special Olympics athletes.

Cotugna N, Vickery CE. J Community Health. 2003 Dec;28(6):451-7.
Department of Nutrition and Dietetics, University of Delaware, Newark, DE 19716-3301, USA. ncotugna@udel.edu

Since 1961, Special Olympics has provided sports training and athletic competition for people with mental retardation. A recent addition to these Olympics has been the Healthy Athletes Program, designed to help the athletes improve their health and fitness, leading to enhanced sports experiences and well being. Original health services included dental and eye screening. In 2002, Special Olympics Delaware piloted a Wellness Park to add nutrition, blood pressure, and flexibility screening. Faculty from a university’s health college trained discipline-specific students to conduct the screenings. Thirty nutrition and dietetics students measured height, weight, waist circumference, and calculated body mass index (BMI) for the athletes. Figures and risk-assessments were recorded on a “health report card.” Two hundred ten athletes attended the nutrition screening. Ages ranged from 8 to 63 years; 81 percent males and 19 percent females. According to BMI standards, 32 percent of the athletes were overweight; 17 percent were obese. Twenty-five percent of adult males and 73 percent of adult females had a high risk waist circumference. Athletes at high risk for obesity-related diseases were referred to their primary physician for follow up. Nutrition education handouts included a simplified Food Guide Pyramid, tips for healthy eating in restaurants, 5 A Day information, and healthful hydration guides. Approximately 1,250 athletes participate in Special Olympics Delaware each year, providing a great opportunity to do some much needed health screening and improve access to health care for this often neglected population.

 

HIV prevention among people with developmental disabilities.

Brown EJ, Jemmott LS.: J Psychosoc Nurs Ment Health Serv. 2002 Nov;40(11):14-21.
University of Central Florida, School of Nursing, Satellite Research Office, 901 NW 8th Avenue, Suite A-4, Gainesville, FL 32601, USA. ejbrown@mail.ucf.edu

This investigation sought to determine the effect of HIV/AIDS on people with developmental disabilities. Inquiries about contributing factors and HIV prevention needs also were made. In this qualitative descriptive study, two focus groups were conducted with individuals from the target population, as well as service providers. Each focus group was held in a conference room of a community-based organization located in Philadelphia on a weekday evening. Sixteen adults participated in the focus groups. Seven were members of the target population, and 9 were services providers. Focused topics were developed to guide the group discussion. Participants identified several contributing factors and barriers associated with risk behavior and HIV risk in this population. Recommendations for HIV prevention needs and strategies also were generated. The results of this formative inquiry indicated there is a need for development of specific HIV intervention strategies for this vulnerable and often overlooked population. Clinical and research implications are proposed.

 

Obesity in people with intellectual disabilities: the impact of nurse-led health screenings and health promotion activities.

Marshall D, McConkey R, Moore G. : J Adv Nurs. 2003 Jan;41(2):147-53.
Down Lisburn Health and Social Services Trust, Disability Resource Centre, Downpatrick, UK.

Background: Obesity appears to be more common among people with intellectual disabilities, with few studies focusing on achieving weight reduction. AIM: Firstly, to follow-up people identified as overweight and obese following special health screening clinics and to determine the actions taken. Secondly, to evaluate the impact of health promotion classes on participants’ weight loss.

Methods: A clinic led by two learning disability nurses was held for all people aged 10 years and over (n = 464) who attended special services within the area of one Health and Social Services Trust in Northern Ireland. In a second study, the nurses organized health promotion classes for 20 people over a 6- or 8-week period.

Findings: The health screen identified 64% of adults and 26% of 10-19-year olds as being overweight or obese. Moreover, those aged 40-49 years who were obese had significantly higher levels of blood pressure. However, information obtained from a follow-up questionnaire sent after 3 months suggested that of the 122 people identified for weight reduction, action had been taken for only 34% of them and only three were reported to have lost weight. The health promotion classes, however, led to a significant reduction in weight and body mass index scores.

Conclusion: Health screening per se has limited impact on reducing obesity levels in this client group. Rather, health personnel such as general practitioners, nurses and health promotion staff need to work in partnership with service staff, carers and people with intellectual disabilities to create more active lifestyles.

 

Wheelchair racing efficiency.

Cooper RA, Boninger ML, Cooper R, Robertson RN, Baldini FD. Disabil Rehabil. 2003 Feb 18-Mar 4;25(4-5):207-12.
Department of Rehabilitation and Technology, University of Pittsburgh, USA. rcooper@pitt.edu

Purpose: For individuals with disabilities exercise, such as wheelchair racing, can be an important modality for community reintegration, as well as health promotion. The purpose of this study was to examine selected parameters during racing wheelchair propulsion among a sample of elite wheelchair racers. It was hypothesized that blood lactate accumulation and wheeling economy (i.e. oxygen consumed per minute) would increase with speed and that gross mechanical efficiency would reach an optimum for each athlete.

Methods: Twelve elite wheelchair racers with paraplegia participated in this study. Nine of the subjects were males and three were females. Each subject used his or her personal wheelchair during the experiments. A computer monitored wheelchair dynamometer was used during all testing. The method used was essentially a discontinuous economy protocol. Mixed model analysis of variance (ANOVA) was used to compare blood lactate concentration, economy (minute oxygen consumption), and gross mechanical efficiency across the stages.

Results: The results of this study show that both economy and blood lactate concentration increase linearly with speed if resistance is held constant. The subjects in this study had gross mechanical efficiencies (gme) of about 18%, with the range going from 15.222.7%. The results indicate that at the higher speeds of propulsion, for example near race speeds, analysis of respiratory gases may not give a complete energy profile.

Conclusion: While there is a good understanding of training methods to improve cardiovascular fitness for wheelchair racers, little is known about improving efficiency (e.g. technique, equipment), therefore methods need to be developed to determine efficiency while training or in race situations.

 

Health promotion for people with disabilities: the emerging paradigm shift from disability prevention to prevention of secondary conditions.

Rimmer JH.P 1: Phys Ther 1999 May;79(5):495-502 Center on Health Promotion Research for Persons With Disabilities, Department of Disability and Human Development, College of Health and Human Development Sciences, University of Illinois at Chicago, 60608-6904, USA. jrimmer@uic.edu

The premise of this article is that, until recently, health promotion for people with disabilities has been a neglected area of interest on the part of the general health community. Today, researchers, funding agencies, and health care providers and consumers are leading an effort to establish higher-quality health care for the millions of Americans with disabilities. The aims of a health promotion program for people with disabilities are to reduce secondary conditions (eg, obesity, hypertension, pressure sores), to maintain functional independence, to provide an opportunity for leisure and enjoyment, and to enhance the overall quality of life by reducing environmental barriers to good health. A greater emphasis must be placed on community-based health promotion initiatives for people with disabilities in order to achieve these objectives.

 

Spinal cord injury medicine. Preserving wellness and independence of the aging patient with spinal cord injury: a primary care approach for the rehabilitation medicine specialist.

Groah SL, Stiens SA, Gittler MS, Kirshblum SC, McKinley WO. Arch Phys Med Rehabil 2002 Mar;83(3 Suppl 1):S82-9, S90-8

Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA 95118, USA. slgroah@hotmail.com

This self-directed learning module highlights consideration and treatment of individuals with long-term spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the challenges of chronic disease prevention, diagnosis, therapeutic options, and the resultant impact on the person with long-term SCI. With cardiovascular disease becoming a leading cause of mortality in this population, risk factor modification through weight, lipid, and glucose control becomes more important. Likewise, bowel dysfunction increases with duration and severity of SCI. Conservative and surgical management options are discussed. Musculoskeletal repetitive trauma injuries occur commonly in long-term SCI but can be prevented with appropriate lifestyle or equipment modifications. These and other conditions occurring in the person with long-term SCI are closely related to psychosocial function with resultant social isolation, depression, and substance abuse. Thus, identification and surveillance of these comorbidities are addressed, with an emphasis on prevention.

Overall Article Objective: To summarize the unique medical, psychosocial, and functional needs of the individual with long-term SCI.

 

Teaching for life: integrating aging into the rehabilitation education program.

Colodny A. SCI Nurs 2002 Summer;19(2):67-70 VA Long Beach Healthcare System, Long Beach, California, USA.

As the population with spinal cord injury (SCI) steadily ages, nurses find it more and more challenging to prevent secondary complications. SCI, an already complex topic, is made more so with the addition of the aging process. Aging need not be a negative occurrence, but can be viewed as a path in life that requires careful navigation along the way. Nurses need to incorporate the concepts of wellness and disease prevention education into the initial rehabilitation program to better prepare patients for a long and healthy life. This article briefly describes respiratory and genitourinary complications associated with aging with an SCI and some specific teaching strategies for prevention and management of these two complications.

 

A randomized clinical trial of a wellness intervention for women with multiple sclerosis.

Stuifbergen AK, Becker H, Blozis S, Timmerman G, Kullberg V. Arch Phys Med Rehabil. 2003 Apr;84(4):467-76. University of Texas at Austin School of Nursing, Austin, TX 78701, USA. astuifbergen@mail.utexas.edu

Objective: To examine the effects of a wellness intervention program for women with multiple sclerosis (MS) on health behaviors and quality of life (QOL).

Design: Randomized clinical trial.

Setting: Community setting in the southwestern United States.

Participants: Convenience sample of 113 women with physician-confirmed MS (mean age, 45.79y).

Interventions: The 2-phase intervention program included lifestyle-change classes for 8 weeks, then telephone follow-up for 3 months. Participants were followed over an 8-month period.

Main Outcome Measures: A series of self-report instruments to measure barriers, resources, self-efficacy for health behaviors, health promotion behaviors, and health-related QOL were completed at baseline, 2 months (after the classes), 5 months (after telephone follow-up), and at 8 months. Principal outcomes measures were health-promoting behaviors (scores on the Health Promoting Lifestyle Profile II) and QOL (scores on the Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36] scales).

Results: Hierarchical linear modeling techniques revealed a statistically significant group by time effect for self-efficacy for health behaviors, health-promoting behaviors, and the mental health and pain scales of the SF-36.

Conclusion: These data provide initial support for the positive effects of wellness interventions to improve health behaviors and selected dimensions of QOL for women with MS.

 

Barriers to nutrition as a health promotion practice for women with disabilities.

Hall L, Colantonio A, Yoshida K.: Int J Rehabil Res. 2003 Sep;26(3):245-7.
Department of Occupational Therapy, Faculty of Medicine, University of Toronto, 500 University Avenue, 9th Floor, Toronto, Ontario M5G 1V7, Canada.

The purposes of this study were to examine the barriers to eating well experienced by women with physical disabilities and the services required to improve eating habits. Participants (mean age=48.9, SD=14.4) completed a questionnaire on health promotion behaviours (n=1096), which included a section on nutrition-related behaviours. Of the 31.8% who stated that they experienced barriers to nutrition, 88.9% wished to improve their eating habits. The most common barriers encountered were: too tired to cook (54.6%), organic/health foods too expensive (34.8%), nutritious foods too expensive (34.5%), lack of desire or will power (31.5%), government disability pension does not cover cost of food (30.6%), difficult to shop (25.1%) and not enough time for attendant to shop or prepare food (21.2%). The most common services identified to improve nutrition were: increase in disability pension (45.2%), assistance with shopping (31.3%), programs that deliver food (28.8%), increase attendant time for shopping/cooking (22.0%) and food box programs that provide single servings (20.1%). These results provide a holistic view of health-promoting behaviours in women with physical disabilities and suggest that greater emphasis should be placed on the individual in her social and structural environment when implementing programs for improving nutrition-related behaviours.

 

Feasibility of a health promotion intervention for a group of predominantly African American women with type 2 diabetes.

Rimmer JH, Silverman K, Braunschweig C, Quinn L, Liu Y. Diabetes Educ 2002 Jul-Aug;28(4):571-80 Department of Disability and Human Development, University of Illinois at Chicago, 1640 West Roosevelt Road, Chicago, IL 60608-6904, USA. jrimmer@uic.edu

Purpose: This feasibility study was undertaken to determine if a group of predominantly low-income, low-education, African American women with type 2 diabetes could achieve good compliance and improved health outcomes with a carefully structured health promotion intervention.

Methods: The sample consisted of 30 participants from an urban setting who were diagnosed with type 2 diabetes but also had multiple chronic conditions (e.g., obesity, hypertension, joint pain, and depression). Participants attended a university-based health promotion program where they completed a 12-week intervention that addressed diet, nutrition, and health behavior. Transportation was provided at no cost to the participants.

Results: Compliance with the 12-week program was 72.5%. Participants made significant improvements in total cholesterol and LDL-cholesterol levels, cardiovascular fitness, muscularstrength and endurance, and nutrition knowledge.

Conclusion: African American women with type 2 diabetes residing in difficult living environments (i.e., poverty, high crime, and lack of family support) can achieve good compliance and health outcomes with a structured health promotion program provided that barriers to participation (e.g., transportation, cost, and commitment) are removed prior to and during the intervention.