Bethany Rigles

Disability and health behavior change

OBJECTIVE/HYPOTHESIS We conducted a review of four health behavior change (HBC) theories (Health Belief, Theory of Planned Behavior, Social Cognitive, and Transtheoretical) to consider how these theories conceptually apply to people with disabilities. METHODS We identified five common constructs across HBC theories and examined how these commonalities fit within the International Classification of Function (ICF). RESULTS Four of the HBC constructs appear to be Personal Factors within the ICF, while the fifth represents Environmental Factors. CONCLUSIONS Using the ICF framework to understand disability and HBC, we propose that including a sense of meaning as another personal factor will further develop HBC theories that lead to more effective HBC interventions for people with disabilities.

Experiences of Rural Vocational Rehabilitation Clients Who Leave the System Prematurely: A Qualitative Exploration.

Vocational rehabilitation (VR) clients who leave the system prematurely experience worse employment outcomes than clients who stay in services. The authors conducted this study to learn about factors leading to premature exit by rural VR clients. Results will inform survey development for a large longitudinal study on this topic. The authors content coded 27 qualitative telephone interviews with former rural VR clients who exited the system prematurely. Reported reasons for premature exit included (a) discrepancies between services provided and services desired, (b) unmet counselor expectations, (c) counselor—client relationship problems, (d) health issues, (e) limited job opportunities, (f) work disincentives, and (g) slow service speed. VR might reduce premature exits by helping clients better understand the VR process, including the types of VR services offered and associated counselor expectations.

The Use of Telecommunication to Deliver Services to Rural and Urban Vocational Rehabilitation Clients

Telecommunication offers a cost-saving alternative to face-to-face vocational rehabilitation (VR) service delivery, yet little is known about the current use. This article describes findings from an exploratory survey of 1,187 counselors, representing 13 VR agencies across the United States. The online survey explored agency, counselor, and client facilitators and barriers to telecommunication use during the VR process. Staff with training in telecommunication strategies reported significantly higher rates of email telecommunication (p < .01). Counselors with a higher rural caseload mix engaged in significantly less email telecommunication during the VR process, and rural clients as compared with urban clients were characterized as having less personal access to a computer with Internet. Although counselors use and rely on simple telecommunication methods such as phone and email to serve their clients, strategies to address barriers are needed to expand telecommunication use during the VR process.

Evaluation of an online health promotion program for vocational rehabilitation consumers.

PURPOSE/OBJECTIVE The purpose of this study was to test the comparative effectiveness of three variations of an online-based health promotion program for improving health and employment outcomes in a sample of Vocational Rehabilitation consumers. RESEARCH METHOD/DESIGN A total of 222 VR consumers participated in a randomized trial of three health promotion variations and provided baseline, 2-, 4-, and 6-month data. Data were analyzed using repeated measures ANOVA. The three health promotion variations included (a) FACTSHEETS-a series of four electronic factsheets; (b) HPE-an online interactive health promotion website that included health behavior content and tailored action planning, and (c) HPE + MI-the online health promotion website plus two 30-minute calls with a trained motivational interviewer. RESULTS Contrary to expectations, evidence did not support between-group differences based on intervention intensity. In fact, the Factsheet, HPE, and HPE + MI participants all experienced significant reductions in secondary conditions, F(2.85, 489) = 7.808, p < .001, HRQoL symptom days, F(2.7, 495) = 4.795, p = .004; and significant improvements in healthy lifestyle behaviors, F(2.6, 495) = 3.66, p = .017 over the 6-month study period. Although this study did not include a control group, a control group from another study with a similar population did not experience similar outcomes. CONCLUSION/IMPLICATIONS People with disabilities experience significantly higher rates of secondary health conditions and lower employment rates than people without disabilities. The combination of these factors signifies the need for health promotion programming outside the work setting.

Access to, Use of, and Attitudes toward Telecommunication among Rural VR Clients.

Telecommunication offers rural vocational rehabilitation (VR) clients a method of communicating with their VR counselor between face-to-face visits. Unfortunately, certain telecommunication methods may not be available to many rural VR clients or may pose barriers in the rehabilitation process. This article describes findings from an exploratory survey of 225 rural VR clients recruited from seven VR agencies across the United States. The mail-based survey explored client access to telecommunication, current telecommunication use during the VR process, and client attitudes about using telecommunication to receive VR services. Although 61% of respondents said they had personal access to a computer with Internet and 63% reported that email would be a “very” acceptable or “somewhat” acceptable method of communicating with their counselors, only 39% reported communicating via email with their counselors. Although a variety of factors play into the effectiveness of telecommunication as a VR service delivery mode, email communication might increase the frequency and productivity of VR client and counselor interactions.