Craig Ravesloot

Living Well With a Disability Health Promotion Intervention: Improved Health Status for Consumers and Lower Costs for Health Care Policymakers

Objective: Investigate effectiveness of a health promotion intervention for adults with mobility impairments. Study Design: Interrupted time series, staggered baseline quasi-experimental with random assignment to treatment start date. Setting: 9 Centers for Independent Living in 8 states. Participants: Adults with mobility impairments living independently (N 188). Intervention: Living Well With a Disability: Facilitated group health promotion (16 hr over 8 weeks). Main Outcomes Measures: Secondary conditions, symptom days, health care utilization. Results: Reductions in limitation from secondary conditions, symptom days, and health care utilization over the intervention period. Effects on secondary conditions maintained for 12 months. Overall cost savings of

Assessing Secondary Conditions among Adults with Developmental Disabilities: A Preliminary Study.

807 per person (total for sample

Health promotion for people with chronic illness and physical disabilities: the connection between health psychology and disability prevention

151,716) projected from reductions in health care utilization of study sample. Conclusions: Health promotion interventions can increase quality of life while helping to control health care costs.

Moving from Independence to Interdependence: A Conceptual Model for Better Understanding Community Participation of Centers for Independent Living Consumers

Pope (1992) asserted that there was a significant need to examine secondary conditions among individuals with development disabilities. In the present study we focused on that need. The development of a secondary conditions surveillance instrument is described, as are the results of a pilot survey conducted with adults receiving state developmental disabilities program supports and with their direct-care service providers. Results of a pilot survey are presented to illustrate how survey data might be used to improve systems of services and supports to enhance the health and participation of adults with developmental disabilities in community life.

Disability and health behavior change

People who have disabilities from injury or chronic illness are at risk for a variety of secondary conditions that can add to the level of disability they experience. Health promotion interventions for people with disabilities have the potential to decrease the incidence and severity of these secondary conditions, but little research has developed models of intervention that specifically address the needs of this population. Two studies were conducted to investigate the utility of integrating the Sense of Coherence (Antonovsky, 1987) and Attribution Style (Abramson et al., 1978) models into a health promotion intervention for people with disabilities. The first study suggested that 45% of the variance in a measure of secondary condition severity could be accounted for by measures of depression, Sense of Coherence and Attributional Style. The second study, a quasi-experimental treatment evaluation, indicated that a health promotion intervention for people with spinal cord injury based on these models resulted in a 37% decrease in reported limitation due to secondary conditions in the treatment group. Combined, the results from these two studies suggest a promising treatment paradigm for conducting health promotion with people who have disabilities.

A Financial Cost—Benefit Analysis of a Health Promotion Program for Individuals With Mobility Impairments

This article provides a brief historical review of disability and personal and environmental limitations to community participation. Attention is given to policies that have limited consumer choice and to the pushback from disability rights advocates. These advocates eventually started the independent living movement as a reaction to the medical model that identifies disability as a personal defect rather than an environmental limitation. The authors discuss the basic philosophy and core services of independent living, and they present a conceptual model for helping centers for independent living (CIL) consumers more fully participate in the community. This model describes a continuum from independence to interdependence approaches to providing CIL services. Finally, the authors describe current research to determine the effectiveness of these two approaches to increasing consumer community participation.

Building the Case for Delivering Health Promotion Services Within the Vocational Rehabilitation System

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.

Secondary Conditions Experienced by Adults with Injury-Related Disabilities in Montana

People with disabilities make up approximately 20% of the U.S. population but account for 47% of total medical expenditures (Max, Rice, & Trupin, 1996). Health promotion programs represent one strategy for both improving health and containing medical costs for this population. This study examined the financial net benefits of the Living Well with a Disability health promotion program from the perspective of a third-party payer. Net benefits were defined as reductions in health-care utilization costs minus program implementation costs. The study sample consisted of 188 people with physical disabilities who completed the Living Well health promotion program. Health-care cost outcomes were collected using a 2-month retrospective recall of health-care services multiplied by Medicare unit cost estimates. The net benefits for the first 6 months postintervention were

Working well with a disability: health promotion as a means to employment.

2,631 per person for the entire cohort and

Housing characteristics of households with wheeled mobility device users from the American Housing Survey: do people live in homes that facilitate community participation?

127 per person for a trimmed data set. The results suggested positive financial benefits and provide grounds for further research about third-party payer support of health promotion programs for individuals with physical disabilities.