Tom Seekins

A contextual-behavioral model of empowerment: case studies involving people with physical disabilities.

When people with disabilities, ethnic minorities, older adults, women, and others lack power, they usually experience adverse conditions disproportionate to other members of society. Emproverment—the process by which people gain some control over valued events, outcomes, and resources—is an important construct for understanding and improving the lives of people of marginal status. This manuscript presents a contextual-behavioral model of empowerment and its application in collaborative research with people with physical disabilities. The eight case studies illustrate 18 tactics for promoting empowerment that flow from the model. The case studies show the use of different combinations of empowerment tactics in a variety of contexts: (a) setting improvement agendas from the perspective of people with disabilities, (b) enforcing ordinances that preserve access to parking spaces designated for people with disabilities, (c) enabling access to homes through housing modifications, (d) enhancing support available through mutual-aid groups, (e) developing skills for recruiting mentors, (f) promoting self-directed behavior hange with personal and health concerns, (g) enhancing skills for personal self-advocacy, and (h) building the capacities of groups of people with disabilities for systems advocacy. Finally, we discuss issues that may contribute to research and action related to empowerment.

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

Secondary Disability Prevention: Involving Consumers in the Development of a Public Health Surveillance Instrument:

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.

Guidelines and Criteria for the Implementation of Community-Based Health Promotion Programs for Individuals with Disabilities:

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.

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

Recent legislation has directed the Centers for Disease Control of the Public Health Service to develop a program of disability prevention. Importantly, this new program focuses attention on preventing secondary disabilities—conditions that occur after an individual has acquired a primary (or first) disability. An important influence on the agenda of secondary disability prevention involves identifying the conditions that define the problem for intervention. In public health, this is often accomplished through surveillance systems. In this paper we describe the development of a consumer-directed secondary disability surveillance tool that is consistent with consumer control tenets of independent living philosophy.

Disability and health behavior change

Health promotion programs for people with disabilities are in the early stages of development. This critical review utilizes a credentialed expert panel to develop a set of guidelines for community-based health promotion programs for individuals with disabilities. The procedures include a review of background material, systematic literature review with drafted guidelines consisting of operational, participation and accessibility recommendations. The role that those with disabilities can play is addressed and includes program planning, implementation and evaluation, physical and programmatic accessibility of programs, and importance of evidence-based practices.

Nutrition Education and Support Program for Community-Dwelling Adults with Intellectual Disabilities.

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.

Prevention of secondary health conditions in adults with developmental disabilities: a review of the literature

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.

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

To test the efficacy, acceptability, and appropriateness of a nutrition education and support program, 4 community-based group homes for adults with intellectual or developmental disabilities participated in a pilot intervention with extended baseline period and pre-post-test design. Adults (N = 32) with intellectual or developmental disabilities, 20 direct service staff, 4 managers of group homes, and 2 health specialists at private service providers participated in the intervention, consisting of a system of nutrition supports in nutrition education and guidelines, menu and meal planning, grocery shopping, and cooking designed for the special needs of this population. Positive impacts were found using the program, including fidelity measures, food systems changes and acceptability to users, planned and served foods, and cost changes associated with implementation.