Healthy lifestyles for people with disabilities: An integrated approach to health and wellness
Presenter Name: Beth Morrell, MPH, CHES
Institution: Oregon Institute on Disability & Development/Oregon of on Disability and Health
Primary Research Interests: Healthy lifestyles for people with disabilities
More people with disabilities are living on their own, working in community jobs and experiencing the same levels of stress as those without disabilities. People with disabilities are experiencing increases in secondary complications such as depression, obesity, and isolation.1 Health education and health promotion have been helpful in reducing the frequency of these issues in the general population, however the specific needs of those with disabilities have not been addressed by standard public health interventions.2 The Healthy Lifestyles for People with Disabilities curriculum has been created to help decrease this disparity.
Historically, the wellness of people with disabilities has been under-examined.3 Today there is that having a disability and being healthy are not mutually exclusive. However it has centered primarily on the clinical aspects of physical health such as losing weight, decreasing blood pressure, health care utilization, and secondary conditions.4 Healthy Lifestyles for People with Disabilities is one of the first curriculums to look at the whole person in respect to health and wellness. This curriculum takes into account social, physical, spiritual, and emotional health.
The Healthy Lifestyles for People with Disabilities training curriculum was developed in 1998 by a work group of professionals from the Oregon Institute on Disability & Development (OIDD) at Oregon Health & Science University (OHSU). The Healthy Lifestyles Project: Making Opportunities for Healthy Lifestyles was a 3-year Project of National Significance grant awarded by the Administration on Development Disabilities.
Goal 1: To increase the ability of persons with disabilities to practice healthy lifestyles.
Goal 2: To develop a knowledge base about accommodations to health and fitness activities for persons with disabilities.
Goal 3: To define health in the area of social, emotional, spiritual, and physical health for persons with disabilities.
The Healthy Lifestyles for People with Disabilities training, an integrated wellness and empowerment curriculum, takes place over the course of two and a half days after receiving an orientation. A team of people leads this training from a Center for Independent Living (CIL) and the Oregon Office on Disability & Health (OODH). The training team included people with and without disabilities. Utilizing support groups and mentors in months following the training, participants are empowered to strive for self-identified goals.
The Healthy Lifestyles orientation takes place two weeks before the training is conducted. The orientation includes an overview of the five aspects of the workshop and how they are interrelated, the video, “Healthy Lifestyles Success” is shown, and refreshments are served. The orientation is lead by a CIL such as ILR and OODH staff. Participants engage in an icebreaker to get to know one another and learn about the goals of the training.
The Healthy Lifestyles training takes place at a central local community organization that is easily accessible to participants. Tables and chairs are set up to form a rectangle so participants can engage each other in a conversational manner. Demonstrating an interactive method based on a Socratic model, the trainers sit at the front of the room. Trainers encourage participation from the group by outlining the training and its exercises on an easel pad that can be hung up around the room for viewing. Participants are able to follow along with the outline by using the Healthy Lifestyles handouts. Handouts are provided in alternate format to meet participant needs.
Components of the Training
During the two and a half day training, five components of health and wellness are interactively discussed: 1) emotional health, 2) physical health, 3) health through meaningful activities, 4) social health, and 5) spiritual health/living your values. Three main segments of the training focus on: 1) encouraging participants to self-define a healthy lifestyle, 2) specific topics such as fitness, nutrition, preventing illnesses, stress and relationships, 3) developing an individual health plan and setting goals for implementing those plans. During the course of the two days the participants engage in NIA (a form of non-impact aerobics), yoga, and chair massage. Healthy meals are served throughout the training.
Once a month Healthy Lifestyles support groups are convened at the same community CIL used for the training. The function of the support groups is to allow participants to share their successes and challenges in meeting their self-identified goals that were developed during the Healthy Lifestyles training. In addition, a guest speaker is brought in to talk about a topic related to health and wellness such as stress management. Healthy refreshments are served.
The mentorship piece is intended to connect participants to an outside resource and assist the mentee in meeting healthy lifestyles goals. Mentors can be volunteers from the disability community or those who would like to learn more about the disability community. Mentor/mentees are encouraged to meet every other week for the nine months following the training. Mentors are provided with a basic training for mentorship, however to date this process is evolving.
During the 2nd and 3rd years of the grant, the curriculum was piloted at six sites throughout Oregon. In the year following completion of the grant, Oregon Office on Disability and Health (OODH) in partnership with Independent Living Resources (ILR), (Portland’s Center for Independent Living), conducted 3 additional trainings in the Portland area.
Fifty-six participants completed the Healthy Lifestyles workshop, including pilot testing, in the following locations: OHSU/CDRC, Enterprise Community of North Portland at the Vocational Rehabilitation Center, Independent Living Center of Portland, Independent Living Center of Grants Pass, The Arc of Umatilla County at Hermiston, The Oregon Technical Assistance Corporation of Salem, and Independent Living Resources in Gresham.
Without monetary incentives for these initial trainings and three done by OODH, recruitment and attendance of individuals for the workshops was difficult. Participation follow-up and mentoring was particularly problematic. However, responses to follow-up phone calls with individuals who completed the training and the follow-up indicated that the participants completed 92% of the goals they developed at the workshops.
Quotes from the trainings include:
- "I am eating more healthy foods, losing weight and focusing on what is important in my life!"
- "Healthy Lifestyles has helped me learn how to make friends and develop social interaction skills"
- "I am going to share with my friends and family what I learned from the HL workshop"
- "I never knew how my emotional health affected my physical health!"
- "We can all exercise even though we are not able to move all parts of our body. This makes me feel better and I know I can exercise now!"
Although evaluative data on the effectiveness of the training program are largely lacking from the first 9 trainings due to difficulties with long-term follow-up of participants, initial results of the earlier trainings are highly encouraging. Participants indicated that they did improve in confidence to design their own healthy lifestyles and they completed self-defined healthy lifestyle goals.
In 2002, OODH received funding from the United States Department of Education, National Institute on Disability and Rehabilitation Research to evaluate the effectiveness of the Healthy Lifestyles for People with Disabilities training curriculum. Today, the Healthy Lifestyles Evaluation Project is conducted by OODH in partnership with ILR. The Oregon Office on Disabilities and Health also receives funding for conducting Healthy Lifestyles trainings from the Centers for Disease Control and Prevention (CDC).
This project involves a highly structured data collection component. Thus, we will soon have good data about the effectiveness of the Healthy Lifestyles for People with Disabilities curriculum in improving the ability of individuals with disabilities to live a healthy lifestyle. Preliminary quantitative data will be available in November 2003. If this curriculum proves to be successful, we will work to make it available in other states to further increase the health and well being of people with disabilities.
- Empirical support for implementing the Healthy Lifestyles training rural, urban, and communities of color.
Empirical support for implementing the Healthy Lifestyles training on national level and studying its effectiveness in other locations.
To promote policy that supports looking at health and wellness of people with disabilities from a wellness model versus a clinical model.
- To promote the use of support groups and mentor piece to assist participants to reach Healthy Lifestyles self-identified goal activities.What implications do your research or training project findings have for changes in concepts of health and disability?Healthy Lifestyles promotes a holistic approach to health and wellness versus a clinical approach. Emphasizing new concepts in health and disability that focus on the whole individual.
- Deschler, M., Tangeman, P., & Westwood, D. (1998). Disabled and healthy: Making opportunities for healthy lifestyles. Unpublished report. Oregon Institute on Disability and Development, Oregon Health & Science University, Portland, Oregon.
- DeJong, G. (1994). Toward a research and training capacity in disability policy. Policy Studies Journal, 22 (1), 152-160.
- National Conference on Disability and Health: Building Bridges for Science and Consumers (1998). Creating a public health focus on disability. Dallas, Texas, October 14-16, 1998.
- Patrick & Erickson (1993). Health status and health policy: Quality of life in health care evaluation and resource allocation. New York: Oxford University Press.