Searching for disability in electronic databases of published literature.

BACKGROUND: As researchers in disability and health conduct systematic reviews with greater frequency, the definition of disability used in these reviews gains importance. Translating a comprehensive conceptual definition of "disability" into an operational definition that utilizes electronic databases in the health sciences is a difficult step necessary for performing systematic literature reviews in the field. Consistency of definition across studies will help build a body of evidence that is comparable and amenable to synthesis. OBJECTIVE: To illustrate a process for operationalizing the World Health Organization's International Classification of Disability, Functioning, and Health concept of disability for MEDLINE, PsycINFO, and CINAHL databases. METHODS: We created an electronic search strategy in conjunction with a reference librarian and an expert panel. Quality control steps included comparison of search results to results of a search for a specific disabling condition and to articles nominated by the expert panel. RESULTS: The complete search strategy is presented. Results of the quality control steps indicated that our strategy was sufficiently sensitive and specific. CONCLUSIONS: Our search strategy will be valuable to researchers conducting literature reviews on broad populations with disabilities.

Development and psychometric assessment of the function-neutral health-related quality of life measure.

OBJECTIVE: The aim of this study was to determine the conceptual framework, item pool, and psychometric properties of a new function-neutral measure of health-related quality-of-life (HRQOL). DESIGN: This is an expert panel review of existing measures of HRQOL and development of a conceptual model, core constructs, and item pool and a validation by experts in specific disabilities and in cultural competence. Items were cognitively tested, pilot tested for functional bias, field tested with a national sample of adults with various limitations, and reliability tested via repeat administration. Final item selection was based on analyses of factor structure, demographic bias, variance in likelihood of endorsement, and item-total correlation. Psychometric properties were demonstrated through differential item functioning analyses, factor analyses, correlations, and item response theory analyses. RESULTS: The results supported a four-domain conceptual model of HRQOL (physical health, mental health, social health, and life satisfaction and beliefs) for a 42-item HRQOL measure with an ancillary 15-item environment scale. The measure has strong internal consistency (α = 0.88-0.97), known-groups validity, and test-retest reliability (r = 0.83-0.91). Tests of convergent and divergent validity confirmed the ability of the Function-Neutral Health-Related Quality of Life to measure health while being relatively free of content assessing function. CONCLUSIONS: A conceptually grounded four-domain, function-neutral measure of HRQOL that is appropriate for use with persons with and without various functional limitations was developed.

Improving cancer screening among women with mobility impairments: randomized controlled trial of a participatory workshop intervention.

PURPOSE: To assess the efficacy of an intervention to promote mammography and Papanicolaou (Pap) testing among women with mobility impairments overdue for screenings. DESIGN: Randomized controlled trial. SETTING: Urban and suburban Oregon. PARTICIPANTS: Women aged 35 to 64 with mobility impairments who reported not receiving a Pap test in the past 3 years and/or mammogram (if age >40 years) in the last 2 years were eligible. A total of 211 women were randomized, and 156 completed the study (26% attrition). The majority were not employed and reported annual income <$10,000. INTERVENTION: The Promoting Access to Health Services (PATHS) program is a 90-minute, small-group, participatory workshop with 6 months of structured telephone support, based on the health belief model and social cognitive theory. MEASURES: Perceived susceptibility to breast and cervical cancer, perceived benefits of and self-efficacy for screening, intention to be screened, and self-reported receipt of mammography and Pap testing. ANALYSIS . Chi-square tests to examine the proportion of women obtaining screening; analysis of covariance to examine change in theoretical mediators. RESULTS: The intervention group received more Pap tests than the control group at posttest (intervention 61%, control 27%, n  =  71, p < .01). No significant group effect was observed for mammography (intervention 49%, control 42%, n  =  125, p  =  .45). CONCLUSION: Findings indicate that the PATHS intervention promotes Pap testing but not mammography among women with mobility impairments.

Using intervention mapping to promote the receipt of clinical preventive services among women with physical disabilities.

This article describes the development of Promoting Access to Health Services (PATHS), an intervention to promote regular use of clinical preventive services by women with physical disabilities. The intervention was developed using intervention mapping (IM), a theory-based logical process that incorporates the six steps of assessment of need, preparation of matrices, selection of theoretical methods and strategies, program design, program implementation, and evaluation. The development process used methods and strategies aligned with the social cognitive theory and the health belief model. PATHS was adapted from the workbook Making Preventive Health Care Work for You, developed by a disability advocate, and was informed by participant input at five points: at inception through consultation by the workbook author, in conceptualization through a town hall meeting, in pilot testing with feedback, in revision of the curriculum through an advisory group, and in implementation by trainers with disabilities. The resulting PATHS program is a 90-min participatory small-group workshop, followed by structured telephone support for 6 months.

Secondary analysis of a scoping review of health promotion interventions for persons with disabilities: Do health promotion interventions for people with mobility impairments address secondary condition reduction and increased community participation?

BACKGROUND: Secondary conditions can have very serious outcomes for people with physical disabilities. Such consequences can range from immobility due to pressure sores to withdrawal and isolation due to depression, decreasing participation in the community. OBJECTIVE/HYPOTHESIS: To further investigate these assumptions, we conducted a review of the literature on health promotion interventions that include physical activity for adults with disabilities to determine whether they have a positive effect on the reduction of secondary conditions and increased community participation. METHODS: We conducted a secondary analysis of the results of a scoping review of health promotion programs containing physical activity for people with mobility impairments (N = 5). This secondary analysis examined the relationship between health promotion containing physical activity and prevention of secondary conditions among people with various physical disabilities. We further examined evidence and effects of independent variables on the outcome of increased community participation for study participants. RESULTS: The outcomes from this investigation are varied, with 2 studies providing evidence of reducing secondary conditions while another shared anecdotal statements referencing a decrease in secondary conditions. Of the remaining 2 studies in this paper, 1 showed no intervention effect on reducing secondary conditions while the remaining study reported an increase in secondary conditions. Regarding increased participation in the community, 2 of 5 studies directly reported on these outcomes, while increased community participation was referenced in another 2 articles, but without any data presented. The final study did not report on any post intervention in the community. CONCLUSIONS: This review demonstrates that research on health promotion interventions containing physical activity lack description about whether such interventions help reduce or prevent secondary conditions. Additionally, the review shows that further work is needed in terms of sustaining health programs effects beyond the initial proximal activity gains, with attention given toward more distal outcomes of increased participant participation in the community.

Description of a media campaign about alcohol use during pregnancy.

OBJECTIVE: This study describes the development and testing of a multicomponent media campaign aimed at increasing discussions of alcohol use during pregnancy. METHOD: Women, Infants, and Children (WIC) programs in Iowa were paired and, within each pair, were randomly assigned to a usual-care group (advice not to consume alcohol while pregnant and the opportunity to watch a 30-second television commercial about the effects of drinking during pregnancy) or intervention group (usual care plus a 10-minute videotape/DVD and a printed pamphlet. Among the 700 research participants in those outreach programs, interpersonal communication about alcohol use during pregnancy was assessed both before and after intervention, and participants were surveyed for knowledge of the effects of alcohol use during pregnancy. RESULTS: More women in the intervention group than in the usual-care group talked to friends about alcohol use during pregnancy. Also, only women in the intervention group demonstrated an increase in relative knowledge about the effects of drinking during pregnancy. CONCLUSIONS: A multimedia campaign may be an effective way to increase interpersonal discussions and awareness of the dangers of alcohol use during pregnancy.

Differential performance of SF-36 items in healthy adults with and without functional limitations.

OBJECTIVE: To determine whether Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) items show differential item functioning among healthy adults with various types of functional limitations as compared with a healthy sample with no identified limitations. DESIGN: Survey responses were analyzed by using partial correlations. SETTING: General community. PARTICIPANTS: Participants (N=206) included (1) adults with spinal cord injury (SCI), (2) adults who were deaf or hard of hearing, (3) adults who were legally blind, (4) adults with psychiatric or emotional conditions, and (5) adults with no reported functional limitations. Participants were screened to ensure the absence of substantial health problems. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: SF-36. RESULTS: Partial correlations showed a significant negative correlation, indicating differential item functioning (ie, apparent bias) for people with SCI on all 10 SF-36 Physical Functioning items. For people who were blind, 5 items showed a significant negative correlation. Two items had significant negative correlations for the deaf/hard-of-hearing group. One item showed significant negative performance for people with mental health conditions. CONCLUSIONS: Our data indicated a possibility for measurement bias caused by the blending of health and function concepts in the SF-36.

Rasch calibration of physical activity self-efficacy and social support scale for persons with intellectual disabilities.

The purpose of this study was to investigate the construct validity of the Self-Efficacy/Social Support for Activity for persons with Intellectual Disability (SE/SS-AID) scales developed by Peterson, Peterson, Lowe, & Nothwehr (2009). A total of 146 participants with intellectual disabilities completed 6 self-efficacy (SE) items and 18 social support (SS) items. After applying the Rasch rating model, all SE items and 17 SS items fit the model and measured a single-construct. Thus, it was able to determine the item difficulty and person's level of SE and SS for physical activity by calculated logit scores. No items showed evidence for differential functioning by the level of intellectual disability. Model fit of SS subscales (e.g., staff, family, and peer) showed good-fit as well. In conclusion, SE and SS scales for physical activity can be measured more accurately for persons with intellectual disabilities by using the modified scales validated in this study.

Guidelines and criteria for the implementation of community-based health promotion programs for individuals with disabilities.

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.

Paths to leisure physical activity among adults with intellectual disabilities: self-efficacy and social support.

PURPOSE: This study tested a path model that included perceptions of social support and self-efficacy for leisure physical activity and leisure physical activity participation among adults with intellectual disabilities. DESIGN: A cross-sectional design was used. Data was collected via oral interview. SETTING: Community-based group, supported-living settings in one Midwestern state. SAMPLE: A total of 152 adults with mild to moderate intellectual disabilities, which provided a 39% response rate. MEASURES: Self-efficacy and social support (from family, residential staff and peers with disabilities) for leisure physical activity were assessed using self-reported scales. Leisure physical activity participation was measured with a self-reported checklist of the frequency of leisure physical activity participation. ANALYSIS: Path analysis was conducted for the entire sample and was repeated for younger and older age groups. RESULTS: The hypothesized model fit the data from each group. Social support and self-efficacy predicted physical activity participation, and self-efficacy served as a mediator between social support and physical activity. Significant sources of social support differed between groups; among younger participants, social support from family predicted physical activity, whereas, for the older group, social support from staff and peers predicted physical activity. CONCLUSION: Self-efficacy and social support for leisure physical activity are related to leisure physical activity participation among adults with intellectual disabilities who are receiving supported-living services. The results provide information to guide health promotion programs for this group.

Physical activity among adults with intellectual disabilities living in community settings.

OBJECTIVE: The aim was to objectively monitor steps accrued by a sample of adults with intellectual disabilities and to describe physical activity patterns by monitoring steps taken across weekdays, weekends, and hours of the day using time-stamped technology. METHOD: This study used pedometers with time-stamped recording capabilities to measure physical activity behavior of 131 adults with mild to moderate levels of intellectual disabilities living in community-based supported living group settings in Iowa. Participants wore a pedometer for seven consecutive days. All data was collected in 2006 and analyzed in 2007. RESULTS: The participants accrued 6508+/-3296 steps/day. Controlling for age, participants with mild intellectual disability were more active than participants with moderate intellectual disability (F=7.03, p<.01). A total of 14.1% accumulated 10,000 steps/day. Participants were more active on weekdays than on weekends (Z=-7.36, p<.01), and least active during the evening period compared to the morning and afternoon hours (F(r)=103.3, p<.01). CONCLUSION: Physical activity (steps/day) achieved by the majority of this population is insufficient for health benefits, particularly among individuals with moderate intellectual disability. Evenings and weekends are especially inactive time periods.

The relationship between active living and health-related quality of life: income as a moderator.

This study used a moderator model to examine the relationship between active living and the physical components of health-related quality of life [i.e. overall physical component of quality of life (PQOL), physical functioning and ability to fulfill physical role] among a randomly selected sample of rural residents (n = 407) from the Midwestern US. Results showed that active living was associated with greater increases in health-related quality of life for those reporting lower income. The effect size of the relationship between active living and the PQOL for the low-income group was over 2 times the effect size for the high-income group. For physical functioning, the effect size of active living for the low-income group was greater than 3 times the effect size for the high-income group. Although active living behaviors have been demonstrated to be less prevalent among those of low socioeconomic status, this group may have the most to gain from these activities. Findings highlight the need for increased and specifically targeted promotion of active living interventions.