Exploring environmental measures in disability: Using Google Earth and Street View to conduct remote assessments of access and participation in urban and rural communities.

The Americans with Disabilities Act has been in place since 1990. Yet, we still do not know the actual levels of accessibility in the nation, how access varies across communities or over time, or how it influences participation in community life. The present two studies explored the use of Google Earth (GE) and Google Street View (GSV) imagery as a database for examining the accessibility of rural and urban cities and towns in the United States. We developed procedures for selecting places in a community to observe multiple access features. Study 1 reports the findings from assessments of 25 communities across 17 states. We observed ≈50,000 m (31 miles) of pathways through the observed places. The Combined Access Score (CAS) averaged 65% across these communities. In Study 2, we evaluated 22 towns and cities in a large rural state. We observed ≈77,000 m (48 miles) of pathways through the Central Business Districts observed as core areas connecting people to community life. The CAS averaged 83.9% across these communities. We noted a Rural Access Penalty (RAP), such that rural areas tended to be less accessible, leading to less community participation. The method for using GSV to examine accessibility is discussed. This study demonstrates an inexpensive and reliable method for evaluating the accessibility of communities and participation in them. Future research should be conducted to gather a larger sample of communities in order to create a baseline from which to monitor changes in accessibility of infrastructure over time.

Living Well with a Disability, a Self-Management Program.

Approximately 56.7 million persons in the United States have functional impairments that can lead to disability. As a group, persons with disabilities show disparities in measures of overall health when compared with the general population. Much of this can be attributed to secondary conditions rather than to the impairment itself. Persons with disabilities can prevent and manage many of the conditions that contribute to these disparities. The Living Well with a Disability program was developed to support persons with disabilities to manage their health. The curriculum helps participants achieve early success in self-management of quality-of-life goals to build confidence for making health behavior changes; it includes 11 chapters that facilitators use to conduct an orientation session and 10 weekly, 2-hour sessions. The program has been implemented by 279 community-based agencies in 46 states. On the basis of the data from the field trial, these community applications have served approximately 8,900 persons since 1995, resulting in an estimated savings of $6.4-$28.8 million for health care payers. Persons with disabilities have unique needs that can be addressed through multiple levels of intervention to reduce health disparities. The Living Well with a Disability program is a promising intervention that has demonstrated improvements in health-related quality of life and health care use.

Integration of chronic disease and disability and health state programs in Montana.

This paper describes the strategies used in one state, Montana, to improve the health of individuals at risk for or living with chronic conditions associated with disability. These strategies demonstrate capacity to intervene at individual and environmental levels, and reveal opportunities for public health professionals to collaborate with independent living and long term care partners. In this paper we attempt to outline some of the challenges inherent in these collaborations and suggest strategies to overcome them.

Participatory action research designs in applied disability and rehabilitation science: protecting against threats to social validity.

Researchers and disability advocates have been debating consumer involvement in disability and rehabilitation science since at least 1972. Despite the length of this debate, much confusion remains. Consumer involvement may represent a spirit of democracy or even empowerment, but as a tool of science, it is necessary to understand how to judge its application. To realize consumer involvement as a design element in science, researchers need a framework for understanding how it can contribute to the scientific process. The thesis of this article is that a primary scientific function of consumer involvement is to reduce threats to the social validity of research, the extent to which those expected to use or benefit from research products judge them as useful and actually use them. Social validity has traditionally not been treated with the same rigor as concerns for internal and external validity. This article presents a framework that describes 7 threats to social validity and explains how 15 forms of consumer involvement protect against those threats. We also suggest procedures for reporting and reviewing consumer involvement in proposals and manuscripts. This framework offers tools familiar to all scientists for identifying threats to the quality of research, and for judging the effectiveness of strategies for protecting against those threats. It may also enhance the standing of consumer involvement strategies as tools for protecting research quality by organizing them in a way that allows for systematic criticism of their effectiveness and subsequent improvement.

A systematic scoping review of measures of participation in disability and rehabilitation research: a preliminary report of findings.

PURPOSE/OBJECTIVE: The concept of participation is emerging as a gold-standard of outcome measurement in disability and rehabilitation. We aimed to assess the status of methods to measure this new concept. METHOD/DESIGN: We conducted a scoping review and a content analysis to assess the literature on participation. RESULTS: We identified 586 articles addressing participation. Seventy-two articles passed all exclusion criteria. Twenty-four articles cited the International Classification of Function as their conceptual foundation. Most studies included individuals with a broad range of impairments (cross disability). Most instruments relied on self-report in a cross-sectional design. We noted three levels of measurement (static, interactional, and dynamic). Few studies reported collecting data on the environment along with participation. Subjective aspects of participation emerged as an important consideration but few articles reported measuring it. CONCLUSIONS: The concept of participation represents more than a "shift from negative to more positive language." It represents a transformational concept that requires new, dynamic measures collected in context.

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

PURPOSE/OBJECTIVE: The purpose of this study was to test the utility of the Working Well with a Disability health-promotion program with vocational rehabilitation (VR) clients. Health-promotion interventions have been shown to reduce limitation from secondary conditions, which can be a significant barrier to labor force participation among people with disabilities. The state and federal VR system represents a potential access point for delivery of health-promotion activities. RESEARCH METHOD/DESIGN: A total of 297 VR clients participated in a randomized trial of the Working Well health promotion program. Control and intervention participants provided baseline and four waves of quarterly follow-up data. Data were analyzed with repeated-measures ANOVA. RESULTS: Intervention-group participants who attended over half of the Working Well sessions reported significantly lower rates of limitation from secondary conditions over the 1-year study span, F(1, 124) = 4.11, p = .004. Control-group participants also experienced significantly lower rates of limitation, but pre- to postdifferences were less dramatic, F(1, 308) = 4.19, p = .006. CONCLUSIONS/IMPLICATIONS: Overall, health data indicated that the Working Well program may be particularly helpful to VR clients with higher rates of secondary health conditions and may represent one strategy for overcoming barriers to employment.

Nursing home emancipation: A preliminary study of efforts by centers for independent living in urban and rural areas.

BACKGROUND: The U.S. Supreme Court's Olmstead decision affirmed the right of individual with disabilities to live in the community. Centers for independent living (CILs) and other disability advocacy organizations have initiated a wide range of efforts to emancipate (i.e., transition) adults with disabilities from undesired nursing home placements to community living. There is, however, a paucity of published information about the nursing home transition process for adults with disabilities. OBJECTIVE/HYPOTHESIS: The objectives of this research were to: (1) assess the levels of nursing home emancipation services and barriers to nursing home transitions, including the role of secondary health conditions, and (2) to assess nursing home transition policies and procedures. METHODS: We conducted 2 studies. First, we surveyed 165 CILs operating nursing home emancipation programs. Second, we reviewed the written transition policy and procedures documents of 28 CILs from 14 states. RESULTS: Respondents reported transitioning a total of 2,389 residents from nursing homes back to community living arrangements during the previous year, with only 4% of those returning to a nursing home for any reason. While most of the policies reflected many components of a standard model, several components appeared underrepresented. CONCLUSIONS: Findings suggest the need to expand on established programs to build evidence-based practices.

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.

A prospective study to examine the influence of secondary health conditions on vocational rehabilitation client employment outcomes.

BACKGROUND: Adults with disabilities experience a variety of secondary health conditions that have a negative association with employment. Vocational rehabilitation (VR) provides one possible access point for providing health promotion activities to help clients manage these conditions. OBJECTIVE: To build the case for providing health promotion services in the VR setting, this research assesses how secondary health conditions impact employment closures over time for VR clients. Specifically, we hypothesize that higher rates of secondary conditions will be negatively associated with employment outcomes at 18 months. METHODS: VR clients with physical disability (n = 162) provided longitudinal data at baseline and at 6, 12, and 18 months. Two binary logistic regression models used self-report data to predict employment outcomes. The first model used explanatory variables measured at baseline or prior to receiving VR services, and the second model measured variables after 18 months in the VR program. Both models included variables to control for demographic characteristics, disability severity, baseline employment, and receipt of social insurance payments. The second model also included variables to account for VR services received. RESULTS: Both models showed that higher reported rates of secondary conditions were associated with lower probabilities of employment (p = .012; p = .022). The expanded model also showed that receipt of counseling services through VR increased the probability of employment (p = .04) and that receipt of medical services through VR reduced the probability of employment (p = .02). CONCLUSIONS: VR can improve client employment outcomes through expanded counseling and guidance services or possibly through improved access to health promotion programming that helps clients manage secondary health conditions.

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.

Nutrition and adults with intellectual or developmental disabilities: systematic literature review results.

Approximately 4.5 million Americans have an intellectual or developmental disability. Concern is increasing about these individuals' nutrition-related behavior and its implications for their health. This article reports on a systematic search of the current literature listed in the PsycINFO and PubMed databases related to nutritional status of adults with intellectual or developmental disabilities. The authors used key terms for nutrition, secondary conditions, and intellectual and developmental disability and categorized literature pertaining to nutrition-related studies of adults with intellectual or developmental disabilities as follows: dietary intake studies, anthropometric assessments of nutritional risks, biochemical indexes, and clinical evaluations.

Nutritional intervention improves menu adequacy in group homes for adults with intellectual or developmental disabilities.

BACKGROUND: Research documents that adults with intellectual or developmental disabilities (IDD) living in the community experience nutritional deficits, inadequate diets, and poor nutritional status. OBJECTIVE: We developed a nutrition intervention that was targeted at improving the food systems in group homes for adults with intellectual or developmental disabilities, called MENU-AIDDs (Materials Supporting Education and Nutrition for Adults with Intellectual or Developmental Disabilities). METHODS: MENU-AIDDs was implemented for 8 and 16 weeks in four community-based group homes for adults with IDD. Improved nutritional adequacy of planned menus was tested as a marker of improved dietary intake in the residents of the homes. RESULTS: Results showed significant statistical and clinical improvements in the planned menus whereby there were significant increases in the appearance on menus of whole grains, vegetables overall and green/yellow/orange vegetables in particular, and low-fat proteins, and significant decreases in the higher-fat proteins, potatoes, and "junk foods." The positive practice of specifying portion sizes on the menus increased significantly. CONCLUSIONS: MENU-AIDDs is a community-based health promotion intervention that can improve menu planning and dietary adequacy while being responsive to the needs of group home residents, direct care staff, and administrators.

Nutrition education and support program for community-dwelling adults with intellectual disabilities.

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.

Assessing secondary conditions among adults with developmental disabilities: a preliminary study.

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.

Self-employment and economic leadership as two promising perspectives on rural disability and work.

A defining difference between rural and urban circumstances for people with disabilities involves opportunities for work. One of the most significant elements of the rural context is that economic conditions in rural communities consistently trail the national economy. This paper presents an overview of disability in rural America and outlines an ecological model for guiding the development of rural solutions to rehabilitation problems. Two promising examples of such solutions, self-employment as a rural vocational rehabilitation employment option and rural economic leadership by people with disabilities, are outlined.