IDENTIFYING GAPS IN PERCEIVED ABILITY:

PROMOTING EXERCISE IN YOUNG ADULTS WITH DISABILITIES

Briana Terrill

~Honors in Major~

Faculty Mentor: Dr. Pamela DiNapoli

Honors Mentor: Dr. Carol Williams-Barnard

Background Nationally, in the United States there are 54

million people with a disability (CDC, 2011).

Locally, it is reported that in New Hampshire 22.3% of the population has a disability (CDC, 2011).

The magnitude of health disparities in this vulnerable population demands improvement in promotion of health-seeking behaviors such as exercise.

CDC Physical Activity Recommendations

Every day children and adolescents should do 1 hour or more of physical activity:

Aerobic Activities Most of the 1 hour should include aerobic activity This should be moderate or vigorous physical activity

Muscle Strengthening At least 3 days a week Include working the major muscle groups

Bone Strengthening These activities put force on bones, which increased strength and growth. (U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, 2009)

“The prevalence of overweight and obesity in children with disabilities was almost twice that in their non-disabled peers” (Reinehr, Dobe, Winkel, Schaefer, & Hoffman , 2010 p. 268)

Individuals with disabilities who are also obese may be less able to participate in physical activity, social and community events (Liou, Pi-Sunyer, & Laferrere, 2005).

Review of the Literature

Review of the Literature

Parent’s roles in health promotion: - Demonstrating to their children the importance of physical activity. (Antle, Mills, Steele, Kalnins, & Roseen, 2008).

Successful change in health behavior - Enhanced by focusing on the perceived ability to carry out health promoting behaviors. (Stuifbergen & Becker, 1994).

A time of transition: From parent-managed healthcare to responsibility for own health behavior

Pender’s Health Promotion Model explores and helps

explain the factors contributing to health behavior. (Srof & Velsor-Friedrich, 2006).

Significance Although there have been many improvements in the

promotion of health in the disabled population, there continues to be significant disparities.

During adolescence there is a transition from dependent to independent living, requiring adolescents for the first time to make health decisions on their own

(Srof & Velsor-Friedrich, 2006).

For young adults with disabilities, parents often make health decisions for, and not with their child. The result may be poor health decisions that lead to negative future health consequences and cost. (Antle, Mills, Steele, Kalnins, & Roseen, 2008).

Purpose

The purpose of this study was to explore how parents of young adults with

disabilities perceive their child’s ability to carry out health promoting behaviors,

specifically exercise, and if this is a shared perception by the young adult.

Theoretical Framework:Pender’s Health Promotion Model

Pender’s Cognitive Affective VariablesIndependent Variables

Perceived Benefits Anticipated positive out comes that will occur from health

behavior. Perceived Barriers

Anticipated, imagined or real blocks and personal costs of understanding a given behavior

Perceived Self-Efficacy Judgment of personal capability to organize and execute a

health-promoting behavior. Perceived self efficacy influences perceived barriers to

action so higher efficacy result in lowered perceptions of barriers to the performance of the behavior (Nursing Planet, 2012).

Dependent Variables

Disability is defined as: "Any person who has a physical or mental impairment that substantially limits one or more major life activities.“

(United States Department of Labor, 2011, p. 1)

Physical Activity is defined as: “Any bodily movement produced by the contraction of skeletal muscle that increases energy expenditure above a basal level.” (CDC, 2011)

Research Methodology

Mixed Methods Quantitative (Parents)

Pender’s Health Promotion Questionnaire

Qualitative (Young Adults) Structured interviews

Sample Inclusion Criteria

Young adults with developmental disabilities who may have deficits in adaptive behavior such as serious emotional disturbances requiring classroom modification (CDC, 2005) were be eligible to participate.

Also included were young adults with any sensory / physical disabilities.

Young adults with more extensive disabilities were excluded as it is less likely they would be able to make their own health promotion decisions.

Sample The convenience sample consisted

(N=9) parents of young adults with disabilities and (N=10) young adults with disabilities.

Parent Demographics

Marital Status

Now MarriedDivorced Widowed Never Married

Less

than

$10

,000

$20,

000

to $

29,0

00

$30,

000

to $

39,0

00

$70,

000

to $

79,0

00

$100

,00

to $

150,

000

$150

,000

or m

ore

0

1

2

3

Household Income

Young Adult Sample

6

4

SexMale Female

Race

American Indian or Alaska Na-tive

Asian Black or African American

White Native Hawaiian or Other Pa-cific Is-lander

Did Not Reply

Young Adult Demographics

101-110 131-140 151-160 161-170 171-180 Above 200

0

0.5

1

1.5

2

2.5

3

3.5

Young Adults Body Weight (lbs.)

Dyadic Data Analysis Social

Cognitive Variables

Parent [N=9] Young Adult [N=10]

Perceived Benefits

My child exercises because: Feels happier Exercise is Fun Will like him/herself better

My story about exercise: I prefer individual sports to teams I feel happy, it’s fun, it’s exciting I like to play outside I like to play with friends It’s healthy! I like doing different activities for exercise

Perceived Barriers

My child might not exercise if: There’s not enough time Doesn’t know how Didn’t like it

I might not exercise if: I don’t understand time The weather is bad If I’m feeling sick If my parents have a poor attitude about exercise.

Perceived Self-Efficacy

My child could exercise even if he/she: had other things he/she wanted to do. had a bad day at school. he/she was not very good at it

I could exercise even if: Decreasing or changing intensity or activity in order to overcome barrier Overcoming barriers: Desire to exercise (including alternative forms) Overcoming barriers: Would still play outside if it was poor weather

Conclusions There was a congruence in

perceived benefits and self-efficacy between the children with disabilities and their parents.

There was a discrepancy in perceptions of perceived barriers between parents and young adults: Parents perceived that their child

just didn’t have enough time. Young adults spoke of not being

able to understand time.

Nursing Implications

Nurses need to “iron” out the wrinkle in time in order to promote exercise in this population.

Using Technology to Close the Gap

Use technology to signal time to exercise

Create an exercise plan with parents and the young adult.

Nurses can use technology to help make adjustments as the arise

Acknowledgements

Dr. DiNapoli : Honors Thesis Advisor

Dr. Williams-Barnard: Honors-in-Major Coordinator Sigma Theta Tau, Eta Iota chapter The University of New Hampshire’s Hamel Center for

Undergraduate Research.

My sincere gratitude goes to these individuals and organizations for assisting and contributing to the

success of this research study.

References

Antle, B., Mills, W., Steele, C., Kalnins, I., & Roseen, B. (2008). An exploratory study of parents' approaches to health promotion in families of adolescents with physical disabilities. Childcare Health and Development , 185-193.

CDC. (2011, January 13). Disability and Health. Retrieved February 12, 2011, from Centers for Disease Control and prevention: http://www.cdc.gov/ncbddd/disabilityandhealth/index.html

Finkelstein E, Trogdon J, Cohen J, Dietz W. Annual medical spending attributable to obesity: Payer- and service-specific estimates. Health Affairs 28, 5(2009):w822-31.

Liou, T., Pi-Sunyer, X., & Laferrere, B. (2005). Physical Disability and Obesity. Nutrition Reviews , 321-331.

Nursing Planet. (2012, January 31). Health promotion model. Retrieved from http://nursingplanet.com/health_promotion_model.html

Reinehr, T., Dobe, M., Winkel, K., Schaefer, A., & Hoffman, D. (2010). Obesity in disabled children and adolescents: an overlooked group of patients. Deutsches Ärzteblatt International , 268-275.

Srof, B. J., & Velsor-Friedrich, B. (2006). Health promotion in adolescents: A review of Pender's health promotion model. Nursing Science Quarterly, 19(4), 366-373. Retrieved fromhttp://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2009298351&site=ehost-live

Stuifbergen, A. K., & Becker, H. A. (1994). Predictors of health-promoting lifestyles in persons with disabilities. Research in Nursing & Health, 17(1), 3-13. Retrieved fromhttp://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=1994182837&site=ehost-live 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. (2009, June). Fact sheet for health professionals on physical activity guidelines for children and adolescents. Retrieved from http://www.cdc.gov/nccdphp/dnpa/physical/pdf/PA_Fact_Sheet_Children.pdf

United States Department of Labor. (2011, February). Office of Disability employment Policy. Retrieved February 12, 2011, from http://www.dol.gov/odep/faqs/federal.htm