As a result of the growing interest among federal funding agencies to improve the health of people with disabilities, the Centers for Disease Control and Prevention (CDC) recently funded several new projects to examine the health promotion needs of people with disabilities. The aim of these projects is to reduce secondary conditions in people with disabilities by reducing or eliminating barriers that prevent them from participating in health-promoting activities.
In a recent study assessing the barriers to health promotion in women with physical disabilities, Rimmer found that the 4 major barriers to participation were transportation, cost of the program, lack of energy, and lack of knowledge concerning where to obtain a program. In one of the one of the CDC-funded projects, these barriers were eliminated by providing free transportation, not charging a fee for the program, reducing the fatigue level that often occurs getting to a site by providing door-to-door transportation, and developing an accessible and individually designed exercise program in a newly constructed fitness center. In the first iteration of stroke survivors, attendance for the 12-week program was over 85%, and none of the participants dropped out. These findings could largely be attributed to the elimination of these barriers.
As shown in the conceptual model of health promotion presented in the Figure, when an individual is discharged from an inpatient facility, the names of 1 or 2 clinically supervised facilities, preferably in close proximity to the person's home, would be provided. Hospital-based fitness centers, university-based fitness centers, and private physical therapy clinics are excellent sites for continuing the recovery process before joining a local health club. These sites offer greater monitoring of the individual's progress and place a strong emphasis on education. For certain individuals who have not had any exposure to a health promotion program, a clinically supervised setting is an excellent intermediary step before joining a local health club.