Living Well with a Disability Health and Wellness Intervention Program

Background

A health promotion and wellness program for adults with physical disabilities, Living WellWith a Disability is based on independent living philosophy and rural traditions of self-care. The program is an eight-week workshop that introduces a goal-setting and goal clarification process and teaches skills for generating, implementing, and monitoring solutions to problems.

Purpose and Anticipated Benefits

The Living Well program is designed to be cost-effective, increase the health of participants, and reduce medical care costs.

Who

Researchers, including Craig Ravesloot and Tom Seekins, University of Montana Research and Training Center: Rural, and Glen White, Research and Training Center on Independent Living, have collaborated on the Living Well With a Disability program.

When

This ongoing project began in 1998.

Method

When the program first started, the researchers chose centers for independent living, which are community-based, non-residential, non-profit programs for people with disabilities, to deliver a program the created after identifying 27 potential secondary conditions of relevance to adults with disabilities related to mobility impairments. Focus groups added another 13 secondary conditions.

A list of these conditions with brief definition of each item was developed with a four-point rating scale to rate the extent to which each condition limited activities. For example, pressure sores were listed and defined as: “These develop as a skin rash or redness and may progress to an infected sore, also called skin ulcers, bedsores, or decubitus ulcers. Persons who use wheelchairs are at risk for developing pressure sores.” This scale then was used to rate the severity and prevalence of secondary conditions.

The scale was filled out by 594 consumers of centers for independent living, residents of three American Indian reservations, and 1,000 randomly selected holders of handicapped parking permits in the state living in 44 of Montana’s 56 counties. The average age of participants was 57 years. Eighty-four percent were white, and 13% American Indians. Besides “other” disabilities, arthritis was the most common condition (28%) followed by spinal cord injury (14%) and multiple sclerosis (13%).

Results

Living Well has proved to be cost-effective, increasing the health of participants and reducing medical care costs over 12 months. In a subsequent study, this program was used by 246 individuals with mobility impairments recruited by centers for independent living in California, Kansas, Mississippi, Montana, Missouri, New Hampshire, New York, and Texas. Of these participants, 188 completed the program and had an average age of 45 years old. Most were women (64.2%), and most were unmarried (63.4%). The participants reported that they had been disabled for 17.5 years on average.

The program required participants to meet weekly for two hours over eight weeks in a row to review the program workbook and complete exercises for each chapter. It cost $596 to provide the program to the participants. This cost included travel costs of the 2.5 day facilitator training in Kansas City.

Analysis showed that the program reduced the average degree of limitation people report due to secondary conditions, the number of symptom days people experience, and health care costs. Results also found the participants increased their overall life satisfaction and the behavior they used to improve health status. The effects lasted at least 12 months after the program end and were similar to two earlier, smaller studies testing the program.

The Secondary Condition Surveillance Instrument, Center for Epidemiologic Studies-Depression Scale, and Health-Promoting Lifestyle Profile II were also used to gather information as well as the number of physician visits, emergency room visits, outpatient surgeries, and days in hospital. The study itself used an interrupted time series, staggered baseline, quasi-experimental design with random assignment to treatment start date.

This study was done with a small number of individuals recruited from a small sample of centers for independent living. However, a similar program focusing on people with severe arthritis showed similar results. Finding suggest that the Living Well With  a Disability health promotion program does reduce disability due to secondary conditions but probably works best when the programs are delivered to the right people at the right time. Few programs are effective for everyone at every point in their lives; an individual does best in these programs when he or she is ready.

Products

The Living Well program continues to be used on the Internet and at various sites; also state-based disability and health networks have used it. Program use is tracked. For example, more than 202 Living Well facilitators from 72 community-based organizations in 17 states have been trained and conducted more than 200 workshops. By 2005, the workshops increased participants' annual symptom-free days by 19,020 days, thus saving from $1.5 to $2.5 million, according to researcher estimates. Other products were:

Ravesloot, C. R., Seekins, T., & White, G. W. (2006). Health promotion for people with disabilities: Development and evaluation of the Living Well with a disability program. Health Education Research.

Ravesloot, C.R., & Seekins, T. (2005). Living well with a disability health promotion intervention: Improved health status for consumers and lower costs for health care policymakers. Rehabilitation Psychology 50(3), 239-245.

Seekins, T., White, G.W., Ravesloot, C.R., Norris, K., Szalda-Tetree, A., Lopez, J.C., Golden, K., & Young, Q.R. (1999). Developing and evaluating community-based health promotion programs for people with disabilities. In R.J., Simeonsson, & L.N. McDevitt (Eds.), Issues in disability & health: The role of secondary conditions and quality of life (pp. 221-238). Chapel Hill, NC: University of North Carolina, FPG Child Development Center.

Ravesloot, C.R., Ipsen, C., & Seekins, T. (2001). Living well could save $31 million annually. RTC: Rural, 2001.