Identifying Gaps in Perceived Ability: Promoting exercise in Young Adults with Disabilities

1. 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

2. 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.

3. CDC Physical Activity Recommendations • Every day children and adolescents should do 1 hour or moreof 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)

4. Review of the Literature • “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).

5. 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).

6. 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).

7. 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.

8. Theoretical Framework:Pender’s Health Promotion Model

9. 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).

10. 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)

11. Research Methodology • Mixed Methods • Quantitative (Parents) • Pender’s Health Promotion Questionnaire • Qualitative (Young Adults) • Structured interviews

12. 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.

13. Sample • The convenience sample consisted (N=9) parents of young adults with disabilities and (N=10) young adults with disabilities.

14. Parent Demographics

15. Young Adult Sample

16. Young Adult Demographics

17. Dyadic Data Analysis

18. 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.

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

20. 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

21. 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.

22. 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. DeutschesÄrzteblatt 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