Purpose To expand the reach of health-promotion efforts for people with disabilities, we piloted a health-coaching intervention with a disability-specific curriculum. We evaluated the intervention’s effects on health-related quality of life and health behavior change. Design Mixed-methods research design using pre-post measures and semi-structured interviews. Setting/Participants A convenience sample of community-dwelling adults with disabilities (n = 39). Intervention Participants engaged in a curriculum-based health coaching intervention, titled Health My Way, which used weekly one-on-one coaching for up to 12 weeks. Methods Participants completed pre- and post-intervention surveys including questions from the Health-Related Quality of Life (HRQOL) measure and the Health-Promoting Lifestyle Profile II. A subset of participants completed in-depth interviews to explore how health coaching influences health behavior change (n = 12). Results We found statistically significant effects on poor-health days due to physical and mental health, and effects on physical activity. We saw additional effects with engagement in relevant curriculum content. Qualitative main themes (tailoring of information, enthusiasm for personally meaningful goals, and social support) indicated processes by which health coaching supported health behavior changes. Conclusions The results of this pilot study indicate health coaching appears to be effective for improving HRQOL and health behavior, especially physical activity, for people with disabilities. Apparent key factors include enthusiasm for personally meaningful goals, having tailored information, and social support.
IntroductionLack of transportation is a significant barrier to community participation for many disabled adults. Living in a rural area introduces additional transportation barriers, such as having to travel long distances to access services or socialize, and limited public transit options. While the importance of transportation access is clear, the mix of different transportation options used by people with disabilities to participate in their communities is less understood, particularly among those who do not or cannot drive.MethodsWe used data from the 2017 National Household Travel Survey to explore transportation behaviors among disabled adults in rural and urban areas and by four regions across the United States. We explored differences by transportation modalities (e.g., driver, passenger, public transportation, taxi/uber, walk) and trip purposes (e.g., social, independent living, healthcare, work). Our sample included 22,716 adults with travel-limiting disabilities.ResultsSeveral geographic differences emerged among non-drivers. Rural non-drivers were less likely to take any trip, particularly for social activities, and reported using less public transportation or walking/rolling than urban non-drivers. Further, respondents from the Northeast were more likely to report using public transportation and walking/rolling options, relative to the Midwest, South, and West. Overall, disabled rural adults reported lower odds of giving up driving, even after controlling for socio-demographic and health characteristics.DiscussionThese findings highlight the relative importance of different transportation modalities for participating in activities and the continued reliance upon personal vehicles, either as a driver or passenger, especially among rural disabled residents. Potential policy insights are discussed.
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