Barriers to Health Promotion and Disease Prevention

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Health promotion has been defined as the process of enabling people to increase control over their health and to improve it. This process requires personal participation and supportive environments. For people with disabilities, however, personal participation is often limited by non-supportive environments. Lack of knowledge on how to modify programs to meet specific needs, poor attitudes, and unfriendly environments often creates insurmountable barriers to participation for many people with disabilities. While innovative medical technology has increased the life span of individuals with disabilities, little attention has focused on improving their health span. The reportedly high incidence of chronic secondary conditions seen in persons with disabilities, including pain, fatigue, low functional capacity, obesity, and depression, is often related to environmental conditions that include poor health promotion practices. Smith wrote: "People with disabilities therefore represent significant health needs and investment in health care resources, both in terms of the primary disability and secondary complications. Although the prevention of these conditions is important, of equal importance is to make living with them as healthy as possible, as many disabilities are life-long. Although health promotion may be significant in leading to lower levels of premature mortality, higher quality of life and lower health care costs for the general population, it has the potential to be even more significant for those already with a disability, whose quality of life and independence rely critically on their ability to maintain their narrow margin of health." With the emerging concept that individuals with disabilities can improve their health in the same manner as anyone else, there is growing momentum for providing quality health promotion programs for people with disabilities. Maintaining health and wellness is especially important for people with disabilities because functional limitations that often accommodate a primary impairment (neurological dysfunction) may reduce a person's capacity to engage in health promoting behaviors and result in a higher frequency of secondary conditions. These secondary conditions are defined as "...physical, medical, cognitive, emotional, or psychosocial consequences to which persons with disabilities are more susceptible by virtue of an underlying impairment, including adverse outcomes in health, wellness, participation and quality of life". The purpose of this paper is to provide an overview of health promotion for people with disabilities in the areas of exercise, nutrition and health education, and to describe a health promotion service delivery model that addresses the gap in services between rehabilitation and community-based health promotion. The vast majority of people with disabilities are not obtaining the recommended amount of physical activity needed to confer health benefits and prevent secondary conditions (e.g., heart disease, obesity, and osteoporosis). In a study by Rimmer, it was found that less than 10 percent of adults with physical disabilities engaged in structured physical activity programs. A possible reason for this high level of inactivity may be linked to the number of actual and perceived barriers to exercise reported by people with disabilities. Transportation, cost of the exercise program, and not knowing where to exercise were listed as the three most common barriers. In a related study, Messent reported that the barriers to physical activity participation in adults with developmental disabilities were unclear policy guidelines in residential and day service programs; transportation and staffing constraints; limited financial resources; and limited availability of physical activity programs in the person's community. While these external barriers may impose major limitations on exercise participation, internal barriers may also create obstacles to participation. Kinne...
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