There are many demographic, general and disability-related health maintenance, and contextual factors that appear associated with the presence of secondary conditions among persons with disabilities. However, the relative influence of these factors requires clearer understanding if appropriate health prevention and promotion strategies are to be identified. The purpose of this study is to investigate the relationship of key disability-related health maintenance practices and contextual factors to the presence of secondary conditions.
The prevention of secondary conditions is a critical health maintenance goal for persons with disabilities (NIDRR, 1999). Although some secondary conditions are common across disabilities with similar functional limitations (e.g., joint and muscle pain or pressure sores for persons who are sedentary), other secondary conditions tend to be more often associated with specific disabilities (e.g., urinary tract infections with spinal cord injury or balance problems with cerebral palsy) (Marge, 1994).
Like the general health of persons with disabilities, secondary conditions are thought to be impacted by the interaction of a multitude of person and contextual factors. Evidence suggests that these factors include demographic characteristics, such as gender, age, income, culture, education and severity of disability (Marge, 1994; Nosek et al., 1997; Pope & Tarlov, 1991). For example, mobility, sensory and intellectual secondary conditions more likely to emerge at older ages (Marge, 1994).
Likewise, general health maintenance practices (i.e., physical activity, healthy diet, not smoking, weight control, adequate sleep, participating in health screening and primary care, moderate consumption of alcohol) impact the development of secondary conditions (Pope & Tarlov, 1991). Passaro, et. al., (1998) found that North Carolina adults with disabilities were somewhat more likely to be smokers, to be sedentary, and to be overweight than those without disabilities. Ehrenkrantz, Miller and Sergeant (1999) found women with disabilities to be less likely to have had a CBE, mammogram or pap smear.
In addition to demographic characteristics and general health maintenance practices, there is emerging evidence that other disability-related health maintenance practices and contextual factors are likely related to the prevention of secondary conditions and general health status among persons with disabilities. The higher level of use of complementary and alternative medicine (CAM) among persons with disabilities at least suggests that individuals perceive CAM as having a positive impact on their health (Krauss, Godfrey, Kirk, & Eisenberg, 1998). Barriers to health maintenance, such as lack of information about health promotion opportunities, environmental inaccessibility or inadequate access to personal assistance services and assistive technology, has also been identified as important (Brandt & Pope, 1997; Passaro et al., 1998; & Pope & Tarlov, 1991).
Due to the multivariate nature of these research questions and the variation in secondary conditions that are associated with different disabilities, we propose to focus this study on persons with cerebral palsy, one of the specific conditions targeted by the priority and one with which our research staff have extensive expertise. However, we believe that the knowledge gained through this focused study will enhance our understanding of key factors that may be associated with the presence of secondary conditions among other disability groups.
Objective 1 Develop the research protocols Objective 2 Conduct survey study Objective 3 Disseminate findings
RESEARCH QUESTIONS & HYPOTHESES:
To what extent are identified disability-related health maintenance practices and contextual factors important for health maintenance?
Key disability related-health maintenance practices and contextual factors identified as important by persons with disabilities will be significantly associated with the presence of secondary conditions among individuals with cerebral palsy.
When demographic factors (i.e., gender, age, income, culture, education and severity of disability) are considered as one set of independent variables, and general health maintenance practices (i.e., physical activity, healthy diet, not smoking, weight control, adequate sleep, participating in health screening and primary care, moderate consumption of alcohol) are considered as another set of independent variables, disability-related health maintenance practices and contextual factors identified as important by persons with disabilities will continue to be significantly associated with the presence of secondary conditions among individuals with cerebral palsy.