Health Promotion Programs

Hughes, RB. (2006) Achieving Effective Health Promotion for Women With Disabilities. Family & Community Health 29(1)Supplement: Promoting Health in Persons With Chronic and Disabling Conditions, 44S - 51S.

Wellness programs for non-disabled women often have equipment or architectural barriers that prevent women with disabilities from participating.

It is increasingly recognized that women with disabilities are an underserved population in health promotion efforts despite their great need for these services. For years, people with disabilities or chronic health conditions were not considered suitable candidates for health promotion efforts because the emphasis in public health was to prevent disability, disease, or infirmity. Today, the focus of public health is shifting from disability prevention to promotion of health.

Unfortunately, wellness programs for women in the general population are often not designed with consideration to women with physical disabilities. Women with disabilities frequently have combined barriers to participation by virtue of being female and being disabled. For example, women with disabilities, like other women, are often caregivers for children or older adults, and they may have difficulties in participating in wellness programs due to difficulty in finding or affording daycare services.

Women with disabilities may also have structural, interpersonal, or policy barriers related to their disability. Health promotion activities that are held in inaccessible clinics, fitness centers, or other settings may present significant barriers to the participation of these women. Programs that use health educators or fitness professionals who have received little training in exercise prescriptions for women with disabilities may be of little benefit to them, and women with disabilities may be reluctant to use their services. Furthermore, the cost of fitness centers, psychological counseling, weight management services, and other health promotion resources is often prohibitive for women with disabilities, who may be on fixed incomes.

Programs aimed at increasing screening rates and preventive services may also overlook women with disabilities. Community health promotion recruitment methods oriented towards the general population may not reach women with disabilities, and physicians may not provide these services. Additionally, mammography equipment and exam tables are frequently inaccessible to women who are unable to stand or walk.

It is not surprising, then, that some researchers have found that women with mobility impairments report lower cervical and breast cancer screening rates and physician smoking inquiries than other women. Women with multiple sclerosis report low rates of pelvic examinations, Pap smears, mammograms and bone density screening.

Health promotion researchers and researchers who are designing interventions should consider whether women with disabilities are being excluded from their programs. Women with disabilities can be excluded from health promotion and wellness programs in ways that researchers and health educators may not easily recognize. Therefore, holding focus groups with women with various types of disabilities and discussing these issues with key members of the disability community is necessary to help health promotion professionals better identify ways to improve the design of the intervention or the setting in order to be more inclusive of this population. Members of the disability community and disability advocates will welcome the opportunity to assist health promotion professionals in this endeavor.

Several new wellness programs have been developed to help women with disabilities develop health promoting behaviors.

Health promotion intervention programs may help prevent or ameliorate secondary health conditions among women with physical disabilities. To date, a handful of wellness programs have been developed and tested for women with physical disabilities.

Researchers have tested wellness interventions for women with multiple sclerosis, polio, sickle cell anemia, mobility impairments, and a variety of physical disabilities. These studies have demonstrated generally quite positive results. Participants have increased healthy behaviors after completion of these studies, such as improved level of physical activity, healthy nutrition behaviors, and relaxation or stress-reduction behaviors. Some studies have also found that women were able to decrease their stress and depression, increase their self-efficacy or confidence for health behaviors, increase social activities, and demonstrate improvements on indicators of physical and general health. However, researchers have documented continued barriers to participation in health promotion activities for these women.

Achieving Effective Health Promotion for Women With Disabilities