1. Guidelines and Criteria from the AIMFREE Assessment Tool
Uncovering disparities in physical activity in Georgia: Recommendations to improve accessibility and inclusion for adults with disabilities
Erin Vinoski, MPH, CHES1, Akilah Heggs, MA2, Rebecca Wells, MSW, MPH2, Douglas Roberts2, & Andrew Roach, PhD2
1University of North Carolina at Charlotte; 2Georgia State University
Background
Results
Demographics. The study sample (n=28) was 50% female; 69.2% White or Caucasian, 23.1% Black or African American, and 7.7% other. The majority of the sample was between 18 and 34 years of age (42.9%). Participants represented a range of disability diagnoses; 21.4% had a visual impairment, 21.4% had an orthopedic impairment, 14.3% had an other health impairment, 14.3% had an intellectual disability, 10.7% had an autism spectrum disorder, 10.7% had multiple disability diagnoses, and 7.1% had a traumatic brain injury or brain damage.
Qualitative Analyses. Table 2 presents preliminary results from qualitative coding. Overall, the most common themes across barriers and facilitators to PA discussed by our diverse group of participants included people who help or hinder access, places that are accessible or not, and individual-level differences. Though not related to barriers and facilitators, each of our participants powerfully described what physical activity means to them. These results are depicted in Figure 2 in the form of a Wordle.
The prevalence of chronic disease among people with disabilities (PWD) has been well documented . Regular physical activity (PA) has shown to be effective in the prevention of chronic disease and premature death , however, PWD also experience a disparity in their rates of PA. This study aimed to understand the barriers to accessing, participating in, adhering to, and functioning related to PA among adults with disabilities living in Georgia. At a second stage, a scoping review of programs available for adults with disabilities in Georgia was conducted.
Table 1. Preliminary Qualitative Results
Figure 2. What Does Exercise Mean to You?
Access
Participation
Adherence
Function
Barriers and Facilitators to PA among PWD
% of codes
Barriers
Functional limitations
20% (20%)
Unavailability of services and information
20% (40%)
Social and programmatic exclusion
15% (55%)
Lack of appropriate accommodations
11% (66%)
Other
34% (100%)
Facilitators
Inclusion/social relationships
30% (30%)
Access to places, programs, and services
24% (54%)
Community & social accommodations
10% (64%)
Informational facilitators
8% (72%)
28% (100%)
The RAMP Framework
The RAMP (Restoring Activity, Mobility and Participation) framework for increasing physical activity among PWD was developed by Rimmer and colleagues (2006) to reflect the broad need to create a barrier-free environment.
Figure 1. RAMP Framework
Scoping Review
Access: Availability and Awareness
Access refers to whether the individual or population can experience typical use of the exercise environment or equipment.
Participation: Usability
Participation refers to developing modalities of physical activity that are both beneficial and appropriate for PWD.
Adherence: Sustainability
Health benefits lessen and fade if one relapses into a sedentary lifestyle. It is critical to develop methods for sustainability for PWD.
Function: Accountability
It is important to find appropriate activities with respect to one’s functions/limitations and identify ways to measure these activities.
A review of the literature identified three key guidelines specifically related to increasing physical activity among individuals with disabilities. We aligned the guidelines and frameworks with the categories of the R.A.M.P. framework to demonstrate the need to address all areas of accessibility to facilitate the inclusion and participation of individuals with disabilities in physical activity programs and services.
Table 2. Title?
RAMP Domains
NCHPAD Guidelines for Disability Inclusion in Physical Activity, Nutrition, and Obesity Program Initiatives
Guidelines for the Implementation of Community-based Health Promotion Programs for Individuals with Disabilities
Guidelines and Criteria from the AIMFREE Assessment Tool
Objectives
Criteria
Subscale Areas
Access
#3: Program Accessibility
#5: Outreach and Communication
#7: Affordability
Criterion #6: HP programs should be socially, behaviorally, programmatically and environmentally accessible.
Criterion #7: HP programs should be affordable to PWD and their families or caregivers.
Built Environment
Equipment
Information
Swimming pools
Participation
#1: Objectives include People with Disabilities
#4: Accommodations for participants with disabilities
Criterion #5: Health promotion programs for people with disabilities should consider the beliefs, practices, and values of its target groups, including support for personal choice.
Policies
Professional Behavior
Adherence
#6: Cost consideration and feasibility
Function
#2: Involvement of PWD in Development, Implementation and Evaluation
#8: Process Evaluation
#9: Outcomes Evaluation
Criterion #1: HP programs for PWD should have an underlying conceptual framework
Criterion #3: HP programs should collect outcomes data using disability appropriate outcomes measures.
Criterion #4: PWD should be involved in the development of implementation of HP programs for PWD.
Methodology
Twenty-eight adults with disabilities living in Georgia were recruited from geographically diverse community programs and advocacy groups to completed an interview over the phone or in person with one member of the research team. Participants were offered a $10 gift card for their participation.
Interviews were transcribed and coded according to the tenets of the RAMP framework. Interviews were independently coded by two members of the research team until 90% agreement was reached. One coder completed the remainder of the coding; the second coder completed reliability checks on 10% of the remaining data.