Rehabilitation Counseling Bulletin

Health promotion has received increasing attention in rehabilitation counseling research. Health promotion research contributes to theory building and provides the foundation for empirically supported interventions that can improve the health-related quality of life and employment outcomes of people with chronic illness and disability. In this article, the authors present their rationale for developing this special issue on health promotion. They highlight some of the exciting new findings reported in the articles contained in this special section as well as some recent health promotion and disability research. The goal of this special issue is to stimulate thinking and discussion about incorporating health promotion strategies in vocational rehabilitation and return-to-work interventions for people with disabilities.

Workplace health-promotion programs have the potential to reduce health care expenditures, especially among people with disabilities. Utilizing nationally representative survey data, the authors provide estimates for health care expenditures related to secondary conditions, obesity, and health behaviors among working-age people with disabilities. Furthermore, by computing the expenditures attributable to secondary conditions, obesity, and health behaviors, the authors emphasize the importance of disability-inclusive workplace health-promotion programs for employees with disabilities. Overall, the authors observed that the annual average health care expenditure among employed people with disabilities was US$4,524 (95% confidence interval [CI] = US$4,248–US$4,800) compared with US$1,325 (95% CI = US$1,299–US$1,351) for employed people without disabilities. Furthermore, obesity accounted for 27% to 41% of excess expenditures for people with various disability classifications compared with their nonobese peers with disabilities. Secondary conditions accounted for about 20% to 25% of higher health care expenditures among working people with various disability classifications, compared with their peers with disabilities who do not have secondary conditions. In addition, lack of exercise and alcohol consumption accounted for one fourth to over one third of excess health care expenditures among employed people with disabilities. The authors discuss implications of these findings for rehabilitation counselors and public health practitioners.

The main objective of this study was to determine whether motivational and volitional variables identified in the health action process approach (HAPA) model can be used to successfully differentiate people with multiple sclerosis (MS) in different stages of change for exercise and physical activity. Ex-post-facto design using multiple discriminant analysis was used. Participants were 215 individuals with MS. The outcome variable was measured by the Physical Activity Stages of Change Instrument, along with motivational and volitional measures (severity, action self-efficacy, outcome expectancy, risk perception, perceived barriers, intention, maintenance self-efficacy, action and coping planning, and recovery self-efficacy). Participants in the precontemplation, contemplation, and action groups can be maximally separated by two significant canonical discriminant functions, volition and motivation. The action group can be differentiated from other groups based on high group mean (centroid) score on the volition function, and the precontemplation group can be differentiated based on low group means on both the motivation and volition functions. The contemplation group can be differentiated based on high centroid score on the motivation function. Research findings of this study support the concept of stage-matching exercise and physical activity intervention. The HAPA framework can be used to design health promotion behavioral interventions for people with MS in vocational rehabilitation.

The main objective of this study was to validate Pender’s Health Promotion Model (HPM) as a motivational model for exercise/physical activity self-management for people with spinal cord injuries (SCIs). Quantitative descriptive research design using hierarchical regression analysis (HRA) was used. A total of 126 individuals with SCI were recruited through the National Spinal Cord Injury Association, other SCI support groups, and professors in rehabilitation counseling across the United States. Outcome measures used were the International Physical Activity Questionnaire and the Physical Activity Stages of Change Instrument. The HRA results indicated that preinjury physical activity/exercise level, severity of SCI, and commitment to a plan for exercise and physical activity were predictive of postinjury exercise and physical activity level. In addition, friend/family support, perceived self-efficacy, and perceived benefits were the strongest predictors of commitment to a plan of action for exercise and physical activity. The research findings support the applicability of Pender’s HPM as a motivational model for exercise/physical activity for people with SCI. The information can be used to design health promotion behavioral interventions for people with SCI living in the community.

The main objective of this study was to evaluate the health action process approach (HAPA) as a motivational model for dietary self-management for people with multiple sclerosis (MS). Quantitative descriptive research design using path analysis was used. Participants were 209 individuals with MS recruited from the National MS Society and a neurology clinic at a university teaching hospital in the Midwest. Outcome was measured by the Healthy Dietary Stages of Change Instrument, along with 10 predictor measures. The HAPA dietary self-management model fit the data relatively well (goodness-of-fit index = .95, normed fit index = .90, comparative fit index = .95, and root mean square error approximation = 0.07) explaining 15% of the variance in dietary self-management behavior. Recovery self-efficacy and action and coping planning directly contributed to the prediction of dietary health behaviors. Action self-efficacy, outcome expectancy, risk perception, and social support influenced intention, and the relationship between intention and dietary health behaviors is mediated by action and coping planning. Action self-efficacy, maintenance self-efficacy, and recovery self-efficacy directly or indirectly affected dietary health behaviors. Empirical support was found for the HAPA model of dietary self-management for people with MS. The HAPA model can be used to design behavioral health promotion interventions for people with disabilities in vocational rehabilitation.

The Physical Activity Scale for Individuals With Physical Disabilities was examined as a physical activity measure for people with severe mental illness. Case manager ratings were more closely related to body mass index than clients’ ratings, challenging the accuracy of self-report physical activity measures for individuals with severe mental illness.