In the United States, approximately 56.7 million people have a disability, including 38.3 million who have a severe disability (Brault, 2012). Research has contributed to a wide variety of policies, programs, services, interventions, and products to enhance the health and function of people with disabilities. Despite this work, a large number of people with disabilities lack adequate access to necessary healthcare, personal assistance services, and rehabilitation services. This lack of access compromises health outcomes (Krahn et al., 2015; National Council on Disability, 2009, Peacock et al., 2015), reduces the general well-being of people with disabilities, and limits their fulfillment of personal aspirations in areas such as employment and community participation (Henry et al., 2007; Waghorn et al., 2008).
Adults with disabilities are substantially more likely than adults without disabilities to be in fair or poor health (as opposed to excellent, very good, or good health) (Reichard et al., 2011; 2015), and to experience a wide variety of diseases and chronic conditions (Bureau for Health Information, Statistics, Research, and Evaluation, 2011; Reichard, et al. 2011; 2015). Health conditions often vary by condition or type of limitation. For example, people with significant vision loss or with an intellectual disability have a greater prevalence of obesity, hypertension, and heart disease than people without disabilities (Capella-McDonnall, 2007; Krahn et al., 2015; Stancliffe et al., 2011). National survey estimates of obesity prevalence show that children with disabilities have between a 27% to 59% greater likelihood of being obese than their peers without disabilities (Bandini et al. 2015). Other research has shown that obesity in childhood and adolescence may have serious consequences, including premature mortality and morbidity in adulthood (Reilly and Kelly, 2011).
People with disabilities experience adverse health outcomes, including reduced longevity. For example, 60 percent of people with serious mental illness die 25 or more years earlier than the general population due to preventable or treatable chronic diseases (Colton, Manderschied, 2006). Despite their substantial health needs and elevated risk of adverse health outcomes, people with disabilities have substantial disadvantage in obtaining access to needed health care services compared to those without disabilities (National Council on Disability, 2009; Yee, 2011; Reichard et al., 2017).
In addition to disparities in health care and health outcomes, people with disabilities frequently experience a wide range of functional limitations that jeopardize their access to employment and other forms of community participation. According to the U.S. Census Bureau, 5 million adults need assistance from another person to perform one or more activities of daily living, such as getting around inside the home, getting into or out of bed, bathing, dressing, eating, and toileting. Approximately 15 million people have difficulty with one or more instrumental activities of daily living such as going outside the home, managing money, preparing meals, doing housework, taking prescription medication, and using the phone (Brault, 2012). As the number of people with disabilities in the United States continues to grow (Institute on Medicine, 2007), it will be necessary to improve the Nation’s capacity to meet their needs and access their talents. This will require the development and refinement of policies, programs, practices, and technologies that reduce functional limitations and improve health outcomes for people with disabilities.
NIDILRR has funded a wide range of disability research and development projects related to the health and functional outcomes of people with disabilities. NIDILRR seeks to build on these investments by supporting innovative and well-designed research and development projects that fall under one or more of NIDILRR’s general “health and function” priority areas, as described in the following funding opportunity description.
To address disparities in health and function and to improve outcomes of people with disabilities NIDILRR proposes to fund a Disability and Rehabilitation Research Project (DRRP) on Health and Function for Individuals with Disabilities.
Bandini L, Danielson M, Esposito LE, Foley JT, Fox MH, Frey GC, Fleming RK, Krahn G, Must A, Porretta DL, Rodgers AB, Stanish H, Urv T, Vogel LC, & Humphries K (2015).
Obesity in children with developmental and/or physical disabilities. July, 2015. Disability and Health Journal.
Brault, M. W. (2012). Americans with Disabilities: 2010. U.S. Census Bureau, U.S. Department of Commerce. (available at: www.census.gov/prod/2012pubs/p70-131.pdf.
Bureau for Health Information, Statistics, Research, and Evaluation (2011). A Profile of Health Among Massachusetts Adults, 2010: Results from the Behavioral Risk Factor Surveillance System. Massachusetts Department of Public Health. (available at www.cdc.gov/ncbddd/disabilityandhealth/data.html).
Capella-McDonnall, M. (2007). The Need for Health Promotion for Adults Who Are Visually Impaired, Journal of Visual Impairment and Blindness, 101(3): 133-145. (available at: http://lvib.org/2010/09/02/september-awareness/).
Colton CW, Manderscheid RW (2006). Congruencies In Increased Mortality Rates, Years of Potential Life Lost, and Causes of Death Among Public Mental Health Clients in Eight States. Preventing Chronic Disease, 3(2): 1-10. (available at: www.cdc.gov/pcd/issues/2006/apr/05_01 80.htm).
Henry, A., Banks, S., Clark, R., & Himmelstein, J. (2007). Mobility Limitations Negatively Impact Work Outcomes Among Medicaid Enrollees with Disabilities. Journal of Occupational Rehabilitation, 17(3), 355-369.
Institute on Medicine (2007). The Future of Disability in America. Washington, DC: The National Academies Press.
Krahn, G. L., Walker, D. K., & Correa-De-Araujo, R. (2015). Persons with disabilities as an unrecognized health disparity population. American Journal of Public Health, 105(S2), S198- S206.
National Council on Disability (2009). The Current State of Health Care for People with Disabilities. National Council on Disability. Washington, DC. (available at: www.ncd.gov/publications/2009/Sept302009).
National Institute on Disability and Rehabilitation Research (2006). Notice of Final Long- Range Plan for Fiscal Years 2005-2009. Federal Register. Vol 71, No 31. P 8166-8200.
Peacock, G., Iezzoni, L. I., & Harkin, T. R. (2015). Health Care for Americans with Disabilities—25 Years after the ADA. New England Journal of Medicine, 373(10), 892-893.
Reichard, A., Stolzle, H, and Fox, M.H. (2011). Health disparities among adults with physical disabilities or cognitive limitations compared to individuals with no disabilities in the United States. Journal of Disability and Health, Vol 4, No 2, P 59-67.
Reichard, A. Stransky, M., Phillips, K., Drum, C., and McClain, M. (2015). Does Type of Disability Matter to Public Health Policy and Practice? California Journal of Health Promotion, Vol 13, No 2, P 25-36.
Reichard, A., Stransky, M., Phillips, K., McClain, M., and Drum, C. (2017). Prevalence and reasons for delaying and foregoing necessary care by the presence and type of disability among working-age adults. Journal of Disability and Health, Vol 10, No 1, P 39-47.
Reilly, JJ and Kelly, J. (2011). Long-term impact of overweight and obesity in childhood adolescence on morbidity and premature mortality in adulthood: systematic review.
International Journal of Obesity (2011), 891-898.
Stancliffe, R., Lakin, K.C., Larson, S., Taub, S., Bershadsky, J., & Fortune, J. (2011). Overweight and obesity among adults with intellectual disabilities who use ID/DD services in the U.S. American Journal on Intellectual and Developmental Disabilities, 116(6), 401-418.
Waghorn, G., Loyd, C., Abraham, B., Silvester, D., & Chant, D. (2008). Comorbid physical health conditions hinder employment among people with psychiatric disabilities. Psychiatric Rehabilitation Journal, 31(3), 243-247.
Yee, Sylvia (2011). Health and Health Care Disparities Among People with Disabilities. Disability Rights Education & Defense Fund. Berkeley, CA. (available at: www.dredf.org/healt hcare/Health-and-Health-Care-Disparities-Among-People-with-Disabilities.pdf).
Priority--DRRP on Health and Function of Individuals with Disabilities
The Administrator of the Administration for Community Living establishes a priority for a Disability Rehabilitation Research Project (DRRP) on Health and Function of Individuals with Disabilities. The DRRP must contribute to the outcome of maximizing the health and function outcomes of individuals with disabilities.
(1) To contribute to this outcome, the DRRP must--
(a) Conduct research in one or more of the following priority areas, focusing on individuals with disabilities as a group or on individuals in specific disability or demographic subpopulations of individuals with disabilities:
(i) Technology to improve health and function outcomes of individuals with disabilities.
(ii) Individual and environmental factors associated with improved health and function outcomes of individuals with disabilities.
(iii) Interventions that are designed to contribute to improved heath and function outcomes of individuals with disabilities. Interventions include any strategy, practice, program, policy, or tool that, when implemented as intended, contributes to improvements in outcomes of individuals with disabilities.
(iv) Effects of government policies and programs on health and function outcomes of individuals with disabilities.
(v) Practices and policies that contribute to improved health and function outcomes of transition-aged youth with disabilities.
(b) Focus its research on a specific stage of research. If the DRRP is to conduct research that can be categorized under more than one stage, including research that progresses from one stage to another, those stages must be clearly specified and justified. These stages: exploration and discovery, intervention development, intervention efficacy, and scale-up evaluation, are defined in this funding opportunity announcement. Applicants must justify the need and rationale for research at the proposed stage or stages and describe fully an appropriate methodology or methodologies for the proposed research.
(c) Conduct knowledge translation activities (i.e., utilization, dissemination) in order to facilitate stakeholder (e.g., individuals with disabilities, employers, policymakers, practitioners) use of the knowledge, interventions, programs, technologies, or products that resulted from the research activities conducted under paragraph (1)(a) of this priority.
(d) Involve key stakeholder groups in the activities conducted under paragraph (1)(a) of this priority in order to maximize the relevance and usability of the research products to be developed under this priority.
Definition: Stages of Research
(a) Exploration and discovery means the stage of research that generates hypotheses or theories by conducting new and refined analyses of data, producing observational findings, and creating other sources of research-based information. This research stage may include identifying or describing the barriers to and facilitators of improved outcomes of individuals with disabilities, as well as identifying or describing existing practices, programs, or policies that are associated with important aspects of the lives of individuals with disabilities. Results achieved under this stage of research may inform the development of interventions or lead to evaluations of interventions or policies. The results of the exploration and discovery stage of research may also be used to inform decisions or priorities.
(b) Intervention development means the stage of research that focuses on generating and testing interventions that have the potential to improve outcomes for individuals with disabilities. Intervention development involves determining the active components of possible interventions, developing measures that would be required to illustrate outcomes, specifying target populations, conducting field tests, and assessing the feasibility of conducting a well-designed interventions study. Results from this stage of research may be used to inform the design of a study to test the efficacy of an intervention.
(c) Intervention efficacy means the stage of research during which a project evaluates and tests whether an intervention is feasible, practical, and has the potential to yield positive outcomes for individuals with disabilities. Efficacy research may assess the strength of the relationships between an intervention and outcomes and may identify factors or individual characteristics that affect the relationship between the intervention and outcomes. Efficacy research can inform decisions about whether there is sufficient evidence to support “scaling-up” an intervention to other sites and contexts. This stage of research can include assessing the training needed for wide-scale implementation of the intervention and approaches to evaluation of the intervention in real world applications.
(d) Scale-up evaluation means the stage of research during which a project analyzes whether an intervention is effective in producing improved outcomes for individuals with disabilities when implemented in a real-world setting. During this stage of research, a project tests the outcomes of an evidence-based intervention in different settings. It examines the challenges to successful replication of the intervention and the circumstances and activities that contribute to successful adoption of the intervention in real-world settings. This stage of research may also include well-designed studies of an intervention that has been widely adopted in practice, but that lacks a sufficient evidence-base to demonstrate its effectiveness.