People with disabilities experience poorer health and have much higher rates of obesity compared to the general population. For the more than 54 million individuals with disabilities in the U.S., there is a significantly higher risk of poorly managed health care. It is estimated that the total national disability-associated health care expenditures (DAHE) were $397.9 billion in 2006, representing 26.7 percent of national health care spending. Compounding the problem is the lack of trained health promotion professionals who understand the health needs of adults with disabilities and are able to provide adequate services for this underserved, vulnerable population. When physicians and other healthcare providers identify health issues in patients with disabilities, there is currently nowhere they can refer their patients for individualized support services. There is no customized health promotion delivery system that can guide a person with a disability such as spinal cord injury in losing or maintaining weight, leaving this underserved population highly vulnerable to the health effects of obesity, inactivity and poor nutrition. This application is in response to RFA PA-11-335 (Lab to Marketplace: Tools for Biomedical and Behavioral Research), a special 2-year Phase I SBIR program to accelerate the translation of behavioral research from academic to the marketplace. The project is based on the extensive research results and expertise in rehabilitation, disability informatics, and health promotion established over the last 15 years with substantial federal funding for promoting health among people with disabilities under the leadership of Dr. James Rimmer, our co-PI at the University of Alabama at Birmingham. This application relies heavily on evidence-based research funded by the CDC for lifestyle weight management for adults with disabilities (particularly, the "Personalized Exercise Program" (PEP) projects: #R04CCR518810 and #R01DD000134) and disability informatics as part of the CDC-funded National Center on Health, Physical Activity and Disability (#U59DD000437). Our overarching goal is to promote the health of people with disabilities. As the result of obtaining successful outcomes from these projects demonstrating weight loss in people with physical disabilities, this proposal aims to develop a web-based Personalized Online Weight and Exercise Response System (POWERS), an intelligent individualized weight management coaching solution and clinical decision support system designed specifically for individuals with disabilities. Its target users are health promotion specialists working in clinical centers, disability and health professionals working in public health programs, rehabilitation professionals, and fitness professionals, who would serve as "telehealth coaches" to assist individuals with disabilities achieve weight loss and improve their health promotion behaviors (improved nutrition and increased physical activity). Participants in the POWERS-supported program are expected to have 1) greater increase in physical activity and nutritional behaviors;2) greater reduction in the number of barriers to physical activity and healthy eating patterns;3) greater improvement in attitudes toward physical activity and healthy nutrition;and ultimately 4) greater reduction in weight and Body Mass Index. This Phase I project has three specific aims: 1) collect feedback from 24 stakeholders on system features, usability design, and perceived usefulness via focus groups and interviews;2) extend the POWERS prototype with a user- centric design process including two formal usability tests involving 12 health professionals and 12 individuals with disabilities;and 3) conduct a pilo randomized study to study the efficacy and feasibility of this approach with 60 subjects.
The complex health status of people with disabilities and the fragmented health care delivery system currently in place for managing obesity and obesity-related secondary health conditions among this underserved population provide strong justification for the development of a system that enables continuity of care from the hospital/clinic to home for a population who typically do not participate in health promoting activities. POWERS will support researchers, health professionals and eventually family members in providing individualized tailored support for addressing obesity in people with disabilities.