CHEER Grant-TCAC

Kentuckians with cognitive or mobility limitations experience higher health disparities than the general population (Disability Health Data System, 2013). Most alarming is that Kentucky ranks higher than the national average on levels of obesity, high blood pressure, and rate of use of blood pressure medications. Among people with disabilities, Kentucky has the highest rate of COPD in the US. Nutritionally, Kentuckians are also falling behind the general population with regard to consumption of fruits and vegetables (CDC State Indicator Report, 2014). A review of NHANES data from 2001-2010 found that adults with disabilities are more likely to have hypertension, even after controlling for sociodemographic and health care access. This disparity, and the variation by disability type, can be explained by behavioral risk factors such as obesity, smoking, and physical inactivity that co-occur with or worsen the effects of hypertension and regularly affect people with disabilities. To address these concerns, Community Health Education and Exercise Resources (CHEER) aims to: 1) strengthen existing collaborations across the state through enhancement of resources that infuse principles of universal design for learning (UDL); 2) build new connections between state and local partners via an active statewide advisory network and community wellness committees, and; 3) nourish environments that promote a culture of health and wellness for all, with an emphasis on individuals with intellectual disabilities through implementation of a multi-site health promotion program. This multi-pronged approach with an emphasis on leadership of self-advocates will ultimately enhance the ability of all partners to ameliorate these startling health disparities. An integral component of CHEER will be to develop, promote, and implement a multi-faceted, evidence based health promotion program targeting individuals with intellectual and other disabilities along with their community of supports. Educational components from Kentucky Department of Public Health initiatives in the areas of nutrition and hypertension will be combined with the HealthMatters curriculum. Curricula adaptations will include universal design for learning (UDL) methodologies to impact targeted groups to support the broadest array of learners. The curriculum will be offered in four regions of the state across a minimum of eight locations currently providing supports for individuals with intellectual and other disabilities. The overarching goal of this initiative is to provide individuals interactive educational opportunities to enhance self-advocacy and empowerment to make healthy lifestyle choices through improved nutritional choices and physical fitness activities, thereby impacting the high rate of need for hypertensive medication. Through the provision of appropriately adapted training in nutrition and physical fitness, coupled with on-going technical assistance, it is hypothesized that positive outcomes will include: (1) a decreased necessity for hypertension medication; (2) a decrease in hypertension medication dosage levels; (3) a stabilization and maintenance of blood pressure in acceptable ranges without progression to the need for hypertension medication; (4) changes in individual weight and reduced levels of obesity; (5) increased levels of physical mobility; (6) an overall change in the organizational environment that promotes healthy lifestyles and self-efficacy for all individuals within the organization; and (7) lasting partnerships within the community. These efforts will promote a culture of health through education, resource development and sharing through community health fairs. Committed partners in this effort include the Kentucky Department of Behavioral Health, Developmental and Intellectual Disabilities, Division of Developmental and Intellectual Disabilities; Kentucky Department of Public Health; the Human Development Institute at the University of Kentucky- Kentucky’s University Center for Excellence in Developmental Disabilities; the Rehabilitation Research and Training Center on Developmental Disabilities and Health; the Commonwealth Council on Developmental Disabilities; Medicaid home and community based waiver provider agencies; University of Kentucky (Colleges of Health Sciences & Education); ARC of Kentucky; and the Kentucky Department of Protection and Advocacy.