Tailored telehealth weight management tool to overweight adults with disabilities

描述（由申请人提供）：残疾人的健康状况较差，与一般人群相比，肥胖率要高得多。对于美国超过5400万的残疾人来说，医疗管理不善的风险要高得多。据估计，2006年全国残疾相关卫生保健支出总额为3979亿美元，占全国卫生保健支出的26.7%。使问题更加复杂的是，缺乏训练有素的健康促进专业人员，这些专业人员了解残疾成年人的健康需求，并能够为这些得不到充分服务的弱势群体提供适当的服务。当医生和其他医疗保健提供者发现残疾患者的健康问题时，目前他们无能为力

DESCRIPTION (provided by applicant): 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.