Perceived health and self-efficacy among adults with cerebral palsy

Journal of Rehabilitation,  April-June, 1995  by Heather Becker,  James Schaller

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Historically, institutional settings constituted the framework in which an individual with a disability's health care needs were addressed (Batavia & Dejong, 1990). As more people with disabilities successfully move from institutional settings to the community, health maintenance and promotion are especially important.

Health promotion is defined as "activities directed toward increasing the level of well-being and actualizing the health potential of individuals, families, communities, and societies" (Pender, 1987, p.4). Pender distinguishes health promotion from disease prevention, which emphasizes behaviors aimed at avoiding specific diseases or health problems. Health promoting behaviors may be ongoing activities that become an integral part of one's life and include physical exercise, nutritional eating, social support, and stress management.

Pender's 1984 model of health promotion is particularly relevant for people with disabilities as it defines health and illness as qualitatively different constructs. Health is seen as an individual actualizing information and skills through goal directed behavior, competent self-care, and satisfying relationships with others. Individuals make adjustments in their lives to maintain their well-being with their surroundings. Absence of illness or disability is not a prerequisite for health; therefore, individuals diagnosed with a chronic illness or living with a disability may be healthy. The concept of health promotion also emphasizes self-care rather than expert-care, and promotes an active, independent attitude toward health care.

The construct of self-efficacy is also relevant for promoting health behaviors. How much effort an individual expends and how long they persist in the face of obstacles is determined by their beliefs about the consequences of their behavior and their beliefs about their ability to perform specific behaviors in certain situations (Bandura, 1982). Bandura argued that perceived self-efficacy for a given situation or behavior emerges from an individual integrating all of the information they have about the situation. Self-efficacy has emerged as a predictor of various health behaviors such as quitting smoking, weight loss, and continued exercise (Strecher, DeVellis, Becker, & Rosenstock, 1986).

Unfortunately, people with disabilities living in the community also experience many barriers to the maintenance and improvement of their health, including discrimination from health care insurers, misperceptions by health care providers, and institutional bias in Medicaid policy (Dawidczyk, Arisco, & Anderson, 1992; Griss, 1991; Nosek, 1984). There are additional considerations as well. For example, exercising regularly may mean developing new skills, acquiring adaptive equipment, and becoming a part of a support network that facilitates participation. These barriers and considerations may influence a person's health care attitudes and behaviors, and interventions that enhance their health promotion.

People with disabilities have identified barriers to the use of health care services. Nosek (1984) noted that health care professionals may harbor misconceptions about the health of people with disabilities and that these misperceptions may lead to inappropriate treatment methods that may create barriers to the maintenance of good health status by people with disabilities. She indicates that health care professionals may focus so heavily on disability itself that they overlook other factors that may impact on health in their diagnosis or treatment strategies. In addition, Nosek has noted that health care providers may hold attitudes that people with disabilities are sick, which may contribute to people with disabilities as thinking of themselves as passive participants in their own health care, rather than as individuals responsible for, and contributing to, their well-being.

Other barriers have been identified that may impact on an individual's perceptions of health and well-being (Dawidczyk et al., 1992; Dawidczyk & Anderson, 1992). Provision of personal assistance services can be one of the biggest factors for people who have significant support needs to live in the community. Yet, people with disabilities may have few options for attendant care coverage and lack access to back-up or emergency services.

Health promotion for people with disabilities is critical, yet a recent national conference on primary care and disability concluded that health promotion issues have been largely ignored by the health care community (National Invitation Conference on Primary Care and Disability, 1989). Exercise, for example, contributes to both physiological and psychological health, inclusion into society, prevention of secondary disabilities, and level of independence (Katz, Adler, Mazzarella, & Luce, 1985; Marge, 1988; Moon & Renzaglia, 1982; Nosek, 1984). Fitness and exercise may be an important prevention for delaying complaints in the areas of endurance and musculoskeletal pain, complaints that may often be voiced by people with cerebral palsy at a younger age than the general population (Turk, 1993). Turk also notes that issues of flexibility and endurance should be addressed throughout adulthood to assist in maintaining a level of activity.