by Lindsey Mullis
The Kentucky CARE Collaborative (Cardiovascular, Assessment, Risk-reduction and Education) is a free blood pressure awareness program that aims to increase the number of people who are taking action to help control elevated blood pressure through appropriate counseling about health behaviors and/or lifestyle changes. Because Kentuckians with disabilities can have higher blood pressure than those without disabilities, HDI is coordinating the Project CHEER effort to provide more inclusive CARE programming.
Project CHEER is a Centers for Disease Control Disability & Health Branch funded effort aimed at addressing the startling health disparities experienced by individuals with cognitive and mobility limitations through education, empowerment, and accessibility. The project works to develop collaborations at local and state levels focused on creating healthy resources and health programming inclusive of individuals with disabilities.
A pilot project was conducted targeting individuals with cognitive and mobility limitations, and Project CHEER made the CARE programming more universally accessible to include individuals with disabilities. 63 participants with disabilities and one family member completed a total of 107 individual CARE interventions. During CARE interventions, Project CHEER took blood pressure and asked participants to identify where their blood pressure fell in the at-risk range (normal, caution, and high). Based on their range results, a health education discussion on lifestyle choices and risk reduction strategies was conducted.
For example, a participant with intellectual disability talked about sodium intake during a first encounter and admitted that he used quite a bit of salt from the salt shaker to season his food. A result of the encounter included the goal for this individual to only shake the salt shaker two times. At the subsequent encounters, this participant remembered the goal and associated the two shakes of salt rule with the CARE CHEER encounter itself. As soon as Project CHEER coordinator, Lindsey Mullis, walked through the door he started emulating shaking salt with his hands and saying “Only two shakes!” Although he was still working on the behavior change and adhering to this goal, he was able to recall the health-minded effort.
To ensure comprehension, Project CHEER made adaptations to the CARE procedures. These adaptations included additional prompting instead of asking for risk identification directly and only three times, asking for blood pressure range readings in different ways like breaking down the numbers individually instead of asking to find the collective amount, and working with caregivers to complete the health education portion of the encounter. CARE resource tools were updated for broader accessibility by incorporating visual representations of the ranges in a specific number scale and face emoticons.
As a result, 91% of individuals in the pilot correctly identified their at-risk blood pressure range, which is comparable to statewide CARE programming, demonstrating that individuals with varying levels of cognitive ability could access and benefit from CARE programming with simple universally designed adaptations. In the future, the new universally designed materials can be integrated into programming by training current and future CARE staff across Kentucky to better serve individuals with disabilities. Project CHEER in collaboration with the CARE Collaborative will be going to Somerset March 27th and Owensboro in the coming weeks looking for collaborative partners in local communities so be on the lookout for how you can be involved!