People with disabilities face challenges in acquiring health behaviors critical to the optimization of their own self-managed health and wellness. Children with disabilities are much less likely to participate in school-based or community-based health promotion activities with their peers, and are far more likely to be sedentary and have a poorer diet quality [1-4]. Adults and youth with disabilities have higher rates of secondary health conditions including pain, fatigue, depression, and obesity [5-8], and report lower rates of participation in health promoting activities such as physical activity [9,10]. Despite physical activity and good nutrition being the cornerstones of evidence-based health promotion interventions for reducing the risk of comorbidities (e.g., diabetes, heart disease, stroke) , many people with disabilities or caregivers who have a child with a disability experience substantial difficulty accessing these programs [12,13]. Inaccessible facilities, lack of transportation to and from indoor and outdoor recreation venues, absence of knowledgeable staff who understand how to include people with disabilities in their programs, and a general perception/attitude among providers that people with disabilities need ‘specialized’ vs. integrated services, feed into a culture of isolation and separation [14-16] and exposes this population to disproportionately higher rates of health disparities .
Not surprisingly, the wealth of evidence-based health promotion literature in policy, environmental, programmatic and infrastructure changes has been generated by researchers who unintentionally or unknowingly excluded people with disabilities . The vast majority of health promotion research targets populations who do not have a disability, and researchers often, if not always, use a ‘preexisting condition’ or disability as one of its exclusion criteria, thus limiting the generalizability of these findings for people with disabilities . While specialized health promotion programs for certain disability groups can be quite valuable in the short-term, they are often difficult to sustain after the project ends and the resources are no longer available (e.g., staff, time, transportation, expertise, space).
The adoption of certain evidence-based research findings often takes years, if not decades, to reach its endpoint in clinical or community practice . The Institute of Medicine , the Canadian Partnership Against Cancer (CAN-IMPLEMENT) [22,23], and the Guidelines International Network [24,25] have suggested that unnecessary and costly duplication of programs or services could be minimized or avoided if evidence-based guidelines were adapted rather than developed de novo. An alternative to the development of health promotion interventions designed for select groups of people with or without disabilities is to formalize a process for adapting guidelines established from the best available evidence. The Guidelines International Network defines adaptation as ‘the systematic approach to the endorsement and/or modification of a guideline(s) produced in one cultural and organizational setting for application in a different context’ . Adaptation can render a program more responsive to a particular target group and increase the program’s sensitivity and fit for a new population that was not part of the original research . It also offers greater transferability to real world settings (i.e., knowledge translation) because the adaptations can be selected by local service providers based on the needs of the end user(s) and the local context .
Adapting evidenced-based strategies/programs established on people without disabilities for people with disabilities holds strong potential for accelerating use of existing and new evidence-based findings in this underrepresented population. This paper describes the development of a process that includes a set of methods and criteria for adapting evidence-based health promotion guidelines for people with disabilities. For the purpose of this paper, we illustrate the approach using a set of evidence-based obesity prevention strategies developed by the U. S. Centers for Disease Control and Prevention (CDC)  that have been adapted for youth and young adults with physical and developmental disabilities.