Disability and Rehabilitation Research Projects (DRRP) Program: Health and Function (Research)

Background:In the United States, approximately 42.6 million people living in the community in the United States have a disability (Paul et al., 2023). Research has contributed to a wide variety of policies, programs, services, interventions, and products to enhance the health and function of people with disabilities. Despite this work, a large number of people with disabilities lack adequate access to necessary healthcare, personal assistance services, and rehabilitation services. This lack of access compromises health outcomes, reduces the general well-being of people with disabilities, and limits their fulfillment of personal aspirations related to employment and community participation. People with disabilities are more likely than those without disabilities to be in poor health and to experience higher rates of chronic health conditions (Mitra et al., 2022). The prevalence of different health conditions varies by disability type. For example, blind people are more likely to experience diabetes, arthritis, stroke, heart disease, and hypertension, relative to people who are not blind (Heydarian et al., 2021). People with serious mental illness are more likely to experience obesity, heart disease, and a number of other chronic conditions, and to and have life spans that are 10-30 years shorter on average than the general population (Cook et al., 2015). People with spinal cord injury experience chronic pain at high rates (Felix et al., 2022). People with intellectual disabilities disproportionately experience multiple long-term health conditions (Mann et al., 2022), as well as co-occuring mental health conditions and behavioral health needs (Linberry et al., 2023). These examples illustrate the variation in health outcomes and in the experience of chronic health conditions among different disability populations. This variation requires distinct lines of research to develop, test, and scale up research-based services, supports, and interventions to maximize health and function outcomes among the heterogeneous population of people with disabilities.Disparities in health and in the experience of chronic conditions are often exacerbated by medical providers' attitudes toward people with disabilities. These negative attitudes lead some providers to turn away patients with disabilities, or to provide them with a lower standard of care despite their needs (Iezzoni, 2023). Nearly 8 million people with disabilities have functional limitations that restrict their self-care activities, and about 15 million people have functional limitations related to their independent living activities in the community (Paul et al., 2023). A substantial portion of NIDILRR’s grants portfolio is focused on rehabilitation to address these and related functional limitations among people with a wide variety of disabilities. This focus reflects, in part, NIDILRR’s historical roots in medical rehabilitation research and practice. NIDILRR’s portfolio of research focused on maximizing functional outcomes among people with disabilities is rich and varied, reflecting the importance of tailoring and improving services, supports, technologies, and other interventions to meet the distinct needs of people in specific disability populations.Health and function disparities between people with and without disabilities are often greater among people from underserved communities. For example, Black and Latino/a adults with intellectual and developmental disabilities (IDD) have worse health outcomes compared to White adults with IDD (Magana et al., 2016). The perceived barriers to health care access also differ significantly between people with IDD from different racial and ethnic communities (Li et al., 2021). There is the higher prevalence of obesity among Hispanic people with spinal cord injury (SCI), relative to White people with SCI (Wen et al., 2019). Transgender people with disabilities in the United States are more likely to have unmet healthcare needs compared to cisgender people with disabilities (Mulcahy et al., 2022). These and other differences in experiences and outcomes within populations of people with disabilities illustrate the need for research that purposefully collects and analyzes data from people with disabilities from underserved communities, either as part of a broadly representative sample or as a distinct focus.NIDILRR’s research portfolio focusing on health and function among people with disabilities includes research at various stages toward development and implementation of evidence-based services, supports, and interventions. These stages include exploration and discovery, intervention development, intervention efficacy, and scale up evaluation. Research in any of these stages may be appropriate, depending on the population of people with disabilities and the phenomena being studied.In accordance with NIDILRR’s Long Range Plan for Fiscal Years 2024-2028 (the Plan), NIDILRR seeks to build on these investments in the health and function domain, by supporting innovative and well-designed research and development, dissemination, and utilization activities in a broad range of health and function priority areas specified in this priority. Research and development grants sponsored under this priority are intended to contribute to improved health and function outcomes among people with disabilities. References:Cook, J., Razzano, L., Swarbridk, M., Jonikas, J., Yost, C., Burke., L. et al. (2015). Health risks and changes in self-efficacy following community health screening of adults with serious mental illnesses. PloS One (10)4): e0123552. https://doi.org/10.1371/journal.pone.0123552.Felix, E., Cardenas, D., Bryce, T., Charlifue, S., Lee, T., MacIntyre, B., Mulroy, S., Taylor, H. (2022). Prevalence and impact of neuropathic and nonneuropathic pain in chronic spinal cord injury. Archives of Physical Medicine and Rehabilitation. 103(4): 729-737. DOI: 10.1016/j.apmr.2021.06.022.Heydarian, N., Castro, Y., Morera, O. (2021). A brief report of the prevalence of chronic and acute health conditions among blind American adults. (2021). Disability and Health Journal. 14(3). https://doi.org/10.1016/j.dhjo.2021.101072.Iezzoni, L., Rao, S., Ressalam, J., Bolcic-Jancovic, D., Agaronnik, N., Donelan, K., Lagu, T., & Campbell, E. (2021) Physicians perceptions of people with disability and their health care. Health Affairs. 40(2). https://doi.org/10.1377/hlthaff.2020.01452. Li, H., Parish, S., Magana, S., Morales, M. (2021). Racial and ethnic disparities in perceived barriers to health care among U.S. adults with intellectual and developmental disabilities. Intellectual and Developmental Disabilities. 59(1): 84-94. https://doi.org/10.1352/1934-9556-59.1.84.Linberry, S., Bogenschutz, M., Broda, M., Dinora, P., Prohn, S., & West, A. (2023). Co-occuring mental illness and behavioral support needs in adults with intellectual and developmental disabilities. Community Mental Health Journal. 59: 1119-1128. https://doi.org/10.1007/s10597-023-01091-4.Magana, S., Parish, S., Morales, M., Li, H., & Fujiura (2016). Racial and ethnic health disparities among people with intellectual and developmental disabilities. Intellectual and Developmental Disabilities. 54(3): 161-272. https://doi.org/10.1352/1934-9556-54.3.161.Mann, C., Jun, G., Tyrer, F., Kiana, R., Lewin, G., & Gangadharan, S. (2022). A scoping review of clusters of multiple long-term conditions in people with intellectual disabilities and factors impacting on outcomes for this patient group. Journal of Intellectual disabilities. 27(4): https://doi.org/10.1177/17446295221107275.Mitra, M., Long-Bellil, L., Moura, I., Miles, A., & Kaye, S. (2022). Advancing health equity and reducing health disparities for people with disabilities in the United States. 2022. Health Affairs. https://doi.org/10.1377/hlthaff.2022.00499.Mulcahy, A., Streed, C., Wallisch, A., Batza, K., Kurth, N., Hall, J., & McMaughan, D. (2022). Gender identity, disability, and unmet healthcare needs among disabled people living in the community in the United States. International Journal of Environmental Research and Public Health. 19(5): 2588. https://doi.org/10.3390/ijerph19052588. National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR): 2024-2028 Long Range Plan. (available at: ACL_Final Transmitted_NIDILRR LRP 2024-2028.pdf).Paul, S., Rogers, S., Bach, S., & Houtenville, A. (2023). Annual Disability Statistics Compendium: 2023. Durham, NH: University of New Hampshire, Institute on Disability.Wen, H., Botticello, A., Bae, S., Heinemann, A., Boninger, M., Houlihan, B., & Chen, Y. (2019). Racial and ethnic differences in obesity in people with spinal cord injury: the effects of disadvantaged neighborhood. Archives of Physical Medicine and Rehabilitation. 9: 1599-1606. https://doi.org/10.1016/j.apmr.2019.02.008.Priority--DRRP on Health and Function of Individuals with DisabilitiesThe Administrator of the Administration for Community Living establishes a priority for a Disability Rehabilitation Research Project (DRRP) on Health and Function Among People with Disabilities. Under this priority, applicants must propose a research project that is aimed at improving health and function outcomes among people with disabilities. In carrying out a research project under this program, a grantee must identify one or more hypotheses or research questions, and, based on the hypotheses or research questions identified, perform an intensive, systematic study directed toward producing (1) new or full scientific knowledge or (2) understanding of the subject or problem studied.The DRRP must contribute to the outcome of maximizing the health and function outcomes of people with disabilities.To contribute to this outcome, the DRRP must--(a) Conduct research in one or more of the following priority areas, focusing on people with disabilities as a group or on individuals in specific disability or demographic subpopulations of people with disabilities:Technology to improve health and function outcomes among people with disabilities.Individual and environmental factors associated with improved health and function outcomes among people with disabilities.Interventions that are designed to contribute to improved heath and function outcomes among people with disabilities. Interventions include any strategy, practice, program, policy, or tool that, when implemented as intended, contributes to improvements in health and function outcomes among people with disabilities.Effects of government policies and programs on health and function outcomes among people with disabilities.Practices and policies that contribute to improved health and function outcomes among transition-aged youth with disabilities.(b) Demonstrate in its original application that people with disabilities from racial and ethnic minority backgrounds will be included in study samples in sufficient numbers to generate knowledge and products that are relevant to the racial and ethnic diversity of the population of people with disabilities being studied. The DRRP must describe and justify in its original application, the planned racial and ethnic distribution of people with disabilities who will participate in the proposed research activities.(c) Focus its research on a specific stage of research. If the DRRP is to conduct research that can be categorized under more than one stage, including research that progresses from one stage to another, those stages must be clearly specified and justified. These stages: exploration and discovery, intervention development, intervention efficacy, and scale-up evaluation, are defined in this funding opportunity announcement. Applicants must justify the need and rationale for research at the proposed stage or stages and describe fully an appropriate methodology or methodologies for the proposed research.(d) Conduct knowledge translation activities (i.e., utilization, dissemination) in order to facilitate stakeholder (e.g., people with disabilities, service providers, policymakers, practitioners) use of the knowledge, interventions, programs, technologies, or products that result from the research activities conducted under paragraph (1)(a) of this priority.(e) Involve people with disabilities in the activities conducted under paragraph (a) and (d) of this priority in order to maximize the relevance and usability of the products to be generated under this priority.Definitions: Stages of research:Exploration and discovery means the stage of research that generates hypotheses or theories through new and refined analyses of data, producing observational findings and creating other sources of research-based information. This research stage may include identifying or describing the barriers to and facilitators of improved outcomes of individuals with disabilities, as well as identifying or describing existing practices, programs, or policies that are associated with important aspects of the lives of individuals with disabilities. Results achieved under this stage of research may inform the development of interventions or lead to evaluations of interventions or policies. The results of the exploration and discovery stage of research may also be used to inform decisions or priorities;Intervention development means the stage of research that focuses on generating and testing interventions that have the potential to improve outcomes for individuals with disabilities. Intervention development involves determining the active components of possible interventions, developing measures that would be required to illustrate outcomes, specifying target populations, conducting field tests, and assessing the feasibility of conducting a well-designed intervention study. Results from this stage of research may be used to inform the design of a study to test the efficacy of an intervention;Intervention efficacy means the stage of research during which a project evaluates and tests whether an intervention is feasible, practical, and has the potential to yield positive outcomes for individuals with disabilities. Efficacy research may assess the strength of the relationships between an intervention and outcomes, and may identify factors or individual characteristics that affect the relationship between the intervention and outcomes. Efficacy research can inform decisions about whether there is sufficient evidence to support “scaling-up” an intervention to other sites and contexts. This stage of research may include assessing the training needed for wide-scale implementation of the intervention, and approaches to evaluation of the intervention in real-world applications; andScale-up evaluation means the stage of research during which a project analyzes whether an intervention is effective in producing improved outcomes for individuals with disabilities when implemented in a real-world setting. During this stage of research, a project tests the outcomes of an evidence-based intervention in different settings. The project examines the challenges to successful replication of the intervention, and the circumstances and activities that contribute to successful adoption of the intervention in real-world settings. This stage of research may also include well-designed studies of an intervention that has been widely adopted in practice, but lacks a sufficient evidence base to demonstrate its effectiveness.