During the last decade, tremendous advances have been made in medical technology and treatment regimens that have improved the health and extended the average lifespan of many Americans. However, the health of underserved populations in America is compromised by actual and perceived barriers to care. These barriers may be related to (1) access to healthcare, (2) continuity of care, and/or (3) suitability or appropriateness of care on the basis of contextual factors,1 including gender, ethnicity, disability, education, income, geographic location, or other life circumstances that may lead to marginalization or stigmatization.2

In recognition of the serious health disparities that such underserved groups experience, The University of Texas at Austin School of Nursing proposed and received funding from the National Institute of Nursing Research, National Institutes of Health, for the interdisciplinary Center for Health Promotion/Disease Prevention Research in Underserved Populations (CHPR). Initially funded in 1999, the CHPR funding has been renewed (P30NR005051) for the years 2005-2009. During this time period, the CHPR will sponsor a total of 4 conferences for the public dissemination of research and 4 invitational collaboratories that will focus on theoretical, conceptual, and methodological issues related to health promotion interventions for a specific underserved group (persons with chronic disabling conditions, underserved women, adolescents, and at-risk elders). We hope that these initiatives to disseminate and translate findings on effective interventions will enhance the focus of health promotion for underserved populations across the lifespan and address one of the overarching goals of Healthy People 2010: to eliminate disparities in the health status of racial and ethnic minority populations; of women and children, in particular those from impoverished backgrounds; and of people with chronic and disabling conditions.2

The first conference/collaboratory held in April 2005 focused on promoting health for persons with chronic disabling conditions, a group which faces substantial barriers that limit their access to and participation in health promotion activities critical to increasing their quality and years of healthy life. The Public Health Service estimates that there are 54 million Americans with disabilities and 40% of these experience at least 1 secondary condition.2 The rates of disability are rising among younger populations, and the "aging" of the US population will result in an overall increase in the numbers with disabilities.2 Yet traditionally, health promotion activities for persons diagnosed with chronic disabling conditions have been underemphasized.

The articles in this collection reflect the substantial research expertise of the authors, who came from 5 universities in the United States and Canada, as well as their personal experiences with disability, program development, and service delivery. Those attending the collaboratory were invited to write articles that tackled the difficult issues surrounding health promotion research for persons with chronic and disabling conditions, drawing on their research experiences (though not writing research reports per se). Articles were initially shared and discussed in this collaborative intellectual environment, and the final versions here represent the outcomes of much individual thought as well as group critique, discussion from the collaboratory, and the input of 23 peer reviewers, who hailed from 14 different institutions.

We lead off the collection with an article by Sally Thorne, which is adapted from the keynote address she gave at the conference. Thorne synthesizes a broad spectrum of research and challenges readers to think about the opportunities healthcare providers have to use communication that is health promoting rather than health inhibiting. We have often assumed that the same health promotion interventions that were advocated to improve the quality of life of the general population would result in the same outcomes for persons with chronic and disabling conditions. Harrison's article is a serious inquiry regarding the very meaning of health promotion for persons with disabilities. Garcia's article raises additional important questions about the relevance of health promotion interventions across cultures and socioeconomic groups.

Another group of articles in this collection addresses issues regarding the design and implementation of health promotion interventions for specific populations. Stuifbergen recommends a process of building health promotion interventions for specific groups through the adaptation of content and processes of existing intervention frameworks with sound theoretical and empirical support. Smeltzer and Hughes both highlight the unique needs and concerns of women with disabilities with regard to access to preventive screening and achieving effective health promotion programs. Coward addresses health promotion among the substantial number of persons living with cancer as a chronic condition. The developmental and social aspects of sexual health promotion among adolescents living with chronic health conditions are explored in the article by Rew.

Two articles in this collection address key methodological and measurement challenges in health promotion research with persons with disabilities. Becker's article supports expansion of the measurement of health in studies with this population. Warms identifies the many factors that must be considered in selecting measures of physical activity and provides a framework to select the most appropriate measures in studies of persons with chronic and disabling conditions.

This special supplement represents the efforts of many individuals and groups. We are grateful to the National Institute of Nursing Research (P30NR005051), National Institutes of Health, for funding to support the conference and staff activities. Dolores V. Sands, Professor and Dean of The University of Texas at Austin School of Nursing and the Cain Excellence Fund provided financial support for the publication of these articles. Sandy Graham, Assistant Director of the CHPR, and Michael Erard, PhD, editor in the Cain Center for Nursing Research, provided administrative support and editorial guidance. Special appreciation is extended to Sally Thorne, PhD, RN, for moderating the 2-day retreat and to the discussants, including CHPR affiliates Elizabeth Abel, PhD, FNP, Sharon Horner, PhD, RN, Eun-Ok Im, PhD, RN, FAAN, Graham McDougall, PhD, RN, FAAN, and Lorraine Walker, EdD, RN, FAAN.

Alexa Stuifbergen, PhD, RN, FAAN

Issue Editor, Director, Center for Heath Promotion and Disease Prevention Research in Underserved Populations, School of Nursing, University of Texas at Austin

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