Health Support Project for Persons With Disabilities

Dietary intake will be captured via a self-designed, closed-ended questionnaire that asks individuals about the frequency of their consumption of 12 food items on a weekly basis. Participants will rate their weekly consumption of each food item on a 5-point Likert scale. On this scale, less healthy food items will be rated from daily consumption (0) to never consumption (4), while healthy food items will be rated in reverse, from daily consumption (4) to never consumption (0). In addition, there is 1 item, "Do you think your dietary habit is health", with responses is rating from "very unhealthy" (0) to "very health" (4). Total scores will range from 0 to 52, with higher scores indicating a healthier diet. For those with intellectual disabilities, the food items will be shorted to 8, with 6 less healthy food items and 2 healthy food items, resulting a total of score ranged from 0 to 32.

Achievement of physical activity goals will be retrieved from each sheltered workshops and integrated vocational rehabilitation services centers if individuals meet the World Health Organization's recommendation of at least 150 minutes of moderate-intensity physical activity per week. The scoring system is dichotomous as: a "yes" response receives 1 point, and a "no" response receives 0 points.

Self-efficacy for physical activity will be assessed using the Chinese version of Self-Efficacy for Exercise (SEE) scale. The SEE evaluates individuals' perceived confidence in overcoming nine barriers to regular exercise: weather, boredom, pain, exercising alone, not pleasurable, too busy, feel tired, stress, depressed. For each situation, individuals rate their current confidence in exercising three times per week for 20 minutes each time using an 11-point Likert scale ranging from 0 (Not confident) to 10 (Very confident). The total score ranges from 0 to 90, with higher scores reflecting stronger levels of self-efficacy for exercise. This scale will not be used for participants with intellectual disabilities.

Body mass index (BMI) will be calculated as the weight in kilograms (kg; measured to the nearest 0.1 kg while wearing light clothing and stand erect, barefoot) divided by the squared height in meters (measured to the nearest 0.1 centimeters).

Blood pressure will be collected twice after a five-minute rest in a sitting position, with a five-minute rest in between. Readings will be taken on the right arm when possible; otherwise, readings will be taken on the left arm for those with conditions that preclude the use of the right arm, using electronic automated sphygmomanometers. The second reading will be used in all analyses, unless missing. According to the national guidelines, hypertension is defined as a systolic blood pressure of 140 mmHg or higher, a diastolic blood pressure of 90 mmHg or higher, or both.

Handgrip strength will be measured three times in kilograms to the nearest 0.1 kg for each hand using a digital dynamometer, with a 60-second rest in between. Participants will be instructed to keep their elbow at a 90° angle flexion while either standing or sitting, with a neutral wrist position, and upper arm set vertically against the trunk. Participants will be required to squeeze the handle as hard as possible for three seconds. Handgrip strength will be considered as the maximum value of the three measurements for each hand.

Medication adherence will be measured with the Chinese version of the eight-item Morisky Medication Adherence Scale (MMAS-8). The scale includes seven dichotomous yes/no questions and one question answered on a five-point Likert scale. For Item 1 through 7, each "no" response is rated as 1, and each "yes" response is rated as 0, except for Item 5, where the "yes" response is rated as 1 and the "no" response is rated as 0. Item 8 contributes a score between 0 (All the time) and 1 (Never) in 0.25-point increments on a 5-point scale that assesses how often patients forget to take their medications. Item 8 will be adjusted for participants with intellectual disabilities as follows: "Do you have difficulty remembering to take all your medication(s)?" In the adjusted Item 8, the response of "difficulty" or "not sure" will be coded as 0, while "without difficulty" will be coded as 1. The total score is the sum of all MMAS-8 items and ranges between 0 and 8.

Mental well-being will be assessed using the Chinese version of the World Health Organization-Five Well-Being Index (WHO-5). The WHO-5 consists of five items, each of which is scored on a 6-point Likert scale with response options ranging from 0 (At no time) to 5 (All of the time). The WHO-5 raw score ranges from 0 to 25 and is conventionally multiplied by 4 to give a percentage score from 0, representing the worst imaginable well-being, to 100, corresponding to the best imaginable state of subjective well-being. For participants with intellectual disabilities, responses will be scored on a 3-point Likert scale: 0 (At no time), 1 (Sometimes), and 2 (All of the time) The total score is obtained by summing the scores of the five items and multiplying the raw score by 10, resulting in a percentage score ranging from 0 (worst well-being) to 100 (best well-being).

Health-related quality of life will be evaluated via the Chinese version of the EuroQoL-5 Dimension-5 Level (EQ-5D-5L) instrument. The EQ-5D-5L descriptive system consists of the dimension of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, and each dimension includes five response categories of 1 (no problem), 2 (slight problems), 3 (moderate problems), 4 (severe problems), and 5 (extreme problems). A total of 3,125 (55) possible health states exists that are derived from the combination of each level of each dimension, with "11111" and "55555" representing the best and worst health states, respectively. The utility score of EQ-5D-5L will be derived using the established Hong Kong value set by weighting each respondent's self-report health status to a single preference-based health index (utility scores). A higher score in EQ-5D-5L will indicate better health-related quality of life.

Productivity levels improved after the launch of the Health Support Program. This improvement will be reflected in statistics from non-governmental organizations, particularly the total number of completed tasks by the people with disabilities in sheltered workshops and integrated vocational rehabilitation services centers.

The satisfaction levels of participants will be rated on a 5-point Likert scale, ranging from"lowest satisfaction" (1) to "highest satisfaction" (5) for each component of the HSP intervention.