Bias, stigmatization, inaccessibility, ableism, and discrimination have direct and indirect effects on the health of those living with disability.1 Recently, the National Institutes of Health (NIH) designated persons living with disability as a population facing significant and persistent health disparities2 and formed an advisory committee to explore the underrepresentation of people living with disability in the scientific workforce and among participants in clinical trials meant to improve public health. The committee's work has resulted in larger efforts to increase knowledge about the harmful impacts of ableism in healthcare, health research, and health promotion.3 Disability awareness trainings are recognized by the World Health Organization (WHO) as an integral part of addressing ableism in health promotion across a wide variety of sectors (e.g., rehabilitation, caregivers, community health workers, among others).1 Disability awareness trainings have been implemented across various sectors (e.g., public health,4 employment,5 physical education,6 medical education,7 higher education,8 law enforcement9) in pursuit of creating greater inclusivity, accessibility, and belonging for people living with disability, and generally result in small to moderate improvements in disability attitudes.10, 11, 12

Though widely known as disability awareness training (some referred to as disability competency trainings13), the goals of these trainings often include behavioral outcomes in line with disability inclusion, namely, competency skills. For example, disability awareness trainings serve to clarify roles and responsibilities in relation to supporting needs of clients/students/community members/participants with disabilities,8 inform disability-inclusive hiring practices,5 improve interactions with persons with disabilities9 among others. However, there has been little work to evaluate actual behavioral changes following disability awareness training delivery, representing a major limitation in the understanding of the impact and usefulness of these trainings.

Although successful initial implementation of disability awareness and competency training is widely reported, little is known about the process of training refinement and the efforts to engage in translational research to increase dissemination, though there are some examples.8,13,14 It is likely that successful disability awareness and competency trainings do undergo revisions and long-term implementation when community partners are involved with the refinement process. However, it is unclear if these results are simply not published, not expected, or are disseminated through different channels (e.g., institutionalized within organizations offering these trainings). The lack of published knowledge about training development may lead to an assumption from those embarking on disability awareness and competency training development that post-pilot empirical refinement is unimportant. Additionally, there remain critical questions about implementation and dissemination of training beyond initial efforts.

In this commentary, we describe the iterative revision process of a training focused on improving disability competency skills conducted among community-based exercise instructors to provide a model for community-academic partnerships who are involved in this line of work. After an initial feasibility pilot trial of the training, we sought to increase effectiveness of the training, increase reach and adoption across a wider audience, increase fidelity of implementation, and design with maintenance/longevity of the training in mind. We utilized RE-AIM to guide our training development and implementation, and to frame our discussion. RE-AIM is a framework that is widely used in public health to track five essential components of dissemination: Reach, Effectiveness, Adoption, Implementation, and Maintenance.15 This framework has been underutilized in the evaluation of disability awareness and competency training.