Experiences of US college students with intellectual and developmental disabilities in developing and maintaining physical wellness

Abstract

College students with intellectual and developmental disabilities in inclusive postsecondary education (IPSE) programs face unique physical wellness challenges. However, the majority of scholarship highlights family and IPSE staff perspectives as opposed to centering student voices. This study explores the lived experiences of college students with intellectual and developmental disabilities in developing and maintaining physical wellness. We used consensual qualitative research to explore physical wellness experiences gathered from semi-structured interviews of 14 college students with intellectual and developmental disabilities in an IPSE program. Following CQR guidelines, we present four fully differentiated domains organized into development, maintenance, and mediating domains. We offer implications for educators, caregivers, and IPSE staff to better support wellness behaviors and address the interconnected challenges of being a college student and living with intellectual and developmental disabilities.

Keywords

college students consensual qualitative research (CQR)intellectual and developmental disabilities physical wellness wellness

Intellectual and developmental disability is the intersection of shared experiences of living with an intellectual disability (e.g., mild, moderate, and severe) and/or a developmental disability (e.g., Autism Spectrum Disorder). The American Association for Intellectual and Developmental Disabilities (AAIDD; AAIDD, n.d) endorsed the intersection between ID and DD and described intellectual and developmental disabilities as significant impairments in intellectual, developmental, or adaptive behaviors before age 22. Although institutional barriers previously discouraged college attendance for individuals with intellectual and developmental disabilities (Plotner and Marshall, 2015), legislative efforts over the last 15 years have provided new opportunities for inclusive higher education. The reauthorization of the Higher Education Opportunity Act in 2008 (HEOA), 2008 ignited the increase of inclusive postsecondary education (IPSE) programs, which now include over 340 programs in the U.S. (Think College, 2025).

Inclusive postsecondary education (IPSE) programs enroll and provide support for students with intellectual and developmental disabilities on existing university or college campuses. Practices and services support student belonging, learning, identity, and contribution within the larger campus community (Uditsky and Hughson, 2012). While there is a level of intentional inclusion afforded across recognized IPSE programs, this is based on a continuum, as some programs are completely inclusive across all domains of college life, and some may only have inclusive opportunities in one or two domains (e.g., social and academic; Grigal et al., 2012). There is variability across IPSE programs in many areas, including the model of support, level of autonomy given to students, residential options (i.e., college dorm or apartment), and programmatic policies to promote personal and professional growth (Plotner and Marshall, 2015; Smith Hill et al., 2024a).

Wellness of college students with intellectual and developmental disabilities

There is a developing interest in health and wellness initiatives for college students. Ohrt et al. (2019) described wellness as the interconnectedness of multiple domains of an individual: physical, social, intellectual, emotional, and spiritual. Each wellness domain has a relationship with the others, and every domain must be considered for someone’s general health and wellness. Recent literature has highlighted the positive relationship between perceived wellness and postsecondary academic achievement, health-promotion behaviors, and mental health symptoms (Cass et al., 2021; Porojan et al., 2013). Despite efforts to explore general college student wellness, college students with intellectual and developmental disabilities are comparatively underrepresented in literature (Oakes et al., 2020b), with most published works related to individuals with intellectual and developmental disabilities focusing on symptom management and diagnostic considerations, as opposed to promoting wellness-based paradigms (Anderson et al., 2013). This raises concern over the quality and equity of access to wellness resources for college students with intellectual and developmental disabilities.

The current wellness literature base for college students with intellectual and developmental disabilities suggests that additional attention is needed to explore the intersecting identities of being a college student and a transition-aged adult with intellectual and developmental disabilities. In their systematic review of 24 articles exploring the health and wellness of college students with intellectual and developmental disabilities, Oakes et al. (2020b) noted the positive influence of educational and practical resources on improving the health and wellness of college students enrolled in IPSE programs. In a separate report, Oakes et al. (2020a) interviewed students or graduates (n = 8) and staff or faculty members (n = 9) of an IPSE program about their experiences of addressing health and wellness in college. The findings included challenges that are shared by college students with and without intellectual and developmental disabilities, like developing healthy wellness behaviors as a result of living independently for the first time and finding a support network beyond staff and faculty in institutes of higher education (IHEs). To that end, Oakes et al. (2020b) noted the unique aspects of living with intellectual and developmental disabilities and the benefits of providing culturally sensitive support and accommodation options to help college students with intellectual and developmental disabilities develop and maintain wellness-based behaviors while in college.

Recent studies continue to expand the understanding of wellness for college students with intellectual and developmental disabilities. For instance, Fields et al. (2024) explored emotional wellness experiences of students with intellectual and developmental disabilities and highlighted that while many students do develop strategies for regulating emotions, they often encounter systemic barriers to wellness such as limited access to resources and inadequate emotional education prior to college. Similarly, Castle et al. (2024) piloted a 10-week hybrid group counseling intervention rooted in wellness counseling, and found that while participants initially reported decreased wellness scores, qualitative findings highlighted meaningful insights into how students understand and apply wellness concepts in their daily lives. Both studies demonstrate the feasibility of implementing wellness-focused interventions and affirm the importance of centering student voices to identify barriers and supports relevant to this population’s holistic development.

Physical wellness of college students with intellectual and developmental disabilities

Physical wellness scholarship indicates unique aspects of living with an intellectual and developmental disabilities in college. Ohrt and colleagues (2019) described physical wellness as encompassing aspects related to physical activity, exercise, nutrition, and maintenance of physical health and body image. Children, adolescents, and young adults with intellectual and developmental disabilities have historically had disparities in aspects of physical wellness compared to peers without intellectual and developmental disabilities, including higher obesity rates and comorbidities with chronic health conditions (Centers for Disease Control and Prevention [CDC], 2020). Scholars have reported that folks with intellectual and developmental disabilities are more likely to have unhealthy eating habits, describe a sedentary lifestyle, and experience barriers to appropriate physical healthcare (e.g., transportation and perceived provider competency) (Lynch et al., 2022; Safi et al., 2024; Siasoco, 2014). Despite disparities in physical health and wellness, Krahn and Havercamp (2019) noted the continued lack of scholarship to explore and address healthcare trends for folks with intellectual and developmental disabilities; a gap that includes a lack of literature specific to college students with intellectual and developmental disabilities. Oakes et al. (2021) interviewed campus recreational administrators across three universities about their experiences with service delivery for college students with intellectual and developmental disabilities. Following a poetic analysis, Oakes et al. (2021) suggested campus recreation staff wanted to support their college students with intellectual and developmental disabilities, but believe additional training about intellectual and developmental disabilities is needed to fully understand how to support their physical wellness. These findings point to a larger need for evidence-informed wellness supports that account for both systemic barriers and individual experiences of students with intellectual and developmental disabilities, and they reinforce the importance of inclusive practices that promote agency, education, and access across campus wellness settings.

From an IPSE programmatic standpoint, Roberts et al. (2018) interviewed IPSE leadership team members (N = 9) about their attitudes towards and practices for physical activity within their respective programs. Notably, Roberts and colleagues compared the leadership team members’ philosophies of structure (i.e., more vs. less structured requirements) and support options (e.g., availability of disability-competent IHE staff and faculty) and advocated for college students with intellectual and developmental disabilities to have a variety of options available to promote physical activity while supporting autonomy. Furthermore, Miller and Berlingo (2023) echoed these findings in their qualitative analysis of physical activity participation among young adults with intellectual disabilities enrolled in a postsecondary education program. Their study revealed that while students expressed interest and motivation to engage in physical activity, they faced pervasive barriers including environmental inaccessibility, lack of knowledgeable staff, and internalized low self-efficacy shaped by ableist assumptions from caregivers and professionals. Notably, participants emphasized the importance of receiving early and ongoing physical education and opportunities to explore various forms of movement, reinforcing that autonomy and self-determination are essential to sustaining physical wellness efforts in adulthood. In essence, IPSE staff members and stakeholders are responsible for supporting each college student with intellectual and developmental disabilities’ unique physical wellness goals.

Current study

With the increasing number of college students with intellectual and developmental disabilities and the growing call to support their health and wellness, additional scholarship is needed to understand the unique aspects of this intersectional identity. To that end, exploring individual domains of wellness, such as physical wellness, supports a deeper understanding of overall wellness (Ohrt et al., 2019), given the limited scholarship in this area that is almost exclusive to the caregiver’s perspective. The present study seeks to understand the lived experiences of college students with intellectual and developmental disabilities in developing and maintaining aspects of their physical wellness. We aim to build off existing research to provide educators, caregivers, healthcare professionals, IPSE staff, and other stakeholders additional insight into the lived experiences of college students with intellectual and developmental disabilities to support healthy physical wellness behaviors. The guiding research question for our investigation is: What are the lived experiences of college students with intellectual and developmental disabilities in developing and maintaining their physical wellness?

Method

To address the proposed research question, our research team followed consensual qualitative research (CQR) methodological procedures (Hill and Knox, 2021), which combines traditions from phenomenology and grounded theory to explore a phenomenon through lived experiences and propose theories based on participants’ shared experiences. Furthermore, we followed a post-positivism epistemological framework (Limberg et al., 2022).

Participants

Our sample consisted of 14 college students with intellectual and developmental disabilities actively enrolled in an IPSE program. The 14 participants fell within Hill and Knox’s (2021) suggested range for CQR studies. Participants were recruited through purposeful sampling strategies due to the specific inclusion criteria: (a) 18 years or older, (b) living with an intellectual and/or developmental disability, (c) enrolled in an IPSE program, and (d) able to provide research consent. In addition, the participants are all in the same IPSE program, which is part of a large, research-intensive, southeastern university. The IPSE program is a four-year, certificate-granting program, and students in the IPSE program have a structured IPSE curriculum and elect to audit university courses pertaining to their professional and personal interests. The full demographics of each participant, including pseudonyms, are in Table 1.

Table 1.

Participant pseudonyms and demographics.

Participant	Gender	Race/Ethnicity	Disability identity	Academic standing	High school diploma
Harper	Female	White	Cerebral palsy	Freshman	No
Phil	Male	Latino	ID	Sophomore	No
Ruby	Female	Black	ASD	Senior	No
Dorothy	Female	White	TBI, physical disability	Sophomore	No
Luna	Female	Black	ID; SLI	Senior	No
Justine	Female	White	ASD	Sophomore	No
Roger	Male	White	ID	Freshman	No
Jake	Male	Mixed race	ASD	Junior	No
Gus	Male	White	Cerebral palsy	Sophomore	No
Todd	Male	White	ASD	Sophomore	No
Ryder	Female	White	ID	Senior	Yes
Jones	Male	Filipino	ID; SLI	Junior	No
Kade	Male	Black	ASD	Senior	No
Sara	Female	White	Williams syndrome	Junior	No

Note. ID = Intellectual Disability; ASD = Autism Spectrum Disorder; TBI = Traumatic brain injury; PD = Physical disability; SLI = Speech/language impairment.

Research team

The research team comprises nine scholars, all with experience working in an IPSE program. The first, third, fourth, and fifth authors hold doctoral degrees in counselor education and supervision and each have experience counseling young adults with intellectual and developmental disabilities within an IPSE program for a combined 12 years of practice. The second and ninth authors hold doctoral degrees in special education and have worked as IPSE program directors. These two authors have a combined experience of 28 years working with young adults with disabilities in education systems. The sixth author has a doctorate in occupational therapy and the seventh and eighth authors are doctoral candidates in counselor education and supervision. Each has experience supporting the mental health and wellness of IPSE students.

Positionality and trustworthiness

To enhance trustworthiness, we attended to the study’s rigor and quality throughout the research process. We maintained detailed process notes, recording awareness on initial biases and reflections immediately after interviews, during transcript review, and throughout coding and consensus meetings. The research team established face validity by reaching a consensus on findings and conducting member checks with participants to verify accuracy (Hill and Knox, 2021). In addition, catalytic validity was fortified in this study by inviting participants to reflect on their daily lives, prompting a level of self-awareness that may lead to considering new perspectives. Furthermore, positionality encompasses the researcher’s physical and conceptual stances across different systemic levels, reflecting our relationship with our participants, subject matter, and research process (Holmes, 2020). Each research team member conducting interviews had a prior relationship of some level with the student participants. A more positivist research orientation may criticize these relationships between researcher and participant, but within our post-positivist approach, we not only recognize that our own identities influenced our research findings and conclusions (Panhwar et al., 2017), but we also utilized these relationships to effectively connect with participants and garner deeper, more rich data.

Data collection

After receiving IRB approval, we contacted potential participants with in-person and email recruitment materials. We followed up on this procedure, meeting with their assigned students during a coaching session. During this individual meeting, research team members facilitated one-on-one plain language reviews of the study’s purpose and informed consent. At the end of this meeting, students were encouraged to contact a research team member to enroll in the study. Following the necessary recruitment steps, our team collected data during the Spring 2023 academic semester. All enrolled participants identified as their own guardians, provided verbal consent, and disclosed other demographic information at the start of the interview process. The interview was semi-structured, consisting of 14 open-ended questions and potential follow-up prompts. The full interview protocol is included in Appendix A. Questions were developed within Ohrt et al.’s (2019) framework on physical wellness. Examples of questions include: (1) what do you believe contributes to someone’s physical health and wellness, (2) how did you learn about physical fitness, and (3) describe your hygiene habits. The questions were supplemented with additional prompts to encourage open dialogue (Glesne, 2016). Each interview took around one hour to complete.

Data analysis

We followed Hill and Knox’s (2021) CQR procedures, including developing domains from individual transcript reviews, coding statements into core ideas, organizing these into categories, and conducting a cross-analysis of participant responses. In line with post-positivist philosophy and CQR guidelines, we did not begin with a predetermined domain list. Instead, we collaboratively reviewed Harper’s transcript using inductive coding, then individually coded Phil’s transcript to refine the domain list through consensus. Remaining transcripts were divided among team members, coded individually, and internally audited to finalize the domains. Core ideas were initially created together for the healthcare management domain and then individually coded and audited for the remaining domains. All core ideas were paraphrased to capture the central message and shared with an external auditor who reviewed them before finalization. We then conducted a cross-analysis to sort core ideas into fully differentiated categories. Categories were first developed jointly and then individually coded and audited for consensus across remaining domains. Frequency counts for each category followed Hill and Knox’s recommendations: general (13+ cases), typical (7–12 cases), and variant (3–6 cases).

Findings

Following a CQR analysis (Hill and Knox, 2021), we identified four domains: (1) education, (2) physical wellness strategies, (3) internal processes, and (4) external factors. The final domains, categories, and cross-analysis are represented in Table 2.

Table 2.

Results of the final domains, categories, and cross analysis.

Domain	Category	Frequency
I. Education	1. College	General
	2. K-12	Typical
	3. Family lessons	Typical
	4. Medical professionals	Variant
	5. Media sources	Variant
II. Physical wellness strategies	1. Eating habits	General
	2. Healthcare management	General
	3. Personal hygiene	General
	4. Physical activity	General
	5. Sleep hygiene	General
III. Internal processes	1. Building habits	General
	2. Recognizing a mind/Body connection	General
	3. Self-efficacy development	Typical
IV. Societal and environmental factors	1. Family	General
	2. Peers	Typical
	3. Campus resource	Typical
	4. Media and technology	Typical
	5. Social stigma and environment	Variant

Frequency Descriptions: Variant = 3-6, Typical = 7-12, and General = 13+.

Domain I: Education

The education domain captures how and from where our participants described receiving education regarding physical wellness. As evidenced in the following categories, the education domain encapsulates both formal and informal education sources. We coalesced five categories: (1) college (2) K-12, (3) family lessons, (4) medical professionals, and (5) media sources.

Education category 1: College

The college category has a general frequency label, as all participants described learning at least one aspect of physical wellness while enrolled in their IPSE program. For example, Sara, Kade, Jones, Todd, Justine, Gus, Phil, and Ruby referenced learning about sleep hygiene and good nutrition in their IPSE small group course titled Health and Nutrition. Participants also referenced university-wide courses. For instance, multiple participants noted that University 101, a course offered to all freshmen at the IHE where the students attend, included modules on physical wellness education.

Education category 2: K-12

Deemed a typical frequency category, many participants detailed K-12 school classes, coaches, teams, and more as sources of information regarding physical wellness. Participants primarily discussed learning about exercise through middle and high school physical education courses, though some mentioned learning about healthy nutrition and good eating habits through high school science or nutrition courses. Justine: “We took a physical-like PE class. We would like do jumping jacks and several other workouts.” Roger described learning about nutrition through a high school health course:

Because in high school, I took like a health class, and I learned it from there…I can remember some of it we learned about, like what to eat more and then what not to eat, that stuff. Like, not that many cookies and stuff. We learned about like, like, the healthy plate-like the food pyramid.

Ultimately, K-12 education appeared to be a springboard to their postsecondary education.

Education category 3: Family lessons

Lessons from family members, often parents, are a typical frequency category. Todd gives an example of how their family taught them about healthy eating and nutrition: “I’ve always had a family that eats healthy. And [they supported risk taking]. I am, like, always been a risk taker. And so I’ve always just kind of was like, Yeah, I’m gonna try this.” Family was also an important influence on educating students about all aspects of physical wellness. Sara describes how her mother’s attempts to discuss physical wellness with her were not helpful:

Sara: ...I'm very insecure about my body. Like my mom makes me very insecure about it. She's like, you're so overweight, blah, blah, blah. I'm like, ‘mom!’

Researcher: Is it helpful when she has these types of conversations with you about your body?

Sara: Yeah, probably has the opposite effect.

Researcher: Kind of makes you sad?

Sara: Yeah.

For more than one participant in the study, family lessons about physical wellness were fraught and not always well-received. Nevertheless, it was apparent that family lessons influenced our participants’ physical wellness mindsets and behaviors.

Education category 4: Medical professionals

A few participants discussed advice and education they received from medical professionals, assigning this category a variant label. Dorothy described lessons learned about appropriate exercise from a physical therapist. Gus described lessons about nutrition learned from their medical doctor:

[The doctor] was saying what will help is me eating more like fruit, fruit, vegetables, salads, apples, all that and less sodas. And then more water which is very helpful because I've been doing that and it actually works out better because I feel great. I feel way better than I was before for sure. So this time just taking your doctor's advice for stuff.

And Sara recalled learning about dental hygiene from their dentist. The ranging medical professionals providing lessons indicated the influence trained professionals have on our participants with intellectual and developmental disabilities.

Education category 5: Media sources

Media sources is another variant category. For the purpose of our coding, we considered TV, movies, technological apps or YouTube videos as media. Phil relayed, “Mostly, sometimes I watch some YouTube about eating healthy or how to stay fit.” Harper described their media use as a source for physical wellness education: “I look at like, a lot of food recipes on TikTok.” In addition to nutrition and healthy recipes, Luna said they utilize apps to learn about exercise: “I got maybe 10 apps. Mm, and some work very well. So I keep those and others I delete because I don’t want to waste all my space. So if you’re trying to have a plan to work out or whatever, I just get some apps that actually help you.”

Domain II: Physical wellness strategies

This domain captures participants’ routine strategies for maintaining their physical wellness. These included a range of behaviors related to (1) eating habits, (2) healthcare management, (3) personal hygiene, (4) physical activity, and (5) sleep. The following categories reflect how participants approached these interconnected aspects of wellness in their everyday lives. All categories in this domain registered a general frequency.

Physical wellness strategies category 1: Eating habits

Participants described various approaches to eating that reflected intentionality, routine, and personal preferences. Many reported engaging in mindful eating practices and described efforts to choose healthier options. For instance, Ruby shared, “I’m trying to limit, like, sodas and trying to limit certain foods that you normally would eat on a typical, um, day.” Others described food choices shaped by health concerns or cultural and personal needs. Gus explained, “If I eat too much sugar, I have blood clots… it’s kind of a balance… just trying to be healthier.” Moreover, eating habits also appeared to have a cultural influence. Luna offered a different perspective to eating habits by describing their fasting schedule. For instance, eating breakfast is outside of their fasting window, and fasting through their experience can impact eating habits at different points across the calendar year.

Comfort foods, described by participants as both healthy and unhealthy, were common. Dorothy said she eats Chick-fil-A twice daily but noted, “It’s bad for me… it’s all carbs.” Conversely, participants like Justine preferred fruits high in vitamin C, such as strawberries and raspberries. Several students described learning to cook and experimenting with recipes found on social media. Harper noted, “I enjoy trying to cook new meals to eat healthily from recipes I find online,” and Luna added that she uses apps to identify helpful workout and food plans. Lastly, participants described the influence of their cooking abilities on eating habits. Harper shared that she enjoys trying to cook new meals to eat healthily from recipes she finds online. Similarly, Kade shared that cooking in their dorm room is one avenue they take for eating on campus as a college student.

Physical wellness strategies category 2: Healthcare management

Students shared diverse experiences managing medical appointments and medications. Some described increasing independence in navigating healthcare, while others described receiving various levels of support from caregivers, such as parents or program support staff. Jake highlighted growth in confidence, stating that he now independently schedules “one-year checkups.” In contrast, Luna shared, “I was uncomfortable… I was like, ‘Do I need to check this part, do I need to check that part?’” when filling out health forms.

Participants also varied in medication and supplement management. Todd said, “I take a pill every day… to increase my focus while I’m at my job.” Others, like Gus, still rely on family for support, explaining, “I still call my mom to be like ‘Which one should I take?’” Despite differences in confidence and independence, all participants acknowledged the importance of managing their medical and medication routines to support physical health.

Physical wellness strategies category 3: Personal hygiene

Nearly all participants shared that they manage grooming routines independently, though the level of consistency varied. Roger stated, “I gotta look fly. Like, I’m seeing a friend or something… otherwise… for class… I don’t really care.” Students described adjusting routines based on their schedule or social plans. This suggests, and is echoed by several other participants in the study, that the students will also alter their routine to include extra steps, on a case-by-case basis. Kade puts additional effort into grooming depending on their social activities, stating: “I mean, it depends what I gotta do, [if] I go somewhere. So, I do it each morning before I come to class, and if I have somewhere else to go after my classes, I’ll brush again.”

Challenges to consistent hygiene included forgetfulness, mental health symptoms, and competing academic demands. Harper admitted, “I think I just have a lot of stuff on my mind. And then, I just forget about [personal hygiene].” Luna noted, “Because my panic attacks were so strong, I wasn’t able to get up [to get ready].” Still, participants acknowledged growth over time. Phil shared, “I think I’ve gotten better over a couple of years, like [since] middle school and high school—I brush my teeth [and] put on deodorant without being reminded.”

Physical wellness strategies category 4: Physical activity

Participants engaged in various physical activities, ranging from informal exercise (e.g., walking across campus) to more structured routines like gym workouts and sports teams. To that point, walking was the most frequently cited. Ruby shared, “It’s good, but it’s kind of hard walking to your classes even though you might not want to, but you have to do it either way.” Students also engaged in strength-building and flexibility routines. Roger said, “I do pushups in my living room… if I am not going to the gym.” Some used digital tools to support fitness. Harper explained, “I started doing Zumba… I watched some videos online and now do some Zumba in my room.” Exercising with peers or teammates also increased motivation. Gus described, “Going to the gym with friends… then going down to swim, play basketball, play racquetball.” Todd reflected on how peer support strengthened his wellness practices: “You got some good friends… you hang out… this is kind of a big opportunity for physical behaviors.”

Physical wellness strategies category 5: Sleep hygiene

Participants described a mix of intentional sleep strategies and ongoing challenges. Many identified environmental and behavioral distractions that interfered with rest, such as dorm noise, room temperature, and screen time. Harper reflected, “If you’re on your phone when you’re trying to sleep, the phone always wins.” Students employed coping tools like brown noise apps and adjusted their routines to promote better rest. In addition to limiting distractions, students demonstrated varying levels of sleep awareness. Some used sleep aids or visited sleep specialists, while others expressed confidence in their routines. Participants also linked sleep patterns with overall health and well-being. For example, some noted that poor sleep increased anxiety, stress, and irritability, while improved sleep supported better emotional regulation. Luna stated that setting a nightly routine helped her feel “well enough to do it” when previously she had been overwhelmed by panic attacks.

Domain III: Internal processes

The internal processes domain captures how our participants described underlying cognitive and affective systems that influenced their understanding and practice of physical wellness. The categories include: (1) building habits, (2) recognizing a mind/body connection, and (3) self-efficacy development, appear to transcend the development and maintenance phases of our participants’ physical wellness, as our participants’ core ideas were typically spread across each transcript.

Internal processes category 1: Building habits

With a frequency label of general, the first internal process described by our participants involved building habits that contribute to their physical wellness. Each of our participants reflected on how building habits was necessary for them to achieve optimal, well-rounded physical wellness and appeared to unfold as a cognitive process. Participants shared aspirations of working on their physical wellness and it appeared that the habit-building process began by identifying the need for a habit. For instance, Jones described his interest in working on his physical fitness and the first step is “...need to find a time that is fit for you.” Moreover, participants commonly remarked that they were trying to challenge old habits, which we interpreted as understanding the importance of starting new habits. Ruby highlighted goals of changing habits and shared, “[I’m] trying to limit, like, sodas and trying to limit certain foods that you normally would eat on a typical, um, day.”

Beyond identifying potential routines, participants appear to use habit-building skills as a strategy to develop aspects of their physical wellness. Phil underscored this notion surrounding building habits and described eating healthier: “Like one time I ate a salad for the first time and it kinda made my stomach a little upset after eating a lot of unhealthy food. But once I started eating salad over and over again, it got better.” After habits appeared to be formed, participants noted that continuing with their habits maintained aspects of their physical wellness. Gus recounted his experiences applying advice to limit unhealthy foods:

I feel healthier by hiding some junk food myself because I know if I eat too much junk food I won't get healthier. I started doing that last summer…. So at lunch and breakfast I just put all my junk food in a bag and just put it up in a cabinet and at night if, like if I'm looking just for a little snack to snack on our scrubs and grab something easy.

Luna had a similar experience with her sleep hygiene and credited healthy sleep hygiene habits to setting nightly routines.

Internal processes category 2: Recognizing a mind/body connection

The next internal process category described by our participants summarizes the potential influence of thoughts and emotions on their physical wellness and recorded a frequency of general. Participants shared that having self-defeating thoughts and cognitions served as a challenge to aspects related to their physical wellness. For instance, Phil described himself as “lazy” for not going to the gym, which led to a self-perceived belief that he could not use the gym. However, Phil challenged his cognitions: “I'd just look around. My body said you can't do this. But I said you can do this; you gotta push yourself.” Beyond cognition, participants more commonly reflected on the potential role of their emotions in developing and maintaining their physical wellness. Justine highlighted a mind/body connection by describing how “panic attacks” interfered with her nightly routines, resulting in staying up later: “...and when I was feeling okay, it was well enough to do it. But I just it’s probably because my panic attacks were so strong I wasn't able to get up and brush my teeth so I could go to bed.” Despite potential barriers, participants also described the role physical wellness has in managing difficult emotions and cognitions. Indeed, Kade reported, “Physical health and wellness is how I manage my stress and what I do to get rid of that stress…[going on walks] gives me time to think, allowing myself to come up with ideas for the future.” Ruby summarized this category when asked what physical health meant to her: “[physical wellness] is what to do like when they're stressed or might have thoughts about you know, like, like, doing something or maybe saying something to somebody that made them mad.”

Internal processes category 3: Self-efficacy development

The third internal processes category registered a frequency of typical and summarized participant experiences building self-efficacy, or a person’s belief in their ability to successfully accomplish specific tasks or goals (Bandura, 1977). For instance, participants commonly described the role of motivation as an initial step in developing self-efficacy. When asked if motivation impacted her physical wellness, Luna acknowledged the role of motivation and continued to share, “you gotta find the right amount of time. And now when everybody said [take physical health seriously] and I’m trying to be like serious now and try to eat healthy and I’m trying to go work out. Go walk on the horseshoe and stuff like that.” Following acknowledgment of motivation, self-discipline and confidence building appeared to maintain efforts towards self-efficacy. Todd, a self-described avid runner, recognized a need to challenge himself to continue running habits: “Uh, usually difficult is like, you know, ran at the longest run you ever tried to do is like, whether you sense like when I’m in the club practice like you can just like run at the least by stadium there the riverfront, riverwalk there. And also you can run at the smallest airport there.” Phil captured building independence through self-efficacy development, describing his new hygiene routine in college. Phil shared:

Getting pretty good with [hygiene routines] ...But it's probably a struggle brushing my teeth. I mean, I probably forgot some mornings because I had to go to class. But I did do it every day someway. I probably…take showers, brush my hair…. I think I've gotten better over a couple years.

These findings highlight the dynamic process through which self-efficacy develops in college students with intellectual and developmental disabilities, as they navigate physical wellness through motivation, self-discipline, and confidence building.

Domain IV: Societal and environmental factors (SEF)

The domain of societal and environmental factors captures how outside factors impact participants’ physical wellness. Participants often spoke to outside influences when asked questions regarding how they learned about eating healthy, physical fitness, and healthy sleep habits. Ultimately, we differentiated core ideas into six categories: (1) family, (2) peers, (3) campus resources, (4) media and technology, (5) stigma and environment, and (6) professional helpers.

SEF category 1: Family

The first category was described as general and focused on how family impacted our participants’ overall physical wellness. For example, when speaking about healthy eating, Harper mentioned that their mom plays a significant role in their healthy eating habits. Harper noted their mom’s role in practicing healthy and routine hygiene by giving Harper a book on healthy hygiene. Phil noted that his mom often encourages him to work out or go on a daily walk together while also being supportive in receiving medical diagnoses and managing medical appointments and medications. Dorothy discussed her dad supporting their physical wellness by teaching her about sleep habits, healthy hygiene, and daily prescription use, ultimately with the message of “never to give up.” While many participants spoke mainly to mother and father figures in their lives related to better understanding and practicing physical wellness, Luna mentioned their uncle modeling positive physical behaviors by going on daily walks and encouraging them to do the same. Although many participants spoke about their family involvement relatively positively, some spoke of times when they felt uncomfortable or discouraged with family involvement in their physical well-being. Sara noted more negative perceptions of family involvement in their physical well-being. Although her mother encourages healthy eating, they have also received messages such as “you’re so overweight,” causing Sara to feel sad about her body.

SEF category 2: Peers

Most participants spoke about their peers within the university playing a role in impacting their physical wellness, resulting in a typical frequency. Justine said she frequently meets with friends for walks and hikes. Roger spoke about changing eating habits based on who they were eating with, noting that if they were with their classmates, they would choose brown rice instead of their typical, less healthy alternative as they stressed the importance of eating healthy to “look fly” around their friends. Todd mentioned “good friends” as a great support in encouraging them to engage in different aspects of physical wellness while noting their involvement with the university cross country club team, which aids them in exercising, healthy eating, and appropriate sleeping habits. While there are many positive aspects of peer involvement in physical well-being, some participants noted negative aspects. Kade and Jake both spoke to their roommates about how it was impacting their sleep habits. Kade noted having roommates in their dorm who would often make it difficult to fall asleep due to noise. In contrast, Jake could not pinpoint what it was about having roommates that made it challenging to practice positive sleeping habits. Ultimately, participants noted positive interactions with their peers that impacted their physical health, such as Ryder’s friends influencing their hygiene for the better by suggesting frequent use of deodorant.

SEF category 3: Campus resources

In-line with being on a university campus, our participants spoke to many different campus resources that impacted their physical well-being, while some of the resources noted were positive, some participants focused on negative resources on campus. The third category had a frequency of typical. Sara, Phil, Luna, Roger, Jake, and Kade all spoke about using the campus gym frequently to support their exercise routines. Additionally, Kade, Todd, Roger, Justine, and Dorothy noted the campus dining as having an influence on their healthy eating habits. While being typical in frequency, only Sara spoke to a campus resource that was not the dining options on campus or the use of the campus gym. Sara had expressed interest in connecting with a campus nutritionist which would be accessible to them at the university wellness center, a center that includes primary care physicians, mental health therapist, a pharmacy, nutritionist, and typically free resources that could impact the physical well-being of a student.

SEF category 4: Media and technology

Another typical category in frequency is the media and technology category, which encompasses the participants speaking to social media apps, advertisements through social media, online videos, and TV shows that impact their physical wellness. Harper, when speaking about recipes she enjoys making, noted going to the social media app TikTok to find new recipes that she enjoys. However, Harper also spoke about social media and TV being distracting for them when attempting to fall asleep. Phil spoke to frequently watching The Biggest Loser with their family, which helped them better understand physical fitness and how hard it is to “push yourself” to lose weight. Luna, Justine, and Jake all spoke to YouTube and movies playing pivotal roles in their physical wellness as they would see and become interested in exercising, specifically noting swimming and boxing. Jake went as far to say that by watching boxing movies, he learned to “keep fighting and try not to do bad things.” A few participants spoke to having specific applications downloaded to their phones that would help them with their physical well-being. Todd specifically mentioned using a sleep tracking application to support his sleep hygiene and also having an application to support outdoor running. Gus spoke to a similar application that allowed them to track their gym progress while also speaking to learning good hygiene, such as cleaning hair, clothes, and teeth through watching TV.

SEF category 5: Social stigma and environment

Social stigma and environment were only noted by five of our participants, indicating a variant frequency. This category largely notes the way in which participants perceived societal views on unhealthy eating, exercise, and self-stigma on the participant’s own habits, as well as how environmental factors such as place of employment impact their physical wellness. For example, Sara spoke about feeling uncomfortable in the gym as she felt people might be watching her, making it difficult for her to want to visit the gym. Roger described often changing his eating habits based on who he is eating with. Ryder demonstrated an example of an environmental factor when she spoke to working at a fast-food restaurant. She mentioned that working there often dictated what they ate as it was often free or reduced in price, convenient, and accessible, further noting that although she would try to eat healthy, being in a fast-food restaurant made it difficult to choose to eat healthy. Similarly, Phil spoke about food choices, only about healthy or bad, with no room for middle-ground food or certain foods in moderation.

SEF category 6: Helping professionals

Lastly, the helping professionals category was labeled as typical and addressed different professionals in participants’ lives who impacted their physical wellness. Examples of helping professionals identified included physical education teachers, wellness group counselors, primary care physicians, athletic coaches, IPSE staff members, professors, nutritionists, physical therapists, physical trainers, and dentists. When speaking about their dental care, Sara noted their dentist as playing a role in supporting them in understanding the importance of proper dental hygiene. Gus, Todd, and Ryder all spoke to their primary care physicians, supporting their physical well-being by helping them understand the importance of taking their medications, regularly scheduling medical appointments, and voicing their medical needs. IPSE staff members were noted frequently as supporting participants in practicing personal hygiene, becoming familiar with the campus gym, understanding how to meet medical needs, and providing support in general physical wellness, such as going on a walk.

Discussion

Our findings highlight our participants’ shared experiences in developing and maintaining aspects of their physical wellness. Engaging in the phenomenological process of the CQR analysis yielded eight domains with fully differentiated categories. Moreover, the grounded theory underpinnings of the CQR analysis indicated a potential relationship between the domains. Figure 1 illustrates the potential relationship between domains and the physical wellness of college students with intellectual and developmental disabilities.

Education emerged as foundational to our participants’ understanding and development of physical wellness. Participants identified structured learning in IPSE and K-12 settings as key sources of information, along with informal education from family, media, and medical professionals. These findings align with Fields et al. (2024) and Miller and Berlingo (2023), emphasizing the importance of accessible wellness education tailored to the needs of students with intellectual and developmental disabilities. Our participants’ experiences suggest that embedding physical wellness instruction across educational levels may help lay the groundwork for lifelong health behaviors.

To maintain physical wellness, students described a variety of strategies spanning food choices, medical care, hygiene routines, physical activity, and sleep. Rather than viewing these behaviors in isolation, participants emphasized how they collectively supported day-to-day wellness. Their strategies reflected a balance between autonomy and ongoing support, highlighting the importance of personalized approaches. For example, while some managed medication independently, others still relied on family prompts. Similarly, students adapted wellness routines to their environments and social contexts, such as cooking in dorm kitchens, exercising with peers, or adjusting hygiene based on daily plans. Across strategies, students acknowledged fluctuating motivation and identified both barriers and facilitators, such as technology use, mental health challenges, or time constraints. These findings illustrate the layered, adaptive nature of physical wellness among students with intellectual and developmental disabilities, and support calls for individualized guidance within IPSE programs (McLay et al., 2021; Miller and Berlingo, 2023).

The internal processes and SEF domains appeared to transcend maintenance strategies, serving as mediators of wellness behaviors. The internal processes domain emphasized how participants conceptualized physical wellness through habit-building, emotional regulation, and self-efficacy. These findings support prior research emphasizing the critical role of routine and motivation in wellness behaviors for people with intellectual and developmental disabilities (Lynch et al., 2022; Singh, 2020). Participants described how developing confidence in managing health routines or challenging negative self-talk helped sustain behaviors across domains.

The SEF domain captured how family, peers, technology, campus resources, and stigma shaped wellness experiences. Participants described family members as both motivators and sources of stress, while peer relationships offered accountability, particularly in areas like hygiene and exercise. The role of digital tools was similarly mixed, offering accessible fitness guidance or healthy recipes but also acting as distractions. Students also highlighted systemic factors, such as gym access, unaccommodating work environments, or lack of inclusive wellness services. These findings align with ecological models of health, underscoring the importance of contextual and social support systems in shaping wellness behaviors (McLay et al., 2021; Oakes et al., 2020a).

Implications

The findings of this study show that college has significantly impacted physical wellness knowledge development and experiences for these participants. While IPSEs are gaining traction nationally and access to these programs is expanding, much work remains to advocate for more IPSE programs for emerging adults with intellectual and developmental disabilities. Students enrolled in these programs must have access to continuing education in all aspects of wellness and health, including physical wellness.

Inclusive postsecondary education programs should advocate for enrolled students to be included in all campus and community life aspects. Access to campus resources, such as the fitness center or gym, nutrition counseling through the student health center, or intramural sports, should be negotiated and differentiated with the support needs of the IPSE students with intellectual and developmental disabilities in mind. The historical exclusion of students with varying types of disabilities from IHEs means that many campus environments are not designed using universal design principles, and therefore, both physical and educational spaces are often inaccessible (Dolmage, 2017; Smith Hill and Stinnett, 2024). Advocacy on behalf of and in tandem with people with disabilities to expand their access and belonging on college campuses is a continued need.

Concomitant with access and accessibility is the continued need to obligate all stakeholders to offer equal opportunities for people with intellectual and developmental disabilities. When adolescents with intellectual and developmental disabilities enter young adulthood not having had the same opportunities to socialize, try out for sports teams, join organizations, or fully integrate as their non-disabled peers; not only has their dignity as humans have been withheld in the name of safety (Hemm et al., 2018; Ward and Stewart, 2008), but they may lack the skills, knowledge, and esteem necessary to engage in all aspects of a fulfilled life. A historical over-protection of students with intellectual and developmental disabilities by parents and others (Hemm et al., 2018; O’Byrne and Muldoon, 2019), coupled with significant environmental barriers to opportunities to make their own decisions and effectively practice self-determination (Hagiwara et al., 2020) has stymied their ability to practice and learn many of the components of holistic wellness. For college students with intellectual and developmental disabilities to effectively implement and understand all aspects of physical wellness, they must be afforded the same opportunities to learn, experience, and practice health-oriented behaviors within their campus community.

Limitations and future research directions

This study has several limitations that should be considered. A key limitation of the CQR method is the potential for researcher bias, which we attempted to mitigate through bracketing and a consensus process (Hill and Knox, 2021). Further, we attempted to limit biases through an auditing process, though we acknowledge that findings may have a more positive undertone due to our interest in wellness and individuals with intellectual and developmental disabilities. Additionally, we note that there are demographic considerations, with a majority identifying as white. Our participants were from the same IPSE program and university, which may influence experiences engaging with physical wellness. To that end, the unique models of support and philosophies of individual IPSE programs may introduce biases, as students in our study benefited from a program that prioritized holistic wellness, potentially skewing their understanding of physical wellness. Lastly, our research team members had a prior relationship with the participants, and they may have answered more favorably, which could influence coding procedures.

Future studies should explore replicable physical wellness interventions for students with intellectual and developmental disabilities, beginning in K-12 settings and formative years in their primary residence (Miller and Berlingo, 2023). Longitudinal student-focused studies are also lacking in IPSE scholarship and could track how physical wellness knowledge and habits develop across educational levels. Moreover, additional research on students with intellectual and developmental disabilities outside of IPSE programs could provide comparative insights. Investigations should also focus on barriers to physical wellness and strategies for improving accessibility to support, contributing to a more inclusive framework for health promotion in postsecondary education.

Supplemental Material

Supplemental Material - Experiences of US college students with intellectual and developmental disabilities in developing and maintaining physical wellness

Supplemental Material for Experiences of US college students with intellectual and developmental disabilities in developing and maintaining physical wellness by Alexander M Fields, Rebecca B Smith Hill, Olivia J Lewis, Madeline Castle, Rachel Gilreath, Lucas M Perez, Megan A Reynolds, Regin Dean, Chelsea V Stinnett in Journal of Intellectual Disabilities.

Footnotes

Acknowledgments

We want to thank our 14 participants for their willingness to share their stories. We hope our work honors your stories, strengths, and life experiences.

ORCID iDs

Alexander M. Fields

Rebecca B. Smith Hill

Olivia J. Lewis

Madeline Castle

Rachel Gilreath

Lucas M. Perez

Megan A. Reynolds

Regin Dean

Ethical considerations

The Institutional Review Board (IRB) at the University of South Carolina approved our study (approval: Pro00128347) on March 10, 2023.

Consent to Participate

Before completing an interview, each participant reviewed a plain language informed consent with a trained facilitator and provided verbal consent.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The authors confirm that the data supporting the findings of this study are available within this article and its supplementary materials. Raw data that support the findings of this study are available from the corresponding author, upon reasonable request.*

Supplemental material

Supplemental material for this article is available online.

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