Evaluating the international classification of functioning, disability and health (ICF) framework as a model of community participation for people with chronic health conditions and disabilities

ABSTRACT

Community participation is defined as an individual's engagement in meaningful life roles such as employment, parenting, education, recreation, interpersonal relation, religion, and healthy living (Iwanaga, Chen, et al., 2021). The ability to assume meaningful life roles and activities in the society is associated with better physical health, mental health, and life satisfaction. The coronavirus disease 2019 (COVID-19) pandemic has significant negative impacts on the disability community (Lund et al., 2020). COVID related challenges and stressors affecting people with chronic health conditions and disabilities include disruption of daily routines;financial difficulties;lack of access to healthcare, rehabilitation, and social services;unemployment;discrimination, physical inactivity;social isolation;and depression and anxiety. Helping people with disabilities gain control of their lives during and after the pandemic and assume meaningful life roles especially employment in the community may be more important than before.The purpose of the present study was to evaluate constructs of the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) as predictors of community participation. A convenient sample of 952 people with chronic health conditions and disabilities were recruited via Amazon Mechanical Turk (MTurk) to participate in this study. A hierarchical regression analysis was conducted to answer the research question. For demographic covariates, age, marital status, educational attainment, and low income were significant predictors of community participation. Older adults and individuals who receive disability benefits were negatively associated with community participation, while individuals who are married and individuals with higher levels of educational attainment were positively associated with community participation. For impairments, pain intensity, perceived stress, and depression were significant predictors of lower levels of community participation. However, pain, stress, and depression were no longer significant in the presence of functional disability indicating that the negative effect of impairment on community participation is accounted for by functional disability. For functional disability (i.e., social-cognitive functioning and activities of daily living functioning), limitations in social-cognitive functioning and activities of daily living (ADL) functioning were significant predictors of lower levels of community participation, with limitations in ADL a stronger predictor than limitations in social-cognitive functioning. For person-environmental contextual factors, hope, core self-evaluations, social support, and environmental supports were positive predictors of community participation. Predictors in the final regression model accounted for 48% of the variance in community participation scores (a large effect size). The results support the utility of the ICF as a model of community participation for people with chronic health conditions and disabilities. Importantly, findings of the present study underscored the significant negative effect of functional disability on community participation. To help people with disabilities assuming meaningful life roles including employment in the community, rehabilitation psychologists and counselors must work with physicians, physical therapists, occupational therapists, and assistive technology specialists to help clients maximize their physical health and functioning and provide psychosocial interventions to increase their personal strengths, social support, and mental health functioning. (PsycInfo Database Record (c) 2021 APA, all rights reserved)