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Activities and Participation are two distinct concepts in the ICF with distinct definitions but measured along the same domains. The ICF offers four possible ways of delineating activities and participation (WHO 2001:16):
to designate some domains as Activities and others as Participation, not allowing any overlap;
same as (a) above, but with partial overlap;
to designate all detailed domains as Activities and use the broad category headings as Participation;
to use all domains as both Activities and Participation.
Annex 3 of the ICF concludes with a statement recognising that practice must be built up, recorded and analysed regarding the 'operationalisation' of Activities and Participation.
This section explores this issue further, leading on to suggestions for practice in Australia and for recording experience.
Draft criteria for delineating Activities and Participation
The delineation of the concepts of Activity and Participation has been a consistent goal of the Australian Collaborating Centre (ACC) and its advisers. Criteria for distinguishing the two concepts, in line with their definitions in the final ICF, were accordingly developed, revised and discussed during the process of revising the ICIDH.
The ACC draft criteria for distinguishing Activities and Participation are included here for use and comment:
Activities focus on the person's individual functioning, while Participation emphasises the person's involvement in society.
A is completely externally observable. P refers to the 'lived experience of the person' (WHO 2001:15).
Activity can relate to a 'test' environment (although it can also relate to a 'real' environment), with or without equipment. Participation is essentially 'confounded' with the environment, i.e. the concept has little meaning without consideration of the physical and social environment, and it cannot be 'assessed' in a 'test' environment.
'Involvement in society' relates in particular to societal roles. This highlights the confounding of Participation with that part of the environment that shapes expected roles and societal norms.
A is fine grained whereas P is broad brushed.
A is about action or process, P relates to the overall goal of actions or sets of actions.
These draft criteria expand on the WHO definitions (see Section 2.1). Both could be applied together in delineating Activities and Participation in practice.
The purpose is either to:
split the A-P domains, so that some apply to Activities and the others to Participation, i.e. option (a)
use the A-P domains with partial or total overlap, together with qualifiers, in order to achieve delineated approaches to Activities and Participation, i.e. options (b) or (d).
These two options are discussed in Section 5.3 and Section 5.4.
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