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This section describes a suggested approach, for use in Australia, to qualifiers for Activities and Participation. The aim is to provide qualifiers that:
can be used to help delineate Activities from Participation for users using options (b) or (d)
can also be used with option (a)
are consistent with the ICF.
Qualifiers for Activities
The ICF gives us:
Activities domains
A qualifier about 'difficulty' with the activity (the generic qualifier); the statement is made that difficulty can be measured with or without assistive devices or personal assistance, and as capacity or performance; the constructs of performance and capacity relate to the person in a specified environment;
Environmental factors that may facilitate or be a barrier to the activity.
Further, it was said in Section 5.1 that:
Performance relates to the usual or current environment (see first ICF qualifier).
Capacity relates to the standardised or uniform environment (see second proposed ICF qualifier). Capacity also appears to relate to an 'optimum' environment as the ICF talks of capacity in terms of indicating 'the highest probable level of functioning that a person may reach in a given domain at a given moment' (WHO 2001:15).
Need relates to the Environmental factors (such as personal assistance, equipment, environmental modifications) that are present in the standardised or 'optimum' environment but are not in the current environment (where current performance is achieved).
Work in progress
What has emerged from discussion in the Advisory Committee on Australian and International Disability Data (ACAIDD) is the need to operationalise more explicitly a concept of 'Assistance with Activity'. This is considered to be an important subset of Environmental factors on which much measurement work has been done, and a major component of disability and aged care services policy in Australia. Work to date conceptualises 'Assistance with Activity' as a multidimensional concept, relating to the duration, frequency and intensity of assistance; information on various scales in use is being assembled. This qualifying concept would be used to describe aspects of the current or standardised or optimum environment, in terms commonly used in measurement and assessment tools - i.e. to record more detail than just 'with or without assistance' as currently envisaged in the ICF. Thus, this concept would be consistent with the ICF and would supplement the information obtained by using the ICF. It is planned to continue work on this idea, starting with including a relevant data concept in the National Community Services Data Dictionary (NCSDD) V3, as a supplement to data elements based on components of the ICF (AIHW 2003a).
Thus two possible qualifiers for Activities are suggested. The ICF generic qualifier ('difficulty') and the qualifying concept suggested above ('Assistance with Activity') can be used in different environments; each could, of course, result in different measures depending on which environment is present.
A guide for use (to be developed) could indicate:
how questions asked would vary to indicate which construct (performance or capacity) and which corresponding environment was being considered
how to record the results (possibly by positioning of qualifiers - this is the method for distinguishing performance and capacity specified in the ICF).
Qualifiers for Participation
Work has been carried out in Australia on the measurement of participation, both during the revision years and since publication of the ICF in May 2001. Two qualifiers were developed for inclusion in the NCSDD V2 on a trial basis - 'Participation extent' and 'Participation - satisfaction level' (AIHW 2000). A recent review of measures of participation has confirmed these ideas as appropriate templates for the development of new data elements for the NCSDD V3 (AIHW 2003a; Bricknell & Madden 2002).
The qualifier 'Participation extent' corresponds to the ICF generic qualifier and indicates the extent of participation restriction. This will correspond to an externally observable (or 'objective') measure of participation.
The qualifier 'Participation - satisfaction level' corresponds to the person's own perspective on their participation, and reflects their attitude to their participation in the various life domains. It is essentially a summary measure in which are embedded the concepts of satisfaction, choice, opportunity and importance. This corresponds to the qualifier for 'involvement or subjective satisfaction' allowed for in the ICF (Annex 2). Such a qualifier may indicate a 'performance gap' for participation, in that a person may indicate life areas where they are not satisfied, and may indicate environmental factors that could ameliorate the situation (see also Section 5.6).
Data elements for Activities and Participation qualifiers
Data elements have been drafted for these qualifiers to operationalise these ICF concepts and options (b) and (d) for Australian use of Activities and Participation. See Section 7 for further detail on this work, and the related national data dictionaries.
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