ICF Australian User Guide V1.0

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6.    Environmental factors

6.3    Current applications

The application of environmental factors is still in its infancy; however, progress has begun with environmental factors being recognised in assessment tools, health and disability surveys, and outcomes research. Three of these applications are discussed below.

One area requiring attention in health and disability data collections is the inclusion of survey questions useful for measuring 'performance gaps' in participation. Bickenbach (2002) refers to these gaps as 'participation gaps', which he defines as 'measurable differences in levels or quality of participation between those with, and those without, disability'. Environmental factors are recognised influences in the creation of such 'gaps' and are responsible for different, or lower, levels of participation by people with a disability. Being able to identify performance gaps in participation is crucial to those evaluating the outcomes of disability services and policy.

Using the ICF as a model, Canadian disability data collectors and users have focused on the component data requirements necessary to identify 'participation gaps' in the population. This work includes the development of questions about the person's physical or built environment as well as their social and attitudinal environment. These questions would be used to identify 'participation gaps' in conjunction with a common set of screener questions and a set of questions on participation in life areas. It is proposed that such questions be introduced into the Canadian Community Health Survey, as well as the Participation and Activity Limitation Survey , to ensure responses are obtained from both the non-disabled and disabled population. This allows comparison between levels of participation of the two population groups and how the environment of the disabled population acts as a barrier to full participation (Bickenbach 2002).

Two projects at the Arthritis Community Research and Evaluation Unit in Toronto have modelled the experience of activity limitation and participation restriction with reference to the ICF and the effect of environmental factors. Both projects have focused on the built environment and the use of aids and equipment, and whether these have an impact on completing daily activities and participating in the labour force.

The first of these modelling projects examined activity limitation (limitation in self-care, mobility, meal preparation, shopping, light and heavy housework and looking after personal finances) and the effects of environmental factors, as represented by aids and equipment and home modifications, as well as personal factors and the presence of a physical or sensory disability
(Badley et al. 1998). Although activity limitation was mainly affected by the presence of a physical disability, this relationship was at least partially influenced by the environment; that is, a person's access to aids and equipment, or having suitable home modifications, offset some of the limitation associated with the impairment.

In the second project, environmental factors were found to influence labour force participation by people with arthritis experiencing mobility limitations (Wang & Badley 2002). The availability or absence of workplace features such as accessible parking, lifts, and appropriate workstation conditions proved to be important faciltators or barriers respectively to people with arthritis. Although mobility limitation greatly affected labour force participation, the strength of that effect was mediated through workplace features.

The AIHW has recently published a report that draws on the ICF to describe the type of environmental factors that potentially influence the lives of people with a disability in Australia (AIHW: Bricknell 2003). The environmental factors defined in the ICF and available in the ABS Survey of Disability, Ageing and Carers were examined in relation to other ICF components (e.g. activities and participation), and personal factors.

The report mainly focuses on the use of aids and equipment, examining the association between the use and non-use of aids and:

• disability status and main disabling condition

• help from a personal carer

• need for assistance with the core activities of self-care, mobility and communication, and other activities (e.g. health care, meal preparation)

• participation in education and employment

• personal factors such as age, sex, and living arrangements.

Additionally, the report investigates services and support for people with disabilities, concentrating on the kinds of services and assistance people with disabilities need and/or receive, specifically in relation to education, employment, public transport and specific daily activities. Such research may suggest how the absence or presence of a particular environmental factor affects an individual's participation extent or ability to perform daily activities.

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