Cultural practices and Environment and Participation assessment

1
Cultural practices and Environment and
Participation assessment

• Classification, Assessment, Surveys and
  Terminology (CAS/EIP)
• World Health Organization
• Geneva
• Marguerite Schneider
• Washington City Group on Measurement of
  Disability Washington D C,
• 18 - 20 February 2002

2
ICF recap

• Start with a health condition - I.e. a medical
  problem - permanent, temporary, present,
  perceived to be there, etc.
• Interaction of that medical problem with
  contextual factors gives an outcome.
• If outcome is a problem for the person an
  experience of disability
• other outcomes functioning
• Disability and functioning are experiences that
  change as environment changes
• disability experience changes with changes in
  environment - not static feature of the person

3
Participation

• Participation is a broad concept that could
  encompass, amongst others, the following aspects
• what the person does in their current environment
  (observed or self-reported) - includes their
  physical, social and other types of environment.
• what the person judges as being their
  participation
• the persons satisfaction with their
  participation
• since ICF is descriptive and not evaluative
  system it would only be used for first option
• need to understand individual aspects that make
  up this broad notion of participation
• measure what the person does or what happens when
  person is in their current or usual environment
  Performance

4
A/P domains Chapter level

• Learning and applying knowledge
• general tasks and demands
• communication
• mobility
• self-care
• domestic life
• interpersonal interactions and relationships
• major life areas
• community, social and civic life

5
E domains Chapter level

• 1. Products and technology
• 2. Natural environment and human-made changes to
  the environment
• 3. Support and relationships
• 4. Attitudes (of others)
• 5. Services, systems and policies

6
What are the issues around culture?

• Culturally relevant and appropriate assessment
  tools
• cultural norms that determine whether
  participation in a specific domain is relevant
• setting threshold too low or too high and
  comparator issues (person without health
  condition) - includes socio-economic context
• cultural practices that cause impairments,
  activity limitations and/or participation
  restrictions
• RESEARCH
• participation restrictions because of culture
  rather than health
• understanding of questions
• asking of sensitive questions

7
Generic categories in ICF

• ICF domains are cross-culturally appropriate -
  work of cross cultural research related to ICF
  and WHO DAS II
• assessment tools need to be culturally specific
• examples
• dressing saris, loin cloth, kaftan, head gear,
  jeans, etc.
• interpersonal relationships use of eye contact
  in some cultures but not in others
• what do we compare - generic categories?

8
Cultural practices related to P

• Some cultural practices may make that certain
  domains are not relevant, e.g.
• work for women under Taliban regime (but the
  women might want this described anyway)
• involved in decision making where certain groups
  are not involved in this
• teenagers and housework (!)
• If certain P domains are not appropriate, then
  issues are
• do we compare only on overlap categories?
• do we compare at chapter level even if some data
  in chapter is missing?

9
If P not relevant

• If domain for participation is not relevant (no
  performance), should we ask about capacity to do
  it anyway
• Research Anthropological and asking what is
  relevant

10
Environment and culture

• Generic domains vs specific assessment examples
  issue for environment as for Participation
• support of family - one culture would see it as
  much more than another
• attitudes will differ across different cultures
• Research
• do the E domains describe all different cultural
  environments?
• What additional categories are required?

11
Cultural notion who is disabled?

• Different cultures would have different threshold
  of what counts as disabled or not e.g.
• Children without birth certificates and with mild
  intellectual impairment - no real sense of age
  hence no real sense of delay not seen as
  impaired
• different understanding and view on disability
  - what happens when use more neutral language
  such as difficulty with/in
• Count using a standard threshold or different
  ones in different countries?
• Comparator in ICF person without health
  condition how deal with generally low
  participation because of socio-economic
  conditions?
• Lack of schools in poor areas - no one goes to
  school, including children with impairments - is
  it Partic. Restriction or not?

12
Cultural practice causing disability

• A cultural practice can itself cause an
  impairment, activity limitation or participation
  restriction
• female genital mutilation causes impairments of
  reproductive system
• ostracisation of people with vitiligo in India
  because asssociated (wrongly) with leprosy -
  medical problem and participation restriction but
  no impairment or activity limitation
• Cultural practice would be a barrier in this case
  and describe using ICF categories

13
Conclusion

• Comparability of generic categories
• development of specific assessment tools that are
  culturally relevant
• researching the role of culture in determining
  activities that people engage in