The objective of this paper is to define and categorize the types of relationships that contextual factors have within models of disability according to the WHO International Classification of Disability, Functioning, and Health (ICF) conceptual scheme.
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A conceptual analysis building on the disability literature specifies the causal relationships for contextual factors in relation to the association between activity limitation and participation using a person with arthritis as an example.
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From a statistical point of view, in relation to the disability process, contextual factors can act as an independent factor, confounding factor, moderating factor, and mediating factor. How the role of a particular contextual factor is specified depends on the researcher's hypothesized disability framework and research goals. Moderating and mediating contextual factors are of particular importance in disability model specification. Various sub-types of moderating contextual factors are also identified.
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This paper provides a framework for the conceptualization of contextual factors in the examination of disability models. This framework has implications in constructing conceptual models as well as for setting up analytical plans. In light of the increasing awareness and application of the ICF model, we intend this work to stimulate additional discussion on this topic.
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| Type of Factor | Definition |
|---|---|
| Moderating | A variable that interacts with the activity limitation variable of interest. The effect of the activity limitation variable on the participation variable varies according to the presence of or the level of the moderating contextual factor. |
| Mediating | A variable that is hypothesized to be linked in a causal chain between the activity limitation and participation variable. |
| Independent | A variable that has an impact on the participation variable of interest regardless of its association with the activity limitation variable. |
| Confounding | A variable that has an independent effect on the participation variable of interest, but it is correlated with the activity limitation variable. Therefore, the true association between activity limitation and participation may be distorted unless the confounding variable is properly controlled for. |
As described in Table 1, a contextual factor is said to be a moderating factor when the effect of activity limitation on participation depends upon its presence or level. For example, the participation in employment of a person with activity limitations may differ depending on the absence or presence of an appropriate environmental adaptation or an assistive device.
Figure 3 illustrates the case where all four types of contextual factors are considered simultaneously. The mechanisms of contextual factors in the disability process have been described in conjunction with the relationship between activity limitations and participation. However, these mechanism are equally applicable to the relationship between body functions/structures and activities, body function/structure and participation as well as when all three domains are being considered.
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