Participation is the nature and extent of a person’s involvement in life situations in relation to impairments, activities, health conditions and contextual factors. Participation may be restricted in nature, duration and quality. (WHO, 1997, p. 14)

Like Nagi’s definition of disability, the ICIDH definitions of handicap and participation are essentially relational concepts. This is made very explicit in the ICIDH-2, which states that:

Participation is characterized as the outcome or result of a complex relationship between, on the one hand, a person’s health condition, and in particular, the impairments or disabilities he or she may have, and on the other, features of the context that represent the circumstances in which the person lives and conducts his or her life … different environments may have a different impact on the same person with impairment or disability. Participation is therefore based on an ecological/environmental interaction model. (WHO, 1997, p. 17)

The conceptual model that accompanies the ICIDH-2 shows that the context potentially has an effect on the expression of all levels of the model: impairment, activity limitation, and restriction in participation. The context refers both to external environmental factors and to more personal characteristics of an individual. The latter range from relatively uncontroversial characteristics, such as age and gender, to aspects of the person relating to educational background, race, experiences, personality and character style, aptitudes, other health conditions, fitness, lifestyle, habits, coping styles, social background, profession, and past and current experience (WHO, 1997). ICIDH-2 includes a draft classification of environmental factors that covers components of the natural environment (weather or terrain), the human-made environment (tools, furnishings, the built environment), social attitudes, customs, rules, practices and institutions, and other individuals (WHO, 1997). All of the above contextual factors may be relevant, in connection with the impairments or activity limitations of a person, for determining whether that person experiences disability in working or not.

Finally, the ICIDH-2 concept of participation goes beyond the performance of roles and deals with the wider issues of the effect of barriers and facilitators to overall participation in society. In the context of work disability these barriers and facilitators include discrimination, stigma, legislation around workplace design and participation (including the Americans with Disabilities Act), attitudes of coworkers, and extra-work issues such as mobility in the community. This means that an assessment of restriction of participation does not necessarily need to be on a personal basis and might, in some situations, be predicted by direct assessment of



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement