Advancing disability-related research on the person-environment relationship: An integrated framework to guide study design

Although almost a decade has passed since the International Classification of Functioning, Disability and Health (ICF) was endorsed internationally, the person-environment relationship has empirically progressed very little. In an effort to advance the science on disability outcomes affected by the environment, this paper presents a framework integrating three conceptual models that together can be used to guide research.

The ICF, by design, provides the foundation for measurement of person factors and of functioning at the body function or structure, activity or participation levels that may be affected by the environment. While the five ICF environment domains are further itemized into specific areas for measurement, the ICF as a model does not suggest any relationship between domains or hierarchy of influence. Integrating the ICF's different components with the IOM's multi-level approach to epidemiology organizes environmental factors into levels of influence. From this socio-ecological model (SEM) perspective researchers can hypothesize person-environment relationships, interactions and intervention points. Given the complexities of both the ICF and SEM, a third model – Donabedian's structure/process/outcome (SPO) model translated for measuring the environment – can be used to strategically plan the development and growth of research agendas to bridge gaps and advance the science on person-environment linkages.

Several case studies intersecting components of the ICF, SEM and SPO will be presented to leverage a discussion on the application of this integrated framework for guiding and advancing disability-related research. As the breadth of environmental factors is empirically better understood, the complex relationships between them can be further examined.