Culture and disability: A structure-process-outcome framework

BACKGROUND: The importance of culture and cross-cultural interactions of those who are in situations of disability has been stressed and yet understudied. It is a highly diversified field, and a framework that encompasses and organizes the full scope of that field might be useful in developing cross-cultural research, policy, and rehabilitation practice. OBJECTIVE: To present a rights-based structure-process-outcome framework to address disparity and access issues in relationship to culture and disability. METHOD: Theoretical development based on professional and field experience and literature review.RESULTS:The framework applies to situations in which persons with disabilities have differing cultures and worldviews from others in their environment. Cross-cultural conflicts between clients and their providers are one such issue. Structure includes categories of culture (such as national, religious, community, or professional cultures), their subcultures, and relevant social structures. Process includes the cultural content of interactions between individuals and environment,translation across cultures, cultural brokering, and acculturation. Outcomes include health, function,and participation; environmental modifications; dignity constructs; meanings and values of the outcome for the person; acculturation; and, accountability. Vignettes and case histories will illustrate these concepts. CONCLUSION. Cultural aspects of disability research and rehabilitation praxis have been somewhat neglected. The proposed framework may highlight them and promote cross-cultural development of the field.