Special communication| Volume 96, ISSUE 4, P569-577, April 2015

Theoretical Foundations for the Measurement of Environmental Factors and Their Impact on Participation Among People With Disabilities


      The ascendance of the World Health Organization's International Classification of Functioning, Disability and Heath (ICF) as the global standard for describing and characterizing aspects of disability has refocused attention on the role that environmental factors (EFs) have on the health and participation of people with disabilities, both as individuals and as a group. There has been a rise in the development of instruments designed to measure EFs alone and in relation to participation. Some instrument developers have used the ICF as a theoretical base for instrument development and to substantiate content validity claims. We contend that this is a misapplication of the ICF. There is a need to step back and reexamine the role that environmental theories can play in developing a conceptually driven approach to measuring the interaction between EFs and participation. For this review, we draw on the fields of social, community, and developmental psychology; disability studies; gerontology; public health; and rehabilitation. We discuss different approaches to the measurement of EFs. We suggest that given the complex nature of EFs and their influence on participation, there is a need for a fresh approach to EF measurement. The thoughtful application of theories and the use of advanced psychometric, measurement, and e-technologies and data visualization methods may enable researchers and clinicians to better quantify, document, and communicate the dynamic interrelationship between EFs and participation and health outcomes for people with disabilities at the individual, group, and population levels.


      List of abbreviations:

      ADA (Americans with Disabilities Act), CAT (computer adaptive testing), EF (environmental factor), EMA (ecological momentary analysis), ESM (experience sampling method), GIS (geographic information system), ICF (International Classification of Functioning, Disability and Health), IRT (item response theory)
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        • Marmot M.
        • Friel S.
        • Bell R.
        • Houweling T.A.
        • Taylor S.
        Closing the gap in a generation: health equity through action on the social determinants of health.
        Lancet. 2008; 372: 1661-1669
        • World Health Organization, World Bank
        The world report on disability.
        World Health Organization and World Bank, Geneva2011
        • Magasi S.
        • Hammel J.
        • Heinemann A.
        • Whiteneck G.
        • Bogner J.
        Participation: a comparative analysis of multiple rehabilitation stakeholders' perspectives.
        J Rehabil Med. 2009; 41: 936-944
        • Alvarelhão J.
        • Silva A.
        • Martins A.
        • et al.
        Comparing the content of instruments assessing environmental factors using the International Classification of Functioning, Disability and Health.
        J Rehabil Med. 2012; 44: 1-6
        • Bronfenbrenner U.
        • Morris P.A.
        The biolecological model of human development.
        in: Damon W. Handbook of child psychology. 6th ed. John Wiley & Sons, Inc, Hoboken2006: 793-828
        • Whyte J.
        A grand unified theory of rehabilitation (we wish!). The 57th John Stanley Coulter memorial lecture.
        Arch Phys Med Rehabil. 2008; 89: 203-209
        • Whiteneck G.
        • Dijkers M.P.
        Difficult to measure constructs: conceptual and methodological issues concerning participation and environmental factors.
        Arch Phys Med Rehabil. 2009; 90: S22-35
        • Reed G.M.
        • Lux J.B.
        • Bufka L.F.
        • et al.
        Operationalizing the International Classification of Functioning, Disability and Health in clinical settings.
        Rehabil Psychol. 2005; 50: 122-131
        • Johnston M.V.
        • Vanderheiden G.C.
        • Farkas M.D.
        • Rogers E.S.
        • Summers J.A.
        Westbrook JD for the NCDDR Task Force on Standards of Evidence and Methods. The challenge of evidence in disability and rehabilitation research and practice.
        (a position paper) SEDL, Austin2009
        • World Health Organization
        International Classification of Functioning, Disability and Health.
        World Health Organization, Geneva2001: 1-303
        • Schneidert M.
        • Hurst R.
        • Miller J.
        • Üstün B.
        The role of environment in the International Classification of Functioning, Disability and Health (ICF).
        Disabil Rehabil. 2003; 25: 588-595
        • Cerniauskaite M.
        • Quintas R.U.I.
        • Boldt C.
        • et al.
        Systematic literature review on ICF from 2001 to 2009: its use, implementation and operationalisation.
        Disabil Rehabil. 2011; 33: 281-309
        • Levasseur M.
        • Desrosiers J.
        • Tribble D.S.-C.
        Comparing the disability creation process and International Classification of Functioning, Disability and Health models.
        Can J Occup Ther. 2007; 74: 233-242
        • Bricout J.C.
        • Gray D.B.
        Community receptivity: the ecology of disabled persons’ participation in the physical, political and social environments.
        Scand J Disabil Res. 2006; 8: 1-21
        • Reinhardt J.D.
        • Miller J.
        • Stucki G.
        • Sykes C.
        • Gray D.B.
        Measuring impact of environmental factors on human functioning and disability: a review of various scientific approaches.
        Disabil Rehabil. 2011; 33: 2151-2165
        • Gray J.A.
        • Zimmerman J.L.
        • Rimmer J.H.
        Built environment instruments for walkability, bikeability, and recreation: disability and universal design relevant?.
        Disabil Health J. 2012; 5: 87-101
        • Escorpizo R.
        • Graf S.
        • Marti A.
        • et al.
        Domain sets and measurement instruments on participation and environmental factors in spinal cord injury research.
        Am J Phys Med Rehabil. 2011; 90: S66-78
        • Cieza A.
        • Geyh S.
        • Chatterji S.
        • Kostanjsek N.
        • Ustun B.
        • Stucki G.
        ICF linking rules: an update based on lessons learned.
        J Rehabil Med. 2005; 37: 212-218
        • Noreau L.
        • Boschen K.
        Intersection of participation and environmental factors: a complex interactive process.
        Arch Phys Med Rehabil. 2010; 91: S44-53
        • Badley E.M.
        Enhancing the conceptual clarity of the activity and participation components of the International Classification of Functioning, Disability, and Health.
        Soc Sci Med. 2008; 66: 2335-2345
        • Dijkers M.P.
        • Yavuzer G.
        • Ergin S.
        • Weitzenkamp D.
        • Whiteneck G.G.
        A tale of two countries: environmental impacts on social participation after spinal cord injury.
        Spinal Cord. 2002; 40: 351-362
        • Lounsbury D.W.
        • Mitchell S.G.
        Introduction to special issue on social ecological approaches to community health research and action.
        Am J Community Psychol. 2009; 44: 213-220
        • Lewin K.
        Environmental forces in child behavior and development.
        Clark Univ Pr, Oxford1931
        • Lewin K.
        Field theory in social science: selected theoretical papers.
        Harpers, Oxford1951
        • Barker R.G.
        Ecological psychology.
        Stanford Univ Pr, San Francisco1968
        • Wright B.A.
        Physical disability—a psychosocial approach.
        Harper Collins, New York1983
        • Bronfenbrenner U.
        Environments in developmental perspective: theoretical and operational models.
        in: Friedman S.L. Wachs T.D. Measuring environment across the life span: emerging methods and concepts. American Psychological Corp, Washington (DC)1999: 3-28
        • Hammel J.
        • Magasi S.
        • Heinemann A.
        • et al.
        Environmental barriers and supports to everyday participation: an qualitative insider perspective from people with disabilities.
        Arch Phys Med Rehabil. 2015; 96: 578-588
        • Lawton M.P.
        • Nahemow L.
        Ecology and the aging process.
        in: The psychology of adult development and aging. American Psychological Association, Washington (DC)1973: 619-674
        • Vygotsky L.
        Interaction between learning and development.
        Mind in society. Harvard Univ Pr, Cambridge1978: 79-91
        • Lawton M.P.
        Environmental proactivity in older people.
        in: Bengtson V.L. Schaie K.W. The course of later life: research and reflections. Springer, New York1989: 15-23
        • Hammel J.
        • Magasi S.
        • Heinemann A.
        • Whiteneck G.
        • Bogner J.
        • Rodriguez E.
        What does participation mean? An insider perspective from people with disabilities.
        Disabil Rehabil. 2008; 30: 1445-1460
        • Gitlin L.N.
        • Winter L.
        • Corcoran M.
        • Dennis M.P.
        • Schinfeld S.
        • Hauck W.W.
        Effects of the home environmental skill-building program on the caregiver–care recipient dyad: 6-month outcomes from the Philadelphia REACH initiative.
        Gerontologist. 2003; 43: 532-546
        • Gitlin L.N.
        • Winter L.
        • Dennis M.P.
        • Corcoran M.
        • Schinfeld S.
        • Hauck W.W.
        A randomized trial of a multicomponent home intervention to reduce functional difficulties in older adults.
        J Am Geriatr Soc. 2006; 54: 809-816
        • Hammel J.
        • Jones R.
        • Gossett A.
        • Morgan E.
        Examining barriers and supports to community living and participation after a stroke from a participatory action research approach.
        Top Stroke Rehabil. 2006; 13: 43-58
        • Bronfenbrenner U.
        Ecological systems theory.
        in: Vasta R. Six theories of child development: revised formulation and current issues. Jessica Kingsley Publishers, London1992: 285
        • Priestley M.
        Disability and the life course: global perspectives.
        Cambridge Univ Pr, New York2001
        • George L.K.
        Socioeconomic status and health across the life course: progress and prospects.
        J Gerontol B Psychol Sci Soc Sci. 2005; 60: S135-S139
        • Heller T.
        • Harris S.P.
        Disability through the life course.
        Sage, Thousand Oaks2011
        • GLAAD
        Where we are on TV report: 2012-2013 season.
        GLAAD, Los Angeles2013
        • Clarke P.
        • Ailshire J.A.
        • Lantz P.
        Urban built environments and trajectories of mobility disability: findings from a national sample of community-dwelling American adults (1986–2001).
        Soc Sci Med. 2009; 69: 964-970
        • Schwartz L.A.
        • Daniel L.C.
        • Brumley L.D.
        • Barakat L.P.
        • Wesley K.M.
        • Tuchman L.K.
        Measures of readiness to transition to adult health care for youth with chronic physical health conditions: a systematic review and recommendations for measurement testing and development.
        J Pediatr Psychol. 2014; 39: 588-601
        • Schulz A.
        • Northridge M.E.
        Social determinants of health: implications for environmental health promotion.
        Health Educ Behav. 2004; 31: 455-471
        • Tarlov A.
        Social determinants of health: the sociobiological translation. Health and social organization.
        Routledge, London1996: 71-93
        • Adler N.
        • Adashi E.
        • Aguilar-Gaxiola S.
        • et al.
        Institute of Medicine’s (IOM) Committee on Women’s Health Research. Women’s health research: progress, pitfalls, and promise.
        National Academies Pr, Washington (DC)2010: 11
        • Cannuscio C.
        • Block J.
        • Kawachi I.
        Social capital and successful aging: the role of senior housing.
        Ann Intern Med. 2003; 139: 395-399
        • Kawachi I.
        • Kennedy B.P.
        • Glass R.
        Social capital and self-rated health: a contextual analysis.
        Am J Public Health. 1999; 89: 1187-1193
        • Narayan D.
        • Cassidy M.F.
        A dimensional approach to measuring social capital: development and validation of a social capital inventory.
        Curr Sociol. 2001; 49: 59-102
        • Putnam R.D.
        Bowling alone: America's declining social capital.
        J Democracy. 1995; 6: 65-78
        • Rothstein B.
        Social capital, economic growth and quality of government: the causal mechanism.
        New Political Economy. 2003; 8: 49-71
        • Woolcock M.
        Social capital and economic development: toward a theoretical synthesis and policy framework.
        Theory Soc. 1998; 27: 151-208
        • Gilbert K.L.
        • Quinn S.C.
        • Goodman R.M.
        • Butler J.
        • Wallace J.
        A meta-analysis of social capital and health: a case for needed research.
        J Health Psychol. 2013; 18: 1385-1399
        • Szreter S.
        • Woolcock M.
        Health by association? Social capital, social theory, and the political economy of public health.
        Int J Epidemiol. 2004; 33: 650-667
        • Heinemann A.W.
        • Magasi S.
        • Bode R.K.
        • et al.
        Measuring enfranchisement: importance and control of participation by people with disabilities.
        Arch Phys Med Rehabil. 2013; 94: 2157-2165
        • Kim D.
        • Subramanian S.
        • Kawachi I.
        Bonding versus bridging social capital and their associations with self rated health: a multilevel analysis of 40 US communities.
        J Epidemiol Community Health. 2006; 60: 116-122
        • Brownson R.C.
        • Hoehner C.M.
        • Day K.
        • Forsyth A.
        • Sallis J.F.
        Measuring the built environment for physical activity: state of the science.
        Am J Prev Med. 2009; 36: S99-123
        • Clarke P.
        • Nieuwenhuijsen E.R.
        Environments for healthy ageing: a critical review.
        Maturitas. 2009; 64: 14-19
        • Clarke P.J.
        • Ailshire J.A.
        • Nieuwenhuijsen E.R.
        • de Kleijn-de Vrankrijker M.W.
        Participation among adults with disability: the role of the urban environment.
        Soc Sci Med. 2011; 72: 1674-1684
        • Feng J.
        • Glass T.A.
        • Curriero F.C.
        • Stewart W.F.
        • Schwartz B.S.
        The built environment and obesity: a systematic review of the epidemiologic evidence.
        Health Place. 2010; 16: 175-190
        • Whiteneck G.G.
        • Harrison-Felix C.L.
        • Mellick D.C.
        • Brooks C.A.
        • Charlifue S.B.
        • Gerhart K.A.
        Quantifying environmental factors: a measure of physical, attitudinal, service, productivity, and policy barriers.
        Arch Phys Med Rehabil. 2004; 85: 1324-1335
        • Fougeyrollas P.
        • Noreau L.
        • St Michel G.
        The Measure of the Quality of the Environment (MQE).
        ICIDH and Environmental Factors International Network. 1997; 9: 32-39
        • Garcia S.F.
        • Hahn E.A.
        • Magasi S.
        • et al.
        Development of self-report measures of social attitudes that act as environmental barriers and facilitators for people with disabilities.
        Arch Phys Med Rehabil. 2015; 96: 596-603
        • Cella D.
        • Lai J.S.
        • Nowinski C.J.
        • et al.
        Neuro-QOL: brief measures of health-related quality of life for clinical research in neurology.
        Neurology. 2012; 78: 1860-1867
        • Carlozzi N.E.
        • Tulsky D.S.
        • Kisala P.A.
        Traumatic brain injury patient-reported outcome measure: identification of health-related quality-of-life issues relevant to individuals with traumatic brain injury.
        Arch Phys Med Rehabil. 2011; 92: S52-60
        • Tulsky D.S.
        • Kisala P.A.
        • Victorson D.
        • et al.
        Developing a contemporary patient-reported outcomes measure for spinal cord injury.
        Arch Phys Med Rehabil. 2011; 92: S44-51
        • Whiteneck G.
        • Meade M.A.
        • Dijkers M.
        • Tate D.G.
        • Bushnik T.
        • Forchheimer M.B.
        Environmental factors and their role in participation and life satisfaction after spinal cord injury.
        Arch Phys Med Rehabil. 2004; 85: 1793-1803
        • Whiteneck G.G.
        • Harrison-Felix C.L.
        • Mellick D.C.
        • Brooks C.
        • Charlifue S.B.
        • Gerhart K.A.
        Quantifying environmental factors: a measure of physical, attitudinal, service, productivity, and policy barriers.
        Arch Phys Med Rehabil. 2004; 85: 1324-1335
        • Gray D.B.
        • Hollingsworth H.H.
        • Stark S.
        • Morgan K.A.
        A subjective measure of environmental facilitators and barriers to participation for people with mobility limitations.
        Disabil Rehabil. 2008; 30: 434-457
      1. AERA, APA, NCME. Standards for educational and psychological testing. Washington (DC): American Psychological Association; 1999. p 10.

        • Magasi S.
        • Ryan G.
        • Revicki D.
        • et al.
        Content validity of patient-reported outcome measures: perspectives from a PROMIS meeting.
        Qual Life Res. 2012; 21: 739-746
        • U.S. Department of Health and Human Services
        Food and Drug Administration guidance for industry on patient reported outcome measures: use in medical product development to support labeling claims.
        Federal Register, Washington (DC)2009
        • Heinemann A.
        • Magasi S.
        • Hammel J.
        • et al.
        Environmental factors item development for persons with stroke, traumatic brain injury and spinal cord injury.
        Arch Phys Med Rehabil. 2015; 96: 589-595
        • Dijkers M.P.
        Psychometrics and clinimetrics in assessing environments. A comment suggested by Mackenzie et al, 2002.
        J Allied Health. 2003; 32: 38-43
        • Feinstein A.R.
        Clinimetric perspectives.
        J Chronic Dis. 1987; 40: 635-640
        • Rushton G.
        Public health, GIS, and spatial analytic tools.
        Annu Rev Public Health. 2003; 24: 43-56
        • Botticello A.L.
        • Rohrbach T.
        • Cobbold N.
        Disability and the built environment: an investigation of community and neighborhood land uses and participation for physically impaired adults.
        Ann Epidemiol. 2014; 24: 545-550
        • Trull T.J.
        • Ebner-Priemer U.W.
        Using experience sampling methods/ecological momentary assessment (ESM/EMA) in clinical assessment and clinical research: introduction to the special section.
        Psychol Assess. 2009; 21: 457-462
        • Hektner J.M.
        • Schmidt J.A.
        • Csikszentmihalyi M.
        Experience sampling method: measuring the quality of everyday life.
        Sage, Thousand Oaks2007
        • Shiffman S.
        • Stone A.A.
        • Hufford M.R.
        Ecological momentary assessment.
        Annu Rev Clin Psychol. 2008; 4: 1-32
        • Chen Y.-W.
        • Bundy A.
        • Cordier R.
        • Einfeld S.
        Feasibility and usability of experience sampling methodology for capturing everyday experiences of individuals with autism spectrum disorders.
        Disabil Health J. 2014; 7: 361-366
        • Granholm E.
        • Loh C.
        • Swendsen J.
        Feasibility and validity of computerized ecological momentary assessment in schizophrenia.
        Schizophr Bull. 2008; 34: 507-514
        • Dijkers M.P.
        Issues in the conceptualization and measurement of participation: an overview.
        Arch Phys Med Rehabil. 2010; 91: S5-16
        • Dashner J.L.
        • Gray D.B.
        Measuring community receptivity using the Community Health Environment Checklists. Presented at the 2012 American Occupational Therapy Association Annual Conference.
        April 2012 (Indianapolis, IN)
        • Reinhardt J.D.
        • Post M.W.
        Measurement and evidence of environmental determinants of participation in spinal cord injury: a systematic review of the literature.
        Top Spinal Cord Inj Rehabil. 2010; 15: 26-48
        • Dickinson H.O.
        • Colver A.F.
        Measurement of the environment of people with disabilities.
        Arch Phys Med Rehabil. 2010; 91: 1310-1311

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