Conceptualizing the construct of participation in adults with disabilities

Participation is a key indicator of health and well-being and a critical rehabilitation goal for individuals with disabilities. Despite the numerous participation measures that have been developed, there is still an absence of agreement on the definition, domains, and dimensions of this construct. The result is that instruments intending to measure the same construct may actually measure quite different aspects of daily life and therefore yield significantly different findings. A solid conceptual model is needed to provide consistent guidance for measurement selection and development. In this article we identify the relevant content areas of participation and propose a conceptual model for adults that is intended to apply across diagnoses, conditions, and settings. We classified participation into 3 main domains: work and education, household, and community. Subdomains are defined within each. The model was reviewed using a semistructured survey by 8 rehabilitation measurement experts. Their feedback regarding the relevance, clarity, and comprehensiveness of the model led to the creation of an alternative structure in which the 3 main domains were recategorized as productivity, social, and community. The proposed conceptual model provides a clear framework for practitioners and researchers to understand the concept of participation and to guide selection or development of measures.