Fair opportunities, social productivity and wellbeing in disability: Towards a theoretical foundation

Theory-based approaches provide explanations of the impact of components of the International Classification of Functioning, Disability and Health (ICF) classification on outcomes such as health and wellbeing.

Here, one such approach is proposed, focusing on social participation and its association with wellbeing. In addition to elaborating a theoretical approach, a narrative review of research on labour market participation of persons with severe disability, spinal cord injury, is conducted to illustrate the utility of the proposed approach. Availability and good quality of productive activities, in particular paid work, are expected to improve wellbeing by strengthening favourable experiences of personal control and social recognition. As these opportunities are restricted among persons with disabilities, conditions that enable full social participation need to be strengthened.

Research identified several such conditions at the individual (e.g. coping, social support, educational skills) and the contextual socio-political level (e.g. quality of care, medical and vocational rehabilitation), although their potential of improving wellbeing has not yet been sufficiently explored.

In conclusion, supplementing the established ICF classification by theory-based approaches may advance explanations of adverse effects of reduced functioning and wellbeing in disability. This new knowledge can guide the development of interventions to improve participation in general and social productivity in particular.