How is your doctor using this to get you 100% recovered? Do not let your doctor use the tyranny of low expectations to suggest anything less than 100% recovery!
Personal factors in rehabilitation
Personal factors (WHO ICF) are an invalid construct. They cannot exist separate from the person as independent influential factors. The person has characteristics, which vary according to the person’s role at the time.
The World Health Organisation’s International Classification of Impairment, Disability and Handicap, published in 1980, was an early interpretation of the biopsychosocial model of illness. It was soon criticised for overlooking the person and their environment. In the International Classification of Functioning, Disability and Health, published in 2000, the WHO introduced environmental and personal factors, which, in 2004, Peter Halligan and I translated into Physical, Social, and Personal contexts. The concept of personal factors and what they include has been researched without a clear answer. Given the central role of the person in all discussions of rehabilitation, I wish to explore the concept of personal context further. Given that the biopsychosocial model leads to a person-centred approach to rehabilitation assessment, I will use that framework. This post works through my analysis, and I conclude that personal context and personal factors complicate matters and are best replaced by talking about the person and their characteristics. This is introduced in the figure here; it shows how the person should be integrated into the biopsychosocial model of illness, the six main constructs that characterise a person, and how the person interacts with every part of the model, including over time.
Table of Contents
Introduction
“What is man, that thou art mindful of him?” This quotation from the King James version of David’s eighth Psalm asks the question of God, but it applies equally to each of us: who is that person when we think of them, and who are we when we think of ourselves? The psalm implies that, though man is an animal like others, there is an added extra that God sees. It asks what that extra is; David asks, how do you, God, describe a person?
When you ask a colleague to describe another person, you would be surprised if they quantified their physical characteristics such as height, weight, hair colour, chest circumference, etc. You expect a description of the person, such as their friendliness, interests, emotional characteristics, way of talking and walking, etc.
You are interested in their personality, but not in a psychometric sense. Some readers will have taken the Myers-Briggs personality test for management or leadership training. However, you would not expect your colleague to give you the person’s scores on that or any other test.
Understanding what we mean by a person is highly relevant to rehabilitation. We must agree on what characterises a person before judging whether we are person-centred or what aspects of the person we should consider. It also might help us understand a person’s response to their illness, for example, if their house or car is associated with how they see themselves.
In a document suggesting a common language for healthcare to use when classifying functioning, the World Health Organisation introduced ‘personal factors’. The intention was to develop a set of headings or domains covering aspects of a person that increased our understanding of a person’s functioning.
What are personal factors?
In its 2002 document, Towards a Common Language for Functioning, Disability and Health, the World Health Organisation (WHO) introduced environmental and personal factors into the biopsychosocial model of illness to help interpret and analyse recorded functioning.
Environmental factors were defined thus on page 10, “for example, social attitudes, architectural characteristics, legal and social structures, as well as climate, terrain and so forth.” The WHO have provided further details in their online International Classification of Functioning. Their idea of environmental factors is over-inclusive, mixing concepts, and Peter Halligan and I have separated social and physical contexts.
Personal factors included “gender, age, coping styles, social background, education, profession, past and current experience, overall behaviour pattern, character and other factors that influence how disability is experienced by the individual.” The WHO has not provided a comparable system for classifying personal factors. Some people have attempted a classification.
In 2012, Sabine Grotkamp and colleagues reviewed previous studies into the classification of personal factors. Most studies were centred on specific populations, for example, people with hearing impairment. Sabine Grotkamp et al. recruited many people with interests covering a range of situations and conditions and identified 72 potential factors. These were then developed into six chapters, groups that covered similar issues. A follow-up study in 2020 confirmed the basic structure, with a few minor changes in single items.
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