Cross-cultural applicability research on disablement: Models and methods for the revision of an international classification

The World Health Organization (WHO) has undertaken the revision of the International Classification of Impairments, Disabilities and Handicaps (ICIDH), originally adopted by the World Health Assembly in 1980. The existing classification has been criticized for not meeting the modern standards of cross-cultural applicability necessary for an international classification. A field-based empirical test of a revised version of the ICIDH was conducted in 17 centers in 15 nations, following extensive discussions among WHO collaborating centers, advocacy groups, representatives of disabilities organizations, governmental health programs, consultants, researchers, and WHO staff. The ICIDH Cross-Cultural Applicability Study utilized a suite of 6 ethnographic and statistical methods chosen to test 12 different aspects of the cross-cultural validity of the classification system and the revision process. The selected methods include: 1) descriptive narratives about disablements in the local culture; 2) translation and language analysis protocols; 3) pile sorting; 4) concept mapping; 5) key informant interviews with ranking exercises; and 6) focus groups. The data produced by these methods were found to be extremely valuable in revising the ICIDH classification and in developing disability-assessment instruments linked to the ICIDH.