Theories of disability in health practice and research

This is the fifth in a series of six articles on the importance of theories and values in health research All health care and research are influenced by theories. This paper considers the influence of implicit and explicit theories1 on interventions and research on disabled people. Another important influence is the experience of disabled people, and their increasing insistence that their voices be heard at all stages of research about their lives.2 ### Summary points The health care that disabled people receive is influenced by theories Positivist theory remains the dominant influence on health care given to disabled people Other theories are beginning to have a significant influence The rise of these theories is posing important questions for health care and research Over the past 20 years, writings by disabled people have transformed our understanding of the real nature of disability. They move beyond the personal limitations that impaired individuals may face, to social restrictions imposed by an unthinking society. Disability is understood as a social and political issue rather than a medical one, and this leads to critical questioning of medical interventions:attempts to cure impairments or to restore “normal” bodily functioning. Instead, social and political solutions are sought, to challenge disabling discrimination. This radically different view is called the social model of disability, or social oppression theory.3While respecting the value of scientifically based medical research, this approach calls for more research based on social theories of disability if research is to improve the quality of disabled people's lives. Definitions are central to understanding theories of impairment and disability.4 In 1986 Disabled Peoples International made a clear distinction:impairment is the functional limitation within the individual caused by physical, mental or sensory impairment; disability is the loss or limitation of opportunities to take part in the normal life of …