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 Inte rnational Classification of Impairments, Disabilities and Handicaps (ICIDH) , originally adopted by the World Health Assembly in 1980. The existing cla ssification has been criticized for not meeting the modem standards of cros s-cultural applicability necessary for an international classification. A f ield-based empirical test of a revised version of the ICIDH was conducted i n 17 centers in 15 nations, following extensive discussions among WHO colla borating centers, advocacy groups, representatives of disabilities organiza tions, governmental health programs, consultants, researchers, and WHO staf f. The ICIDH Cross-Cultural Applicability Study utilized a suite of 6 ethno graphic and statistical methods chosen to test 12 different aspects of the cross-cultural validity of the classification system and the revision proce ss. The selected methods include: 1) descriptive narratives about disableme nts in the local culture; 2) translation and language analysis protocols: 3 ) pile sorting; 4) concept mapping; 5) key informant interviews with rankin g exercises; and 6) focus groups. The data produced by these methods were f ound to be extremely valuable in revising the ICIDH classification and in d eveloping disability-assessment instruments linked to the ICIDH.