Dear Hansika,

contextual environmental and personal factors play an essential part in affecting health problems and the impact of disability on inclusion in society. When looking holistically researchers increasingly come to the point that contextual factors often may have an effect at least as important as impairments and the disease themselves. Therefore I am pleased to draw the attention to the bio-psycho-social disease model and the importance of the philosophy of the International Classification of Functioning, Disability and Health (ICF of the WHO 2001).

Concentrating on the bio-medical disease model alone will risk to miss the negative effect of diseases and the positive effects medical interventions may have on handicaps and participation in its interdependency with contextual factors. To amputate the leg of a postman due to a vascular disease is a highly professional task but a tragedy for the patient. Medical help is not ending after the successful amputation, it is more than that. To identify and evaluate the contextual factors affecting handicaps and participation by operating as facilitators or barriers is crucial to evaluate the overall outome of medical interventions. Integrating environmental and personal factors into the decision process for medical intervention planning and acknowledging their importance from the viewpoint of the owner of the lost leg will be much less strenuous, potentially successful and productive than ignoring them. Thus the consideration of and the attention to contextual factors is a must for healthcare professionals, in rehabilitation units at the latest.

Best greetings

Wolfgang

I think this a central issue, see this work:

http://www.ncbi.nlm.nih.gov/pubmed/22529204

Dear Hansika,

contextual environmental and personal factors play an essential part in affecting health problems and the impact of disability on inclusion in society. When looking holistically researchers increasingly come to the point that contextual factors often may have an effect at least as important as impairments and the disease themselves. Therefore I am pleased to draw the attention to the bio-psycho-social disease model and the importance of the philosophy of the International Classification of Functioning, Disability and Health (ICF of the WHO 2001).

Concentrating on the bio-medical disease model alone will risk to miss the negative effect of diseases and the positive effects medical interventions may have on handicaps and participation in its interdependency with contextual factors. To amputate the leg of a postman due to a vascular disease is a highly professional task but a tragedy for the patient. Medical help is not ending after the successful amputation, it is more than that. To identify and evaluate the contextual factors affecting handicaps and participation by operating as facilitators or barriers is crucial to evaluate the overall outome of medical interventions. Integrating environmental and personal factors into the decision process for medical intervention planning and acknowledging their importance from the viewpoint of the owner of the lost leg will be much less strenuous, potentially successful and productive than ignoring them. Thus the consideration of and the attention to contextual factors is a must for healthcare professionals, in rehabilitation units at the latest.

Best greetings

Wolfgang

Dear Wolfgang,

Thank you for extending the importance of context in the rehabilitation field. I completely agree with your opinion, and suggest that all therapeutic and pharmacological care also be embedded and tied to the context to which the patient belongs. The bio-psycho-social model is deemed incredibly important; however, I have come across research that emphasises only the first two of this triad approach to understanding mental illness. As I reside and work in a multicultural and multilingual nation (India), practitioners and researchers here are conditioned to treat context as important as the patient or the research topic at hand.

You may also be interested in ecological systems theory which advocates the interaction of the individual with the environment in nested systems from the immediate setting up through until the broader culture. Look for Bronfenbrenner 1960's and 70's

Fully agree that the ICF is important not only in care but as you were asking also in research! We analyzed clinical trials and found that research (and funding) still focusses primarily on biomedical "researchable" variables. Funding of research should also focus on the importance of activity/participation and context. DOI: 10.1007/s11136-013-0483-9

Fayed, N., et al. (2013). "Patient-important activity and participation outcomes in clinical trials involving children with chronic conditions." Qual Life Res.

@Denis: Thanks for your input :)

@Olaf: I agree completely. Research funding for contextual variables and studies is hard to come by (probably due to the limits in the applicability of the findings). However, it is difficult, if not impossible, to study social variables in a vacuum, thus giving rise to my query.

I wish to validate what Wolfgang has said about the biopsychosocial model of disease...it certainly matches my observations of the chronic pain patient...or to quote my sweet mother, "They do not go out of the house to get it."

I agree that context is critical. Context triggers reality shaping perceptions for the experiencing person. Alcohol research shows that social drinkers given alcohol without their knowledge interpret the effects of alcohol as a feelings of being unwell, along with dysphoria. Similarly, people who think that they're drinking alcohol (when they're not) can show behaviours associated with inebriation and disinhibition. This is just one of so many examples of how important context is.Context gives us clues on how to interpret what's going in ourselves and the world around us.

Thanks for your reply Deborah. Is it then justifiable or even feasible for researchers to make broad confusions on the bases of their results?

Hi Hansika,

I think it depends on what is being researched. Context itself is something that is interesting to manipulate or observe.

Cheers

Deb

I agree that it is common for context particularly socio-cultural aspects not to be given equal importance to personal factors in healthcare research and practice. In relation to field of pain management in healthcare traditionally biomedical models of research refer to 'pain threshold' as a pain scale measurement with studies classifying low versus high thresholds of pain tolerance. The psychosocial model recognises that what we are really measuring is the expression of pain (rather than the severity of pain) which is always context-related.

Beautiful example Roberta, thank you :) Reporting of pain is socio-culturally determined, more so, it is mediated by the level of somatic-symptom-reporting in a given culture.

I guess we can say that the importance of context might be related to "healing" rather than "curing" The linguistic/semantic differences between 'remedy' , 'cure', 'mend' and 'heal' let me think about your question and the enlightening answers above. Thanks for the topic/question !

I started to rethink the importance of context in language(semantics)in general. Especially in English many words, phrasal verbs, experessions differ in meaning according to their context. When my students ask "Teacher what does XX mean?" , I mostly ask back "What is the context, show me the sentence or tell me where you heard/read it".

That's very true; it happens in most languages, where we can extrapolate the meaning of a word from its context. The use of language would also differ according to the context in which its spoken; e.g. a more formal style when speaking at a colleague in office, and a more casual style while speaking to a friend. And when we expand simple nuances of contextual relevance to the research arena, the influence of context becomes so much more evident.

Context counts for 100%

Genes count for 100%

Experience counts 100%

Psychological traits count for 100%

Ford and Lerner (1992) suggest to always study the "Person-in-Context": not only they assume a full meaning only when studied together, but they also reciprocally influence each other.

In Systemic terms, any time you try to isolate a part from the rest of the system, you loose the interactions of that part with the rest of the system, and the significance of that part is therefore hindered. It would be like studying water by analyzing Hydrogen and Oxygen separately.

I suggest reading: Ford, D. H., & Lerner, R. M. (1992). Developmental systems theory: An integrative approach: Sage Publications, Inc.

Context matters. That's for sure. But how much does it matter? I think it really does depend on what you are talking about - i.e., what sort of context.

So let's think about social context, for Social Psychology, it's practically the entire reason why the field exists. Take "social proof" - i.e., the idea that when we are faced with uncertainty we look to others to determine what it is that we will do.

What about cognitive context? Think of reading things like 987654B21 - you might not notice that the number between 4 and 2 is actually the letter B, if I only presented it for a short period of time.

What about personality context effects. Research has demonstrated that bilinguals have distinct personalities in each of their fluent languages.

But while context does matter - if we agree that context is just another way of talking about nurture - in the nature/nurture debate - or it's just another way of talking about everything that is NOT innate (and also encapsulated - i.e., that CANNOT be influenced by experience) - there are some things where it just doesn't matter that much - see above innate and encapsulated - or where the context is an excuse for reducing the burden of responsibility.