Chapter 2 - Participation Restrictions

• Having an impairment appeared to be associated with experiencing participation restriction in various life areas

• Adults with impairment at both waves were most likely to have a participation restriction in the areas of work, economic life¹, transport, and accessibility outside the home

• Offset adults (who had impairment at Wave One but no longer at Wave Two) were generally less likely to have participation restrictions at Wave Two than at Wave One

• In contrast, onset-acquired adults (who had acquired an impairment at Wave Two) were generally more likely to have participation restrictions at Wave Two than at Wave One

• Most adults, regardless of their impairment status, had a participation restriction in at least one life area at both waves, with transport and leisure being the two areas where a participation restriction was most widely experienced

Notes for Key findings:

1. Economic life refers to the household’s ability to pay bills

This chapter explores how participation restriction was experienced by adults in different areas of their life, and whether there were changes to their experience of restriction between Wave One and Wave Two. The LOS collected information about adults’ participation restriction in eight different life areas - education and training, work, economic life (ability to pay household bills), transport, leisure activities, social contact, accessibility in the home and accessibility outside the home. An adult has a participation restriction in a life area if he/she experiences at least one barrier in that area. Note that the types of barriers reported differ from area to area (e.g., ‘lack of job opportunities’ is a barrier relevant to work, but not to other areas)¹. This chapter focuses on whether adults are restricted in each life area, rather than focusing on the types of barriers reported. Chapters 3 – 5 will examine specific barriers reported by working age (16 to 64) adults in three life areas - work, education and training, and transport.

Within this chapter comparisons are made between the four groups of adults as described in the Introduction – adults with impairment at both waves, offset adults, onset-acquired adults, and adults without impairment at both waves. All analyses in this chapter will include all adults aged 16 and over. As stated in the Introduction, unless otherwise stated, changes and differences mentioned in this chapter have been found to be statistically significant at the 95% confidence level.

Notes for aims of the chapter

1. More information on the makeup of the LOS questionnaire

Adults with impairment at both waves experienced a participation restriction in more life areas (an average of 3.3 life areas at both Wave One and Wave Two) than other groups (see Table 2.1). In contrast, adults without impairment at both waves experienced a participation restriction in the fewest life areas (an average of 2.2 life areas at both Wave One and Wave Two).

Onset of impairment was associated with a rise in the number of life areas where a participation restriction was experienced, and offset of impairment with a fall. On average, onset-acquired adults had a participation restriction in 2.4 life areas at Wave One, and 2.7 life areas at Wave Two. In contrast, offset adults had a restriction in 2.7 life areas at Wave One, and 2.4 life areas at Wave Two.

Data collected on the LOS allows analysis of the change in experience of participation restriction between Wave One and Wave Two. Adults could have experienced more life areas with barriers (an increase), the same number of life areas with barriers (no change), or fewer life areas with barriers (a decrease).

Onset-acquired adults were likely to experience a participation restriction in more life areas, while adults who no longer had an impairment have a restriction in fewer life areas. Table 2.2 shows that 42% of onset-acquired adults had an increase in the number of life areas with a participation restriction, compared with 26% reporting a decrease. Offset adults showed the opposite – 27% had an increase and 46% had a decrease.

For adults with impairment at both waves, around the same percentage had an increase (35%) and a decrease (36%) in the number of life areas with a participation restriction between Wave One and Wave Two. This is similar for adults without impairment at both waves (34% and 35% for increase and decrease respectively).

Having an impairment might not be the only influence on whether adults experience a participation restriction, as around the same percentage of adults in each group (28% to 32%) had the same number of life areas with a restriction across waves (although the specific life areas with restriction might be different between waves).

Regardless of impairment status, the vast majority of adults were restricted from participating in at least one of the eight life areas at both waves. Figure 2.1 shows that across all four groups, between 85% to 94% of adults were restricted in participating in at least one of the eight life areas at both Wave One and Wave Two. Only a very small percentage (around 1% to 2%) did not experience any participation restriction in eight life areas at either or both waves of the survey. As will be shown in Chapters 3 – 5, when we look at each life area on its own, the percentage of adults¹ with a participation restriction at some point of the survey becomes lower².

Notes for 2.4 Change in the number of life areas where a participation restriction was experienced

1. Chapters 3 – 5 focus on working age adults, whereas this chapter looks at all adults aged 16 and over. We found no evidence that working age adults had lower levels of participation restriction in any of the life areas than did adults aged 65 and over

2. This is largely due to leisure and transport, the two life areas where most adults experience a participation restriction - as seen in section 2.5

Leisure activities and transport were the two life areas where most adults experienced participation restriction. This was true for all four groups (see Figures 2.2 - 2.5).

Having an impairment appears to be associated with participation restriction. Adults with impairment at both waves were more likely than adults without impairment at both waves to have a participation restriction in all life areas except social contact. For example, 83% of adults with impairment at both waves experienced a participation restriction to leisure at Wave One, compared with 78% of adults without impairment at both waves (the figures were 84% and 77% respectively at Wave Two).

The onset and offset of impairment also appear to be associated with changes in participation restriction. Between Wave One and Wave Two, the percentage of offset adults experiencing restrictions fell in the areas of work, transport, leisure and accessibility outside the home, while the percentage of onset-acquired adults experiencing restrictions increased in the same life areas. For example, 81% of offset adults experienced a participation restriction to leisure at Wave One, with the figure falling to 76% at Wave Two. For onset-acquired adults, 79% had a participation restriction to leisure at Wave One, rising to 83% at Wave Two. For adults with impairment at both waves, and those without impairment at both waves, there was little change between Wave One and Wave Two in the percentage that experienced a participation restriction in each life area.

Data collected in the LOS allows analysis of whether a participation restriction to each life area was experienced at Wave One only, at Wave Two only, at neither wave, or at both waves.

Transport and leisure activities were the two areas where most adults experienced a participation restriction at both waves. In other areas, most adults were not restricted at either wave. This was true for all four groups (see Figures 2.6 – 2.13).

As seen earlier in the chapter, having an impairment appears to be associated with experiencing a participation restriction. Adults with impairment at both waves were more likely than adults without impairment at both waves to experience a participation restriction at both Wave One and Wave Two, and less likely to experience restriction at neither wave. This pattern is clearest in the following life areas: work, economic life, transport, and accessibility outside the home. Additionally, offset adults were more likely than onset-acquired adults to experience a participation restriction at Wave One only, while onset-acquired adults were more likely than offset adults to experience a restriction at Wave Two only. This was particularly evident in the following life areas: work, transport and accessibility outside the home.

These two patterns can be seen together in accessibility outside the home. Here, a fifth (20%) of adults with impairment at both waves had a barrier at both Wave One and Wave Two, compared with 1% of adults without impairment at both waves. Half (50%) of adults with impairment at both waves had no participation restriction at either wave, compared with 91% of adults without impairment at both waves. Offset adults were more likely than onset-acquired adults to experience a restriction at Wave One only (11% compared with 6%), but onset-acquired adults were more likely than offset adults to experience a restriction at Wave Two only (13% compared with 4%).

The findings in this section suggest an association between impairment and participation restriction. In most life areas, adults with impairment at both waves were more likely than adults without impairment at both waves to experience a participation restriction. It also appears that the onset of impairment was generally associated with an increase in participation restriction, and offset of impairment with a decrease.

These results are consistent with existing research showing difficulties faced by disabled people in various aspects of daily life. In a previous report, we found that adults with impairment at both waves were less likely to be in employment at both waves, and a large proportion of this group, compared with other groups, had an income of less than £200 a week. It was therefore unsurprising that adults with impairment at both waves were also more likely than other groups to experience a participation restriction in areas such as work and economic life (household’s ability to pay bills). In this chapter we also found that adults with impairment at both waves were more likely to experience a participation restriction to transport and accessibility outside the home. Transport and leisure activities were the two life areas where most adults experienced a participation restriction, regardless of whether they had an impairment or not.

It is important to bear in mind that the LOS uses the social model of disability, and the reporting of both impairments and participation restrictions was based on respondent’s personal view (as is the case for all surveys that collect opinion-based data). Therefore, while impairment may give rise to a participation restriction, it is equally possible that experiencing a restriction may lead to the perception of having an impairment. Additionally, the effects of impairments on participation restriction may take some time to become evident. For example, the offset of impairment may not bring about the immediate removal of barriers (and hence participation restriction). In areas like work and economic life, an impairment may lead to persisting unemployment and financial difficulties, and a participation restriction may continue to be experienced for some time after impairment is offset.

Finally, this chapter gave details on life areas where a participation restriction was experienced but did not describe the types of barriers reported. Therefore, it is possible that adults had a participation restriction at both waves, but the specific type of barrier reported had changed between waves (e.g., the barrier to work at Wave One may have been reported as ‘lack of job opportunities’ while at Wave Two, another barrier such as ‘family responsibilities’ may have been reported). Chapters 3 - 5 will give further details on the kinds of barriers reported in the life areas of work, education and training, and transport for working age adults.