External Support for Engaging in Activity

Just as the ICF includes environmental factors (contextual factors) as a component of health and health-related states, participants also identified external factors which contributed to their ability to participate in activities.10

7.4.3.1

A large resource for the participants was social contacts, most notably spouse and family. Four out of the seven participants had spouses who were still living. These couples had been together for many years. For example, one couple had been married for more than 60 years. In their relationship, they relied on each other for help in their everyday activities. John‘s wife commented, ―We're so blessed to have each other.‖

All of the participants relied on their children. Every participant had at least one child living in the same city. They needed their children for support, transportation, and family events. Mary‘s daughter lived with her and her husband to help around the house. Mary said, ―[daughter] does so much for us. It‘s just a blessing. It‘s hard to explain everything that she does. She‘s a real daughter.‖

Although these parents relied on their children, all of them made comments that they do not want to be a burden to their children. John‘s wife commented, ―Sometimes you feel you‘re such a burden.‖

7.4.3.2

A major external resource for the participants was the use of assistive technology. As per the inclusion criteria for recruitment, all participants had at least one assistive device for vision and one to help mobility impairments. All participants said they needed their assistive devices to perform activities in their daily life. It was amazing to hear the joy Susan experienced with her new spectacle-mounted telescope when she was sitting in a large auditorium to watch a play.

Listen, I didn‘t think they‘d work, but they were absolutely sensational. We were back, but not too far. But with these I could see the whole thing! I could actually see her face and I cannot see anybody else‘s face. I was so thrilled. It was

wonderful. (Susan)

On the day of his appointment at the low vision clinic, Alex‘s daughter recalled the day Alex used a new CCTV: ―It was kind of like Christmas that day, because we put on a picture that he hadn‘t seen before and he was able to identify who the people were.‖

7.4.3.3

Another important concept that emerged when discussing external influences relates to the health care system. No participant complained about the health care system. They all had good experiences, but one idea that was apparent for all participants was that there was disjointedness among the health care services.

Alex and his daughter both had comments related to the separation of the health care system:

Interviewer: I know you mentioned you see a therapist for your walks. Do they ever ask about your vision?

Alex: No, she wouldn‘t know about that. I don‘t think so. Nobody asks you about that stuff.

Daughter: I don‘t know if there is anything they can do to help with the vision. They just work on the walking.

Interviewer: And when you were at the low vision clinic, did they ask about the wheelchair?

Alex: No

Daughter: Actually, I was a little surprised they didn‘t ask about the wheelchair for setting up the machine to make sure it was the right height. That‘s something I‘ve had to do on my own with the last one.

7.4.3.4

The last notion related to external influences was the services available to participants, such as public transportation, community centres, programs and resources at residences, and other organized events. One man enjoyed participating in his city council:

And sometimes he'll contribute but he's like a fixture. He's been going for years. I always find on Tuesday he's more talkative. He's heard what the meeting is about and he tries to tell me about the meeting.(John‘s Spouse)

Alex was one of the original members of an accounting group that started over 40 years ago. He continued to participate in the monthly meetings.

Many of the other participants frequented local community centres. Betty mentioned, ―I love that centre. It‘s really a nice centre for anything. It‘s really nice for everything.‖

Another example of the services used was when Susan discussed how she loves the activities and services provided by the residence that she was living in:

They have a bistro down there. It‘s not licensed. We can take wine down to the table. They‘ll bring us the glasses. They‘re not allowed to serve us, you see, and once a month they have a cocktail down in the bistro. We sit around and drink wine –cheap wine!!

In summary, all of the participants expressed they had some type of external support in their life: their spouse, children, assistive technology, health care services, or other organized services. These external factors contributed to the participants‘ ability to engage in activities.