Applying the International Classification of Functioning, Disability and Health to understand osteoarthritis management in urban and rural community-dwelling seniors

Objectives: The objectives of this study were to identify contextual factors as barriers or facilitators of osteoarthritis management in urban- and rural-dwelling seniors by applying the World Health Organization's International Classification of Functioning, Disability and Health (ICF). Design: Secondary analysis was performed on interview transcripts from urban- (n ​= ​11) and rural-dwelling (n ​= ​9) seniors living with osteoarthritis in Canada. Meaningful concepts were linked to ICF codes (Environmental Factors) according to established linking rules. Unclassified content (including Personal Factors) was subjected to qualitative content analysis. Results: A total of 481 and 410 meaningful concepts were identified in interview transcripts from urban and rural groups, respectively. For Environmental Factors, the majority of meaningful concepts linked to "Environmental Factors", then "Activities and Participation", and then "Body Functions" in the ICF. The most frequently linked codes were "e355 Health professionals", "e5801 Health systems", "e5800 Health services", and "e398 Support and relationships, other specified". The most salient barrier and facilitator to osteoarthritis management reflected in our results were "e5801 Health systems" and "e398 Support and relationships, other specified", respectively, for both urban and rural groups. For Personal Factors, qualitative content analysis of unclassified content revealed 3 key themes including (1) Coping Strategies; (2) Age of Osteoarthritis Diagnosis; and (3) Individual Circumstances. Conclusion: Beyond physical limitations, community-dwelling seniors with osteoarthritis encounter a wide range of biopsychosocial factors that can impact disease management. Applying the ICF, we identify "Environmental Factors" as a significant contextual factor impacting osteoarthritis management in both urban and rural communities.