Dissonance in health conception: a comparative study of disabled people and experts in Korea

Despite the WHO’s shift to the ICF model, practitioners still view health through functional limitations rather than environmental interactions. Few studies have compared how people with disabilities and professionals define health within a shared frame. This research identifies such disconnect using the Patrick and Stuifbergen models to suggest policy reforms. A mixed-methods approach was used. Focus Group Interview (FGI) with 14 participants with disabilities defined health from their perspective. A two-round Delphi survey was conducted with 30 panels (10 disabled people, 20 experts) to rate barriers to healthcare access. Evaluations used a 5-point scale based on two frameworks: the Patrick Model, assessing domains including Environmental contexts and Opportunity (Equality, Full participation, Independent living); and the Stuifbergen Model, evaluating psychosocial domains including Acceptance and Self-efficacy. Statistical stability was confirmed by CV < 0.5. FGI showed that participants define health through social participation and autonomy. The Delphi survey identified a systematic gap. Under the Patrick model, people with disabilities reported greater difficulties in Full participation (4.8), Equality (4.7), and Independent living (4.7) than experts, who rated them at 4.5, 4.0, and 4.3. Under the Stuifbergen model, the largest disparity was in Acceptance (disabled participants 4.6 vs. experts 4.0). Overall, experts consistently underestimated the environmental barriers and psychosocial burdens reported by people with disabilities. The findings highlight a structural disconnect: people with disabilities prioritize environmental barriers and social opportunities, while experts focus on individual behaviors. Given that this dissonance in conception risks reinforcing a “disability spiral”, the perceptual gap between these two groups is not a trivial one. Inclusive policy must bridge this gap by reflecting disabled people’s own definitions of health and priorities.

Key messages

• A systematic dissonance in health conception exists, as experts consistently underestimate the environmental barriers and lack of social opportunities reported by people with disabilities.

• Recognizing this perceptual gap is crucial to breaking the disability spiral and developing inclusive policies that reflect the priorities of disabled people.