The article has several sections. In the first section, we describe our conceptual framework, the theoretical background, and our research design. In the subsequent sections, we present three main research steps: the conceptual part, the measurement part, and the analytical part. In the next section, we present our final results, and we conclude with a discussion of the limitations of our analysis and our conclusions.
Conceptual framework
The conceptual framework deals with two basic concepts within the context of disability. The first concept is the quality of life, with a special focus on the multidimensional character of and the measurement dilemmas associated with this indicator. The second concept refers to livability and the creation of the living environment at the local level.
Ideas about what constitutes “the good life” are rooted in ancient philosophy. Based on these foundations, three main constructs are used in the analysis of quality of life and well-being: hedonic well-being, eudaimonia, and life satisfaction. Hedonic well-being underlines the importance of emotions, affect, and subjectivity; eudaimonia points to the value of self-development and self-realization; and life satisfaction refers to cognitive aspects of well-being [
12].
Quality of life as a general concept has been studied in many fields, including economics, political science, psychology, philosophy, and medical science. The concept of QoL was introduced into the public discourse in the 1960s as an alternative to the prevailing focus on social development goals, which were at that time defined as improvements in material living conditions [
13]. Although the term is commonly used, there is no single, universally accepted definition of quality of life [
14]. The World Health Organization’s definition focuses on individuals’ perceptions of their position in life, and the extent to which it corresponds with their expectations. Other definitions include the satisfaction of needs, objective and subjective evaluations of different dimensions of life, agency, and the meaning of life. Interest in measuring QoL is increasing in the area of health care, where it is identified as an outcome of the efficacy of the treatment [
15]. Hence, as the concept of QoL is multifaceted, multidimensional, and ambiguous, a clear definition of it is needed before beginning research on quality of life [
16]. For the purposes of this article, we applied the individual-referenced definition outlined by Schalock et al. [
4], in which they described QoL as a multidimensional phenomenon composed of core domains influenced by personal characteristics and environmental factors. The authors argued that these core domains are the same for all people, although their relative value and importance may vary individually.
Alongside these various definitions, different tools for measuring this phenomenon have been developed e.g., [
1,
16‐
19]. Generally, there are two approaches to measuring QoL among persons with disabilities:
1.
a measure constructed for the whole population and used to assess the QoL of different sub-groups, including persons with disabilities; and
2.
a measure constructed and used specifically to assess the QoL of persons with particular limitations or disabilities.
The most complex measurement guidelines based on the first approach are provided by the final report of the Sponsorship Group on Measuring Progress, Well-being and Sustainable Development and the Task Force on the Multidimensional Measurement of Quality of Life [
20,
21], which was accepted by the European Statistical System Committee. This proposal represents an extension of the QoL measurement concept of Berger-Schmitt and Noll [
22] operationalised in the framework of the European System of Social Indicators, which refers to recommendations of the Report on Measurement of Economic Performance and Social Progress [
23]. Those reports stressed the multidimensional character of QoL, as well as the importance of combining both subjective and objective measures of QoL. Moreover, it was clearly stated that QoL should be assessed at both the individual and the community levels. In its final report, the Task Force on the Multidimensional Measurement of Quality of Life identified nine dimensions to be measured within the framework of the European Statistical System [
20]. Each dimension comprises a set of indicators of a subjective and an objective character. This system of indicators enables the analysis of different life aspects within each dimension and their changes over time, as well as the relative assessment of QoL of individuals or households. However, it does not provide an explicitly formulated guide for operationalising the measurement, or a synthetic measure of QoL.
In the second approach, the concept of quality of life is used to assess the personal outcomes for persons with disabilities guaranteed under the UNCRPD [
24]. In this approach, quality of life is also considered as a multidimensional construct that includes physical, mental, and social dimensions [
19], but it is used in the context of a particular disability or impairment. The influence of a particular type of disability or affliction on a person’s quality of life is visible, and can be measured in different domains using both subjective and objective measures i.e. [
25,
26].
These two approaches (general quality of life and QoL developed for persons with limitations) have important similarities. Both approaches assume that QoL should be composed of the same factors and relationships for all people; is experienced when a person’s needs are met and when the individual has the opportunity to pursue life enrichment in major life activity settings; is comprised of both subjective and objective components; and is a multidimensional construct influenced by both individual and environmental factors [
5,
24]. However, in the overall quality of life measurement approach, which measures QoL in the total population, the scope of the dimensions considered is relatively broad; whereas in the approach for measuring the QoL of persons with disability, the starting point is assessing functioning connected with various limitations.
An interesting proposal for measuring QoL that combines elements of both of the above-mentioned approaches is the capability approach, which was developed and refined by Sen [
27‐
33]. This approach can be used to measure the QoL of the entire population, and specifically of the population with disabilities. The capability approach has been synthesised and practically applied by numerous authors in a wide variety of fields [
34‐
41]. This concept is based on the assumption that commodities themselves are not crucial to achieving a high quality of life. Instead, Sen argued, it is the properties of these commodities that enable individuals to achieve their desired lifestyles. The term “capabilities” refers to a person’s effective possibilities of realizing achievements and fulfilling expectations; whereas the term “functionings” refers to a person’s “beings and doings” that lead to these realized achievements and fulfilled expectations [
42]. To transform commodities into capabilities, three sets of conversion factors – personal, social, and environmental – are needed [
36,
43]. Personal conversion factors (personal characteristics, such as metabolism, physical condition, intelligence, or gender) influence the types and degrees of capabilities a person can generate from commodities. Social conversion factors come from the society in which one lives (characteristics of social settings, social institutions, and power structures, such as social norms, public policies, societal hierarchies, rule of law, political rights, etc.). Environmental conversion factors emerge from the physical or built environment in which a person lives (environmental characteristics, such as climate, infrastructure, institutions, and public goods). The achieved functionings are the result of personal choices selected from the capabilities available, and are subject to personal preferences, social pressures, and other decision-making mechanisms. Moreover, they are constrained by personal, social, and environmental characteristics [
36,
44]. In the context of inequality analysis, people must have equal opportunities to function in their preferred way [
27], as only then are they free to determine their capabilities – i.e., their potential, or possible ways of functioning – and to maximize their quality of life in accordance with these capabilities.
In this article, we have chosen to use the capability approach as a conceptual basis for the measurement model of the QoL. Moreover, we have constructed a measurement model for the whole population that we then apply to the population with disabilities. This macro-level approach could be used to create public policy guidelines aimed at the population with disabilities.
Living conditions, which should be shaped by public policy, especially at the local level, are associated with the concept of livability. It is rarely used in disability research, even though environmental conditions (such as accessible space) are especially important for this group of people. The concept of livability originally comes from the literature on public management. It was used for the first time in the U.S. in the 1970s in the context of discussions about urban sprawl and the problems caused by the degradation of the natural environment [
45]. Since then, the concept has mainly been developed in urban studies, although it originally also referred to rural areas [
7,
46]. While there are many definitions of livability, the term is often used in connection with concepts such as quality of life, living environment, the quality of the place of residence, and sustainable living [
8,
9,
47].
The term “livability” was originally used to refer to residents’ satisfaction with the area they are living in, and especially with the perception of living conditions in a particular area that should be shaped by both residents themselves and local authorities [
7]. This approach underlined two important elements of the livability concept: (1) its relationship with the environment in which the local community functions; and (2) the importance of focusing on the short-term perspective. Many authors have characterized the livability concept as a set of elements that make life in a particular locale easier or more comfortable. Among these elements are economic opportunities, public security, medical services, mobility, and recreation [
47‐
49]. These elements come from the social, economic, and technical (psychical) sphere, and they create possibilities to realize individual QoL [
50]. The interactions between the conditions created in the environment and the individual life situation determine the level of QoL [
51,
52]. In this context, spatial planning plays an important role, especially in cities [
53].
Recently, the livability concept has mainly been used in the context of meeting the social needs of residents [
54]. Therefore, the aim of creating livable areas is connected with social change, in particular through public policy, which should be initiated in those areas. This understanding of livability is in line with that in the UNCRPD, which also takes as a starting point the rights and needs of one particular group – in this case, persons with disabilities – for whom public authorities should create the environmental conditions needed to enable them to realize their desired QoL. Having access to proper environmental conditions is seen as an essential component of the human rights of persons with disabilities.
An important issue raised in livability studies is the measurement of this phenomenon. Two streams in measurement approaches can be distinguished. The first deals with satisfaction with the area where an individual lives, and its determinants [
7,
55,
56]. Howley et al. [
7] divided those determinants into two groups: (1) the first group of determinants are connected with livability (access to employment, social, educational and cultural services, security, housing, etc.), (2) while the second group of determinants correspond to individual characteristics (age, sex, family status, etc.). Cheshmehzangi [
57] also identified similar factors, which he grouped into economic, social, cultural, and environmental categories. The second stream refers to more objective measures of livability. There are many partial indicators created by researchers to measure the level of livability of particular areas (performance indicators) [
56,
58,
59].