Disability & Rehabilitation, 2012; Early Online: 1–7 © 2012 Informa UK, Ltd. ISSN 0963-8288 print/ISSN 1464-5165 online DOI: 10.3109/09638288.2012.717584
PERSPECTIVES IN REHABILITATION
Conceptualizing belonging Alyson L. Mahar, Virginie Cobigo & Heather Stuart
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Department of Community Health and Epidemiology, Queen’s University, Kingston, Ontario, Canada
Purpose: To develop a transdisciplinary conceptualization of social belonging that could be used to guide measurement approaches aimed at evaluating the effectiveness of community-based programs for people with disabilities. Method: We conducted a narrative, scoping review of peer reviewed English language literature published between 1990 and July 2011 using multiple databases, with “sense of belonging” as a key search term. The search engine ranked articles for relevance to the search strategy. Articles were searched in order until theoretical saturation was reached. We augmented this search strategy by reviewing reference lists of relevant papers. Results: Theoretical saturation was reached after 40 articles; 22 of which were qualitative accounts. We identified five intersecting themes: subjectivity; groundedness to an external referent; reciprocity; dynamism and selfdetermination. Conclusion: We define a sense of belonging as a subjective feeling of value and respect derived from a reciprocal relationship to an external referent that is built on a foundation of shared experiences, beliefs or personal characteristics. These feelings of external connectedness are grounded to the context or referent group, to whom one chooses, wants and feels permission to belong. This dynamic phenomenon may be either hindered or promoted by complex interactions between environmental and personal factors.
Implications for Rehabilitation Sense of belonging • Program evaluation and monitoring exist in order to measure success and outcomes of rehabilitation practice. • Sense of belonging is one of the goals of rehabilitation services, but has not yet been defined unambiguously, making it difficult for practitioners to understand if they are achieving these goals. • Researchers and practitioners in rehabilitation can define a sense of belonging as a subjective feeling of value and respect derived from a reciprocal relationship to an external referent that is built on a foundation of shared experiences, beliefs or personal characteristics when conceptualizing and designing tools to measure sense of belonging as an outcomes of their services. people worthy of respect and full enjoyment of human rights. The Convention imposes duties on its signatories, to uphold the dignity and human rights of people with disabilities, including people with physical, mental, intellectual and sensory disabilities. It squarely locates the problems of social inclusion with the social environment, rather than as a result of any individual impairment, and proscribes sweeping measures to insure the full and effective participation of people with disabilities in all walks of social life [1]. While the Convention highlights the importance of research and monitoring, there are many unresolved issues surrounding the concepts of social inclusion, social participation and social belonging and their respective metrics. Community-based rehabilitation was developed by The World Health Organization following the Declaration of Alma-Ata in 1978 as a strategy for making optimum use
Keywords: intellectual disabilities, mental health, sense of belonging, social belonging, social inclusion
Introduction In December 2006, the United Nations General Assembly adopted The Convention on the Rights of Persons with Disabilities, which solidified a new rights based disability paradigm which had been gathering momentum since the 1960s. Prior to that time, people with a disability were viewed as dependent; objects of care; requiring of social protections to help them compensate for their inabilities, rather than
Correspondence: Dr. Heather Stuart, Professor and Bell Canada Chair in Mental Health and Anti-stigma Research, Department of Community Health and Epidemiology, Queen’s University, Kingston, Ontario, Canada, K7L 3N6. E-mail:
[email protected] (Accepted July 2012)
1
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2 A. L. Mahar et al. of local resources to support people with disabilities. It has since evolved into a broad, multi-sectoral strategy that goes beyond meeting the basic needs of people with disabilities, to ensure better access to health, education, employment and social supports needed to enhance social participation and quality of life [2]. However, there is a paucity of evidence of its effectiveness [3,4]. Measuring service effectiveness requires new indicators and measurable elements on the structure, process and outcomes of care to assess progress toward these goals. As well as being scientifically sound (valid and reliable), these new indicators must be perceived as useful and relevant by all stakeholders. They must represent and measure aspects of services and supports considered important to researchers, policy makers, service providers, service users and their family [5]. Developing indicators must then rely on consensual definitions of the structure, process and outcomes of services. In the disability field, various philosophies influence stakeholders’ perspectives and such a consensus is often difficult to achieve [3]. Most recently, the World Health Organization has also identified a need for stronger research and population monitoring. For example, the aim of the World Report on Disability is to provide the “evidence for progressive policies and programmes that can improve the lives of persons with disabilities and facilitate the implementation of the United Nations Convention on the Rights of Persons with Disabilities” [6]. Toward this end, the report strongly recommends an increase in research, particularly data evaluating the quality of services provided to persons with disabilities to monitor service provision and effectiveness. The current lack of data on rehabilitation service effectiveness impedes the development of standards and evidence-based guidelines and consequently limits actions [4,7]. Feeling a sense of belonging to the community has been identified as a core dimension of social inclusion of persons with disabilities [8]. Because the psychosocial experience of disability has been overwhelmingly associated with social exclusion, stigma and discrimination, effective communitybased rehabilitation programmes must increase users’ sense of belonging to their social groups [2]. The current literature on “sense of belonging” is vast and spans a number of disciplines and with no apparent consensus. Before we may begin to tailor interventions to improve social belonging of marginalized groups and measure our effectiveness in achieving this goal, we require a clearer conceptual understanding of “sense of belonging”. We undertook this review in order to develop a transdisciplinary conceptualization of social belonging from the various disciplines and stakeholder groups represented in the literature, to guide measurement approaches aimed at evaluating the effectiveness of community-based programs for people with disabilities. Though we have disciplinary backgrounds that span social science, psychology and epidemiology, our common point of departure was to identify concepts and measurement approaches that could be used in a multi-disciplinary and multi-agency context to assess the extent to which persons’ with intellectual disabilities experienced a sense of belonging to their respective communities of interest.
Methods Data sources We undertook a narrative literature review using the SUMMON database and the key search term “sense of belonging”. Given the various philosophies on sense of belonging in the field of disability and beyond, a systematic review of the literature was not possible [3]. The SUMMON literature collection is a search engine that simultaneously searches Canadian university library collections as well as nationally and internationally published journals, newspapers and magazines. Similar searches were performed in OVID Medline, Embase, Scholars Portal and Academic Search Complete. We limited the search to peer-reviewed literature published between 1990 and July 17, 2011. Articles published in English were included and no study design restrictions were imposed. Study selection and review process The search engine ranked search results for relevance using a standardized algorithm with the result that the most relevant articles appeared at the top of the search results. Although this algorithm is a trade secret and so not publicly available, it looks for exact matches (among other things), primarily in titles. We also conducted manual searches of reference lists. To be eligible for inclusion in the study, articles must have either a) qualitatively explored the meaning of sense of belonging with a referent group; b) had sense of belonging emerge as a theme from qualitative research; or c) quantitatively measured sense of belonging as either a dependent or an independent variable. Selection of studies continued until saturation in the key concepts was reached. Articles were assessed by the first author and article inclusion re-evaluated by the remaining authors. Data extraction and synthesis Descriptive characteristics of each study were recorded by the primary author to provide a summary of the reviewed articles and included the following outcomes of interest: discipline of study, population of interest and definition of sense of belonging. Definitions of sense of belonging were taken from introductory statements and operational definitions from the methods sections. Qualitative studies exploring the meaning of belonging were also considered. Although they did not systematically report a definition of belonging, their findings informed us on the core dimensions of the psychosocial experience of belonging. Main trends and critical themes were identified and qualitatively summarized across all disciplines to provide a transdisciplinary conceptualization. They were categorized into recurrent, coherent and meaningful statements by the first author and then reviewed by the two co-authors. Five core themes were identified and named to represent their meaning without reference to any specific discipline’s terminology. Themes were double coded by the same investigator and the results were identical.
Results Literature search results We identified over 8000 unique abstracts from the SUMMON database from education, mental health,
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cultural/ethnic identity (including immigration and citizenship), disability, religion and other disciplines. Additional searches of OVID Medline, Embase, Scholars Portal and Academic Search Complete did not contribute additional unique articles. Saturation of definitions was
reached after 40 articles, when no new conceptualizations were identified. Twenty of the 40 articles provided conceptual or operational definitions for a sense of belonging and 22 of the 40 articles contributed qualitative results pertaining to a sense of belonging.
Table I. Existing definitions of sense of belonging referenced or used in the transdisciplinary literature. Study Definition Bettez [29] Belonging in human relations is connected to identity, both self-identification and identification with others. Bollen [36] A construct of perceived cohesion, a sense of belonging comprises both cognitive and affective elements. At the cognitive level, judgements of belonging include accumulated information about experiences with the group as a whole and with other group members. At the affective level, judgements of belonging include feelings that reflect the individual’s appraisal of their experiences with the group and group members. Caxaj [37] Experiences of belonging are a culmination of mediating influences of exclusion and inclusion on spatial, symbolic and social relationships. Boundaries of belonging, marked through processes of exclusion and inclusion, are often experiences as highly racialized, gendered and economic realities. Highly contextualized, multidimensional phenomenon informed by personal and environmental factors. Multiple levels. Complex and changing social processes. Highly shaped by specific contexts, it generally involves a sense of connectedness, positive interaction with social others, and a highly complex performance of identity. Chavis [38] Characterized by mutual concern, connection, loyalty and trust that personal needs will be met through commitment to the group as a whole. One element of membership, one of the four constructs that make up a sense of community. Cueto [18] The degree to which people feel socially connected. Associated with peer and teacher relations, perceived discrimination (i.e. Belonging to an ethnic group that is somehow alienated), student motivation (i.e. Efficacy beliefs and valuing school activities) and time on extracurricular activities. Finn [39] The extent of personal membership, respect and support that students feel in the school, feelings of congruence with self and the institution, leading to a sense of value or identification with the school. This sense of identification is mediated by positive and negative encouragement from their family, peer group, teachers and other persons in positions of authority, academic, social, athletic or other successes. Goodenow [21] Believe themselves to be welcomed, valued and respected by others there or have a sense of school membership, referring to not the technical enrolment but the individual’s perception that others in the school are for them and that they count in the school Hagerty [14] The experience of personal involvement in a system or environment so that persons feel themselves to be an integral part of that system or environment. Two critical attributes of sense of belonging: (a) valued involvement or the experience of being valued and needed and (b) fit, the person’s perception that his or her characteristics articulate with or complement the system or environment Hausmann [40] Psychological sense that one is a valued member of the college community. Hill [41] Measured sense of belonging as connectedness, with connectedness being defined as the interrelatedness, intertwining and interlacing of the 7 dimensions forming a circle and represent worldview of Native American Culture (A Conceptual Framework of Nursing in Native American Culture (2001)). Hurtado [13] Perceived group cohesion as a psychological construct separate from observable group cohesion (group membership or participation). Hurtado [42] Latino student’s feeling of social cohesion and group membership based on college attendance. This construct reflects a student’s affinity with their institution, including whether students feel part of campus life, are a member of the community and feel a sense of morale as a result of being a student at their public university. Krause [43] Sense of belonging to a congregation is shaped by the interplay between ones history with a congregation, support received from fellow church members, current levels of church attendance and negative interaction with fellow parishioners. Lee [34] Connectedness one feels towards his or her school. Levett-Jones 2009 [30] A deeply personal and contextually mediated experience that evolves in response to the degree to which an individual feels (a) secure, accepted, included, valued and respected by a defined group, (b) connected with or integral to the group and (c) that their professional and/or personal values are in harmony with those of the group. The experience of belongingness may evolve passively in response to the actions of the group to which one aspires to belong and/or actively through the actions initiated by the individual. Maestas [20] Psychological dimension of integration, feelings of attachment to groups, systems or environments. Museus [44] An individual’s perceived sense of cohesion. Measured as the extent to which an individual felt part of the cultures on campus. Sedgwick [45] A shared sense of socially constructed meaning that provides a sense of security or relatedness. Acceptance from others. Unique to the individual and deeply personal. Strayhorn [46] Consists of both cognitive and affective elements, an individual assesses his or her position or role in relation to the group (cognitive) which in turn results in a response or behaviour (affective). Feeling that one is important to others, that one matters. Operationally defined as their perceived sense of integration. Walseth [47] Belonging to the block incorporates both geographic and familial affiliations, is related to social experiences and tied to close, personal relationships. To belong means to look out for one another. Belonging may be developed or solidified through participation in formal events or organizations within the community. © 2012 Informa UK, Ltd.
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Existing definitions of sense of belonging Table I summarizes the definitions abstracted from the 21 articles that explicitly stated a definition or conceptualization of “belonging”. Sense of belonging was often referred to as a personal feeling or perception of an individual as they related to or interacted with others, a group, or a system that was separate from an individual’s actions, behaviour or social participation. Feeling needed, important, integral, valued, respected or feeling in harmony with the group or system, characterized most definitions of belonging. Connectedness and perceived cohesion with a group were also recurring themes. Several components were not common across all definitions. The contextual nature of a sense of belonging was highlighted by a few studies, and its fluidity and its evolution as either a passive or active experience were also noted. In some cases, attributes of the definition were discipline or context specific, such as feeling included in a particular reference community. For example, perception of peer and teacher relationships, time spent involved in extracurricular activities and perceived support in the school social environment were unique aspects to the education literature. References to Maslow, Durkheim, as well as Spade and Tinto were common throughout the literature as being the original framework for definitions of a sense of belonging [9–12]. Qualitative exploration of a sense of belonging Table II summarizes the themes identified from the 22 qualitative studies that explored the phenomenology and personal meanings of sense of belonging. Themes present in these studies supported the concept of belonging to a relationship, group or system – some entity outside of oneself – but
expanded this notion to include belonging to a relationship, a historical or current event and a place. Feeling valued and respected, and the influence of opinions and interactions of an individual with the group were also identified as being important to a sense of belonging. Specifically, a sense of reciprocity or exchange of feelings or beliefs between the individual and the group of interest, as well as a feeling of acceptance by the group were identified, where acceptance could stem from the shared experiences, understandings or behaviours between the individual and the group. Some existing definitions captured this aspect of a sense of belonging by describing a necessary sense of harmony of characteristics between the individual and the group. This theme was consistently referred to as fitting in, and often equated with normality. The new concepts that arose from the qualitative literature beyond those identified in the empirical studies included multiplicity of belonging, conflict of belonging, the role of identity, the role of choice and the role of the power. The influence of the environment was discussed across disciplines in the qualitative literature, whereas in the quantitative studies this was restricted to the educational literature. Thus, it is important to note that an individual may feel a sense of belonging to more than one relationship, group, system or entity simultaneously with each situation encompassing a sense of belonging that is unique to that relationship. Similarly, an individual’s sense of belonging in one situation may conflict with another. The multiplicity and conflict in an individual’s sense of belonging may be internalized by the individual through adaptation to certain settings or environments, so can best be characterized as a fluid or transitory feeling.
Table II. Common themes of a sense of belonging derived from the qualitative transdisciplinary literature. Theme Study Subjectivity Reciprocity Groundedness Ahnallen [35] √ √ √ Bettez [29] √ √ √ Caxaj [37] √ − √ Chaitin [33] − − √ Cloutier-Fisher [48] − √ − Cortis [49] √ − √ Davidson [15] √ − √ de la Rie [50] − − √ Gracey [51] √ − √ Kember [16] − √ √ Kim [52] − √ √ Lee [34] √ − − Levett-Jones [53] √ − − Nolbris [54] √ √ − Oftedal [32] √ √ √ Ostlie [31] √ √ √ Perry [55] √ √ √ Piat [56] − √ √ Sedgwick [45] √ − − Stewart [57] − √ √ Ussher [17] √ √ − Young [58] − − √
Dynamism √ √ √ √ − √ − − − √ √ − − − − − − √ − − −
Self-determination − √ √ √ − − − − √ − √ − − √ − − − − √ − −
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Conceptualizing belonging 5 The environment may also hinder or promote a sense of belonging to modify the interaction of an individual with others, the group, system or other external entity. Environment was described as internal or external – internal referring to the attitudes and beliefs of the individual experiencing (or not) the sense of belonging and external referring to a range of factors that may impact an individual’s sense of belonging from social support networks to the political climate. It was within the realm of environmental factors that the role of choice and power as contributing to a sense of belonging could be best categorized. For example, an individual may fit the criteria for having a sense of belonging to a group through shared experiences, or a sense of value and respect, yet not be interested in belonging or choose not to belong. Conversely, an individual may feel a sense of affinity for a particular group and have a sense of belonging, yet not have the power to choose as a result of discrimination or perceived isolation. Such experiences create conflicting feelings of belonging.
Conceptualizing belonging As this review has highlighted, the concept of a sense of belonging has been used in numerous disciplines. Existing definitions share several common themes and components of meaning; however, they are not uniformly concordant, completely described and have been limited by particular disciplinary foci. Based on our review, we suggest the following five elements are central to a transdisciplinary, multidimensional understanding of the sense of belonging. Subjectivity First and foremost, a sense of belonging is a perception that is unique to the individual that centres on feelings of value, respect and fit. We would argue that it is important to capture the perceptions of an individual separately from their formal, objective membership or physical participation with an external entity such as a group. For example, Hurtado et al [13]. noted that perception was separate from the observable group membership and its contribution to school attrition needed to be considered separately. Hagerty et al [14]. also emphasized belonging as a psychological construct by placing weight on both the value and perceived fit that an individual perceives in their interactions with a system or environment. Davidson et al [15]. interviewed individuals with a serious mental illness concerning the role of their family in the recovery process. An important theme was the sense of belonging conferred by the family and the contribution of feeling valued, respected and of “fitting in somewhere”. We would argue, therefore, that these instinctive reflections represent an integral part of the definition of sense of belonging as they correspond to the personal and important qualities of how membership in a relationship, group, system makes the individual feel. Of course, this distinction formally divides a sense of belonging from social participation, allows for inclusion of the individual’s reaction or qualitative response to interactions and group memberships and gives weight to the additional feelings that membership or belonging to a relationship, group, system or other entity provides. Therefore, achieving a sense of © 2012 Informa UK, Ltd.
belonging requires that the individual perceive that they are valued, respected or otherwise subjectively engaged.
Groundedness An appropriate understanding of a sense of belonging requires that a referent group for belonging is provided to anchor the subjective feeling. One belongs to something. Though the reference groups of interest differed depending on the disciplinary focus, all identified some external referent to which the individual felt they belonged. For example, in education referent groups included schools or institutes of higher learning, peer groups, classrooms or an entire campus community [16–22]. On a broader scale, Hagerty et al [14]. created a tool to measure a sense of belonging to the general community, which has been used by many to study a sense of belonging in sexuality, mental health and in the context of domestic violence [23–28].. Therefore, to measure a sense of belonging, one must specify the external referent that serves to ground the individuals’ subjective perceptions. Because of the possibility that a sense of belonging may be multifaceted and conflicting, depending on the external referent, a global measure will not have practical applications and may be misleading. Reciprocity Reciprocity refers to a sense of relatedness or connectedness that is shared by the individual and the external referent. Shared feelings, experiences or understandings aid in the creation of a sense of belonging and it should be noted that this goes beyond having similar physical, intellectual or behavioural characteristics. While similar physical, intellectual or behavioural characteristics may be used to exclude someone from a social group; alone they are insufficient to engender a feeling of belonging. While an identifying characteristic or label may place an individual within a social group or system, they lack the weight to define the perception of belonging. For example, Bettez [29] interviewed mixed-race women on how individuals belong to something and how you know when you belong. Although shared physical characteristics were highlighted as contributing to a sense of belonging, it was the shared experiences, understandings and beliefs that created a sense of comfort and safety in an interaction. When describing the sense of belonging felt by nursing students in learning placements Levett-Jones et al [30]. described feelings of having professional or personal values in harmony with the group. The role played by shared histories and beliefs in cementing an individual’s feeling of connection is necessary to perceiving a sense of belonging, although the specific mechanism has not been elucidated in the qualitative literature. Feeling supported by a group, welcomed, prepared or explicit acknowledgement of shared experiences or beliefs facilitates belongingness and helps to build a sense of belonging [16]. An individual may feel a sense of belonging to more than one referent, with each interaction possessing a unique combination of elements that create a sense of belonging for that individual. This theme was especially evident throughout the literature on identity, ethnicity, race, sexuality and citizenship. For example, studies investigating the life experiences of individuals with juvenile idiopathic arthritis found that a common
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theme was the sense of belonging to both the disease and to significant others (such as family members, relationships and peer groups). These feelings contained conflicting negative and positive elements that led to feelings of both exclusion and inclusion [31]. Oftedal (2010) also described these conflicting feelings among individuals with Type II diabetes, in their desire to be considered “normal”, but their belonging to their “illness” preventing this synchronous perception [32]. Thus, conflicting feelings may co-exist through overlapping shared experiences, history or beliefs. Special cases of discordance stem from conflict between social roles, norms or individual characteristics that are socially stigmatized. This may disrupt an individual’s feeling of fit within a group and may result in a heightened feeling of alienation, discrimination or loneliness.
Dynamism Both physical and social environments may contribute to or detract from an individual’s sense of belonging. These environmental factors may be transitory, or they may permanently affect an individual’s sense of belonging, resulting in a dynamic tension. Chaitin (2009) spoke to Israeli and Palestinian immigrants to the United States to explore their sense of belonging to conflict. They discovered that the individual was able to adapt their sense of belonging to culture, religion and to external events so as to be flexible to their current and previous situations [33]. Examples of physical barriers include geographic area, and a disability or illness that restricts access, interaction or complete concordance with a referent. Social barriers may include castes, behaviours of a group toward an individual, prejudice and discrimination or the political or economic climate. The dynamic interplay between enablers and barriers needs to be recognized in any formal definition of sense of belonging. Self-determination Self-determination respects the right of the individual to choose to interact with referents and their perceived power in the interaction. An individual’s ability to feel a sense of belonging and their subsequent decision to feel that they do or do not belong is an interesting intricacy of belongingness. Individuals who feel powerless to belong as the result of physical or environmental factors may otherwise “qualify” for group membership, yet never successfully achieve a sense of belonging [29,33,34]. For example, Anhallen interviewed Japanese European Americans about their ethnic identity in an attempt to understand what belonging meant to them. They emphasized choice and power in determining an individual’s sense of belonging, and discussed the nuance of whether or not exclusion was explicitly conveyed. In those instances, the power to interact was removed from the individual and a sense of belonging was not achieved [35]. Systemic power differentials resulting from historical discrimination, social roles, norms or institutionalized discrimination are, therefore, important barriers to the feeling of self-determination and choice. Choice infers that the individual has control over to whom or what they belong to and the power to develop satisfying reciprocal interactions. This highlights the importance of weighting a sense of belonging against whether or not an individual feels they can belong, and secondarily, whether or not they want to belong.
Summary In this paper we have reviewed key themes of social belonging from a multi-faceted and transdisciplinary perspective in order to arrive at a nominal definition that could be used to guide the measurement of service outcomes related to a sense of belonging. Though our review was restricted in the number of articles included, the concepts represented did reach theoretical saturation. Given the importance of community-based care for people with disabilities we have argued that a clearer conceptualization is necessary in order to appropriately evaluate the effectiveness of community-based strategies that purport to promote social inclusion and social belonging. Based on our review, our conceptualization of social belonging is based on five intersecting themes which we consider are central to the definition: subjectivity, groundedness to an external referent; reciprocity; dynamism and self-determination. From our perspective, then, a sense of belonging can be defined as a subjective feeling of value and respect derived from a reciprocal relationship to an external referent that is built on a foundation of shared experiences, beliefs or personal characteristics. These feelings of external connectedness are grounded to the context or referent group, to whom one chooses, wants and feels permission to belong. This dynamic phenomenon may be either hindered or promoted by complex interactions between environmental and personal factors. Working within a large, government-sponsored research program that is designed to develop indicators of the various aspects of social inclusion for people who have intellectual disabilities, we are now well positioned to devise metrics to capture this important service outcome.
Acknowledgements This review is part of a broader initiative funded by the Ontario Ministry of Community and Social Services. For more information on our research program, please visit www. mapsresearch.ca. Declaration of Interest: This study was undertaken as part of the Multidimensional Assessment of Services and Providers (MAPS). MAPS is a research program to inform the assessment of services and supports for adults with intellectual/ developmental disabilities in Ontario, Canada. MAPS (www. mapsresearch.ca) is supported by a research grant from the Government of Ontario’s Ministry of Community and Social Services. The author benefited from feedback and comments from MAPS co-researchers: H. Ouellette-Kuntz, R. Hickey, Y. Lunsky, R. Lysaght, L. Martin. The views expressed in this study report are not necessarily the views of all MAPS partners, researchers, collaborators or those of the Ministry.
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