Implementation Practices

Globally, the prevalence of university students living with a debilitating mental illness or psychological stress, anxiety and depression  is high. South Africa is no different and better  co-ordinated programmes are desperately /urgently needed to support the wellness of  people with psychosocial disabilities  achieve their educational goals. By developing a disability-inclusive environment that enables  personal recovery, we aim to increase the retention of students with psychosocial disabilities in the higher education sector, and facilitate their optimal participation and transition to dignified work.

Salih Hendricks is a lived experience researcher, disability advocate, and global diabetes and obesity advocate based in Cape Town, South Africa. Living with type 1 diabetes since 1982, Salih brings more than four decades of firsthand experience navigating the complex realities of chronic disease, disability, healthcare systems, and social inclusion.

His journey includes surviving diabetic complications such as peripheral artery disease, vision impairment, stroke, and an above-knee amputation. Rather than allowing these experiences to define him, Salih has transformed them into a platform for advocacy, research, education, and systems change. His work focuses on amplifying the voices of people living with diabetes, obesity, and disabilities, particularly those from underserved and underrepresented communities across the Global South.

Salih serves as a Research Assistant with the Inclusive Practices Africa (IPA) Research Unit within the Department of Health and Rehabilitation Sciences at the University of Cape Town. His work contributes to disability inclusion, lived experience research, public engagement, advocacy, and the development of innovative frameworks that bridge clinical knowledge with the realities of everyday life.

Internationally, Salih has participated in and contributed to initiatives involving the International Diabetes Federation (IDF), World Obesity Federation (WOF), EASD, ADA, and other global health organisations. He is widely recognised for championing the integration of lived experience into research, policy development, healthcare design, and leadership.

Salih is the creator of the 7 Worlds Framework, an innovative model that explores the interconnected biological, psychological, social, environmental, and lived experience dimensions of health. Through this work, he seeks to advance person-centred care, disability inclusion, and a deeper understanding of the human experience of chronic conditions.

His vision is simple yet ambitious: to ensure that no person living with diabetes, obesity, disability, or other chronic conditions is left unheard, unseen, or excluded from decisions that affect their lives.

Why I Developed the 7 Worlds Framework

After more than 44 years of living with type 1 diabetes and experiencing multiple complications, I came to realise that health cannot be understood through laboratory results, diagnoses, or clinical measurements alone.

Healthcare systems often focus on isolated medical outcomes while overlooking the broader realities that shape people's lives. My own journey revealed that diabetes, obesity, disability, and wellbeing are influenced by a complex interaction of biological, emotional, social, environmental, and personal factors.

The 7 Worlds Framework was developed to bridge the gap between clinical knowledge and lived experience. It provides a holistic way of understanding health by recognising that every person exists within multiple interconnected worlds that continuously influence one another.

The framework encourages healthcare professionals, researchers, policymakers, advocates, and communities to move beyond disease-centred thinking toward a more human-centred and inclusive approach.

The Seven Domains

1. Biological World

The genetic, cellular, and physiological foundations of health and disease.

Examples: genetics, immune function, organ systems, inflammation, disease processes.

2. Metabolic World

The body's energy regulation systems and metabolic health.

Examples: glucose regulation, insulin resistance, obesity, weight regulation, lipid metabolism.

3. Physiological World

The functional performance of the body and its systems.

Examples: mobility, circulation, cardiovascular health, sensory function, rehabilitation outcomes.

4. Psychological World

Thoughts, emotions, mental wellbeing, and behavioural responses.

Examples: diabetes distress, depression, anxiety, resilience, motivation, self-efficacy.

5. Social World

Relationships, communities, culture, and social determinants of health.

Examples: family support, stigma, discrimination, employment, education, socioeconomic conditions.

6. Interoceptive World

The internal awareness of bodily sensations and signals.

Examples: recognising hypoglycaemia, hunger, pain, fatigue, emotional awareness, bodily intuition.

7. Exteroceptive World

The external environment and how people interact with it.

Examples: healthcare systems, technology, accessibility, policies, built environments, social attitudes.

Application to Diabetes, Obesity, Disability and Inclusion

The 7 Worlds Framework demonstrates that health conditions do not exist in isolation.

For a person living with diabetes, glucose management may be influenced by emotional stress, financial challenges, access to healthcare, social stigma, mobility limitations, or environmental barriers.

For a person living with obesity, weight is not simply a matter of personal responsibility. Biological predisposition, metabolic adaptation, psychological wellbeing, social determinants, cultural influences, and environmental conditions all interact to shape outcomes.

For people living with disabilities, the framework highlights how participation and quality of life are influenced not only by impairments but also by societal attitudes, accessibility, inclusion, and support systems.

By integrating these seven worlds, the framework promotes:

• Person-centred care
• Multidisciplinary collaboration
• Disability-inclusive health systems
• Reduction of stigma and discrimination
• Greater recognition of lived experience expertise
• Improved health equity and inclusion

Future Research and Implementation

The long-term vision for the 7 Worlds Framework is to establish it as a practical tool for research, education, advocacy, healthcare design, and policy development.

Future areas of development include:

• Academic validation of the framework through qualitative and mixed-methods research.
• Integration into disability-inclusive healthcare and rehabilitation programmes.
• Development of educational resources for healthcare professionals and students.
• Application within diabetes, obesity, disability, and non-communicable disease research.
• Co-design projects with people with lived experience.
• International collaborations across Global North and Global South settings.
• Creation of community-based assessment and intervention tools informed by the framework.
• Exploration of its use in leadership, advocacy, and public health planning.

The ultimate goal is to create a model that helps healthcare systems see the whole person rather than only the disease, ensuring that lived experience becomes a valued and essential source of knowledge in research, practice, and policy.

Developed by Salih Hendricks
Lived Experience Researcher | Disability Advocate | Global Diabetes and Obesity Advocate
University of Cape Town – Inclusive Practices Africa (IPA) Research Unit