INTRODUCTION

The wheelchair provision process plays an important role to ensure the fit and quality of a wheelchair for people with disabilities. The Rehabilitation Engineering & Assistive Technology Society of North America (RESNA) published a wheelchair service provision guide that recommends the essential steps in the wheelchair service delivery process (Arledge et al., 2011), and various sources stress that the consumer of a wheelchair should play the center role in the wheelchair service delivery process (Arledge, et al., 2011; Eggers et al., 2009). However, the process can be overwhelming for consumers, and a lack of information on the service delivery process and mobility devices were noted as issues (Evans, Frank, Neophytou, & De Souza, 2007; Greer, Brasure, & Wilt, 2012; Jedeloo, Witte, Linssen, & Schrijvers, 2002) . To provide a guide specifically for wheelchair users, UsersFirst, an advocacy group for wheelchair users, developed a Mobility Map, which is a web-based tool that provides comprehensive and detailed steps for consumers to  obtain a wheelchair (UsersFirst). However, its portability is limited by the need of using a web browser. Our research team is collaborating with UserFirst to develop a smartphone app to guide consumers through the wheelchair service delivery process. Our aim is to empower and prepare wheelchair users to get through the wheelchair service delivery process by providing timely and step-by-step checklists in conjunction with educational information through the smartphone app. In order to include appropriate and necessary information in the app, we conducted an interview study to collect suggestions and expectations from wheelchair users on how a smartphone app can help them to go through the wheelchair provision process smoothly. This paper is to present a short summary of the findings.

METHODS

The study protocol was reviewed and approved by the Institutional Review Board of the University of Pittsburgh (Pitt IRB), including a waiver to document informed consent. Recruitment was conducted through clinicians at the Center for Assistive Technology (CAT) of the University of Pittsburgh Medical Center (UPMC), and Facebook after we obtained approval from the page owner. Potential participants were provided with a flyer and if interested, he or she contacted the investigators. An investigator followed an approved script to conduct the informed consent process and participants provided verbal consent. The inclusion criteria were: participant was 1) older than 18 years old, 2) a wheelchair user, 3) using his/her wheelchair independently, and 4) using his/her wheelchair as their primary means of daily mobility. The eligible participant was provided with the option to participate in 1) a group interview with other wheelchair users, 2) a one-on-one interview in person, or 3) a one-on-one phone interview.

Prior to the scheduled interview, the participants completed a demographic questionnaire that included his or her history of using mobility devices. The first part of the interview was about the experience during the wheelchair provision process. The second part of the interview was about participants' suggestions and expectations for a smartphone app to help with or facilitate the wheelchair provision process. The investigator explained the purpose and features of the app. Participants then answered a short survey about whether they felt a smartphone app would be helpful. Suggestions and expectations were gathered through an interview using the questions presented in Table 1. Using a guided interview process, participants were prompted to elaborate on each question.

Table 1 Survey questions and guiding interview questions

Survey Questions
If you are going to replace your mobility device, will this app be helpful for you? (Options: Very helpful/ Helpful/ Slightly helpful/ Not helpful) Please write down why the app will or will not be helpful for you. Will this app be helpful for other wheelchair users who are going to replace their devices or get a new device? (Options: Very helpful/ Helpful/ Slightly helpful/ Not helpful) Please write down why the app will or will not be helpful for other wheelchair users. What reviews/comments would you be willing to provide online (check all that apply)? (Options: your mobility device/ wheelchair seating clinic/ wheelchair supplier/ none of the above) Please write down why you would or would not. If you are willing to provide your comments/reviews about your device, would you be willing to provide your demographics (age, gender, disability, transfer methods) online to allow other users know more about how different needs match different devices? (Options: Yes/ No) Please write down why you would or would not.
Guiding Questions
How do you expect a smartphone app to help you if you are going to replace your mobility device? What features that you would expect this app to have? What factors or features may increase your motivation to use this app?

The interviews were audio-recorded and transcribed into typed manuscripts. Descriptive analysis was applied to evaluate the results from the demographic survey and the short survey. Participants' suggestions and expectations about the smartphone app were summarized in the result section.

RESULT

Fifteen wheelchair users participated in the interview study. Table 2 shows participant demographics. Participants’ answers to the short survey were shown in Table 3. Participants’ suggestions included ideas to facilitate the wheelchair provision process and app features for novice wheelchair users, (e.g.,  health management and wheelchair funding information, a wheelchair usage tracker,  and a tool to facilitate connections with wheelchair seating professionals and wheelchair users. The suggestions were categorized and shown in Table 4.

Table 2 Participant demographics

Demographic Variable			% (Counts) or Mean ± SD
Age (years old)			37.3±13.1
Gender: female			33% (5)
Years after diagnosis			22.2±13.8
Diagnosis
	Spinal Cord Injury	-Cervical	(5)
		-Thoracic	(1)
		-Lumbar	(2)
	Cerebral Palsy		(4)
	Muscular Atrophy		(1)
	Delayed Progressive Radiation Myelopathy		(1)
	Spinal Bifida		(1)
Years of experience using a wheelchair			15.7±11.6
Power Wheelchair Users			73% (11)
Smartphone Users			87% (13)
Age of current wheelchair (years)			2.8±2.1

Table 3 Answers for the short surveys along the interview

Option	% (Counts)
App helpful for you?
Very helpful	7% (1)
Helpful	47% (7)
Slightly helpful	27% (4)
Not helpful	20% (3)
App helpful for other wheelchair users?
Very helpful	33% (5)
Helpful	67% (10)
Slightly helpful	0% (0)
Not helpful	0% (0)
What reviews would you provide online?
Mobility Device	93% (14)
Wheelchair seating clinic	73% (11)
Supplier	93% (14)
Willing to share some of your demographics with the review?
Yes	100% (15)

Table 4 Features that the app should equip to help users go through the wheelchair provision process

Information: a guide for the wheelchair provision process (Mentioned by 5 participants)
Information: funding processes (Mentioned by 6 participants)	Insurance coverage and funding process Years of a wheelchair expected to be used Tips for suppliers or therapist to write a good letter to get the wheelchair approved How to apply disability benefits Where and how to find funding
Information: database (Mentioned by 8 participants)	Suppliers and repair shops filtered by areas Wheelchair seating professionals filtered by areas What wheelchair part is covered by the insurance Collections of wheelchair manuals Support groups filtered by areas Accessible restaurants and bars Wheelchairs and their insurance codes
Information: living with SCI (Mentioned by 2 participants)	What to expect and what to do next Health related issues
Information: wheelchair selection and setup (Mentioned by 5 participants)	Options of wheelchairs and parts Assessories can be put on a wheelchair Information to let the user know whether the wheelchair is appropriate or not How to know what is the best wheelchair for the user
Information: wheelchair usage (Mentioned by 4 participants)	Challenges and accessibility issues, especially about transportation Troubleshooting tips when the wheelchair is not working
Provide a communication portal (Mentioned by 6 participants)	A portal that all the team members can log in to track and update the progress of the wheelchair provision process A portal that the user-names of wheelchair users are shown on the map, and one user can connect with another in the same area.
Track wheelchair maintenance (Mentioned by 3 participants)	Warn the user that something about to go wrong with the chair Remind to maintain the wheelchair Track mileage Remind the user to charge the wheelchair
Allow users to leave reviews about wheelchairs, cushions, parts, and suppliers (Mentioned by 3 participants)
Track activity level or stroke number for manual wheelchair users (Mentioned by 1 participant)
Facilitate supplier service (Mentioned by 3 participants)	Track where the supplier is and when will arrive Track the progress of the wheelchair repair or assembly Track and contact the supplier or manufacturer to fix the wheelchair
User interface requirement (Mentioned by 4 participants)	Easy to use; least keystroke to activate a function; icon-based interface; no flashy colors Integrate voice command or hand-free control like Bluetooth Can develop a version to allow multiple users for case managers or lawyers
Should collaborate with clinics, therapists, or supplier to promote the app (Mentioned by 2 participants)

DISCUSSION

According to our participants, providing related information and facilitating communication with the supplier, physician, and therapist are important app features to help individuals go through the wheelchair provision process. A lot of information about the wheelchair provision process can be found online, but the individuals have to collect information from several websites without knowing about the credibility of the sources and the quality of the information. Our research team is working with the clincians from the UsersFirst group to reorganize the information and design the layout of the app to enhance the portability and usability of the materials. Besides the features that would directly help users to go through the wheelchair provision process, several suggestions were about providing information to empower users to proactively manage health, independently and safely use wheelchairs, and make informed decisions concerning wheelchair selection. Currently we are planning to develop an app to provide related information and allow the user to track the progress of the service delivery process independently. In addition, associate apps are also being developed to provide information about wheelchair selection and setup, wheelchair usage, wheelchair maintenance plus a reminder function to notify the user of to-do tasks, and allow users to share their comments about wheelchairs. Figure 1 and Figure 2 are the mock-up app pages that we are currently developing. The app design and development will be described in detail in our future publication. Participants also felt that the databases of wheelchairs, wheelchair seating professionals, and support groups would be helpful, and a communication portal can further facilitate the process to be more client-friendly. These two features are not included in this app development project because they will require significant efforts to collect and organize the information, maintain the database and data transfer, and manage collaboration among every stakeholder in the wheelchair provision process. Participants also suggested features to facilitate communication with suppliers and detect the performance or problems of a wheelchair. These features can be potential features in future app development.