BACKGROUND

It is estimated that approximately one billion people in the world have a disability; in the United States, 27.2% of the population (85.3 million people) have a disability [1,10]. Of the 85.3 million people, individuals experience disability related to vision, hearing, mobility, object manipulation, and cognition (Fig. 1) [2,3]. The three life areas most impacted by a disability are mobility, self-care, and household activities including meal preparation and housework. Of these categories, household activity is reported to be most affected with 71% of people with disabilities having limitations and difficulties making meals for themselves and their loved ones, especially as age increases [4]. Twelve-million adults cannot complete the task independently, and a strong reason is the lack of accessibility and usability of the small kitchen appliances currently on the market [2]. 

Food and beverage preparation, though only one facet of household activities, has a tremendous impact on quality of life, sense of well-being, independence, and health. Many small kitchen appliances, or kitchen countertop appliances, are used every day and allow users to prepare healthy meals and drinks that reduce the risk for depression, stroke, heart disease, cancer, diabetes, osteoporosis, and inflammatory diseases such as arthritis, one of the most common causes of disability in America [4,5]. Disease and disability often keep individuals from being able to leave their home (approximately 1.9 million people), increasing the necessity for the accessible and usable design of small kitchen appliances [6]. The ability to independently prepare food and drink is an important way to express independence and entertain others for social well-being and quality of life.

To date, considering the size of the population with disabilities that challenge meal preparation, a large gap exists to provide accessibility and usability guidelines of commonly used small kitchen appliances. Section 804 of the Americans with Disabilities Act (ADA) guidelines include specifications regarding public or commercial kitchen layout, clear floor space, sink height, storage location, workspace height, dishwasher position, cooktop location, oven relation to workspace, and refrigerator and freezer position. However, there are no guidelines addressing small kitchen appliances [7].

An example of accessible and usable kitchen tools and cookware is the OXO product line that “incorporated plump, resilient handles for twist and push-pull tools like knives and peelers…all handles were oval in cross section, to better distribute forces on the hand and enhance grip...the measuring cups and spoons featured large, high-contrast markings for visibility.” These products help when preparing food and drink, but without the countertop appliances to create a meal, the assistive tools are essentially meaningless [8]. To the best of our knowledge, the only major company selling small kitchen appliances with guidelines related to disability is General Electric (GE). These guidelines are limited to microwave ovens, and only two requirements are published on their website. The first states that the “Maximum high forward reach for controls and operating mechanisms is 48"; maximum low forward reach is 15", and the other states that “controls and operating mechanisms must be operable with one hand and shall not require tight grasping, pinching or twisting of the wrist. The force required to activate controls shall be no more than 5 lbs.” [9]. Though these guidelines act as a start, they encompass a very small percentage of physical disabilities and neglect to address the other categories of disability.

For example, a client with macular degeneration will be unable to read the labels, buttons, or directions on his or her current small kitchen appliances, consequently, making food and drink preparation nearly impossible. The products that have SKA AUDIT scores can be reviewed and recommended to the client by his/her occupational therapist. The results will allow the client to make necessary adaptions and recommendations for the client to continue being independent in the kitchen. 

METHODS

Creating the Small Kitchen Appliance Accessibility and Universal Design Information Tool (SKA AUDIT) involved four steps. First, we determined important definitions as well as which features of small kitchen appliances to include in the AUDIT. We included the following 7 features: doors, lids, dials, on/off, water reservoirs, buttons, and “ready” indications. Following this determination, for the purpose of this AUDIT, we adopted the definition of the term “impairment” as “Any temporary or permanent loss or abnormality of a body structure or function, whether physiological or psychological. An impairment is a disturbance affecting functions that are essentially mental (memory, consciousness) or sensory, internal organs (heart, kidney), the head, the trunk or the limbs.” [10]. We used ADA impairment categories in developing the audit. These categories are: cognitive function, physical function, and sensory function. Cognitive function impairments include: memory limitations, language difficulty, executive functions, and behavior limitations. Physical function impairments include: upper extremity limitation, lower extremity limitation, weakness or abnormality of head, neck, or trunk control/position, and conditions affecting the entire body. Sensory function impairments include: low vision, blindness, hard of hearing, deafness, impaired sensation, and balance disorders - high risk of falls (Fig. 2) [11]. Lastly, we defined accessibility and usability. Accessibility was defined as the fact of being reached, used, or obtained [12]. In other words, if an object is not accessible, it is essentially useless to the individual. Usability was defined as the ability for consumers to use the features of the small kitchen appliances  to meet their needs [13]. The distinct difference between the meanings of accessibility and usability throughout this AUDIT is that accessible features can be used, but usable features have increased ease of use.

Second, we wrote the 200 questions contained within the AUDIT. We developed the first version for practitioners to use support their clients in determining the accessibility and usability of their small kitchen appliances or in making informed decisions when purchasing small kitchen appliances. Then, in the third stage, we imported questions into X-FACT taxonomy editor. Finally in the fourth stage we chose a trichotomous design to offer users the opportunity to select “unsure” when determining the impairment of a client, for instances in which clients may benefit from additional accessibility features. Each question will ask users questions about accessibility and usability of each feature, and response sets will allow users to select “yes,” “unsure,” or “no” (Fig. 3).

When filling out the AUDIT, users will be able to select the impairment(s) their client has, and the AUDIT will filter out irrelevant questions. The AUDIT will then prompt users to answer accessibility and usability questions about each feature of the small kitchen appliance. Users will be given the opportunity to add comments if desired. An accessibility and usability score will be generated once the user answers all of the relevant questions.

 

DISCUSSION

Conclusion

The SKA AUDIT is the first of its kind. While GE as one manufacturer applied two ADA standards regarding the accessibility of their microwaves, more needs to be done to ensure people with impairments are able to access and use small kitchen appliances when preparing food [9]. This AUDIT data can help individuals with impairments make informed choices when purchasing small kitchen appliances. The AUDIT addresses features of devices that exist already, and the authors made predictions of potential future features that will increase the usability of small kitchen appliances. Currently, the AUDIT is designed to be used by practitioners to help their clients. Other potential beneficiaries of the results of this audit include engineers, manufacturers, advertisers, retailers, and family members of individuals with impairments.

Limitations

Due to its recent development, the SKA AUDIT has not been used extensively. Additionally, we still need to develop additional versions that include relevant terminology and question structure for stakeholders than therapists. Lastly, due to the vast amount of available small kitchen appliances and constantly changing technology, it was difficult to include every available appliance feature in the AUDIT. To accommodate for this, the authors included and encourage the use of the comment sections throughout the AUDIT.

Future Directions

Following the development of additional versions, we plan on creating a database featuring all products and ratings based on reviews from users from each disability category. The database will allow results to be available to all stakeholders including: consumers, practitioners, manufacturers, standardization organizations, engineers, and more. Further development of this AUDIT will encourage developers to create small kitchen appliances that are more universally designed. Additional questions will be added to the various versions of the SKA AUDIT as new features of small kitchen appliances are developed, and we plan to make accessibility and usability ratings available to all stakeholders.