RESNA 28th Annual Conference - Atlanta, Georgia
Jill M. Winters, PhD, RN,1 Molly Follette Story, MS,2 Kris Barnekow, PhD, OTR,3 June Isaacson Kailes, MSW,4 Brenda Premo, MBA,4 Erin Schwier, OTD,4 Jack M. Winters, PhD1
1 Marquette University
2Human Spectrum Design, L.L.C.
3University of Wisconsin-Milwaukee
4Western University
The RERC on Accessible Medical Instrumentation is committed to evaluating and developing methods and technologies to increase accessibility and usability of diagnostic, therapeutic, and procedural healthcare equipment and assistive technologies, for people with disabilities. This paper provides an overview of the findings from the recently completed national consumer survey assessing usability and accessibility of 15 categories of medical equipment. Data from more than 400 participants are presented. The four categories of medical equipment that presented the greatest barriers included examination tables, x-ray equipment, exercise and rehabilitation equipment, and weight scales. These are all essential types of equipment for meeting basic healthcare needs.
Medical devices, Accessibility, National consumer survey, Disability
The Centers for Disease Control estimated that during 1994-1995, 54 million Americans had one or more disability (1) . For a variety of reasons, many of these individuals are not receiving adequate healthcare. Disparity of healthcare services available for persons with disabilities may reflect the variability, extent, and nature of health services required (2) , the higher need for short- and long-term health services, healthcare reimbursement issues, and lack of accessible medical instrumentation. Although the Americans with Disabilities Act of 1990 stipulated that access to medical care and public accommodations be made for all, many medical devices available today fall short of this requirement.
Physical access to receiving satisfactory and adequate healthcare for individuals with disabilities is the most obvious barrier, and this issue goes well beyond stairs and doorways. For example, research examining accessibility of mammography equipment found that inaccessible health care facilities and medical equipment make it less likely that a woman with disabilities will receive breast screening (3) . Much of the research done on medical accessibility has primarily focused on breast and reproductive health in women (3) . Little is known about the nature and extent of the barriers in relation to a variety of types of disability and disease with respect to specific medical instrumentation. Therefore, the purpose of this study was to identify the nature of obstacles related to medical instrumentation that prevent people with disabilities from receiving adequate healthcare.
An exploratory cross sectional survey design was employed. The target population was a diverse sample of individuals with a wide scope of disabilities. Inclusion criteria consisted of self-report of at least one disability, at least 18 years of age, able to understand English, and experience with medical devices. Data were collected during 2003-2004.
A carefully structured national needs assessment was constructed by means of a Delphi study (4) . When constructing the survey, we solicited feedback from a list of nationally respected key informants/experts in the field of disabilities. These informants provided feedback with respect to content, layout, and degree of burden for completing the survey. As a result, a web-based survey was launched that appeared to be comprehensive, user-friendly, and presented minimal burden for participants.
Many categories of medical equipment were outlined in the survey including examination tables and chairs, dental equipment, and monitoring devices. Also included were types of equipment used for vision and hearing testing, radiology procedures, cardiac stress testing, pulmonary function testing, medication administration, oxygen delivery, and determining patient weights. Various forms of devices used for cardiac, pulmonary, orthopedic, and neurologic rehabilitation also were addressed, as were assistive aids used for mobility and communication. A final category of “other” was made available for participants who did not feel their experiences with medical devices fit the identified categories.
Participants were recruited via disability-related list-serves and websites, flyers, posters, and personal contacts at independent and assisted living facilities. For those individuals who chose not to complete the survey on the Internet, paper versions and an interviewer were available. Completion of the survey took approximately 30-45 minutes, and it could be completed in one or multiple sessions.
The survey was divided into two parts: 1) a demographic and functional performance questionnaire, and 2) the usability/accessibility instrument. Face validity was established prior to and following the Delphi procedure. Both forced-choice items and open-ended questions were included.
Descriptive statistics were used for the quantitative data. Content analysis was employed for the narrative data. Two investigators coded the narrative data independently. The resultant categories or themes were discussed and consensus on categories was achieved.
Four hundred fifty-seven individuals created accounts on the website or contacted the investigators to complete the survey in an alternative format. Of these 457 prospective subjects, 408 participants provided usable data. Age of participants ranged from the 18-25 range to the over 75 years of age category. The majority of participants were between the ages of 26 and 64. The majority of participants were female (66.1), Caucasian (90.2%), had at least a bachelor’s degree (59.1%), worked full time (79.9%), and used at least one form of assistive technology. The sample represented a wide variety of sensory and physical disabilities, and a vast array of medical diagnoses.
All participants were asked to indicate their level of experience with each of the 15 categories of equipment. If they had experience with the equipment, they were asked to rate their degree of difficulty with using the equipment on a scale of “none” (0) to “impossible to use” (4). All descriptive statistics were executed using the valid sample size, that is, the number of individuals who had experience with the equipment. When all types of disabilities and diagnoses were analyzed together, the top four categories of medical equipment that participants indicated they had moderate or greater difficulty using were exam tables (75.0%), x-ray equipment (68.0%), exercise and rehabilitation equipment (55.3%), and weight scales (53.1%) (See Table 1). When each category (n=39) of disability or diagnosis was examined separately, all categories except for individuals identifying themselves as having cerebral palsy identified exam tables as their most difficult type of equipment to use. Four types of equipment identified as at least moderately difficult by less than 30% of respondents included hearing testing equipment (11.3%), pulmonary function testing equipment (25.0%), monitoring equipment (27.7%), and oxygen equipment (28.4%).
Type of Equipment |
Percentage* of Participants that Ranked Category as at Least Moderately Difficulty to Use |
Examination Tables |
75.0 |
X-Ray Equipment |
68.0 |
Rehabilitation and Exercise Equipment |
55.3 |
Weight Scales |
53.1 |
Mobility Aids |
50.2 |
Examination Chairs |
49.6 |
Communication Aids |
41.3 |
Medication Administration Devices |
40.9 |
Dental Equipment |
38.2 |
Eye Examination Equipment |
37.0 |
Cardiac Stress Testing Equipment |
33.0 |
Oxygen Delivery Equipment |
28.4 |
Monitoring Equipment |
27.7 |
Pulmonary Function Testing Equipment |
25.0 |
Hearing Testing Equipment |
11.3 |
| *Percentages shown as valid percent, i.e., percentage of those with experience with the equipment that rated the equipment as at least moderately difficult to use. | |
After participants rated their degree of difficulty with specific types of equipment, they were asked to describe the difficulty and provide suggestions for how the obstacle might be reduced or eliminated. Details about what made examination tables difficult or uncomfortable when carrying out procedures, activities, or tasks included that tables were too high, too narrow, uncomfortable, and/or unsafe. Other issues included personnel who were not adequately trained or who were unwilling to assist, and issues related to stirrups and gynecological tables. A participant comment that captures some of these issues was, “Too tall so I need assistance. Even if they have a step it is difficult to use. I fear falling off of table when trying to get on them. Tables are too narrow, so my bad arm dangles off the side. Rooms are so small it is hard to maneuver the wheelchair to a good transfer position.” Another comment was “I have contractures so I cannot lie flat or comfortably. I also cannot breathe when I am flatter than 90%. Hard to lift me onto table without hurting me. Rarely enough pillows to brace back and legs.”
Similar issues were found when narrative data about difficulties with x-ray equipment were analyzed. One women’s comments about her experiences with x-ray equipment included, “Cannot flatten out on table, cannot press against chest (x-ray) machine, cannot raise hands above head or grip pulley above head, hard surface causes skin (abrasions), few pillows present, technicians (too) rushed to adapt, cannot flatten out for MRI/CT scan and my legs wouldn't fit through hole because they are too splayed, they didn't have straps or ideas on how to accommodate.”
These data indicate that there are repeated patterns of barriers to using medical instrumentation across types of disability and diagnosis. Results from this study are establishing the basis for focus groups that will provide greater depth to our understanding of these obstacles. In addition, this national consumer survey is being followed up with a healthcare practitioner survey and a medical equipment manufacturer survey. Findings from these efforts will be used to refine, redesign, or develop new equipment that will be more universally accessible to all individuals, irrespective of disability or diagnosis.
This work was supported by the National Institute on Disability and Rehabilitation Research, U.S. Department of Education, under grant #H133E020729. The opinions contained in this manuscript are those of the authors and do not necessarily reflect those of the Dept. of Education.
Jill M. Winters, PhD, RN
Marquette University, College of Nursing
P.O. Box 1881
Milwaukee , WI 53201-1881
414-288-3848