Value beyond function: analyzing the perception of wheelchair innovations in Kenya
Giulia Barbareschi, Sibylle Daymond, Jake Honeywill, Aneesha Singh, Dominic Noble, Nancy N. Mbugua, Ian Harris, Victoria Austin, Catherine Holloway · 2020 · Proceedings of the 22nd International ACM SIGACCESS Conference on Computers and Accessibility (ASSETS 2020) · doi:10.1145/3373625.3417017
Summary
This study evaluates a novel wheelchair service provision model called InnovATe, developed by Motivation UK, that uses Computer Aided Design (CAD) and 3D printing to manufacture bespoke wheelchairs in Kenya. Over five months at the Bethany Kids rehabilitation centre in Joytown, Kenya, the researchers trained five local healthcare professionals (two physiotherapists, one occupational therapist, and two wheelchair technicians) to use the new system and produced eight custom wheelchairs for expert wheelchair users. The InnovATe model uses a parametric CAD system where clinicians take body measurements using a wheelchair simulator and a Dimensional Information Measurement System (DIMS), which feeds data into a model that generates 3D-printable joint components. These joints connect locally sourced metal tubing, enabling production of three-wheeled wheelchairs with custom-contoured backrest support. The study applies Don Norman's Emotional Design framework — which identifies three levels of human-product interaction: visceral (immediate sensory response), behavioral (functional performance), and reflective (personal meaning and identity) — to analyze how both wheelchair users and service providers perceived the innovation. This is the first study to use the Emotional Design model to evaluate assistive technology innovations in low- and middle-income countries, and the first to combine digital and classical manufacturing techniques for bespoke wheelchair production in such settings.
Key findings
Despite acknowledged functional limitations (weak brakes, absent side guards, durability concerns about 3D-printed joints), both users and providers gave overwhelmingly positive evaluations of the InnovATe wheelchairs. At the visceral level, the bright, colorful appearance and elegant low-profile design drew strong positive reactions — users described them as "sexy," "cute," and "pleasing to the eye." Notably, female participants who typically dislike three-wheelers (because they prevent wearing dresses) found the InnovATe design appealing. At the reflective level, the personalized design promoted powerful feelings of agency, empowerment, and self-expression. One participant stated: "first of all you have to see me before you see the wheelchair" — the unobtrusive design made the person visible rather than the disability. The bespoke nature meant wheelchairs reflected users' physical attributes, which was empowering but could also be unwelcome when it highlighted traits users preferred not to emphasize. For local staff, the model fostered professional pride and increased sense of ownership over wheelchair provision. Clinicians valued having control over the full process rather than depending on unknown manufacturers. The service delivery model itself was valued because it placed users at the centre of decision-making — something participants reported was rare in traditional wheelchair provision where "you are just given a wheelchair."
Relevance
This research challenges the dominant paradigm in assistive technology development that prioritizes functional metrics above all else. For accessibility practitioners, the key takeaway is that social and emotional dimensions of assistive products and services profoundly shape user acceptance and satisfaction — a lesson that extends to digital assistive technologies as well. The finding that aesthetic design can reduce stigma and promote self-expression through assistive devices has direct parallels to digital accessibility, where the design of accessible interfaces and tools should not merely function but should also feel empowering and non-stigmatizing to use. The study also demonstrates the value of user-centred service delivery models where people with disabilities actively participate in design decisions, rather than being passive recipients. For organizations providing assistive technology in low-resource settings, the InnovATe model offers a compelling case for local manufacturing using 3D printing, which could reduce dependence on imported, one-size-fits-all solutions. The tensions between clinician expertise and user preferences documented here are relevant to any accessibility practice involving professional intermediaries.
Tags: wheelchairs · assistive technology · 3D printing · emotional design · service delivery · disability identity · Global South · participatory design · customization
Standards referenced: WHO Wheelchair Service Training Package