CLOTHING NEEDS ASSESSMENT FOR WHEELCHAIR USERS
A thesis submitted to the College of the Arts of Kent State University in partial fulfillment of the requirements for the degree of Master of Arts-Fashion
by
Prerna Suri
July, 2016
Thesis written by
Prerna Suri
B.A., Pearl Academy of Fashion, 2011
B.S., Kent State University, 2013
M.A., Kent State University, 2016
Approved by
Mr. J.R. Campbell, Thesis Supervisor
Dr. Kim Hahn, Thesis Supervisor
Dr. Mary Ann Devine, Committee Member
Dr. Catherine Amoroso Leslie, Graduate Studies Coordinator, The Fashion School
Dr. Linda Hoeptner Poling, Graduate Studies Coordinator, The School of Art
Mr. J.R. Campbell, Director, The Fashion School
Dr. Christine Havice, Director, The School of Art
Dr. John Crawford-Spinelli, Dean, College of the Art
© Prerna Suri 2016
TABLE OF CONTENTS Page LIST OF FIGURES ...... 6 LIST OF TABLES ...... 7 LIST OF APPENDICES ...... 8 ACKNOWLEDGEMENTS ...... 12
CHAPTER
I. INRODUCTION…………………………………………………………………………..1 Rationale for the Study ...... 4 Research Questions ...... 6 Definition of Key Terms ...... 6
II. REVIEW OF LITERATURE…………………………………………………………...... 9 Development of Adaptive Clothing for People with Physical Disability ...... 10 Adaptive Clothing ...... 10 Design Modifications ...... 12 Design Features for Adaptive Clothing ...... 14 Balancing Functional and Aesthetic Considerations ...... 19 Factors Affecting Purchase Decisions ...... 19 Theoretical Framework: The Functional, Expressive, and Aesthetic Model ...... 22 Theoretical Framework: Quality of Life…………………………………………29
III. METHODOLOGY……………………………………………………………………….34 Instrument Development ...... 35 Pilot Study ...... 37 Selection and Description of Sample ...... 37 Data Collection ...... 38 Data Analysis ...... 38
IV. RESULTS……………………………………………………………………………….39 Description of Sample ...... 39 Assessing the Clothing Needs and Satisfaction of Clothing Attributes of Wheelchair Users ...... 41 Perceive Incorporation of Advanced Textiles in Clothing for Wheelchair Users ...... 43 Wheelchair Users’ Willingness to Modify Their Clothing Purchasing Behavior and Intentions towards the Customized Adaptive Clothing…………...45 Measure the Perceptions of Quality of Life of Wheelchair Users and its Relationship to Functional, Expressive and Aesthetic Elements of Clothing……46
V. DISCUSSION …………………………………………………………………………...47 Comparison of Clothing Needs and Satisfaction of Clothing Attributes of Ready-to-Wear Clothing, Adaptive Clothing, and Trousers ...... 47 Incorporation of Advanced Textiles in Clothing for Wheelchair Users ...... 48 Wheelchair Users’ Willingness to Modify Their Clothing Purchasing Behavior and Intentions towards the Customized Adaptive Clothing ...... 49 Perceptions of Quality of Life of Wheelchair Users and FEA elements of Clothing ...... 51 Need for Trouser in Professional Workplace Environment ...... 51 Implications ...... 52 Limitations and Future Research ...... 56 Conclusion………………………………………………………………………..59
LIST OF FIGURES
Figure Page
Figure 1. The FEA Consumer Needs Model by Lamb and Kallal (1992) ...... 22 Figure 2. Sub Elements of FEA Model based on Lamb & Kallal (1992) ...... 24 Figure 3. Revised FEA Model by Holland (2007) ...... 25 Figure 4. Quality of Life ...... 30 Figure 5. Modified FEA Model and QOL Model ...... 34
LIST OF TABLES
Table Page
Table 1 WHOQOL Domains and Facets ...... 32 Table 2 Demographic Information of Respondents ...... 40 Table 3 Rate of Independency/Dependency While Dressing ...... 40 Table 4 Satisfaction with Clothing Attribute ...... 42 Table 5 Perceive Incorporation of Advanced Textiles in Clothing ...... 44 Table 6 Most Dissatisfied Pieces of Clothing ...... 45 Table 7 Willingness to Spend on Customized Clothing ...... 45 Table 8 Correlation between QOL and FEA Elements of Clothing ...... 46
LIST OF APPENDICES
Page
APPENDIX A: Questionnaire………………………………..…………………………………...68
ACKNOWLEDGEMENTS
First and foremost, I will like to thank my Thesis Committee, Mr. J.R. Campbell, Dr.
Kim Hahn and Dr. Mary Ann Devine, for mentoring and guiding me throughout the process. I have learnt so much from working with them. I would also like to thank Dr. Catherine Amoroso
Leslie, for her guidance and motivation.
Finally, I want to thank my parents Dr. Nalin Suri and Poonam Suri for their support and encouragement.
PRERNA, SURI, M.A., JULY, 2016 ART
CLOTHING NEEDS ASSESSMENT FOR WHEELCHAIR USERS (99 PP.)
Director of Thesis: J.R Campbell and Dr. Kim Hahn
The number of wheelchair users are sharply rising. Currently, it is estimated that approximately 10 million people of working age, and another 10 million post-retirement
Americans experience mobility impairment. Given the void in clothing designed specifically for wheelchair users, users face difficulties in finding suitable clothing that provides them a good fit with style. The purpose of the study is to assess the perceived clothing needs and satisfaction level of clothing attributes of wheelchair users and link it to the perception of quality of life of wheelchair users. This study found that respondents were least satisfied with attractiveness attributes in Ready-to-wear and adaptive clothing. Results supported that most of the garments available in Ready-to-wear market for wheelchair users are more focused on functionality aspects. Majority of respondents reported concern for potential bacteria growth on fabric due to moisture and heat trap while sitting for long hours. This study developed a relationship between
FEA Consumer needs and Quality of Life models providing a new platform for researchers, designers and manufacturers to understand the advance clothing needs and wants of wheelchair users.
Keywords: disability, clothing needs, wheelchair users
CLOTHING NEEDS ASSESSMENT FOR WHEELCHAIR USERS
CHAPTER I
INTRODUCTION
According to the current 2013 United Stated disability statistics, 12.6% of the entire US population reported disability (United States Government, 2013). Of these people, 2.1% of the
US population reported self-care disability. Considering that the US census of 2013 reported the
US population to be 316 million, over 54 million people in the United States are not capable of independent living either because of physical or cognitive disability. Mobility impairment rate is highest, currently estimated to be 33.6 million (United States Government, 2013). This is a large population close to the entire population of Australia or twice the population of the state of Ohio.
If we assumed that this ambulatory disability is just a reflection of our growing seniors, we would be wrong. What is striking here is that in the working age group of 21-64 years, roughly representing 60% of the population, ambulatory disability is estimated to be 5.6%. Thus, over 10 million Americans in the working age group, are wheelchair users. A more effective construct and mechanism is needed in the fashion industry to develop functional adaptive clothing for the most neglected segment of society - wheelchair users. What makes the case even more compelling is the observation that 23.1% of people of retiree age experience mobility impairment
(United States Government, 2013). With many baby boomers retiring that number is sharply rising. Thus, while we have over 10 million Americans of working age, we also have another over 10 million Americans of post-retirement age on wheelchairs. Within the next five years, these 20 million Americans are estimated to rise to 25 million. 2
People facing physical disability either due to chronic illness, aging, injury or due to some other reasons spend most of their time in a seated position (Y. Wang, Wu, Zhao, & Li,
2014). Wheelchair users can have difficulty in doffing and donning their clothes and thus need assistance from others (de Guimarães, 2013). Depending on the illness, people may vary in percentage of mobility and dependency on others.
Most of the adaptive clothing available in the market are designed to assist the caregivers to reduce the physical strain during dressing people with disability (Buck & Buck, 2015). It has been noted that people with physical disabilities face difficulty in finding suitable clothing that provides them a good fit with style (Carpenter, 2016). There are various reasons behind the issue. First, most of the garments are constructed for people in the standing position. Thoren
(1996) noted that majority of people with disabilities do not fall in the current size category, which means that their body dimensions contrast the current body dimensions in the size system.
Because of sitting in a wheelchair for long hours, their spine can curve or shift forward (Sau-Fun,
Chi-Leung, & Lai-Fan, 2011) resulting in decreased trunk length (Çivitci, 2004). Thus, the traditional proportions of the body that form the fundamentals of clothing design are not applicable to these individuals. This explains why current ready-to-wear garments do not fit individuals with disabilities. Designs that are available in the market do not provide appropriate ease and/or mobility for people with disability. Properly fitted and stylish clothing could help improve self-image and social presentation (Chang, Zhao, Guo, Wang, & Gu, 2009). However, at present, these individuals often have few choices in clothing options thus, must wear what that does not fit well and is not customized to their body type (Freeman, Kaiser, & Wingate, 1985).
The growing disabled population needs specialized clothing solutions for numerous reasons. Many of them depend on medical devices to maintain their health. For example, if a 3 person uses a urinary reservoir that collects urine it would needs to be concealed within the garment. Many people with disability have anatomical bony prominences on which they sit.
The pressure resulting from theses prominences may result in the tearing of the skin causing major ulcer problems (Dean, 2011). Because they are typically in a seated position for a longer periods of time, moisture and heat can get trapped resulting in infections and malodor (Teufel,
Pipal, Schuster, Staudinger, & Redl, 2010). These issues can be addressed through clothing design solutions and specialized fabrics.
Garments intended for people with disability must be customized for functional and aesthetic considerations (Rusk & Taylor, 1959). Redesigning adaptive clothing for wheelchair users can help to improve their self-esteem by promoting independence in dressing by oneself as well as lessen the physical strain and workload of their domestic care providers (Nevala,
Holopainen, Kinnunen, & Hänninen, 2003). Therefore, it is important to design clothes that meet their physical, habitual and psychological requirements. Such clothes will assist them to be more independent in living and possibly improve self-image. It has been recommended that designers look into four areas: functional, psychological, interdisciplinary, and design solution while designing adaptive clothing for non-traditional body types (Garner & Douglas, 1992).
Adaptive clothing designers have found it difficult to cater to the mass population of people with disability, as no two body shapes are alike (Lamb, 1991). The most common barriers shared by non-traditional body types are fit and difficulty in donning and doffing (Stokes, 2010) . The style factor is often minimized as well. People with disabilities do not wish to have functional garments that do not fit well on their body or are unappealing. They want clothes that are helpful in daily living and make them socially attractive. 4
The Americans with Disabilities Act (ADA) (1990) have provided legislation to support people with disabilities to gain improved access to employment, public facilities, and reasonable accommodations. Greater access has resulted in higher admission in college, increased opportunities in the workforce, and greater participation in various public activities. People with disabilities now have a greater need for clothing appropriate for the situation or event so they can experience greater inclusion in society (Abraham-Murali, Kane, & Staples, 2001; Carroll &
Kincade, 2007).
Rationale for the Study
The limited research conducted on clothing that meets the needs and interests of people with disabilities requires designers, brands and manufacturers to understand their needs and design garments that are stylish yet functional. Functional fashions for people with disabilities was first studied in 1959 (Rusk & Taylor, 1959). It was done to analyze the clothing problems and come up with design solutions. Their findings included valuable source information describing how to alter ready-to-wear clothes, how to make a selection of adaptive clothing and order custom-made clothing. Since then, several researchers have shown interest and documented perceived functional clothing needs of this population (Bye & Hakala, 2005;
Emerich, 2011; Holland, 2007). Recently, designers and researchers have started exploring more about aesthetic and expressive elements of the clothing preferences of people with disabilities.
They believe that garments should not only focus on functional needs, but also on aesthetics and expressive elements. Aesthetically pleasing garment allows wearers an opportunity to express themselves and break social barriers.
Through interview discussion with the founder of IZ Adaptive (I. Camilleri, personal communication, April 7, 2016) and ABL Denim (S. Alves, personal communication, April 15, 5
2016), it was evident that wheelchair users are looking for garments that meet their functional needs as well as allowing them to fit in socially. Better fitted and stylish clothes help to boost their self-confidence. The primary focus in designing adaptive clothes had been function, but some designers argue that focus should be on fashion and style, as well (The Art Institues, 2016).
There should be a clothing line that concentrates on seated lifestyle that meets the needs of wheelchair users. This brings up a platform for the researcher to assess the clothing needs of wheelchair users and to learn their purchasing intentions for customized clothing.
On the other hand, it is essential to understand and relate the clothing needs of wheelchair users with the quality of life. “Quality of Life” research focuses on individual’s perception of their life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns (WHOQOL group, 1995). It has six domains overall: physical health, psychological state, the level of independence, social relationships, environment, and spiritual/religion and personal beliefs. To understand the clothing needs of wheelchair users, this study only focused on psychological state, level of independence, and social relationships. These domains were selected on the basis of their facets. For instance, psychological state facets: positive and negative feelings, self-esteem, bodily image and appearance assisted in deriving and analyzing the clothing needs and relating it to the FEA model.
In order to design adaptive clothing, it is suggested not only to focus on one element such as functionality, aesthetics or expressive, rather to attempt to address and balance all three elements. Likewise, to measure the perception of quality of life, it is critical to look at three domains together and no distinguish the facets.
6
Thus, the purpose of the study is to incorporate a combined utilization of the FEA design process model with a modified Quality of Life assessment tool to determine the perceived clothing needs and satisfaction level of clothing attributes of wheelchair users.
Research Questions
Using subjects who are currently wheelchair users, the specific research questions are designed:
1. What are the level of satisfaction of clothing attributes of wheelchair users in regards to:
- Ready-to-wear clothing (in general)
- Adaptive clothing
- Trousers (in specific)
2. How do wheelchair users, perceive incorporation of advanced textile innovations such as
anti-bacterial and moisture wicking fabric in their clothing?
3. Which are the design elements that wheelchair users are looking in clothing to modify
their clothing purchasing behavior and what are their intentions towards the customized
adaptive clothing?
4. What is the relationship between perceptions of quality of life of wheelchair users and
FEA elements of clothing?
Definition of Key Terms
The following is a list of key terms and their definitions used throughout this research.
Clothing for the Clothing for anyone who temporarily or permanently has special Disabled clothing needs (Kernaleguen, 1978).
Disability Any restriction or lack (resulting from an impairment) of ability to
perform an activity in the manner of or within the range considered
normal for a human being ("112 Accessibility for People with 7
Disabilities ", 2012).
Donning and Put on and take off clothes Doffing
FEA Consumer The model defined by (Lamb, 1992) can be used for “assessing user Needs Model needs and wants and incorporating functional, expressive, and aesthetic
(FEA) considerations” (p. 43).
Functional Clothing Clothes that are adapted to serve an individual’s need in overall comfort,
protection, mobility in order to increase efficiency and performance
(Hoffman, 1979; Watkins, 1984).
Functional Garment Elements that offer protection, mobility comfort, safety and fit (Bye & Elements Hakala, 2005) or “relate to utility” (Lamb, 1992).
Moisture “Ability of a clothing material to transport moisture from sweat wetted Management skin” (Barker, 2002).
Needs Assessment “A tool which formally harvests the gaps between current results (or
outcomes, products) and required or desired results, places these gaps in
priority order, and selects those gaps (needs) of the highest priority for
action, usually through the implementation of a new or existing
curriculum or management procedure” (Kaufman & English, 1975).
Pressure Ulcers Pressure ulcer is a localized injury to the skin and/or underlying tissue
usually over a bony prominence, as a result of pressure, or pressure in
combination with shear (“NPUAP Pressure Ulcer Stages/Categories”,
2015).
Quality of Life “Individual’s perception of their position in life in the context of the (QOL) 8
culture and value systems in which they live and in relation to their
goals, expectations, standards and concerns” (WHOQOL group, 1995).
Special-Needs Clothing specifically designed or adapted to meet the needs of disabled Clothing persons; clothing with functional features (Hoffman, 1979).
9
CHAPTER II
REVIEW OF LITERATURE
This review of literature provides a foundation for the study of functional adaptive clothing for wheelchair users based on a larger body of knowledge including existing research on development of adaptive clothing for people with physical disabilities; balancing functional and aesthetic considerations; factors affecting purchase decisions; the Functional, Expressive, and
Aesthetic (FEA) Model and quality of life.
Clothing needs assessment research and looking at the above areas assisted in analyzing the satisfaction level of current wheelchair users and its relationship to quality of life. This study incorporated the Functional, Expressive and Aesthetic (FEA) Consumer Needs Model (Lamb &
Kallal, 1992) and Quality of life theoretical model to address the research questions.
The FEA Consumer needs model is a conceptual framework for apparel design and a powerful tool to investigate the clothing needs for non-traditional body types (Lamb, 1992). The
FEA model focuses on Functional, Expressive and Aesthetic elements to recognize consumer needs and wants. This model is considered as a problem-solving approach that does not distinguish between functional and fashion apparel design.
Quality of Life (QOL) is defined by World Health Organization defines as “individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns” (WHOQOL group,
1995). It addresses six domains: physical health, psychological state, the level of independence, social relationships, environment, and spiritual/religion and personal beliefs. The facets of each 10 domain can be improved by well thought and designed adaptive clothing, thus resulting in improved quality of life of wheelchair users.
Development of Adaptive Clothing for People with Physical Disability
Adaptive Clothing
The term “adaptive clothing” refers to “garments designed with medical function in mind for post-surgery patients, the disabled, elderly, rehabilitation patients, special needs children and adults, people with arthritis, stroke victims, etc. ” (Disabled World, 2015). The purpose of adaptive clothing is to have easy access to body parts without taking off the entire garment and making it easier for the people with disability to don and doff by themselves. It should promote independence in dressing by oneself and doing personal care as well as provide ease in the dressing process for the caregiver (Buck & Buck, 2015).
Russell (1988) conducted a study to investigate clothing resource needs of people with disabilities. Subjects engaged in adaptive physical education classes, disabled student program, and outpatient physical therapy. Three key elements were examined: resources offering clothes for special needs; the use and adaptation of ready-to-wear; and the effect of economic limitations on clothing resource alternatives. It’s noted that resources for special needs clothing include both ready-to-wear clothing that has been modified for special needs and specifically designed for people with disabilities (Hoffman, 1979). Most of this group purchases ready-to-wear clothing, desiring suitable styles and alteration options, but economic conditions limit the adoption of customized unique clothing due to limited financial resources (Shannon & Reich,
1979). Specially designed functional clothing has limited appeal to people with disabilities, as manufacturers give functionality more priority and ignored aesthetic considerations. Product satisfaction is most important factor in considering special-needs clothing resources, but the 11 study using the symbolic-interactionism theory has stated that attractive appearance of clothes is an important factor to people with disabilities (Feather, Martin, & Miller, 1979). Participants in previous research have expressed concern with the noticeable features that are unattractive and draws attention to their disability. Hoffman (1979) discussed the importance of making functional clothing more important for people with disability to highlight desirable features and minimize limitations.
Some of the styles of adaptive clothing are designed for medical purposes. For instance, zippers and VelcroTM are placed in particular areas to provide easy access for donning and doffing. Well-designed adaptive clothing can contribute in retaining the dignity and self-image of an individual with a disability. It can also boost the confidence of a person by having the flexibility of quicker and easy dressing.
Mindy Scheier, founder of “Runway of Dreams” works with the fashion industry to adapt mainstream clothing for people with disabilities. Her research states that modifications such as replacing buttons, zippers with washable MagnaReady closures, adjustable waistband, and alternating the pant lengths, are not only possible, but fit into the existing design process. To have garments reasonably priced and be in the market, it is essential not to recreate the wheel, rather modify it (Bobila, 2016).
Adaptive clothing needs to follow guidelines regarding functionality and aesthetics. It should feel and look like everyday clothing, built to last long and have a broad range of sizes.
People with disability want clothing to conceal rather than highlighting the disability (Disabled
World, 2015). Adaptive clothing designs should look similar to clothes that are available in the market that provides a perfect fit. The enhancements and modifications should be subtle, and the clothes should be lightweight to remove the excess bulk. Incorporating the provision for medical 12 devices adds an additional step in designing and constructing the garment and also states the need for durable fabrics (Disabled World, 2015).
Design Modifications
Wang, Wu, D., Zhao, M. , & Li, J. (2014) designed a set of functional clothing for the wheelchair users. The focus of their designs was to enhance the independent functioning of daily living activities like dressing and undressing, going to toilet and bathing. Questionnaires were distributed to 58 participants to investigate the clothing needs and preference of wheelchair users. The results revealed the need for pants that provided ease with dressing and undressing, design considerations for easy limb movement at the joints and soft water absorbent fabric with thermal properties. Six wheelchair users (3 males and 3 females) were selected from the previous pool of participants as the model and designed set of functional clothing for them.
Standard functional clothing was used for comparison and assessed by the evaluating system adopted from rehabilitation medicine and sports tournament. The results demonstrated that new designed functional clothing facilitated daily living activities such as dressing and undressing, going to the toilet and bathing of wheelchair users.
Wheelchair user oriented clothing was redesigned to reduce the physical work load and strain of personal helpers (Nevala et al., 2003). Dressing and undressing a patient is an everyday activity of personal care- givers, mainly during morning and evening shifts (Pohjonen,
Punakallio, & Louhevaara, 1998). Five women within the age group 18-54 years, who have assisted people with physical disabilities, were selected for the study. Their workload was measured with the current clothes and redesigned clothes worn by the people with physical disability. The physical workload of the helpers, while dressing and undressing the patient, was examined by their hand and back movements, work time, muscular activity, heart rate (HR), 13 percentage of heart rate range (%HRR), and rating of perceived exertion (RPE). Four out of five stated lower perceived exertion, and three had shorter work time with the redesigned clothing, which comprises of patternmaking adjustments, materials selection, and design modifications.
The finding supported that redesigning clients’ clothing can help reduce the physical workload and strain of personal helpers (Nevala et al., 2003).
In Design and Study of Clothing Structure for People with Limb Disabilities (Chang et al., 2009) the researchers had merged the knowledge of human engineering (ergonomics), textile materials and apparel technology in the garment. Specifically, they designed the clothes to de- emphasize the visual evidence of a person’s disability and to strengthen function and convenience to meet the needs of body activities. Clothing was intended to promote the positive relationship between function and beauty, transforming “inconvenient,” “concealment” level to the “convenient,” “beautiful” and “functional.” As a result, the aim was to enhance the quality of life of people with limb disabilities. It will help to build confidence and allow them to be part of the society. Their findings served to set standards regarding style and structural design for people with physical disabilities:
• Putting clothing on and taking them off independently and conveniently
• Clothing variation in body features while presenting no distinction from others
• Providing a physical and psychological sense of comfort and stability Design Features for Adaptive Clothing
Dressing people with limited mobility can be a challenge and assisting the person to don and doff his or her clothing can raise another set of problems. The dressing can be more complex when fatigue or agitation is a factor added to it (Creation Comfort, 2009). Most of the adaptive clothing available in the market are designed to assist the caregivers so that they feel less strain during dressing an individual with a disability (Buck & Buck, 2015). 14
Clothes usually have an open back or shoulder opening so that the dressing process can be fast and easy. However, this doesn’t facilitate the dressing process for an individual with a disability. Clothes should be designed so a person with a disability can don and doff their garments as independently as possible. This independence can enhance the quality of life of people with disabilities and reduce the cost and time of caregiver.
Following key design features should be considered when designing trousers for people with disability:
• Pattern modifications
o Anthropometric Characteristics. Previous studies have compared the
anthropometric characteristics of people with and without disability and have
found several differences between these groups (Das & Kozey, 1999; Goswami,
Ganguli, & Chatterjee, 1987; Lucero-Duarte, de la Vega-Bustillos, López-Millán,
& Soto-Félix, 2012). It is essential to understand differences in measurement
when a body is standing compared to sitting, such as: “Hip bones spread out.
When a body is seated for long, stomach muscles does not work in the same way.
So, waistline becomes thicker” (I. Camilleri, personal communication, April 7,
2016), fat and muscle spreads at butt and thigh region when seated (Fernandez,
2015). Thus, all those changes should be considered while drafting a pattern for a
seated position.
o Ease of Movement. It is essential to keep in mind while designing trousers that it
should not restrict body movement. Wang, Wu, Zhao and Li (2014) noted that for
easy limb movement, location of joints should be given more design
consideration. 15
o Easy Access.
§ Location of Openings: Front opening facilitates the process of dressing
and undressing independently. Openings should be carefully designed as
the person should be able to access independently. Outside seam openings
allow the pants to lay flat on a bed or on a chair. Inside seam openings
allow for taking care of personal needs without getting undressed or even
taking shoes off.
§ Pocket placement: People using a wheelchair have no functional use of the
standard front and back pockets that most of the trousers have. It is
impossible to access the pockets while sitting in a wheelchair. Thus,
pockets should be designed keeping in mind their reach and its directional
opening (S. Alves, personal communication, April 15, 2016). Able2wear
brand has developed cargo pants with handy placing of the leg pocket,
which has been angled for easy access. All IZ Adaptive trousers don’t
have back pockets, as it causes extra fabric at corners of pockets that may
cause skin irritation (I. Camilleri, personal communication, April 7,
2016).
§ Type of Fasteners: Designed adaptive clothing should provide easy access
for people with disability to don and doff, providing independence and
self-confidence to people. Closures such as buttons, Velcro, zippers with
big pull tab and snaps could be used to assist people with disability (Buck
& Buck, 2015). Velcro has been the favorite choice for the designers and
the manufacturers in adaptive clothing for many years. Many have tried to 16
use decorative buttons and zippers to conceal Velcro fasteners, allowing
easy adjustments and making the garment look like conventional clothing.
Magnetic fasteners are applied in clothes replacing hard-to-manipulate
buttons or zippers (“Magnetic button clothing” 2016). (Silvert's, 2016)
o Fit. Proper fit of a garment is determined by the relationship of the size of the
garment compared to the size of the wearer (Huck, Maganga, & Kim, 1997). Past
research studies have demonstrated a significant problem area for fit in protective
and functional clothing is in the crotch area (Huck et al., 1997). This can be
solved by providing appropriate garment ease. Too much of garment ease may
confine leg movements. Following features can assist in providing proper fit in
trousers for wheelchair users (I. Camilleri, personal communication, April 7,
2016):
§ High-cut back waist: the back length to be higher at the back waist, for
natural fit that will not ride down in back
§ Lower front cut: to reduce bunching of fabric
§ Shape back waist: to accommodate movement
§ Elasticated waistband at the back: to provide all day comfort and fit
§ Zipper and button closure in the front: to secure the waist
§ Length of the trouser: cover the ankle
Additional to this, knee movement should be taken into consideration. Knee-caps
change shape when bent, so it’s important to remove extra fabric at the back to let
trousers fall flat (Fernandez, 2015).
o Silhouette: slimmer cut leg to have a clean look. 17
o Accommodation for concealing medical devices and related accessories:
§ Trousers should be engineered in a way to conceal the medical devices
like a catheter. Channel could be sewn into the trousers so that the tubing
of a Foley catheter may be held in place. A pocket could be included on
the lower part of their pants for a drainage bag that could be placed with a
concealed opening to drain the bag as needed from the outside without
having to lift the pants and exposing the bag. The companies like Buck
and Buck uses folds and pleats in adaptive clothing to conceal connections
for feeding tubes, catheters, and other medical devices.
o Type and placement of seam: Seams should be strategically placed and made as flat
as possible to avoid skin irritation resulting in pressure ulcers (I. Camilleri, personal
communication, April 7, 2016). A major concern with heavy weight fabrics is that it
produces bulky seams. Such seams may damage sensitive skins or causes pressure
sores. To overcome this problem, careful positioning of the seams is needed
(Thornton, 1990).
• Specialized fabrics
Past studies have supported that people with physical disabilities wish to have
clothing made of fabrics with unique textile properties. Participants in the study,
Clothing and Related Needs of Physically Handicapped Persons (Shannon & Reich,
1979) showed preference for light to medium weight fabric, with properties to keep them
warm in winters and cool in summers. Cotton and polyester blend fabric was liked by the
most. 18
Wang et al. (2014) in their study designed a set of wheelchair user-oriented
functional pair of clothing. They used water absorbent and air permeable knitted fabrics
to make the garment. Pressure ulcers or infections caused by wet skin are a common
health issue seen by wheelchair users. Thus using these fabrics have alleviated the
problem of wet skin. The participants rated thermal sensation higher. Due to long sitting
hours and less body movement, the body heat is low. Thus, the participants saw the
warmer sensation through fabric as positively improving their experience.
• Wear and Tear of garment
While designing clothes for wheelchair users, it is important to consider the wear and
tear caused by transportation. For instance, the sleeves of shirt and should be carefully
designed as wheelchair arms cause heavy wear at particular points. But at the same time,
seams should be durable enough to withstand tearing and breaking when subjected to
tension.
• Price point
One of the main factors that restrict people with disabilities to buy adaptive
clothing is the price. Most of those individuals do not have much purchasing power as
they rely on security funds or similar source of funding. Resources are limited. So,
while designing the functional adaptive clothing, the price component had to be
considered.
Balancing Functional and Aesthetic Considerations
In the past, some studies had been conducted on clothing design for people with disabilities.
However, most of those designs were mainly focused on functional characteristics, lacking aesthetic considerations (Chang et al., 2009). The focus on clothing for people with physical 19 disabilities that applies both functional and fashionable (aesthetic) considerations began in mid-
1950s by Cookman and Zimmerman (Rusk & Taylor, 1959). Clothing should meet functional needs like protection and comfort as well as contribute values such as self-esteem, respectability, status and confidence (Rosenblad-Wallin, 1985). Aesthetically designed garments assist to focus on other elements rather than on physical appearance. Style and pattern design of the garment should improve the quality of life by encouraging health recovery, enhancing lifestyle and realizing personal expectations (Chang et al., 2009). Functional clothing with aesthetic elements assists to enhance a person’s self-esteem, independence and participation in social activities
(MacDonald, Bua-Iam, & Majumder, 1994).
Tommy Hilfiger developed a collection for children with special needs, making sure that
“the clothing is not only functional but looks exactly the same as the TH Kids collection” The clothes in this collection resemble the mainstream spring collection, but include magnets, Velcro and other modifications for easy access to don and doff the garments (Diament, 2016).
Factors Affecting Purchase Decisions
Following are the key factors affecting purchase decision of people with disabilities.
Perceived Risks. People with physical disability have special clothing needs and represent a particular consumer group for clothing manufacturers, designers, and retailers. Due to their needs, people with physical disabilities may perceive different risks relates to clothing purchases than able-bodied people (O'Bannon, Feather, Vann, & Dillard, 1988). O’Bannon and colleagues discussed various perceived risks including economic, performance, physical, psychological, and social and the relationship between information seeking and risk associated with clothing purchases wheelchair users. The findings ranked the perceived physical risk highest and 20 perceived social risk lowest. Perceived risks first defined by Bauer (1960) as a factor that influences consumer decision-making.
Economic Considerations
Economic conditions influence the buying behavior and it should not be ignored while investigating the clothing needs of people with physical disability (Russell, 1988). Past studies have demonstrated that high cost of specially designed functional clothing is a concern for individuals with physical disability (Freeman et al., 1985). This is likely because economically the majority of people with physical disability have lower incomes and higher health and lifestyle costs (Na, 2007). Financial stress was indicated in the study in clothing and related needs of physically handicapped persons (Shannon & Reich, 1979). People have limited funds in which they have to support themselves including buying specialized medical devices, other additional support services and maintain living lifestyle standards. So, under these stressful financial circumstances, the clothing purchase decisions become more complex (Russell, 1988).
Thus, while redesigning clothing for people with physical disabilities, it is important to aware of their economic resources (Shannon & Reich, 1979).
Price has been seen as one of the factors affecting clothing purchasing decision. It involves the actual cost of the item weighed against the benefits of the item to be consumer over time (MacDonald et al., 1994). A garment should be designed to match with several other pieces, to reduce the cost of each wearing and increase the life span of a garment (Kennedy,
1981).
Perception of functional clothing
The objective of the study on perceptions of functional clothing by able-bodied people was to examine functional clothing as a factor in social interactions between physically disabled 21 and non-disabled people (Freeman, Kaiser, & Chandler, 1987). Most of the students with physical disability felt that clothing and appearance create the first impression and critical in people’s responses towards one another when they first meet. They also found that people with visible disabilities have contradictory feelings when it comes to buying specially designed clothes. They, perhaps, over-estimate the potential of those clothes to make them look different from the crowd and impact on social interactions over the benefits provided by functional features.
People with visible disabilities often feel internally stigmatized even if the clothing functional considerations are well thought out and features highlighting their adaptive components are hidden from perceivers (Freeman et al., 1987). The sense of stigmatization creates attitudinal barriers between people with and without physical disabilities that often hinders meaningful social interactions.
The above literature on past developments of adaptive clothing, design and pattern modifications required in clothing for wheelchair users, need for concealing medical devices, benefits of incorporating advance textiles in the clothing and purchasing intentions towards buying adaptive clothing have led to the research questions one, two and three.
F 22
Theoretical Framework- FEA Consumer Needs Model
The concentric circle Functional, Expressive,
Aesthetic Consumer Needs Model (FEA Model),
developed by Lamb & Kallal (1992) is formed by three
separate circular layers as shown in Figure 1. The target
customer is positioned in the innermost and the center
layer of the model. This component is placed in the
center because the customer is the main focus while Figure 1. The FEA Consumer Needs Model by Lamb and Kallal (1992) designing. In this section elements such as
“demographics, psychographics, physical characteristics, activities, and preferences” (Lamb,
1992) are incorporated to have a better understanding of the target consumer. Lamb & Kallal
(1992) emphasized that the user’s needs must be explored, analyzed and identified at the beginning of the design process. The idea that a designer should first comprehend a user’s needs, and then decode those needs step by step transferring into a final design is productive
(Bye & Hakala, 2005).
The second circular layer of the model represents the culture ring. This layer of the model is justified as follows: “culture acts as a mediator or filter between the intended users of apparel and their requirements or desires in their apparel items” (Lamb, 1992). The third circular layer cites the name and provides sub-attributes of each of the FEA elements. The arrows demonstrate the interrelationship between the functional, expressive and aesthetic elements.
Although, each element is defined individually, they are not, mutually exclusive (Lamb, 1992).
23
Functional considerations
Functional considerations are directed towards the garment’s ability to execute a task, such as performing comfortably in the sitting position for non-traditional body types. Lamb &
Kallal (1992) defined functional considerations as “the utility of the garment”. Fit, mobility, comfort, protection, donning and doffing are other major considerations for the specific target market, as shown in Figure 2.
Expressive considerations
Expressive considerations for a garment must be compatible with a customer’s status and self-esteem for them to wear and purchase the garment. Lamb & Kallal (1992) described expressive considerations as “the symbolic and communicative aspects of dress”. Elements include values, roles, status, and self-esteem. Clothing helps to communicate personal identity and express relationship with others. Plenty of information is passed and received through nonverbal communication. Therefore, it is essential to consider expressive considerations while designing clothes for people with disability.
Aesthetic Considerations
Aesthetic considerations comprise of style and design that should align with any particular customer’s personality. Lamb & Kallal (1992) defined aesthetic considerations as
“component of a garment that use a line, form, color, texture and pattern to create a pleasing design”. The style and design should align with the user’s personality. This model incorporates art elements, design principles, and body-garment relationship. Functional clothes that follow fashion trends are important for people with disabilities (De Klerk & Ampousah, 2003). Most of the garments that are available for this consumer segment in the current market do not look trendy and therefore do not achieve aesthetic needs of the target market. 24
FUNCTIONAL EXPRESSIVE AESTHETIC
1. Fit 7. Values 11. Art elements 2. Mobility 8. Roles 12. Design principles 3. Comfort 9. Status 13. Body- 4. Protection 10. Self- Garment Esteem 5. Donning
6. Doffing
Figure 2. Sub Elements of FEA Model based on Lamb & Kallal (1992)
In summary, the FEA model is user centric aiming to recognize the clothing needs of the final customer (Lamb, 1992). Originally, the FEA model was developed as a teaching tool.
However, it has been successfully applied to particular areas of functional design such as hospital gowns (Cho, 2006) and sailing apparel (Bye & Hakala, 2005).
In this study, sub-elements of FEA considerations have been used to determine the clothing attributes and to determine the satisfaction level of wheelchair users for each of the vectors. Additionally, each consideration of FEA model was observed to analyze how wheelchair users rank them in order of their importance.
Lamb & Kallal (1992) have revised the functional design framework of Watkins, 1984 and took it one step further. They not only tested the functional needs of the wearer, but also addressed the expressive and aesthetic needs. Particular considerations such as fit and mobility were identified related to functional aspects of clothing comparable to the functional design process. Expressive considerations of the FEA model include the messages a garment sends 25 reflecting social status and individual self-esteem. The FEA model may be applied to both functional and fashion clothing design. Both function and fashion were considered when designing clothing for people with disabilities. Using the FEA Model, the final user is at the center of the design process intended to meet their clothing needs. The following studies have demonstrated that functional considerations are the most focused need of the consumer, but at the same time, consumers look for expressive and aesthetic features. Once all the three needs are balanced, garments are more likely to satisfy the consumer both functionally and aesthetically.
The FEA model has been used to investigate the needs of competitive female sailors (Bye
& Hakala, 2005) and high school soccer players (Holland, 2007). One piece uniforms were developed by members of Bye’s research team after evaluating the functional, expressive and aesthetic needs of competitive female sailors (Bye & Hakala, 2005). For the sailors, functional needs included thermal balance, safety, mobility, fit, and quality. Researchers took into account the way sailing uniforms made the wearer feel by examining the expressive needs. Feminine appearance and traditional design were the two aesthetic considerations used to design the new uniform. The most important features of the new design were the feminine silhouette, toileting access, and one-piece design (Bye & Hakala, 2005).
Holland (2007) used the FEA
Consumers Needs Model proposed by Lamb
& Kallal (1992) to recognize whether
functional factors play a role in determining
satisfaction of soccer uniforms. It was
observed that functional and aesthetic user
Figure 3. Revised FEA Model by Holland needs were essentially considered in analysis (2007) 26 and evaluation phases of the apparel design process. To solve the need, Holland proposed a modified model (Figure 3), where she considered two functional designs and one engineer design
(DeJonge, 1984; Lamb, 1992; Regan, Kincade, & Sheldon, 1998). DeJonge (1984) described the functional design as an interface medium and as a design criterion to address the conflicts among factors. That model was later supported by the Engineer Design Model that includes the study of alternative solutions to clarify objectives before prototype and expenditures (Regan et al., 1998).
The FEA model was used as a conceptual framework to be included before and throughout the design development. A six stage design process was planned for the study as the extension of
(Lamb, 1992) previous design development model. The stages are comprised of problem identification, preliminary ideas, design refinement, prototype development, evaluation, and implementation. The first three steps replaced the Koberg and Bagnall (1981) design process of
Accept Situation, Analyze, Define, Ideation, and Select stages. The fourth stage, prototype development, was inspired by two design process methods: Koberg and Bagnall’s Implement stage (1981) and Hanks, Belliston, and Edwards’ Analysis stage (1977). The last two stages, such as evaluation and implementation, remained unrevised. The most frequent gaps in satisfaction were found in fit and impact protection of soccer uniforms. The overall satisfaction with soccer uniforms was somewhat neutral which suggests a need for overall design improvement. A positive correlation between satisfaction with functional and aesthetic components was also identified.
Emerich (2011) examined women’s snowboarding clothing desires and preferences in the context of Lamb and Kallal’s (1992) FEA Consumer Needs Model. To know their clothing desires and preferences, she conducted an interview and survey with fifteen women snowboarders. Findings assisted her in creating two prototypes of snowboarding jackets and 27 pants. On the basis of pictures and fabric swatches of the garment, those prototypes were evaluated through a survey by the original participants. The results demonstrated that the participants had ranked functional consideration as their top priority followed by the expressive and the aesthetic elements. Three sub-themes within the theme of function: performance components, protection & regulation, and durability, were identified. Participants also showed interest for environment elements. In snowboarding sports activities environmental friendly apparel plays a vital role. Accordingly, she modified the FEA Consumer Needs Model and added the environmental consideration to it. The FEA model provided a structure for designing the snowboards garment that focused on the functional, expressive and aesthetic needs of snowboard players. The model was initially formed to address clothing design for individuals with special needs, but this was adopted for the study considering snowboarder’s specific needs such as water and windproof, easy mobility and cold preventing garments.
Stokes & Black (2012) examined the clothing needs of teen girls with disabilities using the FEA model as the conceptual framework. Online surveys were distributed to organizations and individuals with disabilities inquiring about their clothing interest, problems, and needs.
Findings showed that their clothing interests varied from low to high. Most of the responses were aligned to the functional consideration such as the fit, donning and doffing, and comfort.
They also showed a strong desire for stylish clothes with better alternative fastener systems such as Velcro and snaps instead of buttons and zippers. To address the gap between function and fashion, the FEA model was modified. In this case, the body-garment relationship did not fit in any one single consideration type; such as functional, expressive or aesthetic. Here, a combination of functional, expressive and aesthetic considerations was required. Their research 28 team determined that teen girls look forward to clothes that fit them well along with clothes that help them to establish identity and self-esteem.
In 2001, Abraham-Murali et al. (2001) identified and evaluated apparel attributes and personal value for wheelchair users (Abraham-Murali et al., 2001). Value is the “compilation of perceived benefits developed by the consumer from gathering information, owning or using a product” (Fiore & Ogle, 2000). All users including people with disabilities are inclined to make a purchase decision if they conceive value from the product. Four focus group interviews with
19 female wheelchair users were performed on three categories of clothing: formal wear, casual wear, and undergarments. Their responses after content analysis were categorized into Physical
Appearance, Physical Performance, Expressive and Extrinsic Attributes. Physical Appearance criteria were the most noticeable characteristic of a garment. Attributes such as styling were ranked the highest, then fabric, and construction. The color was given the least importance.
Styling was related to position and type of closure, fit and length of attire to make the experience of dressing and undressing pleasant and less stressful.
Physical Performance criteria consist of clothing attributes that contribute to physical aspects of the product such as fabric durability and quality, care, garment, and convenience.
Convenience was ranked the most important, then garment, fabric durability and quality and care, respectively. Two prominent elements of convenience were 1) ease of putting on and taking off a garment and 2) allowance for bodily functions. The criteria for Expressiveness was how a garment looked when dressed by a participant, evoking participant’s feelings and reaction to use. Extrinsic Attributes are the elements that are used to evaluate and make purchase decisions. 29
Understanding of the Functional, Expressive and Aesthetic (FEA) Consumer Needs
Model (Lamb, 1992) and how it was modified by various research scholars to understand clothing needs and satisfaction for particular group, generated the idea of adding heath element into the function clothing. Thus, contributing towards the research question one, two and three.
RQ 1: What are the level of satisfaction of clothing attributes of wheelchair users in
regards to:
-Ready-to-wear clothing (in general)
-Adaptive clothing
-Trousers (in specific)
RQ 2: How do wheelchair users, perceive incorporation of advanced textile
innovations such as anti-bacterial and moisture wicking fabric in their clothing?
RQ 3: Which are the design elements that wheelchair users are looking in clothing
to modify their clothing purchasing behavior and what are their intentions towards
the customized adaptive clothing?
Theoretical Framework- Quality of Life
World Health Organization defines Quality of Life (QOL) as “individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns” (WHOQOL group, 1995). QOL addresses six domains: physical health, psychological state, the level of independence, social relationships, environment, and spiritual/religious/personal beliefs.
For this study, three domains related to the quality of life: psychological, level of independence, and social relationships. Thus, these domains were tested with the participants as a means to determine levels of QOL connected to the FEA design model. Those three domains 30 were selected on the basis of their direct indication of relevance related to the understanding of clothing needs and satisfaction of wheelchair users. Facets of the three selected domains were demonstrated in the figure 4 (Group The Whoqol, 1998):
Figure 4. Quality of Life
Clothing plays a significant role in an individual’s physical, psychological, and social well-being (O'Bannon et al., 1988). Reich (1976) discussed how clothing contributes towards enhancing a person’s body and lessens the threat of psychological insecurity. Meinander &
Varheenmaa (2002) have stated that quality of life for people with disability can be substantially improved by a better-designed clothing regards to functional and aesthetic considerations.
Ready-to-wear clothing is unsuitable for people with physical disabilities as the clothes don’t fit them well, and they lack aesthetic considerations which compromise their sense of self-respect
(Meinander & Varheenmaa, 2002). 31
Well-fitted and designed clothing contributes to psychological balance and self-satisfaction, assisting them to be part of the society. Clothing design research should consider physiology, comfort and psychological tolerance (Chang et al., 2009). There is an apparent difference in living lifestyles of people with physical disabilities and able-bodied people (Chang et al., 2009).
Physical differences have impacted people with physical disabilities psychologically and have distinct characteristics than able-bodied people (Chang et al., 2009). Since body image and appearance are essential elements of face-to-face interactions, clothing can alleviate or aggravate the situation.
Decreased quality of life and diminished well-being are easily noticed in the spinal cord injury population (Chan & Chan, 2007). The purpose of Chan’s (2007) study was to investigate the relationships between spinal cord injury, wheelchair user’s satisfaction, perceptions of their community participation and Quality of Life. To examine the relationship between the thirty-one wheelchair user’s satisfaction and Quality of Life, the Chinese version of the Quebec User
Evaluation of Satisfaction with assistive Technology (C-QUEST) and the abbreviated Hong
Kong version of the World Health Organization Quality of Life Questionnaire (WHOQOL-
BREF) were used. It was seen that the C-QUEST device sub-scores were weakly correlated with four domain scores of the WHOQQOL-BREF, i.e. physical, psychological, social relationship and environmental aspects. Whereas; friends, peers and colleagues were more related with their
QOL than physical environmental counterparts. Therefore, to enhance QOL of people with spinal cord injury, more emphasis should be given to social networks and community services.
On the basis of facets of domains, the following three domains i.e. psychological, level of independence, and social relationships, is used to determine levels of quality of life for this study. Facets of three domains are (Group The Whoqol, 1998): 32
Table 1 WHOQOL Domains and Facets Domains Facets
Psychological Positive feelings Thinking, learning, memory and concentration Self-esteem Bodily image and appearance Negative feelings
Level of Independence Mobility Activities of daily living Dependence on medication/treatment Work capacity
Social Relationships Personal relationship Social support Social Inclusion
For this study, these three domains were selected to measure overall quality of life of wheelchair users. The mean of each domain can determine the selection and preferences of clothing needs.
To measure the quality of life, the World Health Organization (WHOQOL- 100) had developed a method to determine scores for each domain, such as scores relating to the dimension of quality of life (i.e. positive feelings, social support, financial resources etc.), scores relating to the larger domains (i.e. physical, psychological, level of independence, social relationships, environment and spiritual/religion and personal beliefs) and a score relating to overall quality of life. Domain scores were calculated by computing the mean of the facet score within the domain. 33
To maintain a high quality of life for people with disability, adaptions need to be maintained to the current level of functionality, a positive attitude and positive social relationships and emotional support (King et al., 2012). This can be done by generating design solutions in apparels that provide more functionality aspects such as fit, movement, and flexibility. Having clothing that balance functionality and aesthetics expectations/needs may contribute in enhancing self-esteem. It will also assist in developing positive social relationships and positive attitudes towards life and possibly increase their quality of life. Thus, leading to research question four.
RQ 4: What is the relationship between perceptions of quality of life of wheelchair
users and FEA elements of clothing?
34
CHAPTER III
METHODOLODY
To analyze the needs, a questionnaire was developed on the basis of the literature review and World Health Organization Quality of Health (WHOQOL-100) instrument. The questionnaire was sent to 160 wheelchair users, with close-ended questions and one open-ended question in the end. This chapter outlines the conceptual model framework, development and description of the instrument used, selection and description of the sample, data collection and data analysis.
Conceptual Model Framework
Figure 5. Modified FEA Model and QOL Model
As illustrated in Figure 5, Functional, Expressive, and Aesthetic (FEA) Consumer Needs
Model (Lamb, 1992) and Quality of life model have been modified. The health element is linked with the quality of life, determining the clothing needs and satisfaction level of wheelchair users. 35
Revised Functional, Expressive, and Aesthetic (FEA) Consumer Needs Model (Lamb,
1992), is used to identify the problems and challenges faced by wheelchair users in the context of functional, expressive and aesthetic considerations. Functional considerations include fit, mobility, comfort, protection, donning, and doffing. Expressive considerations are defined as the values, roles, status and self-esteem of the wearer. Aesthetic considerations are art elements and design principles (Lamb, 1992). Health has been added to the functional considerations, keeping in mind the specialized fabric that can assist in releasing moisture trap and decreasing the potential bacteria growth and malodor due to long sitting hours. The two-directional arrow shows the relationship between functional, expressive and aesthetic elements of clothing.
Quality of life model is adopted to assess the quality of life of wheelchair users. It has six domains; physical health, psychological state, level of independence, social relationships, environment, and spiritual beliefs. For this study three domains had been selected. Facets of psychological state, level of independence and social relationships assisted in calculating the quality of life score.
The arrow between the two models shows the connection between modified FEA and quality of life model. The added health element under the functional element assists in assessing the quality of life of wheelchair users. It was noted that well-thought-out and designed adaptive clothing can boost self-confidence and makes them inclusive in society, thus improving their quality of life.
Instrument Development
The clothing preferences and interests of wheelchair users were assessed using an existing 5- point Likert scale, to evaluate each component from 1 indicating very dissatisfied to 5 indicating very satisfied. The questionnaire for the study was developed on the basis of previous 36 studies done on clothing needs assessment (Dickson & Pollack, 2000; Holland, 2007). To identify the clothing needs of wheelchair users, the questionnaire comprises of seven sections
(Appendix A).
Section one had questions designed to assess the respondent’s satisfaction level with current ready-to-wear, adaptive clothing and trousers in the context of functionality and aesthetics. The area of focus was on elements of functional and aesthetic under FEA model, proposed by Lamb & Kallal (1992) and clothing attributes of Physical Appearance and Physical
Performance (Abraham-Murali et al., 2001). Section two was to determine how important functionality, expressive and aesthetics of garments were to participants. It measured their clothing preferences that might work for them. The third section addressed the anatomical discomfort issues caused due to sitting for long period. Such feedback will be helpful in recommending the right fabric for the study. Section four has questions focusing on each participant’s strengths and limitations to perform daily activities and what difficulties do they encounter while purchasing trousers due to their disability.
The fifth section was directed to understand whether the participants of the study were aware of any brand or designers specializing in adaptive clothing. Also, this section contained questions to address which factors and design features were important for them to determine and purchase customized trousers.
The sixth section comprised of questions to determine the quality of life. The questions were borrowed from World Health Organization, WHOQOL-100 instrument and modified according to the study. Written approval was taken from World Health Organization to use the questionnaire. Participants were asked to rate their QOL on a 5-Point Scale, to rank each question from 1 indicating not at all important to 5 an extreme important. 37
The seventh section consisted of demographics such as gender, age, ethnicity, level of education, employment status and an annual income of the participants. The last section had an open-ended question for them to comment on further improvement needed on size, fit, style and design for professional trousers.
Pilot Study
A pilot study was performed to ensure that questions and language of the survey were appropriate and not repetitive. 20 participants for the pilot study were recruited through a
“snowball sampling” method (Creswell, 2013) and from the Student Accessibility Services
(SAS) at the Kent State University. Questions were removed, added and modified on the basis of analyzing the responses made by the pilot participants.
Description and Selection of Sample
The sample size for this study was 160 wheelchair users, both men and women between the age 18 to 64 years across the United States. The years that participants are actively using wheelchair varies from 0 to 9+ years. Upon approval from Kent State University’s Human
Subjects Research Committee, the data was collected. Emails with the questionnaire link were sent to organizations serving people with disabilities, independent living centers, spinal cord associations and student accessibility services around the Northeast Ohio in an effort to recruit participants. Snowballing method (Creswell, 2013) based on personal communication and recommendations from other participants were also adopted to recruit more participants.
Messages were sent across through social media networks like Facebook or other chat forums to spread the word. Despite all the efforts, the response rate was very low. It was noted that many of the organizations contacted, due to the confidentiality policies were not able to provide information on individuals with disabilities that could potentially take the survey. However, they 38 were asked to distribute the survey link along with the purpose of the research to individuals that are in their database.
Data Collection
The questionnaire was initially sent to organizations serving people with disabilities, independent living centers, spinal cord associations and student accessibility services around the northeast Ohio through email. Due to the limited response rate, assistance was taken from
Qualtrics, a private research software company, to gather the data.
The purpose of the study, characteristics of the target audience, and research questions were explained to Qualtrics, to receive correct data sample groups. Screening questions were added at the beginning of the survey to determine whether the respondents fit into the parameters and were thus eligible to complete the questionnaire. To ensure valid responses, “attention filter” questions were employed by Qualtrics in the deployment of the questionnaire to incorporate quality controls and screen out the respondents who were not paying attention to the questions.
Data Analysis
The data was analyzed using Microsoft Excel and SPSS. Descriptive statistics along with means, frequencies, and percentages of Likert scale were used for each question. A similar method of content analysis was used by Campbell & Horne (2001) in the study of women’s trousers and Stokes (2010) in finding the clothing needs of teen girls with disabilities (Campbell
& Horne, 2001).
World Health Organization Quality of Life (WHOQOL-100) instrument for decoding and analyzing the results were adopted to determine the Quality of Life. To see the correlation between FEA consumer needs model and quality of life, SPSS was used. 39
CHAPTER IV
RESULTS
The research questions were designed to (a) assess the clothing needs and satisfaction of clothing attributes of wheelchair users; (b) to know if wheelchair users, perceive the incorporation of advance textiles in their clothing; (c) find out what are the design elements that wheelchair users are looking in clothing to modify their clothing purchasing behavior and what are their intentions towards the customized adaptive clothing and (d) to measure the perceptions of quality of life of wheelchair users and its relationship to functional, expressive, and aesthetic elements of clothing.
Description of Sample
A total of 160 wheelchair users completed the survey. Overall, approximately 49%
(n=78) of the participants were male and 51% (n=82) were female. The purposive sample ranged between 18-64 years of age. Among respondents, 30% (n=48) have been actively using wheelchair from 0 to 1 year, 28.8% (n=46) from 1 to 3 years, 18.1% (n=29) from 3 to 6 years and 23.1% (n=37) from more than 6 years. Majority of respondents, 77% (n=123) were
Caucasian/White, 8% (n=12) were Hispanic, 7% (n=11) were African American, 6% (n=9) were
Asian, and 3% (n=5) were Multiracial. They were from Northeast, Southeast, Midwest,
Southwest and West of the United States (Table 2).
40
Table 2 Demographic Information of Respondents Characteristics Male Female
Age range: Mean (SD) n = 78 n = 82 18-38 years 49 (62.8%) 66 (80.5%) 38-58 years 25 (32.1%) 12 (14.6%) 58+ years 4 (5.1%) 4 (4.9%) Years on Wheelchair n = 78 n = 82 0-1 year 24 (30.8%) 24 (29.3%) 1-3 years 24 (30.8%) 22 (26.8%) 3-6 years 12 (15.4%) 17 (20.7%) 6+ years 18 (23.1%) 19 (23.2%) Ethnic Background n = 78 n = 82 African American 2 (2.6%) 9 (11.0%) Caucasian/White 65 (83.3%) 58 (70.7%) Asian/ Island Pacific 1 (1.3%) 8 (9.8%) Hispanic 8(10.3%) 4 (4.9%) American Indian 0 (0%) 0 (0%) Multiracial 2 (2.6%) 3 (3.7%) Other 0 (0%) 0 (0%) Location n = 78 n = 82 Northeast 24 (30.8%) 24 (29.3%) Southeast 19 (24.4%) 22 (26.8%) Midwest 17 (21.8%) 18 (22.0%) Southwest 8 (10.3%) 11 (13.4%) West 10 (12.8%) 7 (8.5%)
Most of the respondents 63.13% (n=101), reported that they need some assistance in dressing, whereas 23.13% (n=37) needs complete assistance, and 13.75% (n=22) can dress themselves (Table 3).
Table 3 Rate of Independency/Dependency While Dressing Participants n=160
Completely dependent 22 (13.75%) Semi dependent 101 (63.13%)
41
Completely independent 37 (23.13%)
Assessing the Clothing Needs and Satisfaction of Clothing Attributes of Wheelchair Users
Hundred sixty respondents completed a five-point Likert scale (1= very dissatisfied, 5 = very satisfied) to assess the satisfaction level of ready-to-wear clothing, adaptive clothing, and trousers. Means and standard deviations were taken out for each clothing attribute. Clothing attributes were borrowed from FEA Model (Lamb, 1992) and study on perceptual criteria as well as attributes were used for evaluation of clothing by women using wheelchair (Abraham-Murali et al., 2001). All 160 respondents evaluated the satisfaction level of ready-to-wear clothing.
When asked if respondents have adaptive clothing, 65% (n=104) replied positively. Majority of respondents 82% (n=131) had trousers as a part of their wardrobe.
Ready-to-Wear Clothing
It was seen that respondents were mostly dissatisfied with “attractiveness” attribute
(M=2.91), followed by “easy to put on and take off” (M=3.04), fit (M=3.14), “movement”
(M=3.16), and “protection” (M=3.19) of ready-to-wear clothing. Respondents were satisfied with style (M=3.25), construction quality (M=3.29), durability (M=3.30), comfort (M=3.37), fabric quality (M=3.38), size (M=3.39) and color (M=3.54).
Adaptive Clothing
As seen in ready-to-wear clothing, respondents were least satisfied with attractiveness attribute (M=3.08) for adaptive clothing. When compared to ready-to-wear, it was noted by the researcher that some of the current issues in ready-to-wear were considered and resolved in the development of adaptive clothing. For instance, results indicated that respondents were satisfied on the variables of, easy to put on and take off (M=3.33), fit (M=3.31), movement (M=3.41), 42 protection (M=3.43), usability (M=3.45), construction quality (M=3.38) and comfort (M=3.43).
However, some of the factors such as style (M=3.16), fabric quality (M=3.35), and size
(M=3.36) were rated more satisfactory in ready-to-wear clothing. Managing fasteners (M=3.32), flexibility in movement (M=3.32), and body coverage (M=3.52) were reported as some of the concerns in adaptive clothing (Table 4).
Trousers
Respondents reported that the easy to put on and take off (M=3.12) was the most dissatisfied attribute with trousers. Unlikely to ready-to-wear and adaptive clothing, respondents were mostly satisfied with style (M=3.46) element of trousers.
Respondents were dissatisfied with accommodations for concealing medical devices
(M=3.15), as well as position of closure (M=3.18), silhouette (M=3.21), placement of seams
(M=3.23), back cut (M=3.26), and pockets (M=3.30). It was seen that attractiveness (M=3.21) was considered at a higher level of satisfaction as compared to ready-to-wear and adaptive clothing (Table 4).
The color was seen as a most satisfying element in all three categories of clothing, i.e. ready-to-wear clothing (M=3.54), adaptive clothing (M=3.54), and trousers (M=3.55).
Table 4 Satisfaction with Clothing Attribute Clothing attributes Satisfaction with current Satisfaction with Satisfaction with Ready-to-Wear current participant's Adaptive trousers Clothing N=160 N=104 N=131 Mean (SD) Mean (SD) Mean (SD) Style 3.25 (.98) 3.16 (1.11) 3.46 (1.02) Color 3.54 (.90) 3.54 (.92) 3.64 (.95) Comfort 3.37 (1.05) 3.43 (1.04) 3.55 (1.04) Attractiveness 2.91 (1.03) 3.08 (1.17) 3.21 (1.06) Usability 3.24 (1.05) 3.45 (1.04) 3.38 (1.04) 43
Fit 3.14 (1.05) 3.31 (1.07) 3.33 (1.01) Movement 3.16 (1.16) 3.41 (1.04) 3.25 (1.06) Construction quality 3.29 (1.02) 3.38 (.98) 3.4 (1.02) Fabric quality 3.38 (1.03) 3.35 (1.06) 3.4 (.98) Size 3.39 (.98) 3.36 (1.08) 3.35 (.99) Protection 3.19 (.97) 3.43 (1.00) 3.35 (.99) Durability 3.30 (1.10) 3.3 (1.08) 3.38 (1.04) Easy to put on and 3.04 (1.16) 3.33 (1.11) 3.12 (1.19) take off Managing fasteners 3.32 (1.10) and zippers Body coverage 3.52 (.99) Flexibility in ease in 3.32 (1.09) movement Position of closure 3.18 (1.03) Type of fasteners 3.35 (1.03) Pockets 3.3 (.99) Length of trousers 3.44 (.96) Back cut 3.26 (.99) Placement of seams 3.23 (1.08) Accommodation for 3.15 (1.02) concealing medical devices Silhouette 3.21 (1.00)
Perceive Incorporation of Advanced Textiles in Clothing for Wheelchair Users
Next, respondents were asked to rate their concerns on several variables using a five- point Likert scale (1= not at all, 5 = an extreme amount). Findings showed that 67.5% (n=108) of respondents were extremely concerned about the discomfort due to moisture and heat trap while sitting for long hours.
Potential bacteria growth on fabric due to moisture and heat trap was another major concern reported by 65.60% (n=105) of respondents. Significant portion, 63.10% (n=101) of respondents showed concern of malodor generated from long sitting hours (Table 5).
44
Table 5 Perceive Incorporation of Advanced Textiles in Clothing Standard Mean Deviation Percentage
Comfort level due to moisture heat trap 3.94 .97 67.50% while sitting for long period of time Potential bacterial growth on fabric due 3.77 1.10 65.60% to moisture and heat trap Malodor generated from long sitting 1.03 63.10% hours 3.79
Inserted anti-bacterial panel in certain regions of adaptive clothing was rated as an important attribute by 53.75% (n=86) respondents.
Wheelchair Users’ Willingness to Modify Their Clothing Purchasing
Behavior and Intentions towards the Customized Adaptive Clothing
Respondents were asked to rate the most dissatisfied piece of clothing they currently own, from most important (top) to least important (bottom). They were most dissatisfied by trousers (M=2.93), followed by jeans (M=3.34), cargo pants (M=3.35), shirt (M=4.41), and outerwear jacket (M=4.45) (Table 6). Approximately half of the respondents reported having some difficulty purchasing trousers, as 53.13% (n=85) indicated taking trousers on and off to be the most difficult part in selecting this piece of clothing. Some of the respondents, 35.63%
(n=57) reported that trousers don’t fit well, 33.13% (n=53) it rides down from the waist, 25%
(n=40) the length is too short and 24.38% (n=39) rear was bulky. Other common difficulties described in an open-ended question by respondents were: need assistance while putting on the trouser, lacks movement, and fabric bunches at the back.
45
Table 6 Most Dissatisfied Pieces of Clothing Mean Standard Deviation Trousers 2.93 1.50 Cargo Pants 3.35 1.53 Formal Suit 3.01 1.76 Shirt 4.41 1.63 Outerwear Jacket 4.5 1.65 Jeans 3.34 1.95
To know the intentions towards the customized adaptive clothing, questions such as willingness to travel, whether they would be comfortable to be 3D-Body-scanned, important clothing attributes for re-designed adaptive clothing etc. were asked. Most of the respondents,
48.75% (n=78) were willing to travel 10 to 20 miles to be fitted to have customized clothing made. Some of the respondents, 31.25% (n= 50) were even ready to travel 20 to 40 miles. Less than half, 46.25% (n=74) were comfortable towards the idea to be 3D-Body-scanned for body measurements.
In order for respondents to purchase the re-design adaptive clothing, it should fit properly and looks aesthetically pleasing (M=4.39), able to don and doff easily (M=4.33), have option to customize (M=4.3), have inserted anti-bacterial panel in certain regions (M=4.28), and able to conceal medical devices (M=4.03).
For the customized clothes that meet respondent’s function and aesthetic needs, 45.63%
(n=73) were willing to pay 25% more on the clothing as compared to standard ready-to-wear clothing (Table 7).
Table 7 Willingness to Spend on Customized Clothing f (N=160) Percentage 10% 38 23.75% 25% 73 45.63% 46
50% 25 15.63% 75% 16 10.00% 100% 5 3.13% None 3 1.88%
Measure the Perceptions of Quality of Life of Wheelchair Users and its Relationship to
Functional, Expressive and Aesthetic Elements of Clothing
To measure an individual’s perception of quality of life, the three domains were focused on: Psychological, Level of Independence, and Social Relationships using a 5 point Likert scale where 1 indicates low, negative perceptions and 5 indicates high, positive perceptions. Means were calculated for each domain. To determine if there’s any relationships among respondent’s quality of life and functional, expressive and aesthetic elements of clothing, correlation was run in SPSS. Psychological aspect had a significant relationship with expressive and aesthetic elements of clothing (p<0.01). Level of independence had a significant relation with function and expressive elements of clothing (p<0.01). Social aspect has a significant relationship with function and aesthetic element of clothing (p<0.01) (Table 9).
Table 8 Correlation between QOL and FEA Elements of Clothing Domains of QOL Mean (SD) Function Expressive Aesthetic Psychological 3.28 (.694) 0.152 .219** .206** Level of Independence 3.28 (.495) .241** .232** .171* Social Relationships 3.23 (.599) .281** 0.147 .201**
Note: p<0.01**, p< 0.5*
47
CHAPTER V
DISCUSSION
Comparison of Clothing Needs and Satisfaction of Clothing Attributes of Ready-to-Wear
Clothing, Adaptive Clothing, and Trousers
The questionnaire assisted in determining the satisfaction level in ready-to-wear clothing, adaptive clothing, and trouser. Respondents were least satisfied with attractiveness attribute in
Ready-to-wear (M=2.91) and adaptive clothing (M=3.08). Previous researchers have emphasized the need for aesthetically pleasing and fashionable garment in functional clothing for people with a disability, but importance was always given to elements such as easy, self-access, and physical comfort (Shannon & Reich, 1979). The results supported that most of the garments available in the ready-to-wear market for wheelchair users were focused on functionality aspects.
Additionally, respondents were least satisfied with taking on and off the garments in ready-to-wear clothing (M=3. 04). Ready-to-wear clothing available in the market were not designed for seated position. From pattern making to fit prototypes, all were done for the mass market. As garments are not developed for sitting position, it might not fit well. Resulting, in restricted body movement. Protection (M=3. 19) was another clothing attribute that respondents were dissatisfied with. People who have had spinal cord injuries have a lack or limited sensation below a point of injury thus are at greater risk for pressure ulcers and infections caused by wet skin. Clothing needs to be constructed to protect the skin from these secondary conditions.
The study compared the respondent’s satisfaction level of ready-to-wear clothing with adaptive clothing. Results demonstrated that some of the dissatisfied ready-to-wear clothing attributes such as easy to put on and take off, fit, movement, protection, usability, and comfort 48 were paid attention while developing adaptive clothing for wheelchair users. This can be noted by the high mean scores of these clothing attributes in adaptive clothing. However, looking at the satisfaction level of adaptive clothing, respondents were least satisfied with attractiveness and styles. They do not have many options available in styles in adaptive clothing. This could be due to fewer designers and brands working on line for people with disabilities as only 7.5 %
(n=12) respondents were aware of brands or designers specializing in adaptive clothing.
Ease to put on and take off was the most important clothing attribute in trousers, as it can promote independence and build self-confidence. Respondents stated that they faced most difficulty in putting on and taking off the trousers, followed by options to conceal medical devices. This could be due to the position and types of closures used in the trouser. As discussed in the literature review, these design elements play a vital role in developing an accessible trouser for wheelchair users. Designers should come up with a design solution and engineer the pattern in a way that the trousers can conceal medical devices. Respondents don’t want themselves to stand apart from the crowd or have trousers that highlight their disability.
Unlikely as in ready-to-wear and adaptive clothing, respondents were satisfied with the style attribute in trousers. This might signify that respondents were more concerned about functionality elements more than aesthetics in trousers. More flexibility in movement, proper fit with the right type of closures and fasteners were required in trousers to perform daily activities like donning and doffing, going to toilet and getting on and off from wheelchair.
Incorporation of Advanced Textiles in Clothing for Wheelchair Users
More than half of the respondents, 67.5% (n=108) showed the discomfort caused due to moisture and heat trap for long period of time. Majority of respondents stated concern for potential bacteria growth on fabric due to moisture and heat trap while sitting for long hours. It 49 is important that fabric should dry quickly, keeping the skin surface dry in order to minimize the undesirable heat loss from skin and reduce the chances for bacteria breeding (Z. Wang, 2003).
Body wetness can increase the bacteria growth, resulting in malodor and skin diseases.
It was easily noticed that respondents preferred to have trousers made or have inserted panels of specialized fabrics such as moisture wicking and antimicrobial in their trousers. It was seen as a major design feature in determining customized trousers for themselves. Majority of respondents showed interest in purchasing the trousers that have inserted anti-bacterial panel in certain regions.
Wheelchair Users’ Willingness to Modify Their Clothing Purchasing Behavior and
Intentions towards the Customized Adaptive Clothing
From pieces of clothing that respondents currently own, they were mostly dissatisfied with trousers, jeans and cargo pants. They were fairly satisfied with shirt and outerwear jacket.
This justifies the need for creating/designing trousers that balance functional and aesthetic elements. Most of the brands such as ABL Denim, IZ Adaptive, Silverts etc. focuses on pants, denims in their collection line, that confirms the findings of this study. Some of the clothing needs had been addressed by these brands.
Respondents encountered fit issues while purchasing trousers for themselves in the market. Most of the trousers available don’t fit properly and are difficult to take on and off.
They progressively ride down from the back during wear. The main issue that was highlighted by many respondents was that they need some kind of assistance from family or caregivers while putting or taking off trousers. Trousers that do exist on the market as adaptive clothing options are predominantly designed to assist the caregivers rather than for an individual to dress by themselves. 50
Special alterations of ready-to-wear clothing to accommodate aids, such as a catheter, were needed by 43% (n=69) respondents. To accommodate their needs, clothes can be customized. It can be done through the traditional way of taking individual’s measurements or by doing 3D body scan to develop customized patterns. To have customized clothing made,
48.75% (n=78) respondents were willing to travel 10-20 miles. That means that almost half of the participant’s desire to have customized clothing for accommodating catheter, better fit, and style. 10-20 miles was a comfortable distance that participants were ready to travel for custom- made clothing.
Emerging technologies can play a vital role in making the production process economical and more time efficient. Technology such as 3D body-scanners can map the dimensions of a person to create custom fit (Kidd, 2006). Transforming those measurements into the pattern making CAD software, could save time and money in developing customized patterns for individuals. Almost half of the respondents, 46.25% (n=74) were comfortable to be 3D- scanned for body measurements.
Most of the respondents showed interest in having their clothes customized. They rated proper fit at the waist as highest, followed by right selection of fasteners for easy don and doff, use of specialized fabrics such as moisture wicking and antimicrobial, length of the trouser, pocket location, ways to conceal medical devices such as catheter and silhouette. They were also asked to rate the clothing attributes according to their importance level in order to purchase re- designed adaptive clothing. They preferred clothes that fit and looks aesthetically pleasing the most. For that, 45.63% (n=73) were willing to spend 25% more on customized clothing that meets functional and aesthetic needs. Therefore, it seems that wheelchair users were willing to modify their purchasing behavior, if their functional needs as well as aesthetic needs were 51 fulfilled. They were comfortable to use technology such as 3D body scan and travel few miles to have customized clothes made that fits them properly.
Perceptions of Quality of Life of Wheelchair Users and FEA elements of Clothing
Three domains: Psychological, Level of Independence and Social relationships were focused on measuring the perceptions of quality of life. The overall quality of life of the respondents were 13.08. Majority of respondents, 70% (n=112) were able to work, 63.13%
(n=101) were semi able to dress themselves dependently, that aligns with their higher domain score for Level of Independence of 13.6.
The positive correlation between domains of quality of life and FEA elements, shows that individuals with higher psychological level such as self-esteem and positive feelings value expressive and aesthetics aspects of garments much more highly. Respondents that were able to work, independently move around and perform daily activities rank highly the functional and aesthetic elements in clothing. Respondents with good personal relationships and social support give higher importance to functional and aesthetic elements in a garment. This signifies the important relationship between domains of quality of life and FEA elements.
The combined mean score of all domains resulted in the overall quality of life (M=13.08) of 160 respondents. That reflects on the higher mean score of function (M=4.41), expressive
(M=3.44) and aesthetic (M=3.49) elements.
Need for Trouser in Professional Workplace Environment
For several decades, the federal disability policy has been focusing on improving the economic conditions for people with disabilities. It was done by reducing or eliminating the barriers for them to participate in the workforce (Brault, 2012). According to U. S. Bureau of
Labor Statistics, the employment rate of people with disabilities have positively increased. For 52 instance, the employment-population ratio of people with disabilities, 16 years and above increased from 17. 3 in April 2015 to 18. 3 in April 2016 (U.S. Bureau of Labor Statistics, 2016).
In this study, more than half of respondents 70% (n=112) reported that they were able to work and 65. 63% (n=105) respondents were currently employed. Respondents who were currently working felt the need for adaptive clothing in professional workplace situation. Since the job interview is the first step towards employment, it is really important to dress up professionally. It can affect the person’s success in an interview and initial salary (Christman &
Branson, 1990; Ray, 1986). It also builds self-confidence and self-esteem of an individual.
Implications
This study has provided a platform for researchers, designers and manufacturers to understand the advanced clothing needs and wants of wheelchair users. This research can help in adding a health factor to the FEA Consumer needs model (Lamb & Kallal, 1992) and identifying and incorporating the need for more advanced textiles to be incorporated into designed solutions, such as anti-bacterial fabrics into garments for wheelchair users.
This study has additionally opened future prospects of investigating further into the relationship developed between FEA Consumer needs model and Quality of Life research.
Recommendations are made below on how researchers from interdisciplinary fields like design and health can utilize the findings of this study as a base for future research, how mass market apparel firms can include adaptive clothing lines into their collection, with options to customize for better fit and how health care system can make adaptive clothing as a part of the insurance.
53
Implications for Academics
Theoretical Contribution to New Knowledge for FEA Design Researchers
FEA Consumer needs model (Lamb & Kallal, 1992) has been used as a conceptual framework to determine the clothing needs and satisfaction levels of wheelchair users in terms of ready-to-wear clothing, adaptive clothing and trousers. The model emphasizes on the importance of balancing functionality, expressive and aesthetics elements of clothing. As mentioned in the literature review, FEA Consumer needs model have been revised throughout the years by researchers. For this study, “health” was added as a functionality attribute of the
FEA model. Health was not a consideration identified in the model, but was identified by the
160 wheelchair users as important when considering the clothing needs and level of satisfaction.
More than half of the respondents, reported the discomfort caused due to moisture and heat trap for long period time, showed concern for potential bacteria growth resulting in malodor and skin diseases. Thus, it is essential to research in this area and come up with advance solutions to promote health and well-being of individuals with disabilities.
Theoretical Contribution to New Knowledge for Quality of Life Researchers
Quality of Life assessment of people with disabilities have been done by many researchers, but no one has linked Quality of Life model with FEA Consumer needs model. The findings of this study have generated the need of looking at facets of each domain not as an independent factor, but as an overlapping elements. Review of past studies have reported that quality of life of people with disabilities can be enhanced if they have good physical health, psychological state, more level of independence, better social relationships, user-friendly environment and spiritual beliefs. For instance, psychological state’s facets such as positive feelings, self-esteem and bodily image and appearance could be boosted with better fitted and 54 stylish clothes. Additionally, by dressing up properly, they can experience greater inclusion and be part of society which increases social relationships. Therefore, it is important to continue to study and develop the links between facets of the quality of life model the FEA consumer needs model.
This overall effort calls for interdisciplinary team building placing the end user at the center of the research, utilizing data related to the FEA research to inform Quality of Life research and vice versa. Experts in fashion, clothing, textile, health sciences and technology must work towards optimal functional adaptive clothing solutions. Such effort will cater to a major and growing societal need, develop novel training opportunities for fashion students, and open up a new market with substantial commercial opportunities.
Implications for the Apparel Industry
Market
Textile research scholars and designers have explored and brought awareness of clothing needs of people with disabilities, but are not able to make a significant change in apparel manufacturing process to develop special needs clothing lines (Kidd, 2006) in a mass-market and profitable model. Manufacturers and retailers consider clothing for people with special needs as belonging to a different consumer segment, as their needs may not be catered for by the mass- produced market (Lamb, 1991). They face challenges with manufacturing and distributions, as no mass market was seen for garments designed for people with physical disability. Thus, clothing market for people with disability with relation to other market segments were small and less financially feasible for companies to cater this group. It is important not only to focus on the end product, but to look at the issue as a system that comprises of manufacturing, marketing, 55 health maintenance and end use. To understand the complete system, it is essential to study both from end user’s and manufacturer’s perspectives (Thoren, 1996).
On the other hand, like the established retailers or brands like Tommy Hilfiger and
Runway of Dreams can step into this target group as they have resources and funds to investigate and launch a clothing line for people with disability.
Customization
The majority of respondents, 73. 13% (n=125) reported that option to customize their adaptive clothing while purchasing adaptive clothing was fairly important to them, but looking at various adaptive clothing brands website, the option to customize was not available. IZ Adaptive used to have customization available for their clients initially for few years, but now they don’t.
Customization is very expensive and a time consuming process (I. Camilleri, personal communication, April 7, 2016). It involves a production process in which the manufacturing is based on single ply cutting of fabrics for production and assembly of the garment. Since the patterns are made for a person and adapted towards his or her needs, cutting is made on a single layer of material (Thoren, 1996), which makes it expensive.
The fitting process in developing special need clothing is difficult and challenging. To address the cost and be more time efficient, clothes can be customized in a way that provides proper fit and looks aesthetically pleasing on wheelchair users. It is essential to understand anthropometric characteristics and differences in body measurements while standing and seating position. Patterns should be modified and accommodated based on wheelchair users need.
Designers, retailers and scholars can incorporate technology such as 3D body-scanning to take an individual’s body measurements to create custom fit. Those measurements can be imported into pattern making CAD software to develop patterns. This can be time efficient and 56 economic. 46. 25% (n=74) respondents in the study were comfortable to be 3D body-scanned for accurate measurements.
Implications for Health Care System
Investigating relationship between FEA consumer needs model and quality of life model can promote better health care system. Well thought-out and designed functional adaptive apparel can have high impact on well-being of people with disabilities. Research on advanced smart textiles can be incorporated as the part of physical health, a domain in quality of life model. Specialized fabrics like moisture wicking and antimicrobial properties can reduce the potential bacterial growth and skin infections. Thus, having a scope of further research in functional adaptive clothing incorporating smart textiles could help to influence policy-makers in healthcare and insurance, to consider adaptive clothing relevant for revising insurance models. It can also create channels for funding support, as it improves quality of life, leading to better physical and psychological health.
Limitations and Future Research
Some of the limitations of the study are:
1) This study was conducted on a small sample size. To have a better understanding of their
clothing needs in respect to functionally, expressive and aesthetics, it would be better for
future research to collect data from a bigger sample size.
2) The respondents were recruited through Qualtrics, a private research software company,
to gather the data. The company might have a selected pool of people that are familiar
with survey methods, that could have influenced their answer choices in questionnaire.
3) Quality of life of current respondents were high. It could be possible that if the quality of
life of the respondents were low, the clothing needs and wants might be different. 57
Respondents could have a different satisfaction level of ready-to-wear clothing, adaptive
clothing and trousers and assessment of functionality, expressive and aesthetics element.
4) Due to limited time and resources, prototype trousers were not developed. The study is
not able to reflect on qualitative research. i.e. interviewing few participants, following by
taking measurements, drafting patterns, and developing trousers. This could be done to
analyze better fit and their clothing preference for trousers.
Future Research
Based on the findings of this study, following suggestions are made for future research direction:
1) It would be beneficial for future research to test the functional, expressive, and aesthetic
findings with a larger population of wheelchair users.
2) Establish an efficient method to reach out to the target sample of wheelchair users for
research purposes.
3) Develop a pair of trousers on the basis of findings and do a comparison study on
available and new designed pair of trousers, utilizing end-user test and evaluation models.
4) Moisture and heat trap due to sitting for long period of time resulting into potential
growth of bacteria and malodor on textiles implies worth conducting research into this
area.
5) Further research can be conducted to show relevance of quality of life model to FEA
consumer needs model.
6) This study was focused on three domains of quality of life. Other three domains;
environment, physical health, and spiritual beliefs can be investigated in future research. 58
7) Due to the limited funds available to wheelchair users, developing clothes with anti-
bacterial fabric can open up a channel for doctors to prescribe the clothing as part of the
insurance.
8) Textiles and clothing educators can play a significant role in research, education and
efforts related to body image and appearance related behavior, that can solve important
quality of life issues (Rudd & Lennon, 2001). 59
CONCLUSION
In conclusion, modified FEA Consumer Needs Model and Quality of Life model assisted in investigating the clothing needs and wants and assessing the perception of quality of life of wheelchair users. Health was not a consideration identified in the FEA model, but was identified by 160 wheelchair users as important when considering the clothing needs and level of satisfaction. Advance textile research is needed to incorporate specialized fabrics like antimicrobial and moisture wicking fabric to avoid potential bacteria growth and malodor. On the other hand, positive relationships found between FEA model and three domains of Quality of
Life model showed that the well designed and fitted garment can help boost self-confidence, thus promoting inclusion in society. Based on the results of this study, recommendations for future applications of the FEA consumer needs model and quality of life were presented.
60
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APPENDIX A: QUESTIONNAIRE
Functional Adaptive Clothing for Wheelchair Users
Q1 My name is Prerna Suri and I am a graduate student pursuing a master’s degree at the
Fashion School at Kent State University. For my thesis project, I am planning to perform an online survey to know the clothing needs & wants and perceptions of quality of life of wheelchair users with my advisors, J.R. Campbell (Director and Professor) and Dr. Kim Hahn
(Associate Director & Associate Professor) at Fashion School. We are looking for wheelchair users that are within the age group: 18-64 male and female. The purpose of this online survey is to 1) Investigate relationships between clothing needs and wants focusing on functionality, aesthetics and overall satisfaction 2) Explore whether wheelchair users are willing to modify their clothing purchasing behavior and intentions towards the customized adaptive clothing? 3)
Understand how modified adaptive clothing can contribute to the perceptions of quality of life
(psychological, level of independence and social relationships)? We estimate that it will take under 10 minutes of your time to complete the questionnaire depending on your reading ability and familiarity with survey methods. You are free to contact the investigators at the below address and phone number to discuss the survey. The risks of participating in this study are no greater than those encountered in daily life. There will be no costs for participating. Any data about the individual’s participant will be kept confidential to protect participant’s privacy and identity. All data will be securely stored and will be used only for research purposes. Your participation in this survey is voluntary. You may decline to answer any questions and you have the right to withdraw from participation at any time without penalty. If you wish to stop your participation in this research you may do so at any time by either closing the browser window or 69 clicking the link on the page entitled “exit”. If you have any questions or concerns about this research, you may contact Prerna Suri at [email protected] , J.R. Campbell at [email protected] or Dr. Kim Hahn at [email protected]. This project has been approved by the Kent State
University Institutional Review Board. If you have any questions about your rights as a research participant or complaints about the research, you may call the IRB at 330.672.2704. Approved
IRB number: 15-648. You must be age of 18 or above and a wheelchair user to participate in the study. By Clicking YES below you are indicating your consent to above procedures and acknowledge you have been informed about this study’s purpose, procedures, possible benefits and risks. You are also acknowledging that you are voluntarily agreeing to participate in this study and not waving any of your legal rights. m Yes m No
If No Is Selected, Then Skip to End of Block
Q2 Are you a wheelchair user? m Yes m No
If No Is Selected, Then Skip to End of Block
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Answer If gc Is Equal to 5
Q3 How long have you been actively using wheelchair? m 0-6 months m 6-12 months m 1-3 years m 3-6 years m 6-9 years m 9+ years
Q4 How long have you been actively using wheelchair? m 0-3 months m 3-6 months m 6-12 months m 1-3 years m 3-6 years m 6-9 years m 9+ years
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Q5 How satisfied are you with current ready-to-wear clothing attributes?
Very Dissatisfied Neither Satisfied Very satisfied dissatisfied dissatisfied or satisfied Style m m m m m Color m m m m m Comfort m m m m m Attractiveness m m m m m Usability m m m m m Fit m m m m m Movement m m m m m Construction m m m m m Quality Fabric m m m m m Quality Size m m m m m Protection m m m m m Durability m m m m m Easy to put on and take m m m m m off
Q6 Do you have any clothes that are specifically adapted towards your needs? This could be as simple as altering the fit of clothing that you purchase. m Yes m No
If No Is Selected, Then Skip To Are trousers part of your wardrobe?
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Q7 How satisfied are you with current adaptive clothing? Adaptive clothing refers to clothing designed for people with physical disabilities who may experience difficult dressing themselves due to a lack of full range of motion. For instance, clothes adapted by manipulating silhouette, easy closures and fasteners etc.
Very Dissatisfied Neither Satisfied Very satisfied dissatisfied dissatisfied or satisfied Style m m m m m Color m m m m m Comfort m m m m m Attractiveness m m m m m Usability m m m m m Fit m m m m m Movement m m m m m Construction m m m m m Quality Fabric m m m m m Quality Size m m m m m Protection m m m m m Durability m m m m m Easy to put on and take m m m m m off Managing fasteners and m m m m m zippers Body m m m m m Coverage Flexibility and ease in m m m m m movement
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Q8 Are trousers part of your wardrobe? m Yes m No If No Is Selected, Then Skip To How important the following attribute...
Q9 How satisfied are you with your favorite trousers following attributes? Very Dissatisfied Neither Satisfied Very dissatisfied dissatisfied satisfied or satisfied Style m m m m m Color m m m m m Comfort m m m m m Attractiveness m m m m m Usability m m m m m Fit m m m m m Movement m m m m m Construction m m m m m Quality Fabric Quality m m m m m Size m m m m m Protection m m m m m Durability m m m m m Easy to put on m m m m m and take off Position of m m m m m closure Type of m m m m m fasteners Pockets m m m m m Length of m m m m m trousers Back cut m m m m m Placement of m m m m m Seams Accommodation for concealing m m m m m medical devices Silhouette m m m m m
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Q10 From the clothing in your wardrobe, how important are following attributes?
Not important A little Moderately Very Extremely important important important important Functionality (fit, mobility, comfort, m m m m m protection, don and doff) Expressive (value, status, m m m m m self-esteem and identity) Aesthetics (pleasing, fashionable, m m m m m design elements)
Q11 How much are you concerned with following attributes:
Not at all Little A moderate Vey much An extreme amount amount Comfort level due to moisture and heat trap m m m m m while sitting for long period of time Potential bacterial growth on m m m m m fabric due to moisture and heat trap Malodor generated m m m m m from long sitting hours
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Q12 How would you rate your limitation in relation to performing daily activities such as dressing:
Incapable Fairly Neutral Semi capable Fully capable capable Don m m m m m (dressing) Doff m m m m m (undressing) Going to m m m m m toilet Getting on and off from m m m m m wheelchair
Q13 What difficulties do you encounter while purchasing trousers for yourself? (May select more than one option) q Dont fit well q Ride down from the waist q Rear is bulky q Length is short q Difficult to take on and off q Other ______
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Q14 From pieces of clothing that you currently own, which are you most dissatisfied with?
Rank most dissatisfied item on the top.
______Trousers
______Cargo Pants
______Formal Suit
______Shirt
______Outerwear Jacket
______Jeans
______Other
Q15 Please rate how much you need special alterations to your ready-made clothing to accommodate aids like catheter etc.? m Not at all m A little m Moderately m Mostly m Completely
Q16 On a daily basis, how would your rate your degree of independence/dependence when you are dressing? m Completely dependent m Semi dependent m Completely independent
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Q17 Are you able to work? m Yes m No
If No Is Selected, Then Skip To Are you aware of any brands/designers...
Q18 How would you rate your ability to work? m Incapable m Fairly capable m Neutral m Semi capable m Fully capable
Q19 Have you ever felt the need for adaptive clothing in a professional workplace situation? m Yes m No
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Q20 How important are following design features in determining customized trousers for yourself?
Not at all A little Moderately Very Extremely important important important important important Fit at waist m m m m m Pocket m m m m m location Length m m m m m Silhouette m m m m m Specialized fabrics like moisture m m m m m wicking and antimicrobial properties Catheter m m m m m concealment Fasteners for easy don and m m m m m doff Color m m m m m Other m m m m m
Q21 Are you aware of any brands/designers specializing in adaptive clothing for wheelchair users? m Yes ______m No
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Q22 How much on average do you spend on clothes every month? m $0-$50 m $50-$100 m $100-$150 m $150-$200 m $200-$250 m $250-$300 m $300 and more
Q23 How far are you willing to travel to be fitted to have customized clothing made? m 10-20 miles m 20-40 miles m 40-60 miles m 60-80 miles m 80-100 miles
Q24 Will you be comfortable to be 3D-Body-scanned for body measurements? m Yes m No m May be
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Q25 How important are following features/attributes to you in purchasing re-designed adaptive trousers?
Not at all A little Moderately Very Extremely important important important important important Option to m m m m m customize Made with moisture m m m m m wicking fabric Inserted anti- bacterial panel in m m m m m certain regions Conceal medical m m m m m devices Don and doff m m m m m easily Fits and looks aesthetically m m m m m pleasing
Q26 How much are you willing to pay more for customized clothes that meet your functional and aesthetic needs beyond standard ready-to-wear clothing? m 10% m 25% m 50% m 75% m 100% m None
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Q27 The following questions ask about your experiences during the last two weeks. Not at all A little A moderate Very much An extreme amount amount How much do you experience positive m m m m m feelings in your life? How much confidence do m m m m m you have in yourself? Is there any part of your appearance m m m m m which makes you feel uncomfortable? To what extent do you have difficulty in m m m m m performing your routine activities? How much you are bothered by any limitations m m m m m in performing everyday living activities? This is an attention check, please m m m m m select "A little" for this question. To what extent does your quality of life depends on the m m m m m use of medical substances or medical aids?
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If This is an attention check,... Is Not Selected, Then Skip to End of Block
Q28 The following questions relates to your experience during the last two weeks.
Not at all A little Moderately Mostly Completely Are you able to accept your m m m m m bodily appearance? To what extent are you able to carry m m m m m out your daily activities? Do you get the kind of support from m m m m m others that you need? To what extent do you feel accepted m m m m m by the people you know? How much do you feel alienated m m m m m from those around you? Do you have enough money to m m m m m meet your needs?
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Q29 The following questions ask your satisfaction in the last two weeks.
Very Dissatisfied Neutral Satisfied Very satisfied dissatisfied How satisfied are you with m m m m m the quality of your life? How satisfied are you with m m m m m the way your body looks? How satisfied are you with your ability to m m m m m perform your daily living activities? How satisfied are you with m m m m m your financial situation? How satisfied are rate your m m m m m quality of life?
Q30 The following question refer to how often you have felt or experienced certain things in last two weeks. Never Seldom Quite often Very often Always How often do you feel you are discriminated m m m m m against because of your health condition?
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Q31 Following questions ask about how well you were able to move around in the last two weeks.
Very poor Poor Neither poor Good Very good nor good How well are you able to m m m m m get around? How much your difficulties in m m m m m mobility bothers you?
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Q32 The following questions ask about how important various aspects of your life are to you.
We ask that you think about how much these affect your quality of life. Unlike earlier questions, these questions do not refer only to the last two weeks.
Not important A little Moderately Very Extremely important important important important How important your overall m m m m m quality of life is to you? How important feeling m m m m m positive about yourself is to you? How important your body m m m m m image and appearance is to you? How important being able to take care of your daily living m m m m m activities (e.g. washing, eating, dressing) is to you? How important to feel included m m m m m socially is to you?
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Q33 What is your gender? m Male m Female
Answer If gc Is Equal to 5
Q34 What is your age? m 18-38 m 38-58 m 58+
Q35 What is your age? m 18-28 m 28-38 m 38-48 m 48-58 m 58+
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Q36 Your current residence in U.S. would be? m Northeast m Southeast m Midwest m Southwest m West
Q37 What is your Ethnicity? m African American/Black m Caucasian/White m Asian/ Island Pacific m Hispanic m American Indian m Multiracial m Other ______
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Q38 What is the highest level of education you have completed? m Some high school m High school graduate m Some college m Trade/ technical/ vocational training m Associate degree m Bachelor's degree m Master's degree m Professional degree m Doctorate degree
Q39 Employment status: Are you currently... m Employed for wages m Self-employed m Out of work and looking for work m Out of work but not currently looking for work m A homemaker m A student m Military m Retired m Unable to work
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Q40 What is your total annual income? m Less than $20,000 m $20,001-$35,000 m $35,001-$50,000 m $50,001 or above
Q41 Any additional comments on further improvement of size, fit, style and design for professional trousers for wheelchair users?