A scoping review of gendered barriers and facilitators of access and use of assistive technology
Abstract
Purpose
A disparity exists in the access and use of assistive technology (AT), with women exhibiting lower rates of access compared to men, despite a higher reported prevalence of disability. To address these gendered inequities in AT, a comprehensive understanding of the influence of sex and gender on AT utilisation, access pathways, and associated perceptions is crucial.
Methods
This scoping review aimed to synthesise existing evidence concerning how sex and gender affect access, use, and attitudes towards AT. A systematic search across seven databases yielded 120 relevant publications.
Results
The identified gendered barriers and facilitators influencing AT engagement are discussed through the lens of the World Health Organization’s 5 “P” framework of AT, encompassing policy, provision, product, personnel, and people. Notably, the reviewed studies predominantly operationalised gender within a binary male/female framework. Across seventy-three distinct analyses examining AT use and related factors, a significant association with gender and/or sex was observed. While findings indicated a higher rate of assistive product usage among women, this group also reported a greater degree of unmet need.
Conclusions
Gender-specific facilitators of AT use identified in the literature include tailored clinical counselling approaches, aesthetically considerate product design aligning with diverse gender expressions, gender-adapted training methodologies, and the adoption of patient-centric care models.
Future research should consider the nuanced influence of sex and gender on user outcomes, and where data allow, these investigations should include other factors that interact with sex and gender to shape AT access, including age, ethnicity, socioeconomic status, educational attainment, and citizenship status.
IMPLICATIONS FOR REHABILITATION
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Enhanced collaboration between designers and users of AT is needed. Adaptive furniture and adaptive fashion are necessary to ensure users’ needs surrounding compatibility of AT with clothing, footwear, as well as desired forms of gender expression.
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Caution is required to avoid the reproduction of stereotyping, double standards and replication of binary gender norms in the design, marketing, and provision of assistive products.
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Greater gender balance among providers, as well as adapted training to address stereotypes, including on disability and sexuality, can enhance user’s comfort and satisfaction with experiences in product provision.
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Provision of clinical counselling can support users to navigate of psychosocial issues related to stigma, gender expression, and perceived shifts in gender-roles relative to assistive product use.
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Ensuring patient centric care systems, including reverence for informed and equal decision making, respect for user opinions and preferences, and attention to privacy and consent, including during physical examination are integral to enhancing the experiences of disabled women in rehabilitation.