Social Construction of Technical Aids - Personal Meaning and Interactional Effects of Disability and Assistive Devices in Everyday Life

University dissertation from Department of Health Sciences, Lund University

Abstract: This thesis concerns the role of disability and assistive devices in everyday life among persons with, for instance, impairments related to mobility (e.g. wheelchair users) and bodily shape and configuration (e.g. dysmelia). Assistive devices are seen as both includators (assisting participation and emancipation) and excludators (limiting participation, restraining empowerment, and stigmatizing). Perspectives include, for instance, stigmatisation, body-image, coping, empowerment, agency, motivation, needs, and everyday life. Use of assistive devices is discussed from the ValMO-model: Value and Meaning in Human Occupations. The discussion concerns the useworthiness, as opposed to usability, of assistive devices from a perspective of not only physics-based effectiveness (Newton), but also from a self-image and agency perspective based on habitus (Bourdieu). In study I, the experience of prescription of active rigid-frame ultra light-weight wheelchairs was reported, using data on 278 prescribers in Sweden. Prescribers emphasised self-image, design, appearance and aesthetics. Even though prescribers want to prescribe an optimal wheelchair, they may lack the possibility to do so due to: (1) lack of practice and specialized knowl-edge; and (2) narrow regulations, both pertaining to municipal political decisions. Study II describes the experience of active wheelchairs and societal provision thereof utilizing thematic qualitative content analysis of eleven interviews with experienced users in Sweden. Results showed users experiencing injustice and unfairness negoti-ating wheelchair needs in terms of physical and social functioning (agency); changes of attitudes/organization are suggested. Study III was grounded theory study that showed an adaptation of stigma-handling strategies to situations in everyday life by women aged 20 to 30 with dysmelia, i.e. upper limb reduction deficiency. Strategies were comprehensive patterns of action aimed at controlling information about one’s status as deviating from a contextual normality. A proofing or being attitude consti-tuted a contextual adaptation understood in terms of a concealing or revealing tactic, aiming at delaying or promoting exposure to contextual attitudes and possible prejudices. If exposure was delayed, a person with dysmelia blended in. Exposure could be voluntary or imposed. After exposure, the relative importance of TULRD in the specific context could decrease, thus a boost of an amplification or altering of the attitude, i.e. boost was the interactional outcome enforcing the choice of strategy in another context.