Assistive Technology and the Wellbeing of Societies from a Capabilities Approach

A special issue of Societies (ISSN 2075-4698).

Deadline for manuscript submissions: closed (15 August 2022) | Viewed by 30311

Special Issue Editors


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Guest Editor
Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne 3800, Australia
Interests: assistive technology; disability
School of Health and Welfare, Dalarna University, Falun, Sweden
Interests: assistive technology; health systems; human rights; service delivery; universal access
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue considers assistive technology (AT) and environmental intervention (EI) through the lens of Sen’s capability approach and Nussbaum’s capabilities approach (CA). AT includes assistive products and related services. EI refers to adaptations to a person’s environment. AT and EI represent a continuum of impactful yet under-realised enablers. The evidence basis for AT and EI concerns the medicine, rehabilitation, vocational, education, and engineering fields and, as we argue, often focusses on individuals rather than societies.

Grounded in human rights and developmental economics, CA offers another path. CA focusses on the combination of internal capabilities (functionings), societal opportunities, and choice, which determines both what a person can do and be and what a person does or is. Capability gaps may arise between one’s internal capabilities and the opportunities presented societally. As instrumental commodities, AT and EI can play critical roles in enhancing capabilities and closing capability gaps. Duty holders, including governments and civil society, have a role in facilitating access to AT and EI.

From the perspective of CA, we invite authors to theoretically and empirically explore the links between access to AT or EI and justice, equity, or the wellbeing of societies.

Contributions must fall into one of the three categories (article/review/conceptual paper) of papers for accepted by the journal and address the topic of the Special Issue. Please see our details at: https://www.mdpi.com/journal/societies/instructions.

We look forward to receiving your contributions.

Dr. Natasha Layton
Dr. Johan Borg
Guest Editors

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Keywords

  • assistive technology
  • capabilities
  • capability approach
  • environment interventions
  • equity

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Published Papers (11 papers)

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Editorial

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3 pages, 355 KiB  
Editorial
Assistive Technology and the Wellbeing of Societies from a Capabilities Approach
by Natasha Layton and Johan Borg
Societies 2023, 13(2), 19; https://doi.org/10.3390/soc13020019 - 17 Jan 2023
Viewed by 1711
Abstract
This Special Issue considers two core facilitators of functioning: assistive technology and environmental intervention [...] Full article
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Research

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21 pages, 455 KiB  
Article
The Assistive Technology Passport: A Resource for Enhancing Capabilities as a Result of Better Access to Assistive Technology
by Mohamed I. Maalim and Malcolm MacLachlan
Societies 2022, 12(6), 182; https://doi.org/10.3390/soc12060182 - 2 Dec 2022
Cited by 2 | Viewed by 2992
Abstract
The value of Assistive Technology in enabling active and equal participation in political, social, economic, and cultural life of people with disabilities, people ageing, and people with chronic conditions is broadly accepted. However, most of the global population who need assistive technology (AT) [...] Read more.
The value of Assistive Technology in enabling active and equal participation in political, social, economic, and cultural life of people with disabilities, people ageing, and people with chronic conditions is broadly accepted. However, most of the global population who need assistive technology (AT) lack access to it, hence the call for international efforts to improve access to AT. Drawing from the capability approach (CA) developed by Amartya Sen and Martha C. Nussbaum, we explore factors that may hinder or facilitate access to AT. We examine the idea of an AT Passport as an innovative user-centered approach for improving access to AT. We used Interpretative Phenomenological Analysis (IPA) to explore service users’ lived experiences of access to AT and their understanding of the AT Passport concept. We identified the core values of human diversity, equity, access to opportunity, and individual freedom to choose a life of significance to them. Access to AT is central to expanding these capabilities subject to conducive personal and social-contextual issues. The AT Passport could be developed as a capability-enhancing resource by facilitating access to AT, harnessing the diversity of people’s personal, social, and environmental factors to enrich peoples’ capability sets. Further research is required to identify core AT Passport functionalities, usability, and acceptability features. Full article
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17 pages, 544 KiB  
Article
Assistive Technology (AT), for What?
by Victoria Austin and Catherine Holloway
Societies 2022, 12(6), 169; https://doi.org/10.3390/soc12060169 - 22 Nov 2022
Cited by 5 | Viewed by 3346
Abstract
Amartya Sen’s seminal Tanner lecture: Equality of What? began a contestation on social justice and human wellbeing that saw a new human development paradigm emerge—the capability approach (CA)—which has been influential ever since. Following interviews with leading global assistive technology (AT) stakeholders, and [...] Read more.
Amartya Sen’s seminal Tanner lecture: Equality of What? began a contestation on social justice and human wellbeing that saw a new human development paradigm emerge—the capability approach (CA)—which has been influential ever since. Following interviews with leading global assistive technology (AT) stakeholders, and users, this paper takes inspiration from Sen’s core question and posits, AT for what? arguing that AT should be understood as a mechanism to achieve the things that AT users’ value. Significantly, our research found no commonly agreed operational global framework for (disability) justice within which leading AT stakeholders were operating. Instead, actors were loosely aligned through funding priorities and the CRPD. We suggest that this raises the possibility for (welcome and needed) incoming actors to diverge from efficiently designed collective action, due to perverse incentives enabled by unanchored interventions. The Global Report on Assistive Technology (GReAT) helps, greatly! However, we find there are still vital gaps in coordination; as technology advances, and AT proliferates, no longer can the device-plus-service approach suffice. Rather, those of us interested in human flourishing might explore locating AT access within an operational global framework for disability justice, which recognizes AT as a mechanism to achieve broader aims, linked to people’s capabilities to choose what they can do and be. Full article
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12 pages, 2410 KiB  
Article
Capabilities Approach Application in the Development of Regional Rehabilitation Systems in Russia
by Alexander Shoshmin, Yanina Besstrashnova and Kristina Petrishcheva
Societies 2022, 12(6), 166; https://doi.org/10.3390/soc12060166 - 19 Nov 2022
Cited by 1 | Viewed by 1573
Abstract
In Russia, the rehabilitation system for people with disabilities (PwD) is developing rapidly, as resources allocated by the federal and regional authorities are increasing. The policy aims to integrate PwD into society through providing equal access to assistive technologies. To create a well-balanced [...] Read more.
In Russia, the rehabilitation system for people with disabilities (PwD) is developing rapidly, as resources allocated by the federal and regional authorities are increasing. The policy aims to integrate PwD into society through providing equal access to assistive technologies. To create a well-balanced regional rehabilitation system, the development measures include both indicators of actual life improvements (satisfaction of PwD with assistive technologies, comprehensive rehabilitation, facilitating access, etc.) and resources (staffing, costs, legislation, cross-sectoral cooperation, etc.). Panel data from 85 regions were collected (2018–2020). The analysis demonstrates that most systems need to be improved by applying the capabilities approach for cost-effectiveness. Full article
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19 pages, 1347 KiB  
Article
Assistive Technology Makerspaces Promote Capability of Adults with Intellectual and Developmental Disabilities
by Alyssa Boccardi, Kimberly A. Szucs, Ikenna D. Ebuenyi and Anand Mhatre
Societies 2022, 12(6), 155; https://doi.org/10.3390/soc12060155 - 2 Nov 2022
Cited by 5 | Viewed by 2862
Abstract
Makerspaces can engage people with disabilities in the design and development of assistive technology (AT) that can enhance their capabilities to perform new activities and function. However, the adoption of makerspaces in the environments and institutions serving people with disabilities remains challenging. The [...] Read more.
Makerspaces can engage people with disabilities in the design and development of assistive technology (AT) that can enhance their capabilities to perform new activities and function. However, the adoption of makerspaces in the environments and institutions serving people with disabilities remains challenging. The authors modeled a makerspace training program, an environmental intervention, based on the capability approach framework. This mixed methods study investigates the feasibility of an 8-week program to train adults (n = 5) with intellectual and developmental disabilities (IDD) and staff members (n = 5) at a community services center. Study outcomes were measured using knowledge tests, surveys, QUEST 2.0 and interviews. Results indicate a significant increase in staff’s knowledge (p = 0.035) and familiarity with program topics (p < 0.05). Participants with IDD were highly satisfied with the ease of use, weight and effectiveness of the AT devices they created. Five themes emerged from the thematic analysis of interviews: (1) inclusive environment, (2) freedom and improved Capability for building technology for self or client, (3) multidisciplinary collaboration, (4) interactive program elements, (5) makerspace challenges. Overall, the makerspace training program is a valuable program that empowers people with disabilities and ensures the realization of their right of autonomy to create their own AT. Full article
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20 pages, 2035 KiB  
Article
Meeting Unmet Needs for Stroke Rehabilitation in Rural Public Health: Explorative Economic Evaluation of Upper Limb Robotics-Based Technologies through a Capabilities Lens
by Natasha Brusco, Andrea Voogt, Melissa Nott, Libby Callaway, Mae Mansoubi and Natasha Layton
Societies 2022, 12(5), 143; https://doi.org/10.3390/soc12050143 - 10 Oct 2022
Cited by 3 | Viewed by 4336
Abstract
Rehabilitation technologies are rapidly evolving, presenting promising interventions for people with neurological impairments. Access to technology, however, is greater in metropolitan than rural areas. Applying a capabilities approach to this access issue foregrounds healthcare recipients’ rights and personhood within the discourse on resource [...] Read more.
Rehabilitation technologies are rapidly evolving, presenting promising interventions for people with neurological impairments. Access to technology, however, is greater in metropolitan than rural areas. Applying a capabilities approach to this access issue foregrounds healthcare recipients’ rights and personhood within the discourse on resource allocation. Within this context, this study aimed to investigate the economic viability of robotics-based therapy (RBT) in rural Victoria, Australia. A regional health network developed a model of care to provide equitable access to RBT following stroke. This explorative economic evaluation examined both the clinical and economic impact of RBT program implementation across six program iterations compared to 1:1 out-patient rehabilitation. While clinical outcomes were equivalent, the per patient RBT cost ranged from AUD 2681 (Program 1) to AUD 1957 (Program 6), while the per patient cost of usual care 1:1 out-patient rehabilitation, was AUD 2584. Excluding Program 1, the health service cost of usual care 1:1 out-patient rehabilitation was consistently higher, indicating that an established RBT program may be cost-effective, specifically providing less cost for the same effect. This research demonstrates the economic feasibility of delivering RBT in a regional public health stroke service. More broadly, it provided a reduction in the capability gap between rural and metropolitan stroke survivors by tackling an access disadvantage. Full article
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10 pages, 227 KiB  
Article
Do Assistive Products Enhance or Equalize Opportunities? A Comparison of Capability across Persons with Impairments Using and Not Using Assistive Products and Persons without Impairments in Bangladesh
by Johan Borg, Natasha Layton, Per-Olof Östergren and Stig Larsson
Societies 2022, 12(5), 141; https://doi.org/10.3390/soc12050141 - 8 Oct 2022
Cited by 2 | Viewed by 1765
Abstract
Aiming to compare capability across persons with impairments using and not using assistive products and persons without impairments in Bangladesh for 16 different functionings, we contrast two sets of self-reported cross-sectional data from eight districts of Bangladesh: (i) data from persons with hearing [...] Read more.
Aiming to compare capability across persons with impairments using and not using assistive products and persons without impairments in Bangladesh for 16 different functionings, we contrast two sets of self-reported cross-sectional data from eight districts of Bangladesh: (i) data from persons with hearing impairment not using hearing aids, persons with hearing impairment using hearing aids and persons without impairments (N = 572); and (ii) data from persons with ambulatory impairment not using manual wheelchairs, persons with ambulatory impairment using manual wheelchairs and persons without impairments (N = 598). Kruskal–Wallis tests were used to compare levels of capability across the three groups in each data set. Results showed that, for all functionings in both data sets, the levels of capability were statistically significantly highest for persons without impairments. Compared to persons with hearing impairment not using hearing aids, persons with hearing impairment using hearing aids scored higher in all functionings, with statistical significance at the .05 level for 12 of them. Persons with ambulatory impairment using manual wheelchairs scored higher than persons with ambulatory impairment not using manual wheelchairs for 11 of the functionings, but none of the comparisons between the two groups were significant at the .05 level. Assistive products—hearing aids more than manual wheelchairs—enhance capabilities but do not fully equalize opportunities between people with and without impairments. Full article
14 pages, 297 KiB  
Article
Each Person as an End? The Users’ Choices in the Service Delivery Process for Assistive Technology in Hungary
by Nóra Menich
Societies 2022, 12(5), 130; https://doi.org/10.3390/soc12050130 - 16 Sep 2022
Cited by 2 | Viewed by 2064
Abstract
Based on notions from the Capability Approach, this study investigates the service delivery process for assistive technology in Hungary. The research aimed to explore whether the service delivery is person-centered, with a specific focus on the users’ possible choices. In addition to a [...] Read more.
Based on notions from the Capability Approach, this study investigates the service delivery process for assistive technology in Hungary. The research aimed to explore whether the service delivery is person-centered, with a specific focus on the users’ possible choices. In addition to a comprehensive analysis of legislative and policy documents, qualitative data were collected in semi-structured interviews with users and professionals (n = 31) to gain a deeper understanding of personal experiences. Our findings indicate that the service delivery system is product-centered and dominated by financial considerations. The policy and legislation framework does not provide an institutional guarantee for users to be able to have their voices heard; the extent to which their opinions and preferences prevail depends on the attitude, knowledge, and goodwill of the professionals involved in the process. The realization of a person-centered approach will be hindered as long as the users’ needs are viewed from a medical point of view. Full article

Review

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15 pages, 270 KiB  
Review
Using the Capability Approach to Review the National Legislative Frameworks for Support Services for Persons with Disabilities in Four Countries in Asia
by Shivani Gupta, Agnes Meershoek and Luc P. de Witte
Societies 2022, 12(6), 185; https://doi.org/10.3390/soc12060185 - 8 Dec 2022
Cited by 4 | Viewed by 2602
Abstract
Implementation of the United Nations Convention on the rights of persons with disabilities (UN CRPD) requires countries to harmonise their legislative frameworks with it. This paper investigates the national legislative frameworks of four Asian countries to see the extent to which they provide [...] Read more.
Implementation of the United Nations Convention on the rights of persons with disabilities (UN CRPD) requires countries to harmonise their legislative frameworks with it. This paper investigates the national legislative frameworks of four Asian countries to see the extent to which they provide support services in accordance with Article 19 of the UN CRPD. The UN CRPD requires persons with disabilities to have access to and choice and control over support services. To analyse the policy alignment with the UN CRPD, an analytical framework based on the Capability Approach (CA) was developed. The results show that most countries address support services, including assistive devices, only from the perspective of a social security measure for persons with disabilities living in poverty, failing to uphold the rights of those not meeting those eligibility criteria. However, while support services are inseparably linked to social security, they also are a right for persons with disabilities. Therefore, a paradigm shift is required in the approach of support services and the distributive systems of countries, from one that addresses persons with disabilities as those requiring care considered a burden, to one that considers them rights holders with equal opportunities, for which, support services are a pre-requisite. Full article

Other

8 pages, 220 KiB  
Concept Paper
Assistive Technology Is a Resource for Building Capabilities, but Is It Just Addressing the Symptoms of Inequality?
by Emily J Steel
Societies 2023, 13(1), 7; https://doi.org/10.3390/soc13010007 - 25 Dec 2022
Cited by 4 | Viewed by 2598
Abstract
Advocacy for assistive technology interventions is compatible with the capabilities approach but is insufficient for addressing the disadvantage experienced by people with disability. This paper reflects on equality as an objective of the capabilities approach arising from economics, and it summarises how assistive [...] Read more.
Advocacy for assistive technology interventions is compatible with the capabilities approach but is insufficient for addressing the disadvantage experienced by people with disability. This paper reflects on equality as an objective of the capabilities approach arising from economics, and it summarises how assistive technology and accessibility are mechanisms for achieving equality in the contemporary legal context of international disability rights. Research and advocacy for assistive technology have failed to communicate a coherent set of actions for policy makers to adopt. Defined concepts and interventions are required to prioritise and coordinate action to support individuals with assistive technology in parallel with improving collective resources by improving accessibility. Radical change in economic paradigms and societal structures that drive poverty and disability may be required for the effective adoption of assistive technology and closure of capability gaps. Full article
12 pages, 1095 KiB  
Concept Paper
When the Wheelchair Is Not Enough: What Capabilities Approaches Offer Assistive Technology Practice in Rural Argentina
by Natasha Layton, Silvana Contepomi, Maria del Valle Bertoni and Maria Helena Martinez Oliver
Societies 2022, 12(6), 158; https://doi.org/10.3390/soc12060158 - 7 Nov 2022
Cited by 3 | Viewed by 1736
Abstract
This article considers the lives of disabled people requiring assistive technology who live in contexts of urban poverty. Provision is often constrained by a range of contextual factors which seem outside the scope of health and rehabilitation services. We critically reflect on health, [...] Read more.
This article considers the lives of disabled people requiring assistive technology who live in contexts of urban poverty. Provision is often constrained by a range of contextual factors which seem outside the scope of health and rehabilitation services. We critically reflect on health, rehabilitation, and capabilities approaches. We explore both rehabilitation and capabilities approaches with posture and mobility practice in an area of urban poverty in Argentina. Contrasting rehabilitation and capabilities approaches to a composite posture and mobility case provides a range of insights. Rehabilitation approaches start with the individual as the locus for intervention. Capabilities approaches reframe interventions such as posture and mobility in terms of the freedoms they offer, and highlight the barriers or capability gaps that must be addressed to achieve outcomes. We conclude that capabilities approaches give practitioners the scope to go beyond posture and mobility processes and attend to the other factors, across the ecosystem, that prevent people from realizing their freedoms. To address capability gaps, a broader scope of practice for health practitioners may include consumer empowerment strategies; partnering with the community; and systemic advocacy with duty holders able to address systemic barriers. Full article
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