Adoption and Use of Customized Wheelchairs Manufactured for Persons Living with Disability: Modified UTUAT-2 Perspective

Abstract

The mobility and independence of people with disabilities could be significantly improved by wheelchairs. Wheelchair adoption is a complex process that is influenced by various factors, including personal demands, social dynamics, and technological advancements. To effectively promote wheelchair adoption and enhance the quality of life for people with mobility issues, it is crucial to understand the adoption of wheelchairs from a holistic perspective. A model comprising six hypotheses was developed based on the UTUAT-2 (Unified Theory of Acceptance and Use of Technology) framework with modifications. The data was analyzed from 330 individuals living with a disability using SPSS and Smart PLS. The study revealed that performance expectancy, effort expectancy, habit, social influence, and perceived infrastructure individually influence the intention to use wheelchairs. The results further revealed that price value and facilitating conditions were not significant predictors of intention to use a wheelchair. The results also showed that aesthetic design moderates the effect of effort expectancy, habit, social influence, price value, and perceived infrastructure on behavioral intention. Through a multidimensional lens, the paper offers practical recommendations to improve the adoption of wheelchairs for people with mobility impairments.

1. Introduction

Disability represents a significant global concern affecting both developed and developing nations, with profound impacts on individuals and their families. These effects extend to the broader economy of a country. Current estimates suggest that approximately 1.3 billion people worldwide, constituting 16% of the global population, live with various forms of disabilities [1]. According to the World Health Organization [2], individuals with disabilities experience a significantly shorter life expectancy—up to 20 years less than those without disabilities—and face a higher risk of developing conditions such as depression, asthma, diabetes, stroke, obesity, or poor oral health. Moreover, persons with disabilities encounter numerous health disparities, including challenges related to inaccessible and unaffordable transportation, which are 15 times more prevalent compared to individuals without disabilities [2]. The situation is particularly severe in emerging economies such as South Africa [3]. In response, governments, in collaboration with various stakeholders, have implemented diverse interventions aimed at mitigating the challenges faced by people living with disabilities (PLWDs). According to Statistics South Africa’s General Household Survey in 2022, approximately 7.5% of the population reported having some form of disability [3,4]. This translates to about 4.4 million individuals in the country living with a disability. Despite the efforts of various stakeholders, the increasing prevalence of disabilities, particularly in rural communities, highlights the need for a comprehensive approach to addressing the challenges faced by PLWDs. Previous discussions on mitigating these challenges have primarily emphasized reducing discrimination and enhancing accessibility, often overlooking the logistical aspects that enable their access to essential social services [5]. Key among these logistics is the wheelchair [6]. Different wheelchairs are available on the market; however, the choice of a particular wheelchair by PLWDs may be influenced by multiple factors, which may be behavioral, technological, environmental, etc. [7]. Considering the challenges associated with the types of wheelchairs available on the market, a modern type of wheelchair was co-created with PLWDs (Figure 1) via advanced manufacturing processes such as additive manufacturing, which is colloquially known as 3D printing [8,9]. The advanced manufacturing process gives the manufacturing engineers the freedom to design the chairs to uniquely serve their intended purpose.

Using advanced manufacturing [10] processes and co-creation principles, customized wheelchairs were produced with unique wheel arrangements for PLWD at the Central University of Technology (CUT), Free State, South Africa, which is the additive manufacturing hub in the country [11]. The manufacturing of the customized wheelchairs with unique wheel arrangements (Figure 1b,c) for use on untarred roads in rural communities is a collaboration between CUT [12,13], Aston University, and Loughborough University in the United Kingdom, as well as PLWD in the various communities in South Africa under the Innovation for African Universities (IAU) program by the British Council [14,15].

The conventional wheelchairs (Figure 1a) are purposely designed for use on tarred/cemented surfaces, while most rural communities do not have lack such surfaces [16]. As a result, PLWD find it challenging to use the traditional wheelchairs for daily activities. They require assistance when using the wheelchairs on untarred/uncentered surfaces.

To provide a practical solution, a co-creation approach was initiated, and customized wheelchairs were designed and manufactured for untarred terrain using advanced manufacturing technology [17] (Figure 1b,c). Compared to the generic wheelchairs (Figure 1a), the customized wheelchairs (Figure 1b,c) have additional features that enable PLWD to propel the chairs easily, even on untarred roads. The customized wheelchair has a variety of features that differentiate it from those available in the market. A few of such features include the fact that it is sustainable, affordable, and suitable for rural conditions. All parts of the wheelchairs, hand bikes, and off-road wheels are bicycle parts that can be easily obtained from any local bicycle shop. Its quick-release axles and folding backrest make transport easy. User-friendly attachments for the hand bikes and off-road wheels; solid tires, and accessible parts allow travel in any terrain without punctures. Its tires are locally manufactured for easy distribution and availability. The single-speed crank-on-hand bike has a back pedal brake system for low maintenance. It features uniquely shaped hand grips for better fit and grip. This chair does not only solve mobility problems in and around the house in rural communities but also traveling issues, where public transport for people with disabilities remains an obstacle. Additionally, it also serves as a training tool to help people stay in shape and live a healthy lifestyle.

It is very important to note that most of the current wheelchairs typically imported, which are not designed for many developing countries, where roads in the local communities are not tarred [18]. The customized wheelchairs have made PLWDs mobility independent. They can maneuver the wheelchairs on untarred/uncemented surfaces with ease. This has even led to economic freedom since some PLWDs use the chairs to access nearby farms for cultivation [14,15]. The co-creation strategy bridged the gap between design, enterprise, and manufacturing, enabling people with disabilities the opportunities to design the chairs according to their needs. This approach has led to empowered PLWD with advanced manufacturing and entrepreneurship skills.

Despite the unique features and the expected comfort embedded in the chair, coupled with its low price, its spread among PLWD in the South African market remains low [19]. Although manufacturing and innovation literature remains silent on the extent of adoption of new technological solutions among disabled persons, it is imperative to investigate the factors that may drive or inhibit the adoption of innovations in new products such as wheelchairs [20].

The key to an innovation’s success lies in how well it is received and implemented [20]. Adopting a wheelchair may be difficult if the user’s expectations are not satisfied [21]. It is very important to determine the “why” and “why not” behind a person’s decision to use a new technology such as a wheelchair [22]. This has been the focus of innovation researchers over the years, seeking to understand the reasons “why” and “why not” individuals adopt or reject a new innovation [21].

Therefore, the current research will focus on providing the answers to “why” and “why not” regarding the adoption of customized wheelchairs by PLWDs. The manuscript will discuss the multifaceted psychological and social factors that influence users’ behavioral intentions in adopting a new technological product such as a customized wheelchair. The paper will demonstrate how performance expectancy, effort expectancy, habit, social influence, and perceived infrastructure individually shape wheelchair usage intentions among PLWDs. The article will provide enlightening expert insights into the factors that drive or inhibit the adoption of innovative products, in an attempt to answer the “why” and “why not” of adopting customized wheelchairs by PLWDs.

2. Theoretical Framework

UTAUT-2, the Model of Personal Computer Utilization (MPCU), the Diffusion of Innovation theory (DoI), the Theory of Reasoned Action (TRA), and the Theory of Planned Behavior (TPB) are only a few of the theories proposed and employed by scholars to shed light on this debate [23,24,25]. These theories have been used to determine the reasons why individuals or societies accept or reject a particular innovation. The UTAUT-2 theory has received attention due to its ability to account for a wide range of phenomena and its widespread application in innovation research [26].

There is a notable lack of information about the use of UTAUT-2 in the study of technological innovation, especially in the context of infrastructure perception, aesthetic design, and motivation in Sub-Saharan Africa. In addition, previous research that has employed UTAUT-2 to comprehend wheelchair adoption and use has not been sufficient. The current research will investigate what variables prompt PLWDs to adopt the use of a new technological product such as wheelchairs, using the UTAUT-2 theoretical framework.

Researchers have argued that it is appropriate to include constructs that reflect the specific nature of the subjects being researched [27,28]. Kazemi et al. [29] emphasized the need to further evaluate the model (UTAUT-2) in unique innovation contexts by incorporating new predictors. To address this gap, the current paper proposes an expanded version of the UTAUT-2 model, which includes the visual aspects of infrastructure and aesthetic design in order to better understand the potential independent constructs that have a major influence on the dependent construct (Figure 2). It has also been noted that while there is a small number of empirical research on wheelchair adoption, none have focused on the African contexts [30]. Most prior wheelchair studies are either experimental [31] or descriptive [30], and are concentrated in developed countries. The current research contributes to the existing knowledge and understanding of wheelchair adoption by focusing on an African context (South Africa). Kazemi et al. [29] noted that scholars using the UTAUT-2 theory to examine wheelchair adoption are rare; meanwhile, it is important to obtain empirical evidence from different geographical regions to validate the UTAUT-2 model. By employing the structural equation modeling approach, this paper adds major contextual, theoretical, and methodological contributions to the existing literature by extending UTAUT-2 with perceived infrastructure, and aesthetic design in the context of a developing country. The findings offer interesting practical and theoretical contributions to innovation studies in the context of PLWDs in the African setting. The findings also provide insights to manufacturers of wheelchairs on how to improve user acceptance of contemporary wheelchairs among PLWDs.

3. Theoretical Review and Hypotheses Development

3.1. Performance Expectancy on Behavioral Intention

Performance expectancy (PE) is the degree to which individuals engaging in particular activities are expected to receive advantages from the use of technological innovations [32,33]. According to Chaisomboon et al. [34], performance expectancy and the desire to use a wheelchair as a mode of transportation are essential. When discussing wheelchair utilization, performance expectancy refers to the user’s expectations for how well the wheelchair will assist individuals in gaining mobility, and an improved standard of living [35]. Individuals may expect that using customized wheelchairs will offer functional benefits such as improved comfort, better mobility, and enhanced support for their specific needs [36]. These expectations can positively influence their intention to adopt customized wheelchairs. Customized wheelchairs tailored to individual needs may be perceived as beneficial for overall health and well-being. PLWDs who expect that using customized wheelchairs will improve their quality of life by increasing their ability to perform daily activities independently or improve their health outcomes are more likely to adopt them [37]. Customized wheelchairs can enhance users’ independence and autonomy. Customized wheelchairs that cater to specific needs may facilitate social integration and participation. PLWDs who expect that using customized wheelchairs will improve their social interactions and participation in community activities may have a higher intention to adopt them [38]. Customized wheelchairs that are aesthetically pleasing or customized to individual preferences can also offer psychological benefits. Individuals who expect that using customized wheelchairs will boost their self-esteem or emotional well-being may be more motivated to adopt them [39]. Thus, performance expectancy influences the behavioral intention to adopt customized wheelchairs by shaping perceptions of functional benefits, health and well-being, independence, social integration, and psychological benefits associated with their use.

Previous research established strong links between performance expectancy and behavioral intention [40,41,42,43]. Studies have indicated that the likelihood of an individual with a disability or the elderly using a wheelchair tends is favorably influenced by its greater performance expectancy, which occurs when those involved believe the wheelchair will be very helpful and equipped to satisfy their mobility demands. In addition, Abbad [32] discovered that users are more likely to acquire and use a wheelchair as a way of enhancing their mobility and general functioning if they feel that doing so would considerably improve their capacity to move around their surroundings and participate in everyday activities. Therefore, recognizing and resolving performance expectations is essential to encouraging the use of wheelchairs and assisting people in making informed decisions about their mobility requirements [44]. For example, a disabled individual in a rural area might have high performance expectancy for a wheelchair designed to navigate rough terrain, enabling them to access community services and participate in social activities more easily. This expectancy could significantly increase their intention to use such a wheelchair. Similarly, a person working in an office setting might have high performance expectancy for a wheelchair with easy height adjustment features, allowing them to reach different desk levels and file cabinets independently, thus enhancing their workplace productivity. Hence, performance expectancy significantly influences behavioral intention.

H1. 

There is a positive and significant influence of performance expectancy on behavioral intention.

3.2. Effort Expectancy (EE) on Behavioral Intention

Effort expectancy (EE) is defined as the extent of ease encountered as a result of using new technology [33,45]. The behavioral intention to adopt a wheelchair heavily depends on effort expectancy [46]. An individual’s assessment of the simplicity of usage and the amount of effort necessary to adopt and operate a wheelchair is referred to as effort expectancy [46].

Individuals may perceive customized wheelchairs as easier to use compared to standard wheelchairs, especially if they are tailored to their specific needs and preferences. This perception of ease of use can positively influence their intention to adopt customized wheelchairs [47]. Effort expectancy also encompasses the perceived ease of learning how to use a technology. Individuals who perceive that using customized wheelchairs requires minimal learning effort are more likely to intend to adopt them. Customized wheelchairs that are ergonomically designed and tailored to individual requirements may be perceived as requiring less physical effort to operate [48]. This perception can increase the intention to adopt customized wheelchairs, especially among individuals with mobility impairments. Effort expectancy includes considerations related to the maintenance and management of a technology [49]. Individuals who perceive that using customized wheelchairs will require less maintenance or management effort may be more inclined to adopt them. Effort expectancy is also influenced by the compatibility of a technology with an individual’s existing skills and abilities [50]. Customized wheelchairs that are aligned with users’ abilities and preferences may be perceived as requiring less effort to use, leading to a higher intention to adopt them. Thus, effort expectancy influences the behavioral intention to adopt customized wheelchairs by shaping perceptions of ease of use, learning curves, physical effort, maintenance and management requirements, and compatibility with users’ skills and abilities. Effort expectancy significantly impacts wheelchair adoption in various real-world scenarios. For instance, lightweight and foldable wheelchairs, such as the Quickie Xenon2, weighing just 8.7 kg, are often preferred due to their ease of transport and storage. Power-assist devices such as the Permobil SmartDrive MX2+ have gained popularity by reducing the physical effort required for manual propulsion. Wheelchairs with intuitive controls and simple interfaces, exemplified by the Pride Mobility Jazzy Air 2, have higher adoption rates among older adults and those with cognitive impairments. Additionally, models offering easy adjustability without tools, such as the Sunrise Medical Quickie Q7 NextGen, are favored for their ability to customize comfort with minimal effort. The ease of maintenance also plays a role, with low-maintenance options such as the titanium-framed TiLite Aero Z appealing to active users. These examples demonstrate how reducing physical and cognitive effort in wheelchair use directly correlates with increased adoption and user satisfaction.

A high number of research studies have shown that effort expectancy has a strong relationship with behavioral intention [51,52,53,54]. According to Cho and Lee [55], the motives for individuals with physical disabilities to acquire a wheelchair are positively influenced when they believe using it is simple and controllable. Individuals with disabilities are more inclined to be inspired to use a wheelchair if they feel that doing so will not require too much physical effort or involve significant challenges in terms of becoming familiar with it [56]. The apparent ease with which a wheelchair may be incorporated into a person’s everyday life and individual willingness to acquire this form of assistive technology are both strongly influenced by effort expectancy [55]. Specialists can increase people’s readiness and intent to use a wheelchair as a way of increasing personal independence and flexibility by fixing and preventing problems linked to effort expectations [57]. Thus, drawing from previous studies, we proposed:

H2. 

Effort expectancy is positively related to behavioral intention to adopt the use of wheelchairs.

3.3. Habit on Behavioral Intention

Habit refers to automating behavior from initial learning to regular use of technology [58]. Prior research has shown strong associations between habit and behavioral intention [59,60,61,62].

Individuals who are already accustomed to using a wheelchair may develop a habit around its use. This familiarity with using a wheelchair, even if it is not customized, can influence their intention to adopt customized wheelchairs, as they may be more open to incorporating a new wheelchair into their existing habits. Habit is often associated with routines [63]. Individuals who have established routines that involve using a wheelchair may find it easier to adopt a customized wheelchair that fits seamlessly into their existing routines, thereby influencing their intention to adopt [48]. Habits are performed automatically, without much conscious thought. If using a wheelchair has become a habit for an individual, they may be more inclined to adopt a customized wheelchair that aligns with their existing habits, as it would require less effort to integrate into their daily lives [64]. Habit can also lead to resistance to change. Individuals who have developed habits around using a standard wheelchair may be hesitant to adopt a customized wheelchair, as it would require breaking their existing habits and establishing new ones. Habits are reinforced through repetition. Individuals who have successfully incorporated a customized wheelchair into their routines may find their intention to adopt it reinforced by the positive outcomes they experience, such as increased comfort or mobility. In summary, a habit can influence the behavioral intention to adopt customized wheelchairs by shaping individuals’ familiarity with wheelchair use, routines, automaticity of behavior, resistance to change, and reinforcement of behavior [65].

According to Hwang [66], some people may be reluctant to consider using a wheelchair if they have grown accustomed to using other mobility aids or tactics. Especially when people have grown accustomed to specific routines and modes of transportation, changing established habits tends to be difficult [67]. In contrast, experts may assist people in reevaluating their behaviors and opening up to the prospect of adopting a wheelchair as an important mobility aid by presenting new knowledge, offering training, and emphasizing the possible benefits of using it [68]. To overcome embedded difficulties and positively influence the behavioral intention to adopt a wheelchair, it is crucial to raise awareness, address concerns, and emphasize the benefits of doing so [69]. Habit plays a significant role in shaping behavioral intentions toward customized wheelchairs for disabled persons in South Africa. Many individuals have developed ingrained routines and practices with their current mobility aids, which can influence their willingness to adopt new, customized solutions. For instance, a person accustomed to maneuvering a standard manual wheelchair might be hesitant to switch to a more advanced, customized version, even if it offers improved functionality. This resistance stems from established patterns in daily living, social interactions, and transportation. Moreover, habits formed around healthcare interactions and maintenance of existing aids can further impact the intention to adopt customized wheelchairs. To address these challenges, stakeholders could implement gradual transition programs, conduct targeted education campaigns, and establish peer support networks. Additionally, designing wheelchairs with customization flexibility that allows users to maintain some familiar aspects of their routines could help overcome habit-related barriers. By recognizing and addressing the influence of habit, providers and policymakers can develop more effective strategies to promote the adoption of customized wheelchairs, ultimately enhancing the mobility and quality of life for disabled persons in South Africa. Following these assumptions, it can be hypothesized that:

H3. 

Habit significantly and positively influences the behavioral intention (BI) to adopt a wheelchair.

3.4. Social Influence on Behavioral Intention

Social influence is the weight that people give to the perceptions of close relationships when deciding whether to employ a certain innovation [33]. According to Alhumaid and Said [70], the behavioral desire to acquire a wheelchair is significantly influenced by social factors. The term “social influence” describes the manner in which the thoughts, feelings, and actions of others affect how someone makes decisions [71]. Social influence in the realm of wheelchair adoption may result from a variety of people, namely friends, relatives, medical experts, and people with disabilities themselves [30]. According to Schukat and Heise [72], the choice to adopt a wheelchair can be strongly influenced by positive social influence, such as helpful and motivating behaviors from those who are familiar with the positive aspects of using a wheelchair. Conversely, wheelchair usage could be hampered and discouraged by a negative social influence or condemning sentiments from others [73]. People often conform to social norms to gain acceptance and approval from others. If there is a prevailing norm suggesting that adopting customized wheelchairs is beneficial or desirable, individuals are more likely to intend to adopt them to align with that norm. Individuals may look to others for guidance or information when making decisions. If they see others successfully using customized wheelchairs and benefiting from them, they are more likely to develop a positive attitude towards adoption. Observing others using customized wheelchairs and experiencing positive outcomes can serve as a form of social learning. Individuals may model their behavior after those they observe, especially if they perceive them as credible or similar to themselves. Additionally, the adoption of customized wheelchairs can also be influenced by social identity factors. If individuals identify strongly with a group that values customization and innovation, they may be more inclined to adopt customized wheelchairs to maintain or enhance their social identity within that group. In essence, social influence can shape individuals’ behavioral intentions to adopt customized wheelchairs through the transmission of norms, information, social learning, and social identity considerations [47]. Moreover, specialists may utilize their position to influence society by facilitating accessibility to support groups, peer mentorship, and opportunities for people to meet with wheelchair users who are willing to share their beneficial experiences [74]. Experts can boost the behavioral intention to use a wheelchair and assist in a more seamless transition towards greater independence and accessibility by creating an encouraging social atmosphere and eliminating any negative social pressures [75]. Therefore, the hypothesis:

H4. 

Social influence is positively related to the BI to adopt a wheelchair.

3.5. Price Value on Behavioral Intention

Price value is defined as an individual’s behavioral equilibrium approach to evaluating the perceived advantages relative to the monetary cost of adopting a certain innovative product [76,77]. Price value was defined by Toh et al. [78] as customers’ cognitive choices between the apps’ ostensible advantages and their associated financial expenses. Senyo and Osabutey [79] determined that if employing a technology offers more advantages than financial costs, then price value becomes positive. According to Chang and Tseng [80], customers’ perceptions of price and value play a key role in their decision to adopt technology. Gerling et al. [81] argue that people weigh the cost of the wheelchair against the actual benefits and desirable outcomes individuals hope to get from using it. Individuals often engage in a cost-benefit analysis when considering the adoption of a product. If the perceived benefits of adopting a customized wheelchair outweigh the perceived costs, individuals are more likely to intend to adopt. Price can signal the quality of a product. Individuals may perceive customized wheelchairs with higher prices as being of higher quality, which can positively influence their intention to adopt. Affordability plays a crucial role in adoption intention [7]. If individuals perceive the price of customized wheelchairs as affordable and within their budget constraints, they are more likely to intend to adopt. The value proposition of customized wheelchairs, including their unique features and benefits tailored to individual needs, can influence price value perception. If individuals perceive that the price is justified by the value offered, they are more likely to intend to adopt [63]. Individuals may compare the price of customized wheelchairs with alternative options, such as standard wheelchairs or other mobility aids. If they perceive that the price difference is justified by the benefits of customization, they are more likely to intend to adopt.

Additionally, Senyo and Osabutey [79] found out that people are more likely to consider using a wheelchair if they believe the cost is acceptable and justifiable given the benefits it provides in terms of improved mobility, self-reliance, and overall convenience of existence. Experts may aid people in making educated decisions and enhance their desire to use a wheelchair as a worthwhile investment to improve their mobility and well-being by resolving issues related to both price and value [81]. Following these assumptions, it can be hypothesized that:

H5. 

Price value influences the BI to adopt a wheelchair.

3.6. Perceived Infrastructure on Behavioral Intention

Perceived infrastructure is the user’s perception of the efficiency provided by a given technology [82]. The connection between how the environment is viewed and the decision to use a wheelchair is significant [83,84]. An individual’s assessment of the physical surroundings and whether it is appropriate for using a given technology is referred to as perceived infrastructure [85]. Individuals’ perceptions of the accessibility of infrastructure, such as ramps, elevators, and accessible public transportation, can influence their intention to adopt customized wheelchairs. If they perceive that the infrastructure supports the use of customized wheelchairs, they may be more inclined to adopt them [86]. The availability of support services, such as wheelchair customization services, repair and maintenance services, and training programs, can impact individuals’ intentions to adopt customized wheelchairs. If they perceive that these services are readily available, they may be more likely to adopt customized wheelchairs. The availability of technological infrastructure, such as assistive devices and technologies that enhance the usability of customized wheelchairs, can influence adoption intentions [87]. Individuals who perceive that such technologies are available and compatible with customized wheelchairs may be more inclined to adopt them. Perceptions of policy and regulation related to customized wheelchairs can also influence adoption intent. Individuals who perceive that there are policies and regulations in place to support the use of customized wheelchairs may be more willing to adopt them. Perceived infrastructure also includes individuals’ awareness and education about the benefits and availability of customized wheelchairs [88]. If individuals are aware of the benefits and know where to access customized wheelchairs, they may be more likely to adopt them. In summary, perceived infrastructure influences the behavioral intention to adopt customized wheelchairs by shaping perceptions of accessibility, the availability of support services, technological infrastructure, policy and regulation, and awareness and education.

Venkataramanan et al. [21] mentioned that people’s intentions to use wheelchairs are positively influenced when they believe that the present infrastructure, including buildings, public areas, transit systems, and accessibility characteristics, is wheelchair-friendly and supportive. According to Patel et al. [89], people are more inclined to be inspired to use wheelchairs if they believe that the infrastructure is made in a way that enables them to traverse their surroundings securely, independently, and with few obstacles. On the other hand, if people believe that the infrastructure is unsuitable and is missing the right stairs, shafts, or paths, it can pose serious problems and discourage people from using wheelchairs [90]. Technicians can enhance both the accessibility as well and the usability of the built surroundings by assisting with and encouraging accessible infrastructure [91], educating the public concerning the value of inclusive layout, and working with the appropriate stakeholders. The availability and quality of support systems, physical environments, and resources directly impact an individual’s willingness to adopt these mobility aids. For instance, in urban areas with well-maintained sidewalks, accessible public buildings, and wheelchair-friendly public transportation, disabled persons may have a more positive perception of infrastructure, increasing their likelihood of using customized wheelchairs. Conversely, in rural or underdeveloped areas with unpaved roads and limited accessibility, the perceived lack of suitable infrastructure may discourage adoption. The presence of skilled technicians for wheelchair maintenance and repair, as well as healthcare facilities equipped to assess and fit customized wheelchairs, can also positively affect perceptions and intentions. Government policies supporting accessibility improvements and funding for assistive devices further enhance the perceived infrastructure. This leads to the hypothesis that:

H6. 

Perceived infrastructure positively or significantly affects behavioral intention.

3.7. Facilitating Conditions on Behavioral Intention

Facilitating conditions refer to consumers’ assurance of the availability of facilities and support systems to use an innovation [33]. Additionally, Nordhoff et al. [92] stated that resources, assistance, and other elements that can make it easier to acquire and utilize a technology are referred to as facilitating conditions. Individuals’ perceptions of access to resources such as financial assistance, insurance coverage, and availability of customized wheelchairs can influence their intention to adopt. If they perceive that these resources are readily available, they may be more inclined to adopt customized wheelchairs [30]. The availability of support services such as training programs, repair and maintenance services, and follow-up care can impact adoption intention. Individuals who perceive that these services are available and accessible may be more willing to adopt customized wheelchairs. Support and recommendations from healthcare providers, such as doctors, physical therapists, and occupational therapists, can influence adoption intention [93]. If healthcare providers recommend the use of customized wheelchairs and provide guidance on their benefits, individuals may be more likely to adopt them. The accessibility of information about customized wheelchairs and their benefits can influence adoption intention. If individuals have access to clear and relevant information about the advantages of customized wheelchairs, they may be more inclined to adopt them. The availability of technological infrastructure, such as assistive devices and technologies that enhance the usability of customized wheelchairs, can influence adoption intention [94]. Individuals who perceive that such technologies are available and compatible with customized wheelchairs may be more inclined to adopt them. In summary, facilitating conditions influence the behavioral intention to adopt customized wheelchairs by shaping perceptions of access to resources, availability of support services, support from healthcare providers, accessibility of information, and technological infrastructure.

According to König and Grippenkoven [95], people are more likely to consider adopting a wheelchair once they believe they have access to the appropriate tools, help, and support networks. These enabling conditions may consist of financial help, social support systems, training programs, maintenance and repair services, and accessibility solutions [96]. In addition, Maziriri et al. [97] argued that people are more likely to be inspired to adopt a wheelchair if they believe they have the tools, information, and support needed to deal with the difficulties of using it. Previous research established strong links between facilitating conditions and behavioral intention [98,99,100]. Professionals may address this relationship by guaranteeing the accessibility of complete support services, offering instruction and training on the long-term usage and upkeep of wheelchairs, and putting people in touch with pertinent resources and financing options [51]. This leads to the hypothesis that:

H7. 

Facilitating conditions positively or significantly affect behavioral intention.

3.8. Behavioral Intention on Actual Usage

The correlation between the behavioral intention and the actual usage (AU) of a wheelchair is a pivotal factor in ascertaining the efficacious integration of wheelchair adoption into the lives of individuals [101]. The term “behavioural intention” describes how an individual’s state of preparedness and inclination to participate in a particular behavior, specifically, the act of embracing the use of a technology [102]. Behavioral intention (BI) symbolizes the a person’s personal commitment to using the wheelchair on a regular basis to achieve more freedom of movement. In contrast, the practical implementation of wheelchair usage is indicative of the degree to which individuals adhere to their intentions and actively incorporate the wheelchair into their daily routines [103]. The correlation between these two variables is crucial since mere intention does not ensure effective utilization. The translation of intention into action can be influenced by a range of factors, including, but not limited to, accessibility, comfort, usability, support, and individual circumstances [104]. Support professionals play a crucial role in ensuring a happy wheelchair experience by removing obstacles, teaching users how to use their chairs, giving continuing assistance, and fostering a sense of community among wheelchair users. The advantages of increased mobility, freedom, and well-being for those using wheelchairs may be maximized with the support of specialists who take the time to learn about and solve the aspects that affect real use [105]. This leads to the hypothesis that:

H8. 

There is a significant or positive influence on BI and AU.

3.9. The Moderating Role of Aesthetic Design on PE and BI

Aesthetic design significantly influences the adoption of customized wheelchairs for individuals with disabilities by addressing psychological and social dimensions beyond functional requirements [100]. By transforming wheelchairs from medical equipment into personalized mobility statements, well-designed assistive devices can enhance users’ self-perception, social interactions, and quality of life. Aesthetically pleasing designs that reflect individual personalities can mitigate stigma, promote dignity, and support social integration, potentially increasing users’ confidence and public engagement. This approach recognizes that wheelchair design is not merely about mobility but about supporting a holistic user experience, emotional well-being, and social inclusion for people living with disabilities. Aesthetic design plays a significant role in how well users adopt technology [106,107]. The significance of the relationship between performance expectancy (PE) and the behavioral intention to adopt a wheelchair is moderated by the aesthetic design. The term “aesthetics” refers to the subjective assessment of the visual allure, desirability, and configuration attributes of a wheelchair [108]. The aesthetic design of a wheelchair can positively influence an individual’s perception and satisfaction with the device. The incorporation of aesthetics may potentially serve as a moderating factor in enhancing the association between performance expectancy and the inclination to embrace a wheelchair [109]. When individuals possess a high level of performance expectancy, indicating their belief that the wheelchair will adequately fulfill their mobility requirements, and this perception is complemented by a favorable aesthetic design, it can serve to strengthen their inclination to embrace the wheelchair [110]. The utilization of aesthetics has the potential to elicit a favorable affective reaction, augment the ascribed worth and appeal of the wheelchair, and ultimately impact the adoption determination. Aesthetic design can enhance the perceived value of a product or service. When users perceive a product as aesthetically pleasing, they may place a higher value to it, thereby strengthening the relationship between their expectations of its performance and their intention to use it. Aesthetic design can evoke positive emotions in users. These emotions can influence their perceptions of the product’s performance and their intention to use it. Aesthetically pleasing products may elicit feelings of pleasure, satisfaction, and enjoyment, positively impacting behavioral intention [111]. The selection of aesthetic preferences for wheelchair design involves a nuanced understanding of user perception, emotional response, and performance expectations. Attractive design is determined through a comprehensive evaluation of visual appeal, functional desirability, and psychological impact on potential users. The aesthetic design of a wheelchair goes beyond mere visual attractiveness, serving as a critical factor in user adoption and satisfaction [102]. Multiple dimensions are considered when determining an attractive design for a target user group. Factors such as age, cultural background, personal style, and individual mobility needs play important roles in determining what constitutes an attractive design [109]. The visual configuration, color scheme, form factor, and overall styling contribute to creating an emotional connection that transcends mere functional utility. It is important to mention that aesthetic preferences are subjective and can vary across different user demographics [107]. The goal is to create a wheelchair that not only performs exceptionally but also makes the user feel confident, empowered, and aesthetically aligned with their personal identity. Aesthetic preferences are shaped by the user’s perception of how well the wheelchair meets their mobility needs while simultaneously providing an emotionally positive experience. When the functional assessment of the wheelchair is complemented by an aesthetically pleasing design, users are more likely to develop a favorable behavioral intention toward wheelchair adoption.

Aesthetic design can differentiate a product from its competitors. When a product stands out due to its aesthetic design, users may perceive it as more unique or superior, leading to a stronger relationship between performance expectancy and behavioral intention. Aesthetic design can capture users’ attention and engage them more effectively [112]. This heightened attention can lead to a more thorough evaluation of the product’s performance, strengthening the relationship between performance expectancy and behavioral intention. Aesthetic design that aligns with users’ preferences and tastes can increase their likelihood of adopting the product. Users may perceive a product that matches their aesthetic preferences as more relevant and suitable, reinforcing the relationship between performance expectancy and behavioral intention [111]. The significance of aesthetics in wheelchair design can be taken into account by professionals, encompassing variables such as color, style, comfort, and customization options [113]. By accentuating the aesthetic value of wheelchairs in conjunction with their utilitarian advantages, experts can augment the correlation between performance expectancy and the inclination to embrace a wheelchair, thereby fostering a more optimistic and attractive encounter for individuals contemplating wheelchair adoption [94]. It could be postulated that aesthetic design moderates PE and BI.

H9a. 

There is a significant positive moderating effect of aesthetic design on PE and BI.

3.10. The Moderating Role of Aesthetic Design on EE and BI

The noteworthy aspect of the relationship between effort expectancy (EE) and the behavioral intention to adopt a wheelchair is the moderating role of aesthetic design. The term “aesthetic design” pertains to the visual appeal, manner, and comprehensive desirability of a given technology [114]. The aesthetic design of a wheelchair can significantly impact on an individual’s overall impression and satisfaction with the device [65]. This effect is moderated by aesthetics, which influences the relationship between effort expectancy and the intention to adopt a wheelchair [115]. When individuals perceive the effort required to operate a wheelchair as high, such as physical exertion or challenges in learning and operation, an aesthetically pleasing design can effectively mitigate these concerns [116]. The aesthetic design of a wheelchair has the potential to elicit a positive emotional reaction and enhance the perceived value and desirability of the device, which may lead to a reduction in the perceived effort associated with its adoption [117]. Aesthetic design can act as a moderator in the relationship between effort expectancy and behavioral intention. In other words, the impact of effort expectancy on behavioral intention may be stronger or weaker depending on the level of aesthetic design. If the aesthetic design is high, the relationship between effort expectancy and behavioral intention may be weaker, as the aesthetic design can compensate for perceived effort [111]. By prioritizing aesthetics and integrating visually attractive design components, experts can augment the association between effort expectancy and the inclination to embrace a wheelchair, thereby rendering it more enticing and potentially diminishing hindrances linked to perceived effort [118]. The findings of this research confirm the idea that aesthetic design moderates EE and BI.

H9b. 

There is a significant positive moderating effect of aesthetic design on EE and BI.

3.11. The Moderating Role of Aesthetic Design on Habit and BI

The significance of the relationship between habit and the behavioral intention to adopt a wheelchair is moderated by aesthetic design [119]. The term “habit” pertains to the involuntary and customary actions that an individual has acquired through repeated practice [120]. In the realm of wheelchair utilization, individuals who have habituated to alternative mobility aids or strategies may initially exhibit resistance or reluctance toward the adoption of a wheelchair [121]. The moderating effect of aesthetic design on the association between habit and the intention to adopt a wheelchair can be observed [122]. In cases where individuals have ingrained habits of utilizing specific mobility aids, the implementation of a visually pleasing and aesthetically designed wheelchair may serve to interrupt this routine, fostering a sense of novelty, and allure [62]. Aesthetic design has the potential to elicit affirmative affective responses, inquisitiveness, and a proclivity for transformation, thereby prompting individuals to contemplate relinquishing their current routine and embracing the use of a wheelchair [123]. By integrating aesthetic design components that align with an individual’s personal preferences and style, experts can strengthen the correlation between habit and the intention to adopt a wheelchair, thereby motivating individuals to explore novel alternatives and embrace the shift in their mobility strategy [124]. The findings of this research confirm the idea that aesthetic design moderates’ habit and BI.

H9c. 

There is a significant positive moderating effect of aesthetic design on habit and BI.

3.12. The Moderating Role of Aesthetic Design on Social Influence and BI

The concept of social influence pertains to the effect that the viewpoints, dispositions, and actions of others have on an individual’s cognitive processes involved in decision-making [88]. The aesthetic design of a wheelchair can potentially serve as a significant moderating factor in the adoption of wheelchairs [125]. The adoption of a wheelchair can be reinforced by an aesthetically appealing design, particularly when individuals are influenced by the positive opinions and attitudes of others toward its use [126]. The aesthetic design of a wheelchair has the potential to augment social desirability and acceptance, thereby increasing the likelihood of individuals conforming to the positive social influence they encounter [127]. In addition, an aesthetically pleasing design has the potential to mitigate negative social stigmas or biases that are commonly associated with the use of wheelchairs [7]. This, in turn, may motivate individuals to overcome potential social obstacles and embrace the notion of utilizing a wheelchair. Through the integration of visually pleasing design elements into wheelchair construction and the propagation of affirmative societal discourses, users can enhance the correlation between social impact and the inclination to embrace a wheelchair, enabling individuals to exercise autonomy in their decision-making process based on their individual inclinations and aspirations rather than being solely swayed by external factors [128]. The findings of this research confirm the idea that aesthetic design moderates social influence and BI.

H9d. 

There is a significant positive moderating effect of aesthetic design on social influence and BI.

3.13. The Moderating Role of Aesthetic Design on Price Value and BI

The significance of the relationship between price value and the behavioral intention to adopt a wheelchair is moderated by the aesthetic design. The concept of price value refers to the subjective assessment of the worth or value that consumers attribute to a particular product or service in relation to its associated cost [129]. When contemplating the adoption of a wheelchair, individuals may evaluate the cost of the wheelchair in relation to its perceived advantages and results [130]. The aesthetic design of a wheelchair may positively influence an individual’s perception of its value, potentially leading to a higher price point [112]. The aesthetic design of a wheelchair has the potential to elicit favorable affective responses, augment user contentment, and foster a favorable overall encounter with the device, consequently amplifying the perceived worth and rationalization of its cost [88]. Individuals may reinforce the connection between financial value and the decision to adopt a wheelchair by including aesthetically pleasing design features and emphasizing the wheelchair’s aesthetic design. By doing this, people will be more likely to perceive the cost as acceptable and desirable [130]. The findings of this research confirmed the idea that aesthetic design moderates price value and BI.

H9e. 

There is a significant positive moderating effect of aesthetic design on price value and BI.

3.14. The Moderating Role of Aesthetic Design on Perceived Infrastructure and BI

The moderating effect of aesthetic design on the connection between how people feel about the accessibility of public spaces and their intentions to start using a wheelchair is important. The term “perceived infrastructure” relates to a person’s view of the surrounding environment and whether it is wheelchair-accessible [86]. The moderating effect of aesthetic design on the relationship between perceived infrastructure and the intention to adopt a wheelchair can be of significant importance [94]. The aesthetic design and wheelchair accessibility of existing infrastructure can have a positive impact on an individual’s inclination to adopt a wheelchair [125]. The creation of aesthetically pleasing and well-designed environments can foster a sense of inclusivity, comfort, and acceptance, thereby augmenting individuals’ overall perception of wheelchair accessibility [131]. The integration of aesthetic design elements into the physical infrastructure, such as visually appealing surroundings, well-designed accessible features, and attractive ramps, can serve as a means for professionals to strengthen favorable perceptions of environments that accommodate wheelchair users [132]. Consequently, this can enhance the association between the perceived infrastructure and the inclination to embrace a wheelchair, fostering a more favorable and hospitable milieu that motivates individuals to contemplate wheelchair adoption as a mechanism to traverse their surroundings with convenience and respect [133]. The findings of this research confirm the idea that aesthetic design moderates perceived infrastructure and BI.

H9f. 

There is a significant positive moderating effect of aesthetic design on perceived infrastructure and BI.

3.15. The Moderating Role of Aesthetic Design on Facilitating Conditions and BI

Aesthetic design has been found to be important for user acceptance of technology [106,134]. The significance of the moderating effect of aesthetic design in the association between facilitating conditions and the behavioral intention to adopt a wheelchair is noteworthy from an academic perspective. Facilitating conditions refer to the existence or accessibility of resources, assistance, and conducive elements that can expedite the acceptance and utilization of a technology [135]. The impression and happiness one has with a wheelchair may be improved if they find it visually attractive and artistically made to fit their particular tastes and style [70]. The implementation of aesthetics in wheelchair design has the potential to elicit favorable affective reactions, enhance the wheelchair’s perceived worth and attractiveness, and foster a more optimistic and engaging user experience [102]. By integrating aesthetic design components that are congruent with the individual’s personal preferences, experts can enhance the association between facilitating conditions and the inclination to embrace a wheelchair [136]. The implementation of such measures can foster an environment that is conducive to empowerment and enablement, thereby instilling a sense of confidence and motivation among individuals to embrace the use of wheelchairs as a valuable means of enhancing their mobility and independence [102]. The findings of this research confirm the idea that aesthetic design moderates the relationship between facilitating conditions and BI.

H9g. 

There is a significant positive moderating effect of aesthetic design on facilitating conditions and BI.

4. Data and Methodology

4.1. Study Participants

Three hundred and thirty (330) wheelchair users in South Africa were the target population. Two hundred and ninety-five (295) questionnaires were completed. The questionnaires were checked for accuracy and completeness, and 217 were suitable for the analysis. As presented in

Table 1. Respondent’s Profile.

Variable	Categories	Frequency	Percent
Age	31–35 years	56	19
	36–40 years	22	7.5
	41–45 years	39	13.2
	More than 45 years	19	6.4
	Under 30 years	159	53.9
Gender	Female	104	35.3
	Male	191	64.7
Highest level of qualification	Bachelor’s Degree/Advanced Diploma	51	17.3
	Doctor’s Degree	19	6.4
	Master’s Degree/Postgraduate Diploma	17	5.8
	National Diploma/Advanced Certificate	143	48.5
	Other	65	22
Ethnic origin	Black South African	186	63.1
	Colored	17	5.8
	Indian/Asian	17	5.8
	Other	17	5.8
	Other Black African	19	6.4
	White South African	39	13.2
Years involved in the manufacturing or using of the wheelchairs	(11–15)	17	5.8
	(16–20)	39	13.2
	(Below 5)	179	60.7
	(Over 20)	60	20.3
	Total	295	100

, the analysis revealed that most of the respondents were under 30 years old (since adults were included, all these participants were at least 18 years), accounting for 53.9% of the total. The next largest age group is 31–35 years, comprising 19.0% of the respondents. Those aged 41–45 years accounted for 13.2%. 7.5% indicated being 36–40 years old. The smallest age group is 45 years and above, with 6.4% of the respondents. From a gender perspective, male respondents represent the majority, accounting for 64.7% of the total, while female respondents make up 35.3% of the total. In addition, the most common qualification among the respondents is the National Diploma/Advanced Certificate, which represents 48.5%. Additionally, 22.0% have acquired other certificates. In addition, 17.3% had a bachelor’s degree/advanced diploma. Doctorate and master’s degree/postgraduate diplomas accounted for 6.4% and 5.8%, respectively. The largest ethnic group among the respondents is Black South African, comprising 63.1%. White South Africans account for 13.2%. Colored, Indian/Asian, Other, and Other Black African ethnic groups each have similar proportions of 5.8%. Finally, 60.7% of the respondents have been involved in the manufacturing or use of wheelchairs. The next largest group (20.3%) has been involved for more than 20 years. Those involved for 16–20 years and 11–15 years accounted for 13.2% and 5.8%, respectively.

4.2. Study Design

Survey data, which is considered suitable for individual-level studies, was used to test the hypothesized model. The method used to test the hypothesized model offers a favorable approach to gathering primary data on a phenomenon that is challenging to evaluate using a secondary data source [137]. The purposive sampling approach was used to select individuals who are already users of the wheelchair being tested. The researchers deemed it appropriate to administer the questionnaire to this group of individuals because the wheelchair was co-created with them, and they have experience with using the wheelchair.

4.3. Instruments/Measurement

Existing validated scales from the extant literature were used to measure the constructs in the proposed model. The UTAUT-2 (Unified Theory of Acceptance and Use of Technology) constructs were adapted from [29]. All questions were scored on a 5-point Likert scale. To ensure voluntary participation, the beginning of the questionnaire required participants to indicate whether or not they were interested in participating in the survey. The demographic information of the respondents was captured in the following section of the questionnaire. The final portion of the questionnaire contained items that measured the variables.

4.4. Data Collection Procedure

The researchers obtained informed consent from all participants before conducting the research. The questionnaire and the purpose of the survey were explicitly explained to all the participants before the commencement of the survey. All the participants were informed that their participation was voluntary and that they could choose either to participate or withdraw at any time. The questionnaire explanation session provided an opportunity to address any unclear points or potential misunderstandings about the survey [138]. After the participants confirmed their willingness to participate, the questionnaire was distributed to them. The completion of the questionnaires on average took eighteen (18) minutes to respond to all the questions. Since the study population is specifically made up of wheelchair users, eligibility screening was unnecessary for this research.

4.5. Data Analysis

The raw data was thoroughly checked to identify and remove any incomplete, incorrect, or duplicate entries. Issues regarding missing data were addressed using the expectation maximization technique [138]. Dimensional reduction analysis was conducted using Smart PLS software 4.1.0.9 to validate the measurement items [137]. Descriptive statistics and Common Method Variance (CMV), Normality, Exploratory Factor Analysis (EFA), and Non-response bias were addressed with SPSS [138]. The paths of the proposed hypothesized model presented in the subsequent section were analyzed using PLS-SEM.

5. Results

5.1. Descriptive and Correlation Analysis

Table 2. Descriptive Statistics and Correlation Analysis.

Constructs	Mean	SD	1	2	3	4	5	6	7	8	9	10
Use behavior	2.87	1.261	1.000
Aesthetic Design	3.52	1.109	0.549	1.000
Behavioral intention	2.87	1.283	0.785	0.551	1.000
Effort expectancy	2.96	1.339	0.677	0.516	0.692	1.000
Facilitating conditions	2.93	1.318	0.682	0.527	0.664	0.780	1.000
Habit	2.45	1.212	0.762	0.604	0.757	0.659	0.679	1.000
Perceived infrastructure	2.69	1.276	0.711	0.598	0.728	0.717	0.679	0.734	1.000
Performance expectancy	2.73	1.278	0.714	0.545	0.703	0.739	0.653	0.706	0.726	1.000
Price value	2.12	1.263	0.477	0.465	0.456	0.448	0.503	0.528	0.506	0.467	1.000
Social influence	2.82	1.241	0.591	0.469	0.623	0.595	0.594	0.624	0.603	0.643	0.416	1.000

presents the means, standard deviations, and correlations among different constructs. The means reflect the average scores, while the standard deviations indicate the extent of variability in the responses. The mean values in Table 2 range from 2.12 to 3.52, showing the distribution of responses across the constructs. Similarly, the standard deviations range from 1.109 to 1.339, illustrating the dispersion of responses around the mean for each construct. Table 2 also demonstrates that there is a moderate positive correlation among actual usage, aesthetic design, behavioral intention, effort expectancy, facilitating conditions, habit, perceived infrastructure, performance expectancy, and social influence. This provides evidence that multicollinearity is not an issue in this study (the result is further confirmed in

Table 3. Validity and Reliability Test.

Constructs	Items	Loadings	CA	CR	AVE	VIF
Aesthetic Design	AD1	0.906	0.892	0.892	0.823	2.840
	AD2	0.928				1.309
	AD3	0.887				2.279
Use behavior	AU1	0.855	0.868	0.874	0.715	2.154
	AU2	0.868				2.234
	AU3	0.855				2.178
	AU4	0.804				1.880
Behavioral intention	BI1	0.933	0.935	0.935	0.885	2.616
	BI2	0.944				1.242
	BI3	0.946				1.268
Effort expectancy	EE1	0.866	0.898	0.899	0.766	2.425
	EE2	0.884				2.635
	EE3	0.891				2.817
	EE4	0.859				2.240
Facilitating conditions	FC1	0.792	0.848	0.853	0.688	1.703
	FC2	0.858				2.107
	FC3	0.864				2.240
	FC4	0.802				1.754
Habit	HT1	0.872	0.902	0.905	0.772	2.650
	HT2	0.873				2.654
	HT3	0.865				2.326
	HT4	0.904				1.030
Performance expectancy	PE1	0.890	0.930	0.930	0.877	2.897
	PE2	0.909				1.417
	PE3	0.873				2.568
	PE4	0.899				1.081
Perceived infrastructure	PI1	0.923	0.915	0.915	0.797	2.237
	PI2	0.942				1.082
	PI3	0.944				1.223
Price value	PV1	0.782	0.797	0.842	0.708	1.566
	PV2	0.847				1.801
	PV3	0.892				1.790
Social influence	SI1	0.916	0.914	0.915	0.853	2.921
	SI2	0.911				1.079
	SI3	0.943				1.174

CA = Cronbach Alpha; VIF = Variance Inflation Factor; CR = Composite Reliability; AVE = Average Variance Extracted.

below using the VIF).

5.2. Survey Bias and Common Method Variance (CMV)

To evaluate and mitigate potential biases in the survey research, several techniques were utilized. Non-response bias was assessed using the Armstrong and Overton [139] technique, which involved a t-test comparing early and late arrivals. The results showed no statistically significant differences between the two groups. Harman’s single-factor methodology was employed to examine common method bias, revealing that no single factor accounted for more than 50% of the total variation. Additionally, the Kaiser–Meyer–Olkin measure of sampling adequacy (KMO) was calculated to be 0.971, indicating high adequacy for factor analysis. These techniques help ensure the reliability and validity of the research findings.

5.3. CFA, Reliability, Validity, and Collinearity

CFA was first conducted to ensure the validity and reliability of the constructs in the model. Table 3 indicates that the CA values for all the constructs were above the threshold (CA > 0.7), indicating reliable constructs. Table 3 also shows that all the items display strong loadings (>0.7), indicating their major contribution to the constructs. CR values were also above the threshold (CR > 0.7), reflecting high scale-level reliability. AVE values show a supported convergent validity (AVE > 0.5). Discriminant validity was checked using the Fornell-Larcker criterion, showing higher correlations within constructs than between constructs (see

Table 4. Fornell-Larcker Criterion.

Constructs	1	2	3	4	5	6	7	8	9	10
AU	0.846
Aesthetic Design	0.549	0.907
Behavioral intention	0.785	0.551	0.941
Effort expectancy	0.677	0.516	0.692	0.875
Facilitating conditions	0.682	0.527	0.664	0.78	0.829
Habit	0.762	0.604	0.757	0.659	0.679	0.879
Perceived infrastructure	0.711	0.598	0.728	0.717	0.679	0.734	0.936
Performance expectancy	0.714	0.545	0.703	0.739	0.653	0.706	0.726	0.893
Price value	0.477	0.465	0.456	0.448	0.503	0.528	0.506	0.467	0.841
Social influence	0.591	0.469	0.623	0.595	0.594	0.624	0.603	0.643	0.416	0.923

).

Table 5. HTMT Test Results.

Constructs	1	2	3	4	5	6	7	8	9	10
Use Behavior
Aesthetic Design	0.622
Behavioral intention	0.866	0.603
Effort expectancy	0.760	0.576	0.755
Facilitating conditions	0.786	0.608	0.744	0.891
Habit	0.858	0.673	0.821	0.730	0.775
Perceived infrastructure	0.785	0.656	0.781	0.784	0.765	0.801
Performance expectancy	0.797	0.604	0.760	0.814	0.742	0.776	0.787
Price value	0.551	0.538	0.513	0.508	0.595	0.604	0.568	0.527
Social influence	0.659	0.517	0.673	0.655	0.675	0.684	0.653	0.703	0.464

displays the HTMT test, showing that the values are below the threshold of 0.85, suggesting that the constructs are distinct from one another. VIF results displayed in Table 3 show perfect collinearity, indicating no collinearity issues (VIF < 3) [137].

5.4. Hypothesis Testing

Table 6. Hypothesis Testing for Relationships.

Hypotheses	Path	StD	T Value	p Values	Results
Performance expectancy -> Behavioral intention	0.121	0.036	3.377	0.001	Supported
Effort expectancy -> Behavioral intention	0.121	0.038	3.217	0.001	Supported
Habit -> Behavioral intention	0.332	0.036	9.353	<0.001	Supported
Social influence -> Behavioral intention	0.103	0.029	3.591	<0.001	Supported
Price value -> Behavioral intention	−0.018	0.026	0.684	0.494	Not Supported
Perceived infrastructure -> Behavioral intention	0.195	0.036	5.472	<0.001	Supported
Facilitating conditions -> Behavioral intention	0.054	0.035	1.554	0.120	Not Supported
Behavioral intention -> AU	0.785	0.014	55.614	<0.001	Supported
Aesthetic Design x Performance expectancy -> Behavioral intention	0.061	0.035	1.722	0.085	Not Supported
Aesthetic Design x Effort expectancy -> Behavioral intention	0.135	0.039	3.463	0.001	Supported
Aesthetic Design x Habit -> Behavioral intention	0.105	0.029	3.657	<0.001	Supported
Aesthetic Design x Social influence -> Behavioral intention	0.338	0.034	10.085	<0.001	Supported
Aesthetic Design x Price value -> Behavioral intention	0.199	0.034	5.814	<0.001	Supported
Aesthetic Design x Perceived infrastructure -> Behavioral intention	0.119	0.035	3.375	0.001	Supported
Aesthetic Design x Facilitating conditions -> Behavioral intention	−0.013	0.024	0.555	0.579	Not Supported

and Figure 3 presents the evaluation of the structural model, indicating a good fit between the proposed model and the observed data, with an SRMR value of 0.76, below the 0.8 threshold recommended by [140]. Figure 3 also shows that the model accounts for 67.8% of the variation in behavioral intention and 61.6% in actual usage. Table 5 displays the hypothesis testing results, showing that there is strong support for the relationships between performance expectancy, effort expectancy, habit, social influence, and perceived infrastructure with behavioral intention (β = 0.121, p < 0.05; β = 0.121, p < 0.05; β = 0.332, p < 0.05; β = 0.103, p < 0.05; β = 0.195, p < 0.05). However, the relationships between price value and facilitating conditions on behavioral intention are not supported (β = −0.018, p > 0.05; β = 0.054, p > 0.05). The result also show that the link between behavioral intention and actual usage is supported (β = 0.785, p < 0.05).

The study also proposed the interaction effect of aesthetic design. The results revealed that the interaction effect between aesthetic design and effort expectancy, habit, social influence, price value, and perceived infrastructure on behavioral intention are mostly supported (β = 0.135, p < 0.05; β = 0.105, p < 0.05; β = 0.338, p < 0.05; β = 0.199, p < 0.05; β = 0.119, p < 0.05). Additionally, the interaction effect between aesthetic design and performance expectancy and facilitating conditions on behavioral intention were found not supported (β = 0.061, p > 0.05; β = −0.013, p > 0.05).

6. Discussion and Implications

The purpose of this study was to examine the underlying factors influencing the usage behavior of wheelchairs among PLWDs. The study also examines the interaction effect of aesthetic design on the relationships. The framework for the study was developed based on UTAUT-2. The results revealed that behavioral intention (BI) is significantly influenced by performance expectancy (PE) [54,141], effort expectancy (EE) [51,53,61] babit (HB) [59,62], social influence (SI) [74], and perceived infrastructure (PI) [21]. This implies that the intention to use a wheelchair, focusing on PE, EE, HB, SI, and PI, can be positively influenced, leading to increased wheelchair adoption and improved mobility for PLWDs. The results also revealed that behavioral intention is not significantly influenced by price value, which contradicts prior studies [79,81]. This implies that the cost associated with the use of a wheelchair may not significantly influence PLWDs’ intention to use it. Furthermore, behavioral intention is not significantly influenced by facilitating conditions which also contradicts prior studies [98,99,142,143]. This implies that the availability of supportive factors, such as accessible environments, assistance, or resources, may not significantly influence PLWDs’ intention to use a wheelchair. The results showed that the link between behavioral intention and actual usage is statistically significant. The result is consistent with earlier studies [144]. This implies that behavioral intention plays a significant role in determining PLWDs usage of a wheelchair. This highlights the significance of addressing intention formation and promoting positive attitudes, self-efficacy, and information provision to improve behavioral intention.

The study also proposed the interaction effect of aesthetic design. The result revealed that the interaction effect between aesthetic design and effort expectancy, habit, social influence, price value, and perceived infrastructure on behavioral intention are statistically significant. This implies that integrating aesthetic design with these factors (EE, HB, SI, PV, and PI) in interventions can improve behavioral intention and promote an increase in wheelchair usage. Enhancing the overall user experience and intention to use the wheelchair, personalization and customization options should be considered to align wheelchair designs with individuals’ preferences and needs. Additionally, the interaction effect between aesthetic design and performance expectancy and facilitating conditions on behavioral intention were found not significant. This implies that aesthetic design does not play a significant role in PE, FC, and BI interaction, and it also does not highlight the significance of aesthetically attractive wheelchair designs for PLWDs.

The study finds that behavioral intention (BI) is significantly influenced by performance expectancy (PE), effort expectancy (EE), habit (HB), social influence (SI), and perceived infrastructure (PI). This suggests that interventions focusing on these factors can positively influence the intention to use a wheelchair among PLWDs, leading to increased adoption and improved mobility. Contrary to prior studies, the study finds that price value (PV) and facilitating conditions (FC) do not significantly influence behavioral intention. This implies that the costs associated with wheelchair use and the availability of supportive factors may not be primary considerations for PLWDs when deciding to use a wheelchair. The study highlights the significance of behavioral intention in determining wheelchair usage among PLWDs. This underscores the importance of promoting positive attitudes, self-efficacy, and information provision to improve behavioral intention and ultimately increase wheelchair usage. The study also examines the interaction effect of aesthetic design with other factors on behavioral intention. The results show that the interaction effect between aesthetic design and effort expectancy, habit, social influence, price value, and perceived infrastructure is statistically significant. This suggests that integrating aesthetic design with these factors in interventions can improve behavioral intention and promote increased wheelchair usage among PLWDs. The study highlights the importance of considering personalization and customization options in wheelchair designs to enhance the overall user experience and the intention to use the wheelchair. However, the study finds that the interaction effect between aesthetic design and performance expectancy, as well as facilitating conditions, is not significant, suggesting that aesthetically attractive designs may not significantly impact these factors.

7. Theoretical Contributions

The theoretical significance of UTAUT-2 in relation to the results presented in Table 5 is noteworthy. The findings of Venkataramanan et al. (2020) [21] indicate that the UTAUT-2 framework is applicable in the context of technology adoption, as the supported relationships between performance expectancy, effort expectancy, habit, social influence, and perceived infrastructure with behavioral intention align with this framework. The aforementioned results serve to corroborate the concept that people’s intention to utilize technology is impacted by their assessments of its usefulness, ease of use, customary conduct, and social sway. Furthermore, the absence of significant associations between price value and facilitating conditions with behavioral intention underscores the necessity of incorporating additional variables beyond UTAUT-2 in comprehending the adoption of technology among individuals with disabilities. This implies that individuals with disabilities may give varying degrees of importance to different factors when developing their intentions to utilize technology. The study highlights the crucial role of incorporating aesthetic design and user experience in technology design for individuals with disabilities, as evidenced by the notable interaction effects observed between aesthetic design and other factors on behavioral intention. The present study expands upon the UTAUT-2 model by highlighting the significance of aesthetics in influencing behavioral intentions within a particular user cohort. In general, the results enhance the theoretical comprehension of UTAUT-2 by presenting practical proof of its relevance in the setting of PLWDs and explaining the determinants that affect their intention to embrace technology. The aforementioned insights can serve as a valuable resource for future research endeavors and facilitate the creation of customized interventions and strategies aimed at fostering technology acceptance and improving the quality of life for individuals living with disabilities.

8. Practical Contributions

The findings of this study offer valuable practical implications for practitioners working with individuals living with disabilities (PLWDs) to improve wheelchair adoption and enhance their quality of life. Practitioners should prioritize addressing the key factors identified in the study that influence the behavioral intention to use wheelchairs. This includes emphasizing the benefits and capabilities of wheelchairs to improve performance expectancy, ensuring wheelchairs are designed with a focus on user-friendliness and ease of use to reduce effort expectancy, developing strategies to help PLWDs integrate wheelchair use into their daily routines to establish it as a habit, fostering supportive social environments that normalize and encourage wheelchair use to leverage social influence, and working to improve the accessibility of the built environment and transportation systems to enhance perceived infrastructure. Additionally, given the significant interaction effects between aesthetic design and other factors, practitioners should prioritize incorporating visually appealing and user-friendly design elements into wheelchair solutions. This could involve collaborating with designers and engineers to create customized, stylish, and ergonomic wheelchair designs that cater to the preferences and needs of PLWDs. Practitioners should also consider alternative approaches that do not overly emphasize price value and facilitating conditions, as these factors may not significantly impact the behavioral intention to use wheelchairs. Instead, they can focus on promoting the perceived benefits, ease of use, habit formation, and social influence to encourage wheelchair adoption. Finally, practitioners should engage in inclusive design practices that actively involve PLWDs throughout the design, development, and implementation of wheelchair solutions. This will help ensure that the unique requirements and preferences of the user population are prioritized, leading to a more comprehensive and satisfying user experience. By addressing these practical implications, practitioners can play a crucial role in facilitating the adoption of wheelchairs and improving the overall quality of life for individuals living with mobility-related disabilities.

Expanding independence and mobility is a key benefit, as the research highlights that wheelchair adoption can significantly improve the autonomy and freedom of movement for those with disabilities. By promoting wheelchair usage, the study aims to address social dynamics that may hinder accessibility, fostering greater social inclusion and integration for PLWDs. Ultimately, the paper contributes to enhancing the overall quality of life for people with mobility impairments. Increasing wheelchair accessibility and usability can directly improve the physical, psychological, and social well-being of PLWDs, empowering them to lead more fulfilling and independent lives. The multidimensional insights provided by the study can also inform policymakers, healthcare providers, and technology developers, guiding them to make more informed decisions about wheelchair services, infrastructure, and product design. This, in turn, can lead to the creation of more accessible, user-friendly, and affordable wheelchair solutions. In a broader sense, by addressing the barriers to wheelchair adoption, this paper contributes to the goal of disability inclusion. Enhancing wheelchair usage can help to normalize the presence of PLWDs in public spaces and promote a more inclusive society that values the participation and contributions of individuals with disabilities. Overall, the findings of this study have the potential to significantly improve the lives of people with mobility impairments, ultimately contributing to a more equitable and accessible world.

9. Limitations and Recommendations for Future Studies

Although the insights gained from the ongoing investigation are valuable, it is important to recognize that there are some limitations that need to be acknowledged. The study acknowledges significant methodological limitations, particularly in the subjective assessment of aesthetic design and perceived infrastructure. The research’s reliance on self-reported data introduces potential bias in participants’ evaluations, as individual perceptions of wheelchair aesthetics and infrastructure can be highly variable and influenced by personal experiences, cultural backgrounds, and individual preferences. The absence of robust control measures to standardize these subjective assessments may compromise the reliability and consistency of the findings. Moreover, the lack of objective criteria for evaluating aesthetic design and perceived infrastructure could potentially skew the interpretation of results, limiting the generalizability of the study’s conclusions across diverse user populations. Future research should incorporate more rigorous methodological approaches, such as standardized assessment tools, multiple rater evaluations, and controlled experimental designs, to mitigate these inherent subjectivity challenges and enhance the scientific validity of the research on wheelchair adoption behaviors. Depending on the context, the study may not fully represent the diverse experiences and perspectives of individuals with disabilities living in different environments. Future research should consider the possibility of increasing the sample size to include a wider range of participants from various backgrounds. Moreover, the reliability of the study was based on self-reported evaluations, which may be subject to social desirability bias and response inaccuracies. To enhance the reliability of results, future studies could explore using unbiased metrics or alternative methods for collecting information, such as carrying out observations or interviews. Additionally, the research focused on a specific set of variables that were derived from the UTAUT-2 model. There may be other relevant variables that were not considered in the current study. Further investigations could explore additional factors that may influence the adoption and use of technology by people with disabilities, such as personal characteristics, environmental factors, or the effectiveness of assistive technologies. Additionally, if a cross-sectional methodology is used in research, it may limit the ability to establish causation. Future studies using longitudinal investigations or experimental methodologies may provide a stronger foundation for understanding the relationship over time between the variables identified and behavioral intentions. It is worth noting that the results obtained from the present research may only be applicable to the specific technology or setting that was studied. Replicating the research using different technologies or in various domains would be beneficial in gaining a more comprehensive understanding of the factors that impact technology acceptance among people living with disabilities (PLWDs).

Future research should extend the current investigation by conducting a comprehensive demographic analysis of wheelchair adoption factors, specifically examining variations across different age groups and between sexes. A nuanced exploration of how performance expectancy, effort expectancy, habit, social influence, perceived infrastructure, and aesthetic design differ among males and females, and across various age categories (e.g., youth, working-age adults, elderly), would provide critical insights into the heterogeneous needs and preferences of wheelchair users. Such a stratified analysis could reveal gender-specific and age-specific determinants of behavioral intention, enabling more targeted and personalized wheelchair design and intervention strategies. By disaggregating the data and understanding the unique psychological and social factors that influence wheelchair adoption for different demographic subgroups, researchers can develop more precise, user-centered approaches to assistive technology design and implementation. Different age groups and genders may have varying perceptions of wheelchair design that affect their behavioral intention to adopt assistive mobility devices [107]. Younger users might prioritize modern, streamlined designs that align with contemporary technology and personal style, viewing the wheelchair as an extension of their young identity [93]. The younger generation may be more likely to seek customization options that reflect individual personality and break away from classical generic wheelchairs. In contrast, older users might value functionality (practical performance) more than aesthetic considerations. Gender can also influence wheelchair adoption, while females might be more inclined towards designs that promote social integration and emotional well-being, prioritizing aesthetic elements that enhance higher societal status; men might emphasize design aspects that convey strength, independence, and higher technological complexity.