Why Assistive Technology Gets Abandoned and How to Reduce Device Nonuse

OVERVIEW

A device that sits unused helps no one. It also represents wasted funding, wasted professional time, and, for the person it was meant to help, a period spent without an effective solution.

Assistive technology abandonment, also described as device nonuse or discontinuance, has been studied for decades. Research in this area has identified a number of factors associated with device discontinuance, several of which relate to how a device was selected, introduced, and supported rather than to the person using it.

This article summarizes the factors most often identified, and what tends to reduce the risk. It is educational and general. It does not evaluate any particular device or situation.

ABANDONMENT IS NOT A USER FAILURE

It is worth stating plainly, because the framing affects what people do about it. When someone stops using a device, the most productive question is what the device was being asked to do and whether it was a reasonable fit, not whether the person tried hard enough.

Stopping use is sometimes the correct decision. Needs change, better options appear, and a device that was appropriate at one point may stop being appropriate. Discontinuing a device that no longer fits is a sensible outcome, not a problem to be corrected.

The concern is the other case, where a device would have worked but did not, because of how it was chosen or supported.

WHAT THE RESEARCH POINTS TO

A frequently cited study of assistive technology abandonment by Phillips and Zhao, published in the journal Assistive Technology in 1993, surveyed adult device users and found substantial rates of device discontinuance. That study reported four factors associated with abandonment: lack of consideration of user opinion in selection, easy device procurement, poor device performance, and change in user needs or priorities.

These are associations reported in that study rather than demonstrated causes, and the study describes one population at one point in time. Two of the four are worth pausing on.

The first is user opinion. In that study, devices selected without meaningful involvement of the person who would use them were more likely to be abandoned.

The second is counterintuitive. Easy procurement was also associated with higher abandonment. One possible explanation is that a quick or low effort route to a device can bypass the assessment, trial, and matching steps that make a good fit more likely, though the association itself does not establish that. Getting a device quickly is not necessarily the same as getting the right device.

The factors described in the next section are drawn from practice as well as research, and are offered as things worth checking rather than as established predictors.

COMMON CONTRIBUTING FACTORS

Mismatch between the technology and the actual need. A device may address a problem adjacent to the real barrier. If the real difficulty is fatigue by mid afternoon, a device that is efficient but effortful may not help.

Limited involvement of the user in selection. Decisions made for a person rather than with them tend to produce devices that do not reflect that person's priorities, preferences, or daily reality.

Complexity. A device with more features is not automatically better. Complexity increases setup burden, training time, and the number of ways something can go wrong.

Inadequate training. Training is frequently compressed into a single session at delivery. Skills that depend on practice, or that are needed only occasionally, are unlikely to survive that.

Environment mismatch. A device may work in a clinic or a quiet room and fail in a noisy classroom, a bright outdoor setting, a workplace with its own software restrictions, or a home with unreliable connectivity.

Lack of ongoing support. When no one is responsible for follow up, small problems accumulate. A password change, a software update, a broken mount, or a flat battery can end use of a device permanently.

Changes in the person's abilities or circumstances. Strength, endurance, vision, hearing, cognition, and motivation change. So do jobs, schools, housing, and support networks.

Device reliability and maintenance. Equipment that fails often, or that takes a long time to repair, tends to be abandoned. Repair turnaround matters as much as initial quality.

Social acceptability. Some people stop using a device because of how it looks or how it makes them feel in front of others. This is a legitimate consideration in selection, not a reason to dismiss a person's preferences.

No reassessment. Where nothing triggers a review, a device that no longer fits simply stops being used, without anyone learning why.

WHAT TENDS TO REDUCE THE RISK

Start from the task, not the device. Identify what the person is trying to do, where, and what specifically breaks down. The framework this site uses for matching a person, a task, an environment, and an access method is described on the AT Assessment and Selection page.

Involve the person throughout. This means in identifying priorities, in comparing options, and in the final decision. Preference is not a secondary consideration.

Trial before committing. Trials surface problems that specifications do not. State Assistive Technology Act programs, coordinated nationally through the AT3 Center, frequently run device demonstration and short term loan programs that make this practical.

Try simpler and lower cost options first where they are plausible. Built in accessibility features and low technology tools resolve a great deal, cost little, and carry a much lower abandonment risk. Low Cost Assistive Technology covers these.

Test in the real environment. Whenever possible, try the device where it will actually be used.

Plan training as a process. Include the people around the user. A device that only one person understands is fragile.

Decide who provides ongoing support, before delivery. Name the person or service responsible for troubleshooting, repair, and questions.

Schedule a follow up. A check in some weeks after delivery catches problems while they are still fixable.

Reassess when circumstances change. New school, new job, new home, change in health, or a change in the task are all reasons to revisit.

Pay attention to access method as well as device. Where a device is technically suitable but hard to operate, the access method may be the problem rather than the device. Switch Access, AAC Access Methods, Alternative Keyboards, and Alternative Mice and Pointing Devices cover access options, and Seating, Positioning, and Pressure Management covers how seated position affects access.

FUNDING AND ABANDONMENT

Funding processes can unintentionally increase abandonment risk, for example where a funding route favors a particular product category, where trials are difficult to arrange within a timeline, or where funding covers a device but not training, mounting, or repair.

Where possible, it is worth understanding at the outset what is covered beyond the device itself. Funding Assistive Technology and Assistive Technology Funding Systems describe funding pathways at a general level. This article does not state what any program will cover for any individual.

WHAT TO DO IF A DEVICE IS NOT BEING USED

If a device has stopped being used, the useful first step is to find out what happened rather than to encourage more effort. Whether it ever worked well, when use stopped, whether something changed, whether it still functions, whether it is charged and configured, whether the person wants to use it, and whether the original goal is still the right goal are all more informative than a general push to persist.

The answers frequently point to something fixable, such as a settings change, a mounting problem, or missing training. Sometimes they point to a different device. Sometimes they point to the conclusion that the goal has changed.

RELATED ASSISTIVETECHNOLOGY.ORG RESOURCES

For the framework behind matching a person, a task, an environment, and an access method, see AT Assessment and Selection. For lower cost and built in options, see Low Cost Assistive Technology. For funding pathways, see Funding Assistive Technology and Assistive Technology Funding Systems. For access methods, see Switch Access and AAC Access Methods.

AUTHORITATIVE RESOURCES

• Phillips B and Zhao H, Predictors of Assistive Technology Abandonment, Assistive Technology, 1993, available through PubMed

• Administration for Community Living, Assistive Technology, for the Assistive Technology Act and state AT services including demonstration and device loan

• AT3 Center, National Assistive Technology Act Technical Assistance Center, for locating state assistive technology programs

• Quality Indicators for Assistive Technology, for quality indicators covering assessment, implementation, and evaluation of effectiveness

ABOUT THIS ARTICLE

This article is provided for general educational purposes and is maintained by Accessibility Clinic, Inc. It does not evaluate any specific device, service, or situation, and it does not constitute medical, legal, or financial advice or an individualized assistive technology evaluation. For an individualized evaluation, see AssistiveTechnologyEvaluations.org.