A cross-sectional study was designed using a questionnaire to examine the perspectives of people with disabilities on HAs and APs. A structured questionnaire was developed comprising four main sections: (1) participant background—collected demographic and general information about the respondents; (2) perceived benefits of HAs and APs—assessed participants’ views on the advantages and usefulness of HAs and APs in daily living; (3) accessibility and usability—examined the availability, ease of access, and usability of HAs and APs in participants’ homes and communities; and (4) challenges and barriers—identified obstacles and limitations faced by persons with disabilities in adopting or using HAs and APs. Before its deployment, the questionnaire underwent validation using the item-objective congruence method to evaluate content relevance and clarity. Each item was rated on a scale from –1 to +1, where +1 indicated clear relevance (congruent), 0 indicated uncertainty (questionable), and –1 indicated irrelevance (incongruent). Items scoring 0.5 or higher were retained. Those with lower scores were either revised based on expert feedback or removed if no feedback was available. Content validation was conducted by 3 licensed occupational therapists, each with over a decade of experience working with persons with disabilities in rural Thai communities. Following expert review and revision, the final version of the questionnaire achieved an item-objective congruence index score of 0.83, indicating strong content validity. Participants responded to survey items using a five-point Likert scale: (1) strongly disagree, (2) disagree, (3) neutral, (4) agree, and (5) strongly agree.

The required sample size was calculated with Cochran’s sample size formula for proportion [28]. The total persons with disabilities population in Doilor subdistrict, Chiang Mai Province, was obtained from the database (n=235). The Cochran sample size formula was modified for a smaller (finite) population, resulting in a sample size of 91. After adding 5% for the nonresponse rate, the final sample size was calculated to be 96 persons with disabilities.

The study used a structured approach to data collection. Between October and November 2022, the research team visited the Doilor Community Rehabilitation Center to administer questionnaires to persons with disabilities who met the inclusion criteria. Questionnaires and informed consent forms were provided for participants at home. All participants reviewed and signed the consent forms before completing the questionnaires. Additional information was collected regarding the participants’ home settings and surrounding environments. To ensure the quality and reliability of the data, each step of the research process was carefully documented.

The study analyzed survey data using descriptive statistics and employed the Mann-Whitney U test to compare median responses on Likert scale items between 2 independent groups. Data analysis was conducted using SPSS version 25.0 for Windows (SPSS Inc). Given the nature of the data, nonparametric tests were used to compare participants with and without experience using home HAs and APs. The Mann-Whitney U test assessed group differences, with statistical significance set at P<.05 (1-tailed).

The study was approved by the Ethics Committee of the Faculty of Associated Medical Sciences at Chiang Mai University (reference AMSEC-65EX-030). Before participation, written informed consent was obtained from the legally authorized representatives of all participants. The data safeguarded participants’ privacy, maintained the confidentiality of all information collected, and ensured fair compensation for their involvement.

This study explored the experiences of persons with disabilities in a rural Thai community (Doilor subdistrict) regarding HAs and APs, which are individualized for each participant. The findings contribute valuable insights to the understanding of HAs and APs for persons with disabilities. In this study, most participants without HAs and APs were dissatisfied with their living conditions (36/48, 75%) and felt unsafe at home (33/48, 69%), while those with HAs and APs experience reported greater satisfaction (21/36, 58%) and safety (25/36, 69%). According to several studies, home modifications and APs can enhance the satisfaction of persons with disabilities in daily life, improve postmodification safety, and positively impact their mental well-being by reducing feelings of insecurity at home [29,30]. Importantly, this study found that participants with experience using HAs and APs had shown more positive perceptions of their home environment (P<.001), greater confidence in its safety (P<.001), and stronger self-rated usage skills (P=.03). However, no significant differences emerged between the groups in terms of their perceived potential for improving activity skills, such as functional mobility (eg, moving safely within the home), self-care tasks (eg, bathing, dressing, and feeding), and household activities (eg, cooking and cleaning); through APs and HAs (P=.41). This finding is noteworthy as it indicates that both groups equally acknowledged the value of these interventions in promoting engagement in daily life. The convergence of views suggests a shared understanding among persons with disabilities of the essential role that HAs and APs play in fostering independence, safety, and participation in meaningful activities. Furthermore, the agreement across groups regarding the potential for increased participation in family and social activities underscores the broader social implications of such interventions. Consistent with previous studies [31,32], these findings reinforce the importance of integrating home modifications and assistive technologies into rehabilitation and community-based support strategies. Regardless of differences in demographic or functional characteristics, the need for accessible and supportive home environments remains a priority for improving the quality of life of persons with disabilities in rural contexts.

In this study, persons with disabilities also believed that using HAs and APs contributed to the restoration of daily functioning (45/48, 94% among nonusers and 33/36, 91% among users) and enhanced efficiency and quality of life (46/48, 96% among nonusers and 31/36, 86% among users). According to Moon et al [30], the implementation of the Korean smart home modification program and devices assisted individuals with physical disabilities in maintaining occupational performance and improving their engagement in daily activities, ultimately promoting a higher quality of life. Furthermore, this study found that persons with disabilities perceived that using HAs and APs could support time (45/48, 94% among nonusers and 31/36, 86% among users) and reduce the risk of accidents or injuries (46/48, 95% among nonusers and 33/36, 92% among users). Consistent with Petersson et al [8], this study explored how home modifications influence the ability of persons with disabilities to carry out daily tasks. The findings demonstrated that home modifications not only alleviate difficulties in performing everyday activities but also result in measurable time savings within 6 months. Similarly, Jo and Kim [18] implemented occupation-based home modifications for persons with disabilities, demonstrating improvements in time efficiency, participation in activities of daily living, and occupational performance. Furthermore, the innovative safe at home provided various in-home accessibility enhancements such as grab bars, safety railings, stair lifts, and bathtub cutouts for older adults and individuals with disabilities. This study revealed high program satisfaction (190/241, 79%), an absence of falls, and a notable reduction in fear of falling following the use of APs and environmental modifications [33]. In contrast, our study observed no significant differences between groups (without and with experience using HA and AP) regarding perceived improvement in daily function, efficiency, quality of life, timesaving, or accident and injury prevention.

In our study, participants with previous experience using HA and AP reported that such modifications, along with improvements in the living environment, significantly enhanced their engagement in family and general activities (15/36, 41% strongly agreed while 19/36, 53% agreed. In contrast, among participants without experience with HA and AP, only 19% (9/48) strongly agreed and 75% (36/48) agreed with this sentiment. Goddard et al [29] observed that individuals with mobility impairments perceived home modifications as beneficial in reducing physical exertion while enhancing social interaction and independence. Similarly, Greiman et al [34] emphasized that improved home usability enables access to appropriate housing, thereby promoting community participation among individuals with disabilities. Their findings further suggested that enhanced home usability facilitates participation by improving health, autonomy, social interaction, organization, and safety. This is confirmed that our study of both groups of participants presented significant differences in relation to increasing participation in family and social activities (P=.04).

The key barrier reported by participants identified financial constraints as the primary obstacle to modifying homes and acquiring affordable APs reported by 98% (47/48) of nonusers and 94% (34/36) of users. Gusheh et al [35] noted that most persons with disabilities were compelled to self-finance modifications, which were frequently unaffordable, especially for individuals with constrained financial resources. Layton et al [36] similarly assert financial limitations significantly impede the availability and implementation of HAs and APs for persons with disabilities. Existing funding structures often fall short in accommodating the necessary adaptations, thereby fostering inequities in access to essential resources. Consistent with Puli et al [37], financial exclusion continued to impact persons with disabilities in low- to middle-income countries. Although the demand for affordable and accessible housing is rising, current financial mechanisms remain insufficient to meet these needs. Many families face financial constraints that limit their ability to afford necessary HAs and APs. In addition, there is often a lack of availability and accessibility of these products in rural areas, which poses a significant barrier to improving the living conditions of persons with disabilities [26,32]. In the long term, the effectiveness of sustainable approaches to addressing this issue has been demonstrated in a study conducted in India [38]. Prajapati et al [38] highlight that integrating persons with disabilities into the economic structure could increase national gross domestic product by 3%‐7%, demonstrating their potential as active contributors rather than passive beneficiaries. Furthermore, industry collaboration, start-ups, and public-private partnerships could enhance access to affordable assistive technologies while also generating employment opportunities for persons with disabilities. Importantly, initiatives such as academia-industry collaboration, corporate social responsibility funding, and innovation parks have been shown to support sustainable models of device development and distribution. Thailand should learn from and adapt these strategies to effectively address the financial limitations of persons with disabilities.

The lack of mandatory accessibility standards in residential construction continues to reinforce the prevalence of inaccessible housing, highlighting the need for greater awareness about HAs and APs. Our study revealed that a substantial proportion of individuals face difficulties accessing HAs and APs services (40/48, 84% among nonusers and 32/36, 89% among users). In addition, a widespread lack of information was observed, especially among participants with no previous experience: 92% (44/48) reported insufficient knowledge, compared with 86% (31/36) among those with previous experience. According to the studies, evidence from both low- and middle-income countries indicates that persons with disabilities often lack awareness of available HAs and APs, as well as knowledge on how to access or use them. In Nigeria, for instance, Okonji and Ogwezzy [39] found that only 36% (152/423) of visually impaired adults were aware of assistive technologies, and just 17.4% (74/423) reported knowing how to use them. Similarly, a study by Senjam et al [40] in India revealed that among visually impaired patients, high levels of awareness were observed for only 2 out of 42 assistive devices, with more than 30 devices showing awareness levels below 33%. These findings underscore a critical gap in information that must be addressed by health care providers, rehabilitation professionals, and policymakers. Enhancing awareness and facilitating the use of APs and technologies should be a priority in service delivery.

Beyond statutory schemes, Thailand has an active system of nongovernmental organizations (NGOs) and foundations that raise awareness and enable practical access to HAs and APs in rural communities. The Mahasarakham University Universal Design Center’s Home for Life program trains multidisciplinary local teams (public health staff, civil servants, and built-environment actors) to identify hazards and plan universal-design home changes; the program has been scaled with Thai Health Promotion Foundation support and a train-the-trainer model (improving local capacity for sustainable adaptations) [41]. The Rajanagarindra Institute of Child Development Wheelchair Project sources and customizes wheelchairs and mobility aids that often require complementary home changes (eg, ramps and bathroom adaptations) supplies adapted mobility and daily living devices through community programs [42]. Community-based organizations such as Buddy HomeCare coordinate home-based support and link clients to product or adaptation options, frequently acting as catalysts for simple, affordable environmental modifications [43]. The initiatives led by these NGOs and foundations enhance awareness, facilitate referrals, and mobilize community resources, providing practical pathways to overcome the access barriers identified in the Thai sample.

Furthermore, persons with disabilities and their families frequently report a lack of clarity on how and where to obtain reliable information on home and APs. As highlighted by Jutai et al [44], individuals with low income and disabilities often face compounded barriers due to both limited access to information and insufficient resources for device acquisition. In many cases, the absence of centralized or accessible information emerges as a primary obstacle to the broader adoption of APs. This trend is evident across diverse settings; for example, in Bangladesh, Myanmar, and similar contexts, Pryor et al [45] report that many individuals remain unaware of available devices, services, or even the existence of disability support programs. This systemic lack of information presents a major challenge to equitable access and usage of home modification and device support. Although our study found no statistically significant differences between participants with and without previous experience regarding barriers to HAs and APs, the difficulty in accessing services approached significance (P=.05). This implied that some users with experience of HAs and APs may have slightly better knowledge or access to services, which could explain the small difference between the groups.

Maintaining home and environmental adaptations, as well as APs, poses a significant challenge for persons with disabilities and their families. In this study, 88% (43/48) of participants without experience using HAs and APs, and 81% (29/36) of those with experience reported difficulties in maintaining them. This highlights the difficulty of repairing or maintaining these devices at home, with users struggling to access appropriate repair services, ensure sustainability, and manage upkeep. Toro Hernandez [46] found that among 142 Indonesian wheelchair users, 34% (n=142) required more than one repair after receiving a new wheelchair, and 70% (n=142) did not receive complete repairs—underscoring a gap in maintenance training. Similarly, Eide et al [47] found that in low-income countries, only 7% of repairs were handled by government services, while 40% were managed by users or their families; another 40% of devices remained unrepaired due to financial constraints and other barriers. While Oldfrey et al [48] conducted a synthesis of findings across 4 distinct studies and contextual settings, their analysis revealed that, in low-resource environments, the scarcity of specialized repair services poses a significant barrier to the effective provision of assistive devices and technology. In such contexts, community-based repair practices often serve as the primary means of device maintenance. To improve the efficacy of assistive devices and technology delivery, formal systems should recognize, incorporate, and support these grassroots repair mechanisms. Nonetheless, a critical gap persists in the availability of data tracking AP outcomes over their lifecycle, particularly in areas such as follow-up, repair, and maintenance, which hampers further advancements. Strengthening community-based repair networks may also facilitate more accurate referrals to specialist services when complex repairs are needed.

The quality and appropriateness of HAs and APs can also be strengthened through 3 mutually reinforcing strategies. First, copartnerships among local small and medium-sized enterprises, universities, and clinical services should collaborate with the industrial sector to identify relevant APs related to the needs of persons with disabilities and users in the communities [49]. Integrating suppliers for prequalification, product standards, and service standards (eg, WHO guidance for priority APs and wheelchair provision) should be implemented to ensure the safety and maintenance of after-sale support in rural communities [50,51]. Second, product development which embraces ramps, low-cost transfer aids, context-appropriate wheelchairs, bathroom modifications, and toilet adaptations should be designed in alignment with the local context and combined with local materials including easy repair [52]. This development should be coordinated with social enterprises and public agencies [53]. Third, training programs should be implemented to develop local staff competencies that include (1) community workers for screening and follow-up; (2) technicians for fitting, customizing, and fixing and repairing; and (3) therapists for assessment, evaluation, prescription, fitting, and monitoring. These strategies could support persons with disabilities in the needs of HAs and APs based on the local contexts [54].

Even though subsidies could reduce immediate financial limitations of the families of persons with disabilities, they are not a long-term solution for ensuring equitable access to HAs and APs in the low- and middle-income countries [55,56]. Subsidy approaches by public agencies could fail due to the weak service capacity, supply chains, and follow-up and maintenance systems. Sustainability should be coordinated based on community-based rehabilitation, NGOs, and private partnerships. This would build local capacity through train-the-trainer models and strengthen the sustainable community mobilization [57]. In APs such as wheelchairs, the use of the WHO Wheelchair Service Training Package needs to be used in service step assessment, fitting, training, and follow-up. This subsidy and training program could enhance the ability of persons with disabilities to meet their outcomes and reduce the condition of dependence and abandonment [58]. The use of local materials in manufacturing and designs could reduce costs and increase supply chains [59]. Effective procurement, outcome-based contracts, and microcredit with transparency could allow the families of persons with disabilities to access the money with accountability [60]. Finally, integrating a competency-based workforce for persons with disabilities into employment will be a successful process that is supported by mentoring under therapists and stakeholders to ensure long-term usability. These approaches should be reinforced to provide service delivery and supply, quality, and local ownership to remove obstacles and promote independence for persons with disabilities.

In Northern Thailand, HAs and APs are vital for promoting mobility, independence, and the overall well-being of persons with disabilities in rural areas. Nevertheless, access to these essential supports is significantly hindered by geographic isolation, limited health care infrastructure, and socioeconomic constraints. Homes often have hazardous features, such as inappropriate door widths and high thresholds, which can impede mobility and independence for individuals with disabilities. These environmental barriers highlight the need for targeted home modifications [61]. Although global progress has been made in advancing disability-inclusive policies, rural regions in low- and middle-income countries often remain underserved due to persistent economic, infrastructure, and sociocultural barriers. While HAs and APs are instrumental in facilitating daily activities, a pronounced disparity between urban and rural access persists, with rural persons with disabilities facing greater obstacles in obtaining these resources. To effectively address this challenge in rural Northern Thailand, local municipalities, governmental and private agencies, and NGOs, including industrial sectors, should not only provide targeted subsidies but also strengthen the ability and capability of persons with disabilities to use HA and APs.

The primary limitation of this study lies in its recruitment from a single subdistrict (Doilor community), which restricts the generalizability of the findings to the broader population of persons with disabilities in rural Thailand. In addition, the reliance on self-reported data may have introduced social desirability bias, potentially leading to an overestimation of the perceived benefits of HAs and APs. The study also provides limited exploration of important contextual and cultural factors, such as stigma, family support, and beliefs surrounding disability, which may significantly influence the use and acceptance of HAs and APs. Furthermore, it lacks detail regarding the specific types and contextual appropriateness of HA and AP in the rural northern Thai setting. These limitations affect the external validity of the study and constrain the applicability of its findings across different disability types and geographic areas. Future research should conduct a longitudinal approach to examine the long-term impact of HA and AP use on quality of life, allowing for a deeper understanding of users’ evolving experiences over time.

Enhancing access to HAs and APs for persons with disabilities in rural communities requires a comprehensive and collaborative approach. These supports are essential for improving quality of life by promoting safety, efficiency, independence, and participation in daily activities. Active engagement of families and communities is equally important, as they play a crucial role in mobilizing local resources to support budgeting, information sharing, accessibility, and ongoing maintenance. To ensure sustainable and equitable access, both local and central governments must work to address barriers, strengthen community support systems, and implement inclusive policies that facilitate the provision of HAs and APs. In addition, further studies are needed to explore the long-term impacts of these interventions, helping to develop contextually appropriate and effective solutions for persons with disabilities in underserved rural areas.