Incorporating embarrassment of publicly help-seeking into technology Acceptance: Policy pathways for mobility scooter adoption among people with disabilities

Source abstract

Although mobility among people with disabilities has been studied extensively, evidence concentrates on large cities in high-income countries, leaving a gap for Low- and Middle-Income cities where advanced mobility aids are scarce. This study examines mobility scooters adoption among people with disabilities in Iran, comparing behavioral determinants between a metropolitan city and a small regional city. We extend the Technology Acceptance Model by incorporating two stigma-related constructs: internalized shame and Embarrassment of Publicly Help-Seeking (EPHS). Together, these capture both enduring self-evaluative stigma and situational, visibility-driven discomfort experienced in public spaces. While prior studies have examined internalized stigma (e.g., shame), EPHS is introduced as a novel construct that isolates an externally triggered, visibility-sensitive barrier specifically associated with public help-seeking. Using data from 785 face-to-face interviews, we applied structural equation modelling (SEM) along with Multiple Indicators Multiple Causes (MIMIC) and Multi-Group Analysis (MGA) to assess behavioral determinants and contextual heterogeneity. We also code responses to an open-ended question to reveal unmeasured barriers. The extended model demonstrates good fit and explanatory power for behavioral intention. Attitude is the dominant predictor; perceived usefulness adds, while perceived risk weakens both. Stigma is noticeable: shame weakens perceived ease of use, perceived usefulness, and intention; EPHS can increase favorable attitudes by focusing on independence and social participation. Heterogeneity emerges: in the large city, instrumental evaluations (usefulness) dominate; in the smaller city, norms linked to shame and higher perceived risk weigh more. Policy implications span five interrelated domains. From a governance perspective, coordinated regulation and safety standards can enhance trust and legitimacy. Equity measures, including subsidies, gender-responsive onboarding, and tailored support for users with varying health profiles, can expand accessibility. Inclusion policies that engage families and promote stigma-reduction campaigns are vital for normalizing scooter use. Infrastructure and design improvements, such as accessible pavements, safer scooter designs, and integration with public transport, can improve usability and safety. Finally, technology and innovation policies encouraging locally adaptive design and continuous monitoring can ensure sustained, context-sensitive implementation.