Adoption of Universal Design Principles

R4: Barriers, Facilitators and Priorities for Adopting Universal Design Principles by Equipment Manufacturers and Public and Private and Recreation Facilities: A Mixed Methods Study


Use of health club and fitness facilities in the U.S. is rising with current membership at 55.3 million1.  However, despite the number of facilities available, studies have cited their limited accessibility to people with physical disabilities2-6.  A recent study by RecTech102 examined the accessibility of 227 fitness facilities across the U.S. and concluded that the majority do not fully meet standards outlined by universal design principles or the American with Disabilities Act.

Universal design (UD) is defined as the “design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design.”7  Sources such as Universal Design of Fitness Equipment published by the American Society for Testing Materials, and National Guidelines for Inclusive Fitness currently under development by the Rehabilitation Engineering and Assistive Technology Society of North America, could assist equipment manufacturers and facility personnel in the development of equipment, programming, services, and facility space that incorporate UD principles.8  To date, no published research is available describing why facility personnel and equipment manufacturers have not considered or adopted UD principles.


This project will explore the barriers to, and facilitators for, adopting UD principles by equipment manufacturers and public, private and recreation facilities.

  1. To determine the barriers to and facilitators for producing accessible fitness equipment.
  2. To determine the barriers to and facilitators for designing accessible public and private fitness facilities in the context of programming, services and environments.
  3. To assess the relative importance of criteria and “trade-offs” individuals with disabilities would make when prioritizing UD features in public and private fitness facilities.
  4. To compare and contrast the perceptions of equipment manufacturers and fitness facility personnel to the priorities given by individuals with disabilities regarding UD features.


This mixed methods exploratory study will use both qualitative and quantitative methods to address our 4 aims.  We will use qualitative methods to 1) gather perceptions of equipment manufacturers and recreational fitness facility personnel regarding the barriers to and facilitators for applying UD principles; and 2) identify attributes and associated attribute-levels, which will guide consumer survey development.  We will use quantitative methods to survey consumer preferences through discrete choice experiments, and importance of attributes by individuals with disabilities, to prioritize UD features.  We will then use the results of the manufacturer and fitness personnel qualitative interviews and consumer surveys collected from the manufacturer and fitness personnel to develop a driver diagram to illustrate the collective views of these stakeholders, and to delineate processes for enhanced application of UD principles.

Phase 1/Aim 1: Manufacturer Perceptions of UDFE.  We will complete one-to-one audio-recorded qualitative interviews using pilot tested interview questions.  An invitation to participate will be sent to manufacturers who produce fitness equipment.  Interviews will be conducted face-to-face or online.

Phase 2/Aim 2: Fitness Facility Personnel Perceptions.  We will use the same methodology as described in Phase 1/Aim 1 for manufacturers.  To ensure trustworthiness of the qualitative data in both Phases 1 and 2, we will apply methods of analyst triangulation and member checking. Analyst triangulation will be applied by enlisting two qualitative researchers to code all interview transcripts.  Inter-coder agreement will be recorded and respondent validation will be performed.

Phase 3/Aim 3: Perceptions of Individuals with Disabilities.  We will design a survey to learn the relative importance and priorities or key attributes of UD design principles from the perspective of individuals with disabilities using discrete choice experimentation (DCE).  DCE is a preferred method for researchers to identify preferences and the importance of key attributes of a health service or product.

Stage 1 – Qualitative online focus group with a pilot tested script will be conducted and audio-recorded to determine the attributes and associated levels of UD application to fitness facilities.  This information will be used to guide survey development in Stage 2.  We will ensure trustworthiness of the focus group data through analyst triangulation as described earlier.

Stage 2 – In the second stage of the DCE process, we will develop an online survey that will present attribute and attribute-levels as choice sets that capture series of sets of alternatives from among the different attribute and attribute-level combinations.  The survey attributes, attribute-levels and choice sets (combinations of these attribute and attribute-levels) will be derived from the focus group results coupled with the use of a D-efficiency design.  The goal of a D-efficiency design approach (also known as D-optimality) is to maintain statistical efficiency of the survey and minimize response burden as it may be impractical and unnecessary for participants to respond to all the combinations of the attribute-levels (i.e., full factorial design).

Phase 4/Aim 4: Compare and Contrast Results Obtained in Previous Phases.   Integration of data derived from manufacturers and fitness personnel (Phase1 and 2) to that collected from individuals with disabilities (Phase 3) will be used to innovatively develop a driver diagram.

Final Outcomes

Appropriate instruments will be created to survey key stakeholders who represent the fitness industry to better understand the barriers to and facilitators of adoption of UD principles.


  1. International Health RSA. About the Industry. Accessed 07-17, 2017.
  2. Vasudevan V, Rimmer JH, Kviz F. Development of the Barriers to Physical Activity Questionnaire for People with Mobility Impairments. Disabil Health J. 2015;8(4):547-556.
  3. Dolbow DR, Figoni SF. Accommodation of wheelchair-reliant individuals by community fitness facilities. Spinal Cord. 2015;53(7):515-519.
  4. Rimmer JH, Riley B, Wang E, Rauworth A. Accessibility of health clubs for people with mobility disabilities and visual impairments. Am J Public Health. 2005;95(11):2022-2028.
  5. Rimmer JH, Riley B, Wang E, Rauworth A. Accessibility of health clubs for people with mobility disabilities and visual impairments. Am J Public Health. 2005;95:2022-2028.
  6. Rimmer JH. The conspicuous absence of people with disabilities in public fitness and recreation facilities: lack of interest or lack of access. Am J Health Promot. 2005;19(5):327-329.
  7. The Center for Universal Design. The Principles of Universal Design, Version 2.0. 1997; Accessed 07-17, 2017.
  8. ASTM International. ASTM F3021-17 Standard Specification for Universal Design of Fitness Equipment for Inclusive Use by Persons with Functional Limitations and Impairments. design and fitness equipment&resStart=0&resLength=10&. Accessed 07-17, 2017.