Investigating the challenges of air travel in the United States: a qualitative study of the lived experiences of wheelchair users with spinal cord injury or disorder

Abstract

Study design

Qualitative exploratory study.

Objectives

To understand the lived experiences of individuals with spinal cord injuries or disorders (SCI/D) who use wheelchairs during air travel in the United States (US), with a focus on the challenges and barriers to accessing this form of transportation.

Setting

Wheelchair users with SCI/D living in the community in the US.

Methods

Semi-structured interviews were used to collect data from six wheelchair users with SCI/D. Data were analyzed using a six-step thematic analysis.

Results

Experiences of wheelchair users during air travel clustered into three themes; experiences interacting with the airport, experiences interacting with the airplane, and experiences across all stages of air travel. Barriers to airport accessibility were minimal. Physical barriers to airplane accessibility and damage to wheelchairs occurred when interacting with the airplane and airline staff. Undertrained staff and a shift in responsibility to the passenger with a disability impacted all stages of the experience.

Conclusion

Wheelchair users with SCI/D encounter challenges that can result in unsafe and inaccessible air travel within the US. Adverse consequences of air travel often impact the individual’s independence and quality of life during and after the flight. Participants provided recommendations to improve the air travel experience for wheelchair users, including the ability to remain in one’s wheelchair while onboard the airplane.

Introduction

Participation in travel has a positive effect on quality of life and well-being [1]. A successful trip can build self-confidence and promote independence while a negative experience can limit future travel, especially for individuals with disabilities [2]. Decreased participation in travel can create feelings of isolation and social exclusion among wheelchair users [3]. Although traveling by air is an essential form of transportation in the United States (US), wheelchair users continue to limit use of this form of transportation or avoid flying altogether due to accessibility and safety concerns [4].

Research from countries outside the US has indicated that air travel is a negative experience for individuals who use a wheelchair due to systemic, physical, and attitudinal barriers [5–7]. Challenges to a positive flight experience encountered by wheelchair users include inaccessibility of the airplane, mishandling of mobility equipment, and added emotional distress caused by existing policies [6–9]. However, laws and regulations that address anti-discrimination and accessibility related to passengers with disabilities vary greatly among countries. These differences in federal codes and cultures limit the generalizability of study results to passenger experiences during air travel in other countries [7].

In the US, two federal policies prevent discrimination against passengers with disabilities during air travel: the Americans with Disabilities Act (ADA) and the Air Carrier Access Act (ACAA). Airports operated by local, state, or federal governments and privately run businesses within airports (e.g., restaurants, shops, lounges) must comply with the requirements of the ADA [10]. Conversely, the ACAA outlines anti-discrimination, service, and accessibility requirements to which airlines operating within the US must adhere [11].

Although research examining the barriers encountered by wheelchair users during air travel in the US is limited, one study found that the most challenging experiences occurred when moving on and off the plane and going through security [12]. These experiences may be due to negative service aspects including airplane inaccessibility, damage to wheelchairs, and long wait times [6, 7, 12]. However, in-depth exploration of wheelchair users’ experiences within the US during these stages of air travel has not been conducted.

Accordingly, the purpose of the present study was to explore individual wheelchair users’ lived experiences during air travel within the US. While research into the experience of wheelchair users during air travel has focused on issues that arise while interacting with the airplane [6–8], this study focuses on the entire air travel experience including aspects that do not directly involve the airplane. Additionally, the study identifies ways to promote accessibility and inclusion in air travel by incorporating participant suggestions for improvement.

Methods

Study design

This qualitative exploratory study was designed to better understand the unique perspectives of wheelchair users with SCI/D during air travel. Six individual semi-structured interviews were conducted to collect data from individuals who had recently participated in air travel within the US.

Participant sampling and recruitment

Individuals living with SCI/D were eligible to participate in the study if they met the following inclusion criteria: 18 years of age or older, a full-time wheelchair user, had flown within the US in the past seven years, and agreed to participate in an in-person interview. Individuals who met the study criteria were identified through the researchers’ professional networks. Purposive sampling techniques were used to select participants with varied air travel experiences due to the level of assistance required and the type of wheelchair used. Snowball sampling was then used to expand recruitment; participants were asked to identify other individuals who may have been interested in participating in the study. Sampling continued until data saturation was reached [13].

Data collection

Semi-structured interviews were conducted at the participant’s preferred location between January 2023 and June 2023. Participants completed a single interview lasting approximately 90 min. Interviews were conducted using an interview guide for which a literature review on the travel experiences of individuals with disabilities was used to derive four sets of questions (See Table 1). The first section of the guide included questions related to participant demographics. Open-ended questions about factual issues were asked in the air travel history section, allowing the interviewer to build rapport with the participant [14]. The core of the interview, the air travel experience section, was designed to prompt participants to share stories about traveling by air as wheelchair users. Participants were asked to discuss their experiences in the four stages of air travel: pre travel, pre-flight, in-flight, and post-flight [9]. The experiences covered in each stage are presented in Table 1. The final section of the interview guide asked participants to give suggestions on how to improve the air travel experience for wheelchair users. Participants were also provided the opportunity to add additional comments related to the overall flight experience.

Table 1.

Interview guide organization.

Section 1: Demographics

Age, race, disability, wheelchair type

Section 2: Air travel history

Frequency of flying, reasons for flying, history of wheelchair damage, history of injury

Section 3: Air travel experiences

Pre-travel: booking flights and getting to the airport

Pre-flight: initial check-in, going through security, navigating airport terminals, arriving at the gate, and boarding the plane

In-flight: takeoff and landing, accessing the onboard bathroom, and communicating with airline personnel during the flight

Post-flight: accessing baggage claim, exiting the terminal, and filing a disability-related complaint

Section 4: Suggestions

Suggestions for airport and airline personnel to improve the air travel experience for wheelchair users

Data analysis

Qualitative data collected from the interviews were analyzed using a combined deductive and inductive approach. Coding and theme development were derived from the literature and the collected data. Thematic analysis of the qualitative data followed an established six-step framework [15]. To increase familiarization with the data, participant responses were manually transcribed from the audio recording, and initial codes were generated using open coding. Next, initial themes were identified and refined through systematic review. The emergent themes were then defined, named, and recorded. Two members of the research team independently performed the six steps of the thematic analysis. Final themes were compared between the researchers to ensure consistency. Differences in theme definition were discussed and resolved when discrepancies occurred.

Results

Participant demographics

The six participants in this study ranged in age from 38 to 64 years. As is presented in Table 2, participants had a diverse set of characteristics that shaped their air travel experiences. Four participants used power wheelchairs and typically flew with companions, whereas two participants used manual wheelchairs and flew almost exclusively by themselves. On average, participants completed two to four round trip flights per year, ranging from one trip every few years to 15 trips in one year. At the time of the interview, all participants had flown within the past two years.

Table 2.

Participant demographics.

Demographic	Category	Number of participants
Age (years)	31–45	2
	46–60	3
	61+	1
Gender	Male	5
	Female	1
Race	White	6
Disability type	Spinal cord injury; C5-8 AIS A	2
	Spinal cord injury; T1-S5 AIS A	3
	Spinal muscular dystrophy type 2	1
Wheelchair type	Manual	2
	Power	4
Transfer type	Independent squat pivot	2
	Dependent, one-person	1
	Dependent, two-person	3
Flights per year (round trip)	Fewer than one	1
	1–2	1
	3–6	3
	More than 6	1
Main reason for flying	Work	4
	Leisure	2

Key findings

The analysis indicated that the experiences of wheelchair users during air travel differed significantly depending on whether the individual was interacting with the airport or the airplane. Participants described the challenges that occur within the airport as being considerably less in number and impact than those that occur when interacting with the airplane. Subthemes also emerged that reflected participants’ entire air travel experience. As is depicted in Fig. 1, undertrained staff and responsibility shifts from the airline to the passenger influence all stages of travel.

Fig. 1. Diagram of thematic results.

Challenges when interacting with the airport, airplane, and across all stages of air travel.

Experiences interacting with the airport and associated facilities

Participants reported that barriers to airport accessibility are minimal; “for the most part, I have no issues with airports as far as accessibility.” Participants described airport terminals, restaurants, and shops as no less accessible than other buildings that offer public accommodations or services. However, participants discussed physical barriers related to airport parking and bathrooms. Inadequate accessible parking was the most common concern (descriptive quotes are presented in Table 3, Q1). Participants with decreased hand strength also reported difficulty grasping the ticket needed to access the parking structure (Q2), thereby impacting independence (Q3). Single-use bathrooms at the airport were preferred due to privacy, cleanliness, and space for performing bowel and bladder management. Two participants encountered issues accessing single-use bathrooms due to the lack of automatic doors. One participant recalled getting stuck in the bathroom (Q4), and another participant reported having to use a lactation room instead of the bathroom (Q5).

Table 3.

Descriptive quotes.

Experiences interacting with the airport and associated facilities
Physical barriers to airport accessibility
Q1	As in every place you go. No matter what, there’s not an accessible spot open. They’re always taken. So, I have to park on an end spot. Sometimes I park where it says, ‘compact car only’… But, [my van] is sticking over the line.
Q2	First of all, as a [tetraplegic], I mean, you’ve got to be able to pull a ticket to get into the parking garage. So, I just say a big prayer, I lick my fingers, hoping I can get enough of a grip to get the tag and get the gate open.
Q3	Well, the big issue is that I can’t grab the ticket out of the machine if I’m going through the gate. There’s no way I can reach that thing. So, I stop. My wife gets out and runs over. Goes by the machine. I pull up. When she pulls out the ticket, I go through the gate. She runs around the gate and gets back in the van. And, we go into the airport and park.
Q4	I had to call [my wife] on our most recent trip because I couldn’t get out of the bathroom. The door, I was able to push in but then it was just too heavy to get it open when I was in there.
Q5	I was trying to get into the family bathroom. [The door] was so stinking heavy, I just couldn’t do it. Next door, or, right next to that there was a nursing room. A mother’s room with a door opener. And I’m like, well I’m just going to go in there.
Experiences interacting with the airplane and associated airline
Physical barriers to airplane accessibility
Q6	They are called ‘straight backs’ for a reason…They’re ram rod straight. So, with no balance it’s really, really difficult. So, to add in a little bit of tilt would be lovely. Just for stability.
Q7	The seats need more padding…I’m all bone. So, that’s always my biggest fear is even if I’m just on it for a couple minutes, doesn’t matter.
Q8	On the flight there’s no way for me to go to the bathroom. If I were to need to urinate, I would have to use my urinal and just go in front of people. Hopefully, nobody embarrasses me too much. But that would be my only option.
Q9	I’m always making sure that I have a bulkhead aisle seat. Having a wall in front of you where there’s some separation, rather than another seat, that makes all the difference for a transfer. It’s still not easy, but it’s feasible.
Q10	Sometimes the armrest by the aisle doesn’t go up. So, I have to kind of transfer onto the edge, more or less, and then down into the seat…It’s a pretty hard surface and I’m worried about pressure sores. So, I try to make that move quickly.
Damage to wheelchairs
Q11	Well, it’s very frustrating, especially when I need to move and I can’t. I remember one time, shortly after flight, I went to the bathroom and I turned my chair off, like I would naturally, and I was stuck in the bathroom 5 or 10 min trying to get that centered so I could move again.
Q12	And when you say, ‘oh, yeah just put him in another chair.’ Okay, physically I can get into that chair, and I can sit in that chair but if you want me to do daily functional living, I can’t do it.
Q13	That way when I came home, they might have screwed that [travel wheelchair] up, it might have been awful for the trip, but then when I came home, I knew I had my [primary] chair when I got here.
Experiences impacting all stage of air travel
Undertrained staff
Q14	They sent two people in who had no clue what they were doing to help me…And I finally just made them stop and I had my friend help me instead because it was not going to end well.
Q15	I think it’s dismissive because they don’t understand. I can’t even go to the bathroom now by myself because I don’t have the support to be able to do what I need to do. It’s just a lack of understanding of the seriousness of the situation. Which is just, once again, frustrating and infuriating.
Q16	I would feel better if I knew that it was the last thing packed on [the plane] rather than stuffed in there and mixed around with everything else.
Shift in responsibility
Q17	We do go through everything and it all sounds all good except for when I call back, they don’t know what I’ve said. And then when I show up, they don’t know that I’ve said it.
Q18	Legally, it can’t go under the plane. Then you have a pilot saying you’re not allowed to bring it on. And so, having to pull up the paperwork and show them, no, this has to come on the plane. [Federal Aviation Administration] rules say that it has to.
Q19	We have placards. So, when we take the seat and everything off [my wife] has plastered little diagrams on the seat and the back. We put it in the three locations with detailed instructions…Just to protect the chair so we’re having a better trip wherever we go.

Experiences interacting with the airplane and associated airline

Physical barriers to airplane accessibility

Difficulty accessing aspects of the airplane because of physical barriers was frequently discussed. Many participants described this as the worst aspect of the air travel experience; “the most humiliating times of flight are getting on and off the plane.”

According to respondents, equipment used to access the airplane is not well designed and often in poor working condition. To gain access to the airplane, wheelchair users must often use an aisle chair. An aisle chair is designed to transport a person in a seated position down the narrow airplane aisle. As such, the seat width of an aisle chair is substantially narrower than a wheelchair. Furthermore, an aisle chair cannot be independently propelled or maneuvered, requiring an additional person to assist the passenger in accessing the airplane seat.

The most commonly mentioned concern with the aisle chair was that the design increased the risk of serious injury. Lack of lateral support, a narrow seat width, and the angle of the seat back resulted in decreased stability and concerns of loss of balance, especially for those who had decreased trunk control (Q6). Additionally, placement of the footrest resulted in fears of injury to the foot and lower leg. Several participants discussed incidents of their feet slipping off the footrest and being dragged on the floor as they were transported down the airplane aisle. Participants experienced close calls of their feet being caught beneath airplane seats and reported being “surprised they haven’t broken my foot yet.” Minimal padding on the aisle chair seat also brought up anxieties about skin integrity and pressure injuries (Q7).

Others noted that important components of the aisle chair were often broken or missing, compounding the safety issues. Participants described times in which the aisle chair did not have working safety belts or wheel brakes. A participant recalled “being tied in with seat belts because they don’t click.”

Inability to access on-board bathrooms has led to embarrassment and concerns about medical complications. The only participants able to access on-board bathrooms had paraplegia and were able to transfer independently. However, barriers continued to exist in accessing features of the bathroom including difficulty transferring from the aisle chair to the toilet and inability to close the door for privacy. Participants who required physical assistance with transfers were unable to access the on-board bathroom (Q8).

As a result of not being able to access the bathroom once on-board, participants reported restricting food and fluid intake. For some participants, restricting water intake started 8 to 12 h prior to the flight. They expressed concerns about reducing fluid intake leading to dehydration and increased risk of urinary tract infections.

In addition, participants discussed changes in bowel and bladder management to reduce the likelihood of experiencing incontinence on the airplane. Modifications varied from altering catheterizing procedures to wearing adult incontinence products. Resulting embarrassment if an episode of incontinence occurred was highlighted by several participants.

Appropriate seating accommodations are limited on-board the airplane. Participants reported that seating accessibility is paramount to a safe transfer and being able to perform medically necessary procedures during the flight. Bulkhead seating is often preferred; these seats provide increased space to perform transfers and decreased time on the aisle chair (Q9). However, participants stated that immovable armrests in the bulkhead row make transfers more difficult as the individual must maneuver up and over the armrest to access the airplane seat. This physical barrier adds to concerns about being injured during the transfer (Q10). Limited space while seated on the airplane impacts the participant’s ability to perform weight shifts or bladder elimination procedures. Additionally, participants with decreased trunk control reported that restrictions to reclining the seat contribute to loss of balance, especially during turbulence and landing.

Damage to wheelchairs

All participants interviewed reported having their wheelchairs returned to them damaged following a flight, often on multiple occasions. Damage ranged from minor incidents, such as scratches and dents that did not impact the usability of the wheelchair, to significant damage including broken joysticks, wheels, and actuators. Participants stated that the potential for damage to their wheelchair was the greatest obstacle to flying. As one participant explained, “the safety of the wheelchair and the operation of the wheelchair is paramount to me.”

Damage to wheelchairs impacts the passenger’s quality of life during and after the flight experience. Damage to a passenger’s wheelchair is not just inconvenient, it can severely impact independence during and after the trip. One participant, whose controller had been damaged during the flight, recalled repeated incidents of being stuck in the bathroom due to the damage (Q11). Another participant reported waiting three months for the airline to replace a wheelchair they had damaged. When extensive damage occurs to an individual’s wheelchair, a loaner wheelchair that does not fit the individual’s needs is often used. Participants reported that use of a loaner wheelchair negatively affected their ability to independently perform daily tasks including transfers, bladder management, and general mobility (Q12).

Quality of life is also impacted when wheelchair damage results in missing portions of trips. One participant discussed losing an entire day of a vacation waiting for the airline to repair and return their damaged wheelchair. This also resulted in a monetary loss as the participant was unable to use the accessible van rented for the trip.

Passengers make choices that adversely impact themselves to avoid damage to their wheelchairs. Wheelchair users often make choices to reduce the likelihood of their primary wheelchair being damaged or lost, which adversely impacts the air travel experience. Participants reported avoiding layovers to reduce the number of times the wheelchair is handled by staff. Several participants described driving to a larger airport, up to three hours away, to take a direct flight to their destination. Others reported missing major life events due to concerns about the number of layovers required to fly to the event’s destination.

Additionally, wheelchair users may choose to use a “travel wheelchair” when flying to avoid damage to their primary wheelchair. Some participants traveled using older model wheelchairs that no longer met their needs, and power wheelchair users elected to use manual wheelchairs. Although deciding to use a “travel wheelchair” may cause discomfort or decreased independence during the trip, this strategy was identified as the only way to ensure that the participant’s primary wheelchair was not damaged (Q13).

Experiences impacting all stages of air travel

Undertrained staff

Most participants indicated that airline and airport personnel generally try to be helpful. However, a lack of training in disability etiquette and providing disability-related accommodations creates negative experiences for wheelchair users. As one participant described, “usually everybody’s really nice. They just…don’t really know what they’re doing.”

Airline staff are not properly trained to perform manual handling. Participants stated that airline staff are not properly trained to perform manual transfers, which are required for many wheelchair users to board an airplane. Lack of training in performing manual transfers creates an unsafe environment, with participants reporting concerns regarding the potential for injury to themselves and those helping them. Some participants recounted skin-related injuries after being inadvertently bumped into metal armrests, and one participant experienced being dropped to the floor during a transfer. Some participants discussed how the use of third-party contractors contributed to the problem. As a result, participants often relied on companions to assist with transfers to ensure their safety (Q14).

Lack of understanding about disability from airline and airport staff leads to moments of frustration and embarrassment. Participants discussed being treated with disrespect during the air travel experience as a result of being wheelchair users. Feelings of disrespect most often occurred when dealing with Transportation Security Administration (TSA) agents while going through security. One participant suggested that “the indignity with which [TSA agents] do things” was a result of lack of training concerning disability. More specifically, participants stated that airline and airport staff did not understand the importance of the wheelchair to the passenger’s quality of life, which led to lack of empathy when interacting with staff after a wheelchair is lost or damaged (Q15).

Ground crew members need more training in the proper handling and stowage of wheelchairs to reduce damage. Poor handling of wheelchairs often happens when the wheelchair is transported between the passenger and the stowage compartment. Participants reported witnessing poor handling techniques by the ground crew when looking out the airplane window. One participant “saw my manual chair being dragged up the steps. Like, upside down.” Another described watching their power wheelchair being “wrenched on.” Participants also believed that the majority of wheelchair damage occurred as a result of improper securement underneath the airplane, causing the wheelchair to shift during takeoff, landing, or times of turbulence (Q16).

Shift in responsibility

Participants discussed how the responsibility in ensuring that airports and airlines follow federal legislation is often placed on the passenger with the disability.

Passengers with disabilities must advocate for their rights to accommodations. Several participants discussed having to advocate for the rights afforded to them under the ACAA and reassert their needs throughout the air travel experience. Although all participants reported specifying the accommodations they need when booking tickets, when participants arrive at the airport their needs often have not been communicated to the appropriate staff (Q17). Although personnel are required to be trained in the services and accommodations guaranteed to passengers with disabilities, participants reported having to educate staff on these rights. Participants have encountered personnel who do not understand federal requirements related to checking medical devices, stowage of wheelchair batteries, and availability of an on-board wheelchair. When advocating for their rights, participants faced resistance, as one participant encountered when traveling with a lithium battery wheelchair attachment (Q18). More often, participants reported that staff were simply unaware of the services and accommodations they are obligated to provide.

Wheelchair users develop strategies to protect themselves and their property. Wheelchair users endure additional responsibility to protect themselves and their property during air travel. To avoid injury, wheelchair users must take it upon themselves to educate transport personnel on safely performing transfers; “I’m really good about explaining what to do, how to do it, for my safety but also for theirs.” Additionally, participants reported taking additional steps to protect their wheelchairs including bringing removable pieces on-board, adding indicators to proper lifting points, and attaching operational instructions to the wheelchair (Q19).

Discussion

More than thirty-five years after passage of the ACAA, individuals with SCI/D who use wheelchairs continue to encounter unsafe and inaccessible experiences when participating in air travel for transportation. This study found that air travel in the US is an arduous and, at times, dangerous experience for wheelchair users. Although there are some challenges when navigating the airport and associated facilities, wheelchair users indicated that the greatest barriers to flying occurred when interacting with airplanes and airlines. Wheelchair damage and physical barriers to accessing the airplane were the most prominent factors impacting the air travel experience. Additionally, undertrained staff and a shift in responsibility to the passenger to ensure safe and equitable air travel occurred throughout the stages of travel.

A key finding of this study is that wheelchair users reported damage to the wheelchair as the most significant barrier to flying. Participants stated that wheelchair damage occurred because of poor handling of the device by airline personnel and improper securement within the cargo compartment. This finding supports the results from Major and Hubbard who identified loss of and damage to wheelchairs as the top concern during air travel for passengers with disabilities. In 2022, approximately 31 wheelchairs and scooters enplaned by US airlines were lost or damaged each day [16]. Though the ACAA requires airlines to repair or replace damaged assistive devices, the replacement process took three months for one participant. During this period of waiting, the individual must choose between continuing to use the damaged wheelchair or using a temporary replacement wheelchair that does not fit their needs. Wheelchair damage can result in adverse consequences to the user including missing work, school, and medical appointments; loss of independence; and even injury [17].

A second finding from this study is that wheelchair users continue to encounter physical barriers to accessing the airplane seat and on-board bathroom, confirming research conducted in other countries [6, 7]. Participants discussed several safety concerns that arise from these physical barriers. Due to limited space within the cabin, an aisle chair and manual handling by airline personnel are required to access the airplane seat. A lack of staff training and equipment in poor working condition compound the safety issue during transfers. Manual handling causes emotional distress and increases the risk of physical harm, especially when performed by poorly trained or inexperienced personnel. Musculoskeletal and skin-related injuries, which can decrease quality of life by limiting participation in daily and community activities, may result from improper manual handling techniques. Due to the inaccessibility of on-board bathrooms, wheelchair users may implement strategies to avoid using the toilet during flight including reducing liquid intake up to 12 h prior to departure. Depriving the body of fluids can decrease blood volume and reduce skin pliability, increasing the risk of pressure injuries [18]. Diseases of the skin, including pressure injuries, are among the leading causes of rehospitalization for individuals with spinal cord injuries [19].

Thirdly, the airport and accompanying facilities are reported to be no less accessible than other public facilities. This contrasts with reports from wheelchair users of being unable to physically access the airplane and its facilities. Federal air transportation policy in the US contributes to this inequity in accessibility between the airport and the airplane. Airport facilities such as parking, terminals, and retailers must comply with the ADA, whereas airlines and airplanes must comply with the ACAA. While the ADA outlines detailed design requirements to ensure that facilities are physically accessible to people with disabilities, accessibility requirements are not clearly specified under the ACAA. Additionally, the ACAA does not provide for a private right of action, meaning that passengers have no recourse, other than filing a complaint, when airlines violate their rights. The absence of significant consequences for violating the ACAA may contribute to airlines transferring their responsibilities to passengers who use wheelchairs.

Recommendations

Participants provided recommendations for airports and airlines to improve the air travel experience for wheelchair users. Suggestions focused on reducing wheelchair damage, expanding personnel training, and improving communication. The most common suggestion was to redesign the airplane to allow passengers to remain in their wheelchairs while onboard. The ability to remain in one’s wheelchair would eliminate the need for manual transfers and stowage of the wheelchair underneath the airplane, drastically reducing the greatest barrier to flying, namely, wheelchair damage. Participants also recommended improved training for airline personnnel, specifying that better hands-on training is needed concerning performing safe manual transfers and properly handling wheelchairs. Currently, airlines are responsible for developing their own training to fulfill the general requirements outlined in the ACAA. To improve training consistency, the Department of Transportation should develop a standardized disability-related training course that all airline personnel must complete. Finally, streamlining the communication process among airline personnel was suggested to reduce the need for passengers to reiterate the disability-related services and accommodations previously identified. Effective communication would also reduce wait time, ensuring passengers receive the services federal legislation affords them in a timely manner.

Limitations and strengths

The results of this study may not fully represent the population of wheelchair users with SCI/D who travel. Use of convenience and snowball sampling increases the risk of sampling bias. Limitations of the sampling technique are evident in that all but one participant interviewed had a traumatic spinal cord injury. Wheelchair users with non-traumatic SCI/D (e.g., multiple sclerosis or cerebral palsy) may have vastly different experiences during air travel. Another limitation to this study is the lack of comparison between groups because of small sample numbers. Wheelchair type, level of assistance required, and the intersection of gender, race, or cultural background with disability status may affect the air travel experience for passengers with disabilities.

One strength of this study is the inclusion of wheelchair users with a variety of experiences during air travel. Inclusion of passengers who use various wheelchair types and require varying levels of manual assistance allows for a more complete representation of the air travel experience. Use of a semi-structured interview enabled more in-depth responses in which the participants helped drive the direction of the questions. As one of the first empirical studies on the lived experiences of wheelchair users with SCI/D during air travel within the US, exploration of the topic was necessary.

The findings of this research demonstrate that the greatest barriers to air travel in the US for wheelchair users with SCI/D are related to interacting with the airplane. These barriers can have long-term consequences for independence and quality of life. Further research is needed to determine the prevalence of injury and wheelchair damage during air travel and the direct impact of these barriers on health status. The ability to remain in one’s wheelchair while on the airplane, as occurs in other forms of transportation, would eliminate many of the barriers to air travel. In the immediate future, improved training of airport and airline staff, along with a streamlined communication process, is necessary to make air travel safer and more accessible.

Author contributions

JLP was responsible for designing the study protocol, recruiting participants, collecting and analyzing data, interpreting results, and writing, revising, and finalizing the manuscript. WB was responsible for recruiting participants and collecting and analyzing data. He contributed to the study design, interpreting results, and revising and finalizing the manuscript. PR provided feedback on the study design, giving methodological support, and co-writing the final report of the results.

Data availability

The data generated and analyzed during the current study are not publicly available due to the possibility of identifying information being present in the qualitative data. Datasets may be made available through direct requests to the corresponding author of this article.

Competing interests

The authors declare no competing interests.

Ethics approval

This study was approved by the University of Kentucky Institutional Review Board. All participants provided written informed consent.

Supplementary information

The online version contains supplementary material available at 10.1038/s41394-024-00641-6.