With the help of content experts, the interview protocol was developed from a literature review and personal experience (34). The CQR process calls for open-ended questions that provide a framework for responses, combined with follow-up questions that encourage elaboration of responses while intentionally avoiding influencing responses. The interview was structured with respect to two primary goals rapport building and information gathering. The interview protocol focused on the main topic of interest and focused on the participant’s subjective definition of terms. Scripted questions were used to ensure consistent information and probed specifically for attitudes, beliefs, and feelings about certain experiences. The final section of the interview protocol asked participants to reflect more broadly on issues related to intimate relationship development.

The interview protocol was assessed as per Hill and colleagues (32) with one participant who fulfilled participant criteria but not included in the final sample. The pilot run of the protocol provided valuable information through the interview responses and participant feedback and used to revise the final protocol used in the study.

Women are generally underrepresented in research, specifically rehabilitation research (35). Participants were drawn from two disability service organizations, and from there, a snowball convenience sampling method of initial participants was used to recruit other participants. Six women ranged in age from 23 to 60 years old, currently living independently in the community. Five out of six identified as Caucasian, the other as Black. All participants self-identified as having visible physical disabilities. Three reported having muscular dystrophy, two reported cerebral palsy, and the other reported amniotic band syndrome. The relationship statuses, sexual orientations, and education levels of the participants were mixed and represented a broad range of experiences (Table 1).

The transcribed interviews were used to create a list of meaningful and unique topic areas, called domains. Researchers independently reviewed the data and identified proposed domains through an iterative process of identifying and extracting meaningful data units based on excerpts of transcript and general ideas. The team met to compare notes and consensually create an initial domain list that best fit the data (32, 34). The domain list was then given to the auditor to review. The auditor provided feedback about the clarity of the domain titles the level of specificity of the domains. Data was then blocked and assigned to domains. The group came together and formed a consensus on the appropriateness of the block and its domain.

The next step was the construction of core ideas from the existing data units. This allowed for each participant’s response to be in clear, understandable language with consistency across cases. Domain development was done similarly to care ideas; researchers developed core ideas for several cases, then developed core ideas for the remaining cases with consensus from the research team. Consensus yielded a version of the data that contained the raw data, core ideas, and domains. The auditors again reviewed the consensus version and recommended changes, after which the team met to discuss them.

Every participant endorsed what this research has labeled as core values of intimacy and gave insight into what was most important for intimate relationship development. The most endorsed core-value was Shared Experiences (4,typical). Attitudes ranged from the joys of dating and sharing experiences, “Just being able to connect with someone… even if it was just for an evening.” to an emphasis on the shared experiences of long-term relationships.

Participants endorsed what was coded as the sub-category of Shared Values (4,typical). These values often related to their partners sharing their values about intimacy. One participant emphasized openness to disability as a “…lens to see the world through. How you define beauty, how is beauty important, and do you have people that see past the surface?” Other notable shared values included honesty, trust, openness to intimacy, and communication. Two participants talked at great length about their openness to intimacy. Both commented how their openness has contributed to their successes in intimate relationship development. One said her successes were due to her “…openness and willingness to do intimate things,” while the other said, “…having that level of confidence in my sexuality and my sexual preferences, also would be a success.”

Attraction (2,variant) as a sub-category highlighted both the need for emotional and physical attraction in intimate relationships. One person denounced physical attraction and went so far as to call it “shallow,” while the other person emphasized that relationships that were purely emotional were lost because, “You kind of have to be attracted to someone in other ways that are not in the emotional.”

While the project’s initial intent was to develop a better understanding of romantic intimacy, the definition of intimacy was left broad to capture the women’s experiences better. Four women endorsed the sub-categories, Family and Friend Intimacy (4,typical) and Conflicting Roles of Intimacy (4,typical).

Four women recognized friendship and familial intimacy as having a significant impact on their attitudes, both romantic and non-romantic. Those relationships provided, “grounded, consistent, and respectful mutual relationship[s].” The women focused on the comfort and the value of deep emotional connections with friends or family. “It’s really important that you can share your heart…I think that’s when you have your most intimate, wonderful relationships.”

Three women focused on Conflicting Roles of Intimacy (3,typical). This category focused on the forced intimacy of caregivers and how that role can conflict with romantic intimacy. One participant shared how her, and likely other’s attitudes about intimacy, were shaped by having a caregiver, and the other two recounted difficulty for partners switching roles between caretaker intimacy and romantic intimacy

All of the women surveyed people mentioned the stigmatizing effects of disability as a societal barrier to intimacy.

Some respondents recounted how the perceptions of others shape their dating lives. One respondent believes that people often do not consider her as a romantic partner because of her disability. “I think they ‘friend zone’ me relatively quickly because a lot of people that I date…have limited experience with the disability community.” Another respondent reported feeling an overall pressure and vulnerability related to her disability and how the able-bodied world interacts with women with disabilities.” I feel vulnerable to the judgment of other people, to microaggressions, and to being framed according to the language and the stereotypes.” Several others referred to people not viewing them as dateable or intimate beings. One even recounted being viewed as a means of satisfying curiosity about how people with disabilities have sex. Another participant described how her perceived fragility is a limiting factor in her development of romantic and non-romantic intimate relationships. “Touching, because of my wheelchair, I feel that most everybody, even my family members, are sometimes very uncomfortable hugging, touching; they’re afraid it might hurt me.”

Four participants shared struggles related to physical barriers to intimacy, capturing the various biological and functional limitations disability poses on intimate relationship development. For instance, disability causes not only physical distance, “I’ve always wanted to hold someone’s hand and walk, but because I have a walker,” but also lack of spontaneity in relationships, “We can’t necessarily make out in a car because the fact of my disability makes it awkward and difficult to do that.”

There was some overlap with the sub-category Stigma and sub-category Perceived Limitations (3,typical), explicitly discussing how disability affects perceptions of others who are not disabled. One participant acknowledged her inability to communicate her needs effectively and attributes that to assumptions about her partner’s perception of her disability. “I’ll just assume that the other person won’t get it, and I won’t talk about it, and I’ll just shut down.” Similarly, the same participant focused on overcoming these Perceived Limitations as a process “…That has been more of a barrier to me than the people themselves, or the way that they treat me.”

This category mostly centered around past formative experiences that affected each person’s outcome expectancy. One participant had a negative outcome expectancy for dating other people with disabilities because of her previous experience. Another reflected that she had her heart broken too many times to have hope for an intimate relationship “it is no longer something I have been able to do is be intimate because I’ve gotten my heart broken way too many times.” Another focused on messages that she had gotten from her family early in life that she is still combatting, “Those kinds of rejections were again validating maybe mom was right.”

The interview concluded with a question about hope for the future. Each of the women articulated either what they wanted from themselves, what they wanted from their partners, or what they wanted in intimate friendships. One participant hoped for the relationship she had now but in the future. At the same time, others talked about matching partner values and relationships. One person wanted a relationship where she “can feel comfortable being vulnerable and sharing the parts of myself that are most complex, and a lot of times that means my disability and the way that it affects my identity.” Still, another participant hoped for a healthy romantic relationship, both emotionally and sexually, despite the work that comes with longer-term relationships.

Concerning Non-Romantic Relationships, one participant specifically mentioned intimate friendships. She is confident that she will develop more intimate friendships, and while she had mentioned that she felt too old for romantic relationships earlier in the interview, she said, “I’ve never been willing to turn off the idea that I will find someone that might find me sexually attractive or intimately attractive.”

People with disabilities are not readily included in societal concepts of sexuality, leading to a devaluation of sexual identity. Several participants identified family values as playing a role in how they conceptualize themselves. One participant focused on her intersecting identities as a person with a disability and her cultural identity as of Caribbean descent. Disability was seen as a weakness in her culture and a negative reflection on her family. Another participant discussed how her other identities (e.g., student, worker, friend) took priority over relationship development. This holds with Bishop’s Disability Centrality model that discusses quality of life as moderated by domain importance (43). For that particular participant, intimate relationships shifted to lower importance when compared to her other identities and disability management.

Women who reported positive self-efficacy seemingly engaged more in intimate relationship development tasks and seemed better able to cope with rejection. Conversely, individuals who appeared to have low self-efficacy for intimate relationship development had fewer opportunities and seemed to give up more quickly, which served to lower self-efficacy. Thus, participants’ self-efficacy, whether positive and negative, seemed to dictate their sense of identity and behaviors towards intimate relationships (42).

A broader conceptualization of intimacy to include romantic and non-romantic intimacy allows for a view of intimacy as a normative part of overall well-being for people with disabilities. Encouraging positivity regarding intimacy has been shown to have important implications for the overall health and quality of life (44). Participants were careful to distinguish intimacy as connectedness and broadly relational and not as just sexually related.

Of the many values of importance to individuals with disabilities listed, the most ubiquitous in this study was communication. Communication was detailed as a strength, a limitation, and an essential quality in a future intimate relationship. Communication with respect to intimate relationships may be directly linked to relationship self-efficacy. Other aspects of core values that were identified were honesty, trust, comfort, and attraction.

Another central theme that was present was validating relationships and shared experiences. Several participants shared experiences of validating or invalidating relationships with peers, family, and friends. Those validating and invalidating relationships influenced many aspects of participants’ lives, including their disability identity, self-efficacy, self-concept concerning relationships, and their outcome expectations.

Four out of six participants said that disability, itself, did not present any barriers or insurmountable barriers to developing relationships. This research supported past investigations that enumerated the multiple barriers people with disabilities face within any psychosocial interactions. There were a few barriers that bear mentioning in that they help form a richer picture of intimate relationship development for women with physical disabilities and the hardships they endure.

Women in the study talked about specific barriers to intimacy that shaped how they perceive and navigate intimate relationships. Barriers mentioned were physical limitations of disability that included age and functionality, and the physical logistics of spontaneity. Some women reported that society perceived them as frail and lacking desire based on their disability. These perceptions are often perpetuated by myths or stigma about disability (4). Of course, stigma plays a significant role in shaping how these women navigate intimate relationship development. Several of the women focused on negative societal barriers and the stigmatizing effects of disability. These findings are supported by the literature, which suggests that these women are perceived as less worthy, less valuable, and less desirable as intimate partners (14, 15). They reported avoidance, rejection, and patronization. Several mentioned specific formative negative experiences as a result of stigma that influenced their identity, their self-concept, their self-efficacy, and their outcome expectations.

There were three standout themes about facilitators of intimate relationships: openness, communication capacity, and self-concept. The women were asked about some of their personal strengths and what sustained their relationships. One of the most salient themes was openness. The women that were more open to new experiences and risk-taking had well-developed interpersonal skills and communication skills.

In the same vein, communication skills were a repeated theme throughout the research process. For instance, one participant noted a communication skill deficit hindered her relationships, while another participant, who was reportedly more successful with relationships, noted it as one of her strengths. The reportedly more successful women were confident enough to initiate relationships and confident in expressing and advocating for their wants and needs.

The third salient theme that was a facilitator of intimate relationships was self-concept and self-efficacy. Women who were more confident in their identities as people with disabilities, as measured by willingness to disclose disability, were more apt to have higher intimate relationship self-efficacy. Self-concept and disability identity seem to be related to specific formative experiences. Specific formative experiences such as the imposition of family values related to disability or specific experiences related to disability may alter individuals’ attachment patterns.

The results provide some insight into the question, “What makes some people more successful than others at developing intimate relationships?” In any community, there are people with uncommon but successful strategies that help them find better solutions to problems than their peers. This research has sought to label facilitators of intimate relationships for people with physical disabilities. It is the hope that future research will focus more specifically on this severely neglected area that is of the utmost importance to people with disabilities.