Barriers and enablers to participation in Immersion Therapy for people living with disability

Objectives This study explored the perceived barriers and enablers to participation in Immersion Therapy, a novel water-based intervention for people living with disability. Methods A mixed-methods design was used, comprising a custom survey with Likert-scale responses and optional comment sections, followed by semi-structured interviews. The survey was distributed to current and past Immersion Therapy participants recruited through purposive sampling in Adelaide, South Australia, between June and August 2024. Interviews were completed 2–6 weeks after the survey. Quantitative data were summarized descriptively, and qualitative insights were analyzed using reflexive thematic analysis. Although full data saturation was not achieved, consistent themes were identified across data sources. Results 16 participants completed the survey, and seven completed interviews. Key barriers included travel distance, changeroom accessibility, and anxiety around participation. Some were impairment-specific (e.g., temperature regulation, confidence in unfamiliar environments). Enablers included strong staff support, perceived safety, clear communication, and enjoyment. Participants often described a sense of empowerment and freedom of movement in water not achievable on land. Conclusions Barriers and enablers to participation in Immersion Therapy at the single center studied reflect the complex interplay of environmental, psychological, and individual factors. The findings highlight the importance of inclusive facility design, participant-centered communication, and program flexibility. Given the modest sample size and single-site design, the findings should be interpreted as exploratory. Addressing these modifiable barriers may support improved accessibility to therapeutic exercise services for people living with disability.