## 4 Qualitative Findings and Discussion
### Individualizing Needs and Balance of Design
#### 4.3.4 Cleanliness  
Participants reported issues regarding the cleaning process of LSAD. Some participants using semi-rigid LSAD reported that the cleaning time is excessively long, and it is challenging to thoroughly clean them: \"In principle, you're not supposed to wash it, but over time it inevitably gets dirty. So, you must dampen it and clean it slowly, which takes a very long time. That's why my partner helps me every time\" (Participant 3). However, for participants using flexible LSAD, the cleaning process remains a highly inconvenient issue: \"You can't put it in the washing machine. I ruined several by doing that before, so I must wash it by hand very gently\" (Participant 7).  
In addition to the challenges of lengthy and incomplete cleaning, some participants also mentioned other difficulties related to LSAD cleaning. One issue is that the cleaning process may result in wear and damage to the equipment. Participant 6 expressed this concern: \"I worry that I might damage it during cleaning. After all, this equipment is not cheap, and I don't want to shorten its lifespan just because of cleaning.\" Additionally, some participants also mentioned that the cleaning process could be an extra burden for individuals living independently.  
\"No one can help me clean this device, so it is a task which I do alone. It adds to the strain on my lower back. Sometimes, I worry that the cleaning isn't thorough enough, which affects my mood.\" (Participant 13)  
The final overarching theme for lower-back pain patients regarding LSAD experiences is the individualizing needs and balance of design. This theme conveys the perspectives of LSAD users on aesthetic design and other issues related to LSAD. The research findings indicate that young lower-back pain patients place significant emphasis on the negative perceived stress brought about by LSAD, and this stress to some extent affects their normal social interactions and activities. In terms of aesthetic design, some LSAD studies focusing on user preferences have suggested that the inner wear-shape design (a design form that can be worn under clothing) [39] and neutral colors [38] are currently the most favored designs among users. Therefore, for the personalized needs of lower-back pain patients, subsequent improvements or developments of LSAD should focus on reducing the perceived stress among young patients and incorporating some fashionable elements to garner support from the younger demographic.  
In addition, cleaning LSAD has become a common challenge for all participants. This is mainly because most LSAD in the current market do not support disassembly, a point supported by our interview data. For future improvements, we recommend adopting a modular design concept that supports the separation of the inner lining and the support framework. This would not only facilitate thorough cleaning of sweat and bacteria from the inner lining but also mitigate the risks to the lower-back during the manual cleaning process.  
Finally, based on the results of QUEST 2.0, the satisfaction levels for LSAD dimensions (M = 3.79, SD = 0.86) and safety (M = 3.86, SD = 0.74) were not very high. Combining these findings, we recommend establishing a set of standard sizes for LSAD based on authoritative local anthropometric data. Regarding LSAD safety, manufacturers should consider avoiding the inclusion of voltage devices within LSAD.