MSc Research: Touch, Confidence, Sport, and Blindness

 

 

“It is only after you have come to know the surface of things that you can venture to seek what is underneath. But the surface of things is inexhaustible.” 

― Italo Calvino (1983/2016, p. 55) 

 

“Things don't exist unless I touch them.” 

― Participant 3 

 

 

TABLE OF CONTENTS 

 

1. Abstract 4 

1. Introduction 5 

1. Method 10 

1. Results 16 

1. Discussion 21 

1. References 28 

1. Appendices 36 

 

ABSTRACT 

Lack of full proprioception in visually impaired and blind people (VI) negatively affects their lifestyle and, in combination with structural and societal barriers, lead to low participation in physical activities (Alcaraz-Rodríguez et al., 2021; Lieberman et al., 2018), deemed to build confidence and social interaction with further benefit to their phycological well-being (Elsman et al., 2018; Ilhan et al., 2020). Being confident in touching and being touched by people (i.e. touch exchange; TE) is part of exercising and sports, but for VI could be crucial in building self-efficacy in social settings, particularly from a Self-Determination Theory standpoint (Bandura, 2000; Deci & Ryan, 2011; McAuley et al., 2006). Using Reflexive Thematic Analysis (Braun & Clarke, 2006; Braun et al., 2016), this study explored seven semi-structured interviews with VI (two women, five men, mean age 41, one heavily visually impaired, six completely blind) focusing on the influence of TE on confidence and exercising, and produced four overarching themes: 1. Things don't exist unless I touch them; 2. In the right context, TE speaks volumes to human connections; 3. TE gives the freedom to become incrementally confident; 4. Sport and TE build confidence and can drag you away from dark places. The results confirmed TE as a valuable, trainable skill bridging human interactions and physical/psychological well-being against the many negative emotions often perceived by VI. Theoretical/practical implications on the development of new Touch Avoidance Scale Questionnaire (Ozolins & Sandberg, 2009) measuring TE confidence levels in future sport psychology interventions bespoke to VI were considered.  

Key words: visual impairment, self-efficacy, psychological well-being 

 

INTRODUCTION 

 

Visual impairment and physical activity 

According to the World Health Organization (WHO), visual impairment and blindness are affecting hundreds of millions of people around the globe, and, in the UK, they have incidence of more than 3% over the general population (Pezzullo et al., 2018), resulting in an estimate 2 million people living with sight loss, 340.000 of whom are registered with the Royal National Institute for the Blind (RNIB, 2021). Overall, across the different degrees of visual impairment, proprioception (that is, the sense of one’s body into space), posture and motor skills are affected as for the lack of important cues to interrelate with the surrounding environment (Papadopoulos et al., 2013). Consequentially, independence and performance of the simplest daily activities (e.g., walking independently) can be severely compromised, with comorbidities such as sedentary lifestyle, and sub-optimal dieting (predominantly because of the consumption of pre-prepared meal to avoid long process in preparing food, taking up to 2 hours per meal), leading to obesity which, in fact, affects more than 40% of the community since young age (Alcaraz-Rodríguez et al., 2021; Jones & Bartlett, 2018). The lack of exercise among visually impaired and blind people (VI) is also made worse by the barriers encountered in joining inclusive sport activities (Lieberman et al., 2018). When considering children, the impossibility for family members to participate represents an extra layer of difficulty to the problematic logistic organization and planning, although participation in sport and exercise is recognized by parents as important, potentially, to build independence, confidence and social interaction for their children (Columna et al., 2017; Elsman et al., 2021). Previous studies have highlighted the importance of further researching quality of life, physical and psychological wellbeing among the blind community (Elsman et al., 2018; Ilhan et al., 2020; Papadopoulos et al., 2013), deemed to improvement through bespoke applied exercise and sport interventions (similarly to what consolidated in the general population; Roztorhui et al., 2018). Particularly when considering team sports (Eather et al., 2023), it is in fact well established how participation in physical activity can positively contribute to mental health, emotional regulation, resilience, cognitive function, as well as to psychological conditions treatments (Martín-Rodríguez et al., 2024). In this regard, it is also important to consider the extremely low engagement rate in such activities among VI (Alcaraz-Rodríguez et al., 2021). 

Visual impairment, confidence and well-being 

Studies confirm that younger adults affected by visual impairment have problems in creating social, and romantic relationships, and experience lower levels of psychological wellbeing than older VI adults (Elsman et al., 2018), and that sexuality for VI women can be even forbidden altogether as a protection against abuse (Haskan Avcı, 2023). Among students, self-esteem has been found decreasing significantly, in case of late sight loss (Onuigbo et al., 2020), unless they participate in sport activity which, in turn, makes visually impaired more confident and proactive not to fall into obesity (McMahon et al., 2019), and can positively influence their emotional state during their daily life (Roztorhui et al., 2018), hence well-being. Well-being is, in fact, a complex construct involving one’s perceptions on mental/social aspects as much as on physiological/physical cues all contributing to one’s self-aware optimal functioning and satisfaction in life (Giles et al., 2020).  

Consensus across literature links physical exercise (different than physical activity in that it implies a repetitive effort to enhance one’s physical capabilities in a planned, structured way) to well-being through the positive neurological, cognitive and physiological changes that it facilitates (Carek et al., 2011; Mandolesi et al., 2018). Across different cultures and ages, wellbeing has been consistently positively correlated with physical exercise and moderated by the integration of a sense of agency, skill-acquisition and social connection/support. According to Self-Determination Theory (SDT; Deci & Ryan, 2011), in fact, the satisfaction of these psychological needs works both as a nourishment and drive for getting people into action (Ryan & Deci, 2017; Vansteenkiste et al., 2020). 

Martial Attitude training for VI 

Martial Attitude C.I.C. (MA) has developed through the years a training program bespoke on the needs of VI based on some elements of KUNG FU Wing Chun which are designed to build sensitivity in the contact with other people when pressure is received through the contact of arms and forearms. When trained in pairs, irrespective of the other being fully sighted or not, both people are learning new skills which are transferable to other real-life situations. More specifically, the training is meant to improve VI posture and overall confidence in touching and being touched by others, whilst helping them to deal with occasional contact with strangers (e.g., in crowded places, on public transport, at the grocery store) by acquiring important cues about their positioning and posture in space (see movements’ breakdown diagrams in Appendix A). Across multiple feedback with some of the major associations for VI in UK and Italy such as the Royal National Institute of Blind People (RNIB), Thomas Pocklington Trust (TPT), Metro Blind Sport (MB), and Fondazione Chiossone (FC), it became evident the importance of exploring the meaning of “confidence” and “touch” among VI when considering both interconnectedness with others and participation in physical activity. 

Self-efficacy and agency 

Motivation is recognized as an active and inherent aspect of human nature, continuously learned and integrated throughout life, although it is influenced, but not entirely controlled, by social context. According to SDT, intrinsic motivation fundamentally drives people's engagement in new activities and exploration of new behaviors that may benefit them, fueled by curiosity. Essentially, people engage in highly satisfying activities because these activities align with their personal sense of self, rather than being dictated by external forces or incentives (Cognitive Evaluation Theory; CET, the first "mini theory" within SDT; Deci, 1975 in Vansteenkiste et al., 2010). Further, participation in physical activity is closely linked to self-efficacy, defined as “the belief one has in being able to execute a specific task successfully” (Bandura, 1977).  

In a kernel, Bandura’s Social Learning Theory posits motivation, reinforcement (in reference to coaching, see Weight et al., 2020), and past experiences as key components to promote what is often referred to as confidence. When individuals perceive themselves as capable, they are more likely to start and to be consistently involved in activities (Neupert et al., 2009), and in sport self-efficacy is a high predictor of performance (Feltz & Lirgg, 2001). Importantly, in a reciprocal relationship with behavior, self-efficacy can then enhance intrinsic motivation by reinforcing a sense of competence and autonomy (Bandura, 2000; McAuley et al., 2006), key elements of SDT. Given their limited proprioception, this belief can be particularly critical for VI, as overcoming barriers related to movement and orientation in space intuitively requires a strong sense of self-efficacy, and ultimately promote their overall psychological and physical health. 

Confidence in “touch exchange” 

However, the presence of stressors significantly affects people’s behavior, which evolve also over time (Lazarus, 1993). The core concept, outlined in the Transactional Model of Stress and Coping (TMSC; Lazarus & Folkman 1984 in Vollrath, 2001), is that individuals and their environment continuously interact (trans-act), with emotions serving as moderators between cognitive responses and coping mechanisms. Additionally, any stressful situation results in either a balance or imbalance between the demands and the individual's available resources to manage them (Hulbert-Williams et al., 2012). Crucially, one of the major stressors for VI when interacting with other people could be considered de facto contact, that is “touch exchange” (TE).  

VI cannot anticipate other people’s movements and “automatically” accommodate for them so to integrate both perception of the incoming movement and interpretation to their own reaction to it as part of “normal” behavior. It is sensible for fully sighted people when interacting with VI to not touch them (without anticipating it or before being prompted to do so), and verbal communication is by far the most important means of exchange. Thus, paradoxically, it would appear reasonable to assume that this accepted social norm further limits the possibility for VI to acquire more confidence in touch and, even more so, to be involved in physical activity regardless of the potential well-being benefits. Also, to date, there is not a suitable quantitative research tool measuring VI confidence in touching people and being touched by them. Therefore, it would extremely be hard to gauge any possible improvement in it, when an intervention was attempting to address the challenge to enhance confidence by means of TE among VI. 

Present study 

Consequentially, TE as a unique experience independent from the commonly known and referred to as “sense of touch” will be here explored by looking at how different VI (sharing the same potential stressor in everyday life situations since affected by their impairment) make sense of it, through a series of semi-structured interviews. The present study’s aim will be twofold: Firstly, to help better understand and define different kinds of “touch” and identify possible correlates with confidence and sport participation in an underrepresented population, contributing to the limited existing literature on the topic, and opening new venues in addressing their overall well-being. Secondly, to provide valuable insights into particular words or constructs deemed as important to implement future and most needed measures of TE confidence among VI. 

 

METHOD  

 

Study design 

A generic qualitative approach was employed for this study, deemed more suitable for exploring the diverse meanings that different individuals attribute to a set of emotions and feelings experienced at various times and in various ways (Smith, 2016). Unlike a quantitative approach, which relies on an objectivist epistemology to statistically interpret social behaviours as immutable realities and generalize findings, a qualitative approach considers the context shaping people’s actions, allowing participants to describe their experiences in their own words through interviews (Krauss, 2015; Yilmaz, 2013). People and situations interact, influencing knowledge (transactional epistemology, which acknowledges the subjectivity of knowledge) and resulting in individual-specific knowledge (relativist ontology, recognizing that multiple social realities coexist as ever-changing constructions) that can only be examined through personal exchanges between the investigator and the respondent (hermeneutical and dialectical methodology; Guba & Lincoln, 1994). Consistent with this perspective, the study explores how touch and confidence are understood by VI using an interpretative approach, as reality can only be depicted through an ongoing negotiation between people and its nature (Sandberg, 2005). Participants and sampling 

Purposeful and snowball sampling was used in the present study as it helps gaining access to information-rich participants particularly experienced with the subject of interest (i.e., visual impairment) and, therefore exposed to the potential phenomenon researched (i.e., touch being experienced as possible stressor). In addition, their willingness to participate in long semi-structured interviews allowed the researcher to evaluate their ability to share opinions in a rich, articulate and reflective manner as consistent with the aims of the study (Palinkas et al., 2015).  

The researcher met Participant 1 (P1, male, British, age 32, partially sighted) at the local gym and approached him in case he needed any assistance to safely navigate the space. In the conversation which followed, the researcher was able to introduce himself and P1 was happy to accept his invitation to take part in the research. P2 was introduced by Thomas Pocklington Trust (male, British, age 44, blind). The researcher had the opportunity to know P3 (male, British, age 43, blind) a few months back before the start of the current study: the occasion being the researcher reading an article of his on The Psychologist about his practice in Leeds, UK, as a Chartered Counselling Psychologist affected by visual impairment. Following, the researcher reached out to him via LinkedIn and, when prompted by the participant himself, via email before and phone later to invite him to take part in the research. P4 (male, Cambodian, age 19, blind) contacted the researcher via email from Cambodia, after coming across a post of RNIB on social media about the study. Participant 5 was introduced by P4, but due to other family commitments, the interviewee asked to interrupt the recording, and it was not possible to reschedule for a second time. Therefore, the results of this partial interview were not included in the present study. Participants 6 (male, American, age 33, blind), 7 (female, British, age 59, blind), and 8 (female, British, age 54, blind) were similarly recruited via researcher’s social media and website channels, where the participation information letter was made available to be contacted by potential participants. 

Data collection and ethical considerations 

An information sheet was provided to all participants prior to the start of the study (Appendix B), and their written informed consent taken (Appendix C). Provided the type of participants’ disability, at the very beginning of each interview, the researcher restated the purpose and value of the study as for the Participant Information Sheet and read out loud all the points of the Informed Consent Form and asked the participants’ consent to each of them. Accordingly, the consent to participate in the research and of the audio recording of the semi-structured interviews was documented by audio recording participants’ verbal response (Trujillo Tanner et al., 2018). In fact, only P1 had returned the informed consent form (Appendix D), whilst all the other participants preferred to audio record it, and it is therefore available at the beginning of the verbatim transcriptions for participants 2, 3, 4, 6, 7, and 8, thereby adhering to institutional ethical guidelines (section 19 of Appendix E). All participants met the inclusion criteria for the study as their visual acuity was between the ranges indicated by RNIB (2024) for severe sight impairment (blind) and sight impairment (partially sighted; details available in section 18 of Appendix E). 

Research questions and interview protocol 

All interviews analyzed in the present study were performed face-to-face or online and lasted between 41 and 85 min (total recording time = 404 minutes, mean time/episode = 58 minutes). The following main points were addressed: A: Drawing from their own experience, how do VI make sense of their sense of touch when in contact with other people?  B: How do they think this “touch exchange” contributes to their overall confidence? C: Are TE and confidence somewhat related to participation in physical activity? 

 Using a semi-structured format, all VI were led through an identical set of 32 questions also similarly phrased (Appendix F). However, the interviews were run in a flexible way, to dive into specific topics as these arose or the occasion permitted, enhancing fluency and richness of information acquired (Patton, 2015), and to avoid an excessive rigidity which could undermine the possibility to fully capture the VI experience (Dale, 1996 in Biddle et al., 2001). According to Patton’s interviews principles, different probes were used to unpack issues at a finer level of detail (e.g., Let me rephrase this: you said X, Y, Z... correct?”; “Could you please expand on this more?”; “What do you mean by this?”). Overall, the interviews were run as conversations with a focus point on touch and confidence in respect to sport participation. Therefore, the researcher introduced the interviewee and usually started off with a series of general questions related to their social background, their studies, and their job to make the VI first feel fully at ease with the interviewing experience, but also to facilitate rapport-building between the interviewer and the VI. Only after, the researcher started posing more challenging questions on the level of visual impairment they would be affected by and on the other interconnected topics, these also structured with an ideal logical order.  

Data analysis 

Reflexive Thematic Analysis (RTA) was selected for this study due to its flexibility in developing and analyzing existing data to identify and interpret comprehensive common themes. RTA can be highly inductive, enabling the analysis of embedded language elements such as beliefs or assumptions that may be shared among different interconnected individuals (Fairclough, Mulderrig & Wodak, 2011). The RTA was conducted with an explicit lens (Braun & Clarke, 2006), employing a practical approach rather than a theoretical one as in Interpretative Phenomenological Analysis (IPA), which focuses on uncovering hidden meanings (Spiers & Riley, 2018). This methodology allowed the researcher to actively participate in the process, avoiding a purely mechanical, descriptive analysis that could limit further interpretation of the data and new understandings of the social world (Braun et al., 2016; Braun & Clarke, 2006).  Furthermore, the RTA approach’s characteristic to narrow down complex concepts into shorter strings of words, was deemed a perfect fit to identify any potentially missing TAQ item or to highlight possible correction of existing ones. 

Reflexive thematic analysis procedural overview and “quality” criteria 

Critics have pointed out how qualitative research is difficult to constrain under any specific quality check, because of its inherently slippery subjectivity and idiosyncratic texture (Biddle et al., 2001). Nevertheless, the researcher finds himself philosophically prone to share/declare the purposes and practices adopted when undertaking the research not to guarantee “quality”, but to offer a “coherent perspective” for reviewers and readers to better understand the final product. RTA was conducted using the systematic six-phase model of Braun et al. (2016) and their 15-point checklist. First, the interviews were transcribed verbatim (Appendices G, H, I, J, K, L, and M). Second, multiple readings of each transcript facilitated familiarization with the data (phase 1), and notes were taken, leading to the creation of initial codes (phase 2) that labeled interesting parts of the data relevant to participants' experiences. Third, the identified codes were grouped into candidate themes (phase 3), highlighting what was significant to the VI and its meaning to them. After careful review, some refined and named themes were organized into a structure presenting overarching themes, which could include subthemes (phase 4). These finalized themes, best representing the data, formed the backbone of the rich analysis development (phase 5) (Appendix N). Finally, all existing notes and written analytic work were edited and compiled into the overall report (phase 6). The six phases were not merely consecutive steps; new insights allowed for revisiting previous steps (Braun & Clarke, 2006; Braun et al., 2016).  

Amid the complexity and the debatable necessity of aligning perfectly with universal quality criteria (Smith & McGannon, 2018), the researcher evaluated RTA's “quality” (traditionally/conventionally) with Finlay (2021)’s '4 R's': rigor (diligence throughout the analysis process), relevance (contribution to understanding the researched phenomenon, i.e., touch and confidence among VI), resonance (use of evocative imagery in the RTA text for clearer, impactful communication), and reflexivity (researcher transparency regarding subjective openness and self-awareness). 

Transparency and reflexivity 

Qualitative research is inherently subjective and, therefore, reflexivity is essential as all interviews are all led by the researcher who, being a dynamic part of the process, might influence the information gathered by underlying beliefs (e.g., how data is collected, coded, analyzed and reported; Braun & Clarke, 2006). The researcher has actively trained in Kung Fu over the years, discovering a preference for those emphasizing defensive technique movements. Retrospectively, he has noticed how much these helped him overcome unresolved issues with past episodes of physical and verbal abuse happened in separate moments at the hands of different people, not part of family and friends, which triggered profound feelings of fear at the time of events. Combined with his Sport and Remedial Massage practice through the years, the researcher is certainly invested in the task at hand, also considered the years spent in developing the MA training system for VI. As for in the past, this has not rushed him into delivering results over proper theoretical and practical education and training.  

Provided his belief in the potential social impact of this work, the researcher is however more worried to find viable ways to take the research further in applied practice overcoming his own limitations as a man rather than because of potential lack of insights or results in the present research. Any personal, political or religious belief that people should always try to do their best to help themselves has not affected the analysis nor the coding process, in the researcher’s opinion. If anything, a weakness in the results and their interpretation could be linked to the impeding impostor syndrome lived by the researcher as making his ongoing sense of inadequacy more difficult to bear when confronted by the responsibility towards a minority group which could benefit from his good work as opposed to his shortcomings. Lastly, transparency of the analysis was enhanced by the researcher using NVivo (version 14), which allowed to have an audited trail of the process and, by extension, allowing greater trustworthiness and plausibility over the reported results (Appendix O). 

 

RESULTS 

 

The RTA produced four overarching themes, namely: 1. Things don't exist unless I touch them; 2. In the right context, touch exchange speaks volumes to human connections; 3. Touch exchange gives the freedom to become incrementally confident; 4. Sport and touch exchange build confidence and can drag you away from dark places. 

  

Things don't exist unless I touch them 

Touch is indeed understood as a second option, in comparison to sight which is “the sense that rocks” according to P2, to navigate the world from a distance in full safety and to have a better understanding of human emotions and communication through face-reading. Most remarkably, though, as opposed to hearing which comes in as fundamental for space navigation, touch is recognized as a “mundane” yet an exceptional “utility” tool to interact with the real practicalities of the everyday world and for personal/professional development. For example, P2 clarified the concept by saying:  

(For navigation) hearing is by miles the more important. But when I think about household tasks and stuff like that, touch is definitely a big deal. I think, you know, touch for me is a very practical thing. You know, it gets a lot of jobs done. It was the secret to me being literate and to me studying. 

Across interviews, it became evident that those who has always been blind or lost their sight at a very young age found themselves somewhat in an advantaged position as opposed to those who could not be as proficient in, for instance, telling the difference between Braille characters and building from there a deeper layer of texture recognition. Nevertheless, for all of them touch goes beyond that. Simply put by Participant 3, who is affected by visual impairment is also cornered by the knowledge that “things don't exist unless I touch them as well”. The looming existential threat of being lost and isolated in a distant, vast, and “empty” world appears far too daunting to fathom for those who had to come to terms with their sight loss later in life. For them, the gap is immense, as for in the words of P7: 

Couldn't do without it. I don't know how people manage... I think some people are better at it and I don't know if that's a difference in someone who has always had a sight problem or is its psychological acceptance... I don't know if it's me or if it's just the fact that I was sort late coming to the table, you know, acquired sight loss. It probably has got different levels than not knowing anything else. 

Crucially, P7 pointed out how VI struggle to have occasion to experience touch with others just because sight “prompts more interaction” even in ordinary family life as opposed to being blind and becoming more protective of yourself.  

In the right context, touch exchange speaks volumes to human connections 

This superordinate theme was influenced by the context-dependent meaning attribution of touch, so that VI “will read and attempt to control over that sudden, unexpected, unrequested grab of an arm. And they might be doing it for the best of reasons, but the blind person is not going to appreciate it” (P2) as opposed to “I'd say within my familiar environment, I'm fine” (P7). At its core, the proposition behind such extremes on a continuum of feeling is to safeguard one’s sense of agency and independence when in contact with fully sighted people. These, in the words of P2, think “on the spur of the moment that they can probably have more control over our safety and keep us safer than we can by ourselves. And of course, you know, the exact reverse is the case.” 

On the other hand, TE is understood by VI as the freedom to manoeuvre for space without antagonizing, that is “learning to understand space around you, that sort of equivalent of crowd reading that a lot of other people would do by sight” (P2). The emphasis could be expected to be on the moment where contact between people is happening, when TE is unexpected. As it turned out in the interviews instead, the accent was predominantly posed on the feeling of reassurance that touch can offer in safer contexts, such among friends or well-known acquaintances, and it was clearly expressed by P7:  

It's sort of like an affirmation in the right way you know the touch in... any physical exercise or whatever but there's something about it that connection, physical connection, that speaks volumes... maybe it's a way of not replacing a verbal exchange but adding substance to it. It gives it another layer. 

Quintessentially, touching a table is clearly perceived as different than touching a person for VI. In the latter case, something happens, and it affects them. The table of the example, instead, “does actually nothing for them” (P1). Thus, it sounds clear how just feeling the texture of the reality of things is profoundly different from, and not enough for, creating factual connection and communication. Two elements that play a central role in negotiating one’s sense agency in any given situation, that is the freedom to express confidence. 

Touch exchange gives the freedom to become incrementally confident 

This theme is rooted in the declination of confidence stated by P7 as “an incremental accumulation of training, experience, knowledge, and skills” which are context specific. This idea that confidence is structured as multiple peels stratifying on different “onions” (that is, each challenge/barrier) was corroborated across participants. The digital barriers represent the challenge uber alles, although to a different degree depending on the individual’s social environment and background. Otherwise, rather than spatial orientation, the attention, across interviews, landed on the less instructional/educational facets of confidence. Confidence was depicted as expression of “self-love” (P1), a “demonstration of positive self-esteem" (P8) which translates to “that ability to kind of back yourself, not dwell on mistakes and just go, you know, just crack on” (2). Ultimately, VI confirm the taxing ever-present cognitive effort in getting things done (see Themes 1) when delivering the most natural acts such as walking (see Theme 4). That is true to the extent that confidence, to them, becomes a self-assessment guide in working towards realistic goals given one's limitations. P3 was extremely clear about it when stating: 

So, I think to an extent it (confidence) can be learned, but it takes an enormous amount of energy, I still imagine, even if you are got those much more capable skills to do these things. Because every time you do it, you are kind of getting confronted with more of the systemic barriers that the world presents for you and increases your level of struggle with these things. 

Hence, confidence assumes a very practical aspect fundamentally supported by TE in social settings, where VI feel there is a big gap for them to cover in terms body posture, being physically relaxed, and understanding what positive body language looks like. If P7 summarized that “TE I would say instills confidence”, the rich data from the interviews led also to highlight the intertwined relationship between TE, confidence, and freedom. When relating to other people, the point made is that the more freedom VI have, the more they are able to touch, feeding back boosts of confidence that, in turn, lead to a greater sense of freedom.  

Sport and touch exchange build confidence and can drag you away from dark places 

The last overarching theme is stemming from the widespread background sense of discrimination perceived by VI, who also shared the necessity of dealing with feelings of isolation, frustration, and anger, exemplified by P7 saying that “I don't mean it's a similar loss, but sight loss (is like) bereavement, because you are grieving the loss of your sight to an extent”. Provided that “blind people don't go for a casual stroll because you can't, you need to be thinking about it too much” (P2), physical activity (mostly if nurtured by a supporting and safe environment like a smaller private gym where navigation is easier and feeling judged by others is contained) is valued as incredibly important for getting in touch with one's body, for better posture and balance, and for building confidence gradually. About exercising, P1 said: 

I'm feeling great. It's making me want to stick to it. It's making me more dedicated to it. And it's making me feel like it's not a waste of time... And honestly, I just feel like I should have done this sooner because I feel like it's gonna increase my confidence a lot... The reason I never went for so long is because, number one, I just wasn't confident enough to... I was like I was in a dark place. So, I never came out of my comfort zone. 

The social aspects of exercise were found in the improvement of overall confidence through time for VI, who might be protective of themselves but still wanting to reciprocate energy with others in a controlled and gentle way. Crucially, often TE plays a role in facilitating this process, as highlighted by P2: 

It's interesting because I think anything that involves that kind of TE and sort of balance and, you know, obviously something like a martial art too, well, obviously help all those messages, but also make it a bit more fun and a bit more interactive. 

 

DISCUSSION 

 

Previous research has emphasized the need for further investigation into the quality of life, physical, and psychological well-being of the blind community (Elsman et al., 2018; Ilhan et al., 2020; Papadopoulos et al., 2013). Participation in physical activities is known to enhance mental health, emotional regulation, resilience, cognitive function, and support treatment for psychological conditions (Eather et al., 2023; Martín-Rodríguez et al., 2024). Despite these benefits, engagement in such activities remains notably low among visually impaired individuals (Alcaraz-Rodríguez et al., 2021). Hence, it was found that the living individual experiences of VI facing similar stressors in everyday life and this existential divide between connecting with the world and being physically distanced from it qualified them to be suitable subjects to learn from on the topic through a generic qualitative approach (Smith & Sparkes, 2016). Seven semi-structured interviews were conducted with as many VI and revolved around the core idea that touch is an essential part of their life, although TE is kept to a minimum, at least in social settings, to the benefit of verbal communication. Using RTA (Braun & Clarke, 2006; Braun et al., 2016) to investigate the relationship between the sense of touch/TE (understood as the contact between people), confidence, and participation in physical activities (where touching is often involved) among VI, this study produced four overarching themes. 

Things don't exist unless I touch them 

The first theme confirmed the importance of touch for understanding the texture of the world and navigating it by enabling practical means of communication, primarily. Even in such a small cohort of participants, the big divide between people who were born blind and those who lost their sight in their late 20s and 40s was staggering, when intaking their accounts about the difficulty in mastering their sense of touch and, more generally, appreciating differences between touch and TE. One consideration is that, for the latter group, the exclusion from the world in the absence of touch, in very practical ways, is adding up to the sense of loss felt when comparing what was before enabled and accommodated by the sense of sight. In the literature reviewed (Elsman et al., 2018; Ilhan et al., 2020) such a distinction is importantly missing (in Elsman et al., 2021 was pointed out the severity of visual impairment instead), as it would be plausible to immediately suggest different support systems for either group, once identified who would benefit the most from receiving specific therapy/support aimed to the adaptation for what is lost vs the education of what is surrounding the individual.  

On the other hand, it is worth considering the fast-paced evolution of voice-controlled digital technologies and what this entails for VI. Braille (marking its 200th anniversary this year) and typewriting are set not to be much longer as predominant as they once were, and already AI-implemented systems (e.g., Alexia, Siri and the kin) are addressing many challenges faced by VI faster than ever before. Paradoxically, this also means how they will be less and less exposed to rely on their use of touch. Touching, and being touched, shouldn't be something to fear—quite the opposite. However, the lack of visual prompts to connect with others physically also highlighted the existential threat posed by limited TE, that is being completely isolated in the void of the world. 

In the right context, touch exchange speaks volumes to human connections 

The second theme suggests that, not triggering stress in situations perceived as respectful, TE adds layers of meaning to interpersonal communication and feelings of reassurance, provided that the world’s existence is at stake unless touched, then people do not exist unless they are touched (see Theme 1). Coherently with SDT, the theme offered some sort of overlapping conceptualization of three fundamental psychological needs essential for human well-being: autonomy (the ability to think and make choices freely, fostering a sense of ownership over one's actions and emotions), competence (the development and mastery of skills), and relatedness (forming meaningful connections with others and a broader community; Deci & Ryan, 2011). When these needs are unmet, a lack of autonomy/agency may result in feelings of being forced out of one’s own control (precisely as the act of grabbing a VI’s arm with the best intentions but with the arrogance of knowing better); insufficient competence can lead to helplessness (similarly to the limitation in freedom when navigating crowed places without antagonizing without a developed familiarity in TE);  a lack of relatedness to feelings of exclusion or social isolation (as the absence of TE would do as opposed to amplify human interconnectedness and to make VI feel safer). 

Touch exchange gives the freedom to become incrementally confident 

Supported by Bandura’s Social Learning Theory (Bandura, 1977), this theme stably positioned confidence as the result of an incremental individual development in any given area. The accumulation of self-efficacy based on past experiences resonated in the words of participants as an affirmation of self-love and self-esteem, too. The reviewed literature indicated positive effects of sport activity on VI self-esteem (understood as alignment between one’s expectations and perception of adequacy; Onuigbo et al., 2020). In the light of the results, self-esteem was also reviewed further as associated with greater well-being and, crucially, to the ability to move independently (for a systematic review see Augestad, 2017), whilst body image satisfaction was associated with self-confidence (Jameel & Shamim, 2019), always in VI children. 

Similarly, in this research VI found themselves in need of filling a gap, in social settings particularly, and did concur that TE can play a part in building proprioception confidence, so that they could adjust for what they cannot see: Not only a better posture per se, but also the reaction of people to it. That is, for the extra benefit of learning what positive body language looks like. VI are actively seeking to blend in among fully sighted people and understand that, in a world ruled by visual appearances, they could not stand out too much so to avoid triggering potential resistance in communication/relationships (at best) or plain discrimination/isolation (at worst). 

Sport and touch exchange build confidence and can drag you away from dark places 

As theorized, TE was identified as having a role to better reciprocate energy with others in a controlled and gentle way. However, the mentioned reciprocation encompassed the general principle of agency for the VI individual, that is the increased confidence in controlling the environment when this is “materialized” in contact (again linking back to theme 1). Confidence was reciprocally benefiting from TE which, in turn, was also organically integrated in physical exercise which fed back in being consistent to it, coherently with the literature reviewed (Neupert et al., 2009). Progressive participation in physical activity was also confirmed to build resilience against negative feelings linked to lower psychological well-being (Elsman et al., 2018; Ilhan et al., 2020; Martín-Rodríguez et al., 2024). 

Nevertheless, as this study progressed, common feelings of bereavement and frustration as well as the accidents of life appeared to be dealt with differently by participants, ranging from being fundamentally fatalistic to proactively advocating for VI diversity against discrimination or barriers. Hence, future interventions could consider measuring baseline locus of control (LOC), which differentiates people believing they can control their health (internal LOC, deemed to contribute to higher well-being among VI on daily basis; Papadopoulos et al., 2013), and people who believe their health is primarily controlled by external factors or by chance/fate (external LOC; Lefcourt & Davidson-Katz, 1991). 

Limitations and future avenues 

RTA proved to be an effective methodology to come in closer contact with the individual experiences of VI and to investigate their beliefs upon a personal matter such as their confidence in touch, providing the best quality of the data source. However, this study does not come without limitations. The most compelling one, in a sense, being the nature of the findings presented in the first theme. In fact, the duality of interpretations and understanding upon the difference between touch and TE rooted in participants who were blind since birth as opposed to those who became it later. In this case, it seems to be true that the absence of evidence is not evidence of absence. That is, the conceptualization of TE as different from touch might be correct from a theoretical standpoint, but it felt like it was met with more difficulty by participants blind from birth. Which could indicate the validity of the basic assumption of TE as an asset for VI and, therefore, that future research should be careful in terms of design to produce and interpret data at the benefit of what appear to be two different populations, rather than to one (VI), as addressed here.  

Also, the data revealed an emphasis on how different cultural and environmental backgrounds affected participants’ lived experiences and, again, according to the nature/timeframe of the occurring blindness. Thus, future research should use the utmost caution when approaching the present findings or when, through it, further exploring of the phenomena. Particularly, the researcher thinks about the influence of national identity and religion when addressing the meaning of discrimination and inclusion among VI, worth exploring in greater depth by other qualitative methods, such as IPA (Spiers & Riley, 2018).  

Other than using LOC to assess VI’s attitude towards life at baseline, future studies measuring their confidence levels pre/post experimental interventions on TE such as MA could consider the Touch Avoidance Scale Questionnaire (TAQ; 5-point Likert scale; Ozolins & Sandberg, 2009; Appendix P) as a viable tool. Although originally designed to assess the level of touch avoidance to diagnose potential past abuse via understanding developmental antecedents of different physical contact-seeking attitudes, it is researcher’s opinion that the TAQ could be considerately adapted for VI (in non-clinical settings, see Appendix Q), in the light of the present findings. As an example, a 20th item “my confidence in touching and being touched by others is related to my participation in physical activity” could be introduced to voice the important existential nature of touch exchange for blind people as a bridge to confidence and participation in physical activities here suggested. 

Conclusion 

To summarize, using an interpretative generic qualitive approach from a transactional epistemology standpoint (RTA), seven semi-structured interviews with VI were analyzed, and the produced four main overarching themes indicated that: Touch is a prime tool to interconnect with the texture of the world and to communicate; TE creates meaningful human connections and a sense of safety in being free to navigate public spaces; TE promotes confidence by the acquisition of important cues on body language to better engage in social setting; TE is a skill developed also by taking part in physical activities which, in turn, help coping confidently with the negative emotions created by the challenges VI face in their life. The role of TE should be studied further for its critical role in creating a bridge to greater confidence and well-being for VI. Theoretical/practical implications on the development of new TAQ questionnaire measuring touch-exchange confidence levels in future sport psychology interventions bespoke to VI were considered. 

 

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APPENDICES 

 

Appendix A 

Kung Fu Wing Chun overview and movements’ breakdown. 

 

A bespoke training program for visually impaired and blind people based on some aspects and techniques of KUNG FU Wing Chun. Particularly, in Wing Chun, Chi Sao stands as a cornerstone technique where practitioners engage in a dynamic exchange of energy and movement. It's a tactile practice where two individuals connect through their arms, feeling the subtle shifts in pressure and position. Through Chi Sao, practitioners develop not only physical sensitivity but also mental acuity. The constant feedback loop of sensing and responding builds a deep understanding of timing, distance, and control. This heightened awareness instils a sense of confidence in one's ability to navigate different scenarios, both in training and real-life situations. As practitioners become more adept at Chi Sao, they cultivate a profound sense of self-efficacy, knowing they can adapt and respond effectively to varying challenges (see figure 1). 

 

 

 

Figure 1. A young Lee Yun-fan (aka Bruce Lee, on the left) and Yip Man (on the right), training Chi Sao. To observe, the relaxed muscles tension between the two. In movement, the arms’ positioning of one will rotate clockwise and anticlockwise into the other practitioner’s arms positioning. Whilst moving, both participants aim not to lose contact to one another, irrespectively of the pressure applied in any given moment. Image source: https://www.sifusingh.com/blog/wing-chun-is-the-nucleus-of-jeet-kune-do 

 

However, Chi Sao is a complex movement which must be approached in a progressive manner. Therefore, although Chi Sao, or part of it, is going to be introduced at some point in time during training, according to each participants’ proneness and interest, the primary focus of the initial sessions is set to be an exercise called Chi Dan Sao.  

Chi Sao arms/forearms/hands break down exercise description: 

• Initial Contact: Practitioners begin by making contact with their partner's arms, typically at the forearm level. They maintain a relaxed yet connected stance, allowing for fluid movement and response. 

• Rolling Hands: The primary movement in Chi Sao involves rolling the arms in a circular motion, maintaining contact with the partner's arms throughout. This rolling action facilitates the exchange of energy and helps practitioners develop sensitivity to changes in pressure and direction (figures 2 and 3). 

 

 

 

Figures 2 and 3. Lee Yun-fan and Yip Man training Chi Sao where it is possible to observe the mirroring exchange of arms positioning in the flow of movements. Images source: http://www.kaplanwingchun.com/EN/chi-sao-sticking-hands 

 

With practice, Chi Sao can be further implemented with Lap Sao (Pulling Hand): As one partner rolls forward, the other may execute a Lap Sao, which involves pulling the partner's arm down and to the side while maintaining contact. This manoeuvre disrupts the partner's balance and creates openings for entering the partner’s space. Practitioners can then learn to intercept these “invasions of their space” while simultaneously launching their own openings, all while maintaining the flow of movement and contact. Also, although the focus is primarily on arm and hand movements, practitioners can incorporate footwork to maintain proper distance and angle relative to their partner and can start practicing moving up and down in the room. 

However, Chi Sao is a complex movement which must be approached in a progressive manner. 

Chi Dan Sao is the Chi Sao simplified counterpart and focuses on refining techniques using just one hand. This stripped-down approach allows practitioners to concentrate on specific aspects of Wing Chun, acquiring precision and control in a more targeted manner. Through the repetition and refinement inherent in Chi Dan Sao practice, individuals gradually build competence and confidence in their abilities. They learn to trust their instincts through touch sensitivity and capabilities, possibly enhancing their self-assurance and self-belief both on and off the training floor through a reinforcement of a resilient mindset, challenged with continuous assurance and physical feedback (see figure 4). 

 

 

 

Figure 4. Diagram showing the three different positioning of the arms in Dao Chi Sao. As for in Chi Sao, the two participants flow across the movements being always in contact with one another. Image source: https://www.pinterest.co.uk/pin/pinterest--563018684478256/ 

Chi Dan Sao arms/forearms/hands break down exercise description: 

• Single-Handed Contact: Unlike Chi Sao, Chi Dan Sao involves using only one hand to make contact with the partner's arm or forearm. This simplifies the practice and allows practitioners to focus on refining techniques with one hand at a time. 

• Single-Hand Rolling: Like Chi Sao, Chi Dan Sao emphasizes the rolling motion of the arm, albeit with only one hand. Practitioners maintain contact with their partner's arm while executing controlled rolling movements to develop sensitivity and control. 

• Balance and Stability: Chi Dan Sao encourages practitioners to maintain balance and stability while executing techniques with one hand. This challenges their coordination and strengthens their ability to adapt to different situations. 

Transition to Chi Sao: Chi Dan Sao serves as a stepping stone for practitioners to transition into full Chi Sao practice. By mastering the fundamentals with one hand, practitioners build a solid foundation for more complex two-handed drills and applications. Also, through Lap Sao (see above, in Chi Sao section), it is possible to transition ceaselessly from Chi Sao to Chi Dan Sao and vice versa. In both Chi Sao and Chi Dan Sao, the emphasis is on maintaining sensitivity, control, and adaptability while engaging with a training partner. 

 

Appendix B 

Participant information sheet  

Section A: The Research Project

You have been invited to take part in the following research project: 

 

• Title of the project: Touch exchange, confidence and physical activity among visually impaired and blind people.   

• The purpose and value of study is to investigate how a bespoke training program based on techniques derived from Kung Fu Wing Chun can enhance sensitivity in touching and being touched by other people, with positive effect in participation in physical activities, confidence levels and overall well-being among visually impaired and blind people. 

• Researcher name: Mathias Alberton 

• Contact phone number: +447549554857 

• Email address: 2309443@live.stmarys.ac.uk 

• Researcher’s Supervisor name: Tom Williams 

• Email address: tom.williams@stmarys.ac.uk 

• Course and dissertation research project: MSc in Applied Sport Psychology 

• University: St Mary’s University Twickenham, London 

• The results of the study will be used to implement the Martial Attitude Training program for visually impaired and blind people and possibly will be published for the benefit of the wider sport psychology academic community and of the general public.

Section B: Participation in the Research Project 

• You have been invited to take part to research project as you are registered as VI at your local authority or because member of either the Royal National Institute of the Blind, Thomas Pocklington Trust or Metro Blind Sport, or you have been referred by one of them to participate. 

• You have the possibility to refuse to take part, as this invitation is not bonding you to any commitment. 

• You can withdraw from the project at any time, by sending the researcher an email. 

• If you were to agree to take part, you will be asked to participate to an audio recorded semi-structured interview which will be approximately 1 hour long, after you provided informed consent. 

• The interview will focus on your experience with the sense of touch, about your sense of confidence in touching and being touched by others in your daily life and on how your participation in physical activity, if any, might contribute to them. For the purposes of the research, the transcription of your interview will be analysed to find possible similarities and differences with those taken with other participants, so to provide a deeper understanding of the topic and to help implementing a questionnaire on Touch Confidence to be used in future research.  

• The interview recording will take place at a location and a time of your preference, either online, according to both yours and researcher’s schedule. Interviews will be anonymized using a pseudonymous, if you felt more comfortable by doing so. 

• The interviewing process will be not physically or psychologically demanding, and it will not involve any question designed to make you feel uncomfortable or to investigate your understanding of touch in a romantic sense. However, should you feel at any moment uncomfortable or tired, or in need for a break, that will always be possible as well as the freedom to stop at any moment, to ensure well-being and safety.  

• Your participation in the project will be kept confidential throughout the process and in the final editing of the research paper as all data will be anonymized. The researcher will work towards the possibility for publication; hence he states that he will keep the data for a period of 10 years. Data will be stored and handled in accordance with the General Data Protection Regulations brought in under the Data Protection Act 2018.   

• You will be given copy of this information sheet to keep together with a copy of their consent forms.  

 

 

 

 

Appendix E 

Approval Sheet 

 

Appendix F 

Semi-structured interviews’ guide 

 

Warm-up questions: 

1. How old are you? 

1. In which city do you live? 

1. What kind of studies have you done? 

1. Was it a school specifically for VI? 

1. Do you work? 

1. (If YES) What is your job? 

1. (If NO) Would you like to work and what kind of job would you like to do? 

Visual impairment: 

1. Do you live on your own? 

1. What level of visual impairment do you have? 

1. (ACCORDINGLY) Was it always like this? 

1. (ACCORDINGLY) Will it get worse? 

1. (ACCORDINGLY) What age were you when it (first) affected you? 

1. What kind of support do you need in your daily life? 

1. Do you have hobbies? 

1. Do you do any physical activity? 

1. (If YES) Since when? 

1. (ACCORDINGLY) Is it the only one you do? 

1. (If NO) Why? 

Touch: 

1. What is “touch” to you? 

1. How do you understand the difference between the sense of touch and what we could call the sense of “touch exchange”, when in contact with others physically? 

1. How do you feel, generally, when someone touches you? 

1. In your opinion, did your visual impairment take away from you the possibility to get closer to people, or to have more friends? 

1. Do you believe that fully sighted people engage physically with one another differently than visually impaired people do? 

1. In your opinion, what are the two most challenging situations you are confronted with daily? 

1. What kind of feelings do these two challenging situations provoke in you? 

1. How do you cope with them? 

1. (ACCORDINGLY) Did this/these coping mechanisms change over time? 

1. (If YES) How? 

Confidence: 

1. How would you define “confidence” in your own words? 

1. How is confidence related to touch and to “touch exchange”, in your experience? 

1. Do you believe that confidence can be gained or trained? 

1. Do you believe your current sense of confidence is somewhat related to your level of participation in physical activity? 

Closing remarks: 

• Do you have any questions? 

• Thank you for participating in this interview and for your precious feedback. 

Possible prompts to be used throughout the interviewing process: 

• What do you mean by this? 

• Could you please expand on this? 

• Let me reframe this... 

• If I understand correctly, you are saying that... 

 

Appendix G to M 

Verbatim transcription of the interview with Participant 1 to 8 available on request 

 

Appendix N 

Overarching Themes NVivo Codebook 

Touch exchange, confidence, and physical activity among visually impaired and blind people 

Overarching Themes 

  

Name	Description	Files	References
THEME 1.   Things don't exist unless I touch them	Whilst touch is primarily understood as a second option, in comparison to sight, to navigate the world from a distance, to understand human connections, and to provide safety, it is also recognized as the most mundane yet exceptional tool to create mental images on the fringes of awareness which allows all physical interactions of everyday life's necessities. In some, it is more developed as triggered earlier in life. For all, it is understood more as a practical thing than a relationship building aid.	5	13
THEME 2.   In the right context, touch exchange speaks volumes to human connections	VI don't like to be grabbed and pushed around because that feels disempowering and makes them embarrassingly feel like they have lost their agency. On the opposite, touch exchange is understood as the freedom to manoeuvre for space without antagonizing. Most importantly, through touch exchange, VI can feel reassured upon their own safety whilst, at the same time, it enables them to add important layers of meaning when connecting and communicating with others, being positively affected.	6	22
THEME 3.   Touch exchange gives the freedom to become incrementally confident	Confidence is understood as an incremental accumulation of training, experience, knowledge, and skills which are context specific. Also, confidence is recognized as the ability to back oneself up, to incrementally work towards realistic goals given one's limitations. In this regard, touch exchange plays a fundamental role in having greater social confidence, freedom, and sense of agency.	7	18
THEME 4.   Sport and touch exchange build confidence and can drag you away from dark places	Provided that blind people don't even go for a casual stroll because there is far too much thinking about it, exercising goes beyond its incredible importance for managing the familiar and widespread feelings of isolation, frustration or anger present among VI. Physical activity is valued for getting in touch with one's body, for better posture and balance. Crucially, the social aspect of it contributes to the improvement of overall confidence through time for VI, who are wanting to reciprocate energy.	6	21
BACKGROUND THEME.   Discrimination, frustration and a sense of bereavement are common in the disjoined and challenging VI community	Discrimination is a major issue, coming across as the absolute impossibility to take part in many activities, for some, or as the inaccessibility to digital means of communication, for others. Barriers or unwanted physical exchanges with other people trigger frustration, a sense of exclusion, and feelings similar to those of bereavement which are difficult to address also for the perceived lack of joint support in the VI community.	7	39

 

Appendix O 

NVivo complete coding process file (accessible by researcher’s Supervisor) 

 

Appendix P

Original Touch Avoidance Scale (TAQ; Scale Ozolins & Sandberg, 2009) 

 

1. *I wish my partner would hold me for hours.
2. Often, I have to tell my partner to cease touching me.
3. For most of the time, I don’t like it when my partner touches me.
4. My partner often complains that I don’t touch him/her enough.
5. Sometimes I make efforts to avoid touching my partner.
6. I wish my partner touched me more often. 
7. *I love to hug and caress my partner for hours.
8. *I’m always happy when my partner touches me.
9. I often find my partner’s touch unbearable.
10. It makes me sad that my partner won’t touch me in the way I would like to be touched. 
11. Sometimes I find my partner’s touch irritating. 
12. It takes a while to get used to my partner’s touch, if we have been apart for some time. 
13. I have considered ending our relationship because my partner dislikes touch. 
14. I don’t want my partner to touch me in public.
15. I strongly dislike any physical contact with my partner’s relatives. 
16. *I always hug/ged my mother when I see/saw her. 
17. *I always hug/ged my father when I see/saw him. 
18. *I grew up in a cuddly family. 
19. *There is a lot of physical contact between me and my siblings. 
20. I was seldom hugged by my father. 
21. I was seldom hugged by my mother. 
22. I often find it hard to touch a same-sex friend. 
23. *I like to hug a same-sex friend. 
24. I try to avoid touching/being touched by a same-sex friend. 
25. *I like to sit near a same-sex friend. 
26. *I like it when a same-sex friend hugs me. 
27. I strongly dislike a same-sex friend touching me. 
28. I often find it hard to touch an opposite-sex friend. 
29. *I like to hug an opposite-sex friend. 
30. I try to avoid touch with an opposite-sex friend. 
31. *I like to sit near an opposite-sex friend. 
32. *I like it when an opposite-sex friend hugs me. 
33. I strongly dislike it when an opposite-sex friend touches me. 
34. I dislike physical contact with other peoples’ children. 
35. I often find touching/being touched by other people intrusive. 
36. *I find touch by professionals (e.g., hair-dresser, masseur) pleasant. 
37. I find it very unpleasant to be in contact with unknown people (e.g., in queues, on the bus).

The TAQ-items (the final version in italics). Items with an asterisk (*) are reversed in the scoring, in order to make a high score a high level of touch avoidance. 

 

Appendix Q 

Before completion of the present study, it was attempted by the researcher a first modification of the TAQ scale, comprising 20 items vs 31 of the original: Two of which were re-introduced after the original removal as more pertinent to behavior with lesser familiar people and strangers in social/public contexts (items 15 “I strongly dislike any physical contact with my partner’s relatives “ and 36 “I find touch by professionals - e.g., hairdresser, masseur - pleasant”); Five were removed from the “partner” cluster to balance it out with the other clusters (items 2, 3, 5, 9, 11, 14), as well as for two in the “family” cluster (items 20 and 21), also to allow the “stranger” cluster to weight more than in the original version relatively to the overall resulting scores of the questionnaire. Also, three similar items were removed from the “same/opposite sex” clusters (three for each cluster, respectively items 23, 23, 27 and 28, 29, 33; e.g., item 27 “I strongly dislike a same-sex friend touching me” was removed, whilst item 24 “I try to avoid touching/being touched by a same-sex friend” was kept) to reduce any gender bias. A point considered to be less relevant when measuring VI comfort in “touch exchange” as opposed to the original TAQ scale’s focus on attachment style (Bowlby, 1970). Crucially, item 20 “my confidence in touching and being touched by others is related to my participation in physical activity” was introduced as a direct consequence of the findings in the present study, highlighting the reciprocal beneficial relationship between confidence, physical exercise and its touch exchange component. The final TAQ-items hereby proposed for consideration are detailed below. 

 

Suggested Touch Avoidance Questionnaire for future studies (adapted from Ozolins & Sandberg, 2009): 

 

1. *I wish my partner would hold me for hours.   

1. My partner often complains that I don’t touch him/her enough.   

1. *I love to hug and caress my partner for hours.   

1. *I’m always happy when my partner touches me.   

1. I strongly dislike any physical contact with my partner’s relatives.   

1. *I always hug/hugged my mother when I see/saw her.   

1. *I always hug/hugged my father when I see/saw him.   

1. *I grew up in a cuddly family.   

1. *There is a lot of physical contact between me and my siblings.   

1. I try to avoid touching/being touched by a same-sex friend.   

1. *I like to sit near a same-sex friend.   

1. *I like it when a same-sex friend hugs me.   

1. I try to avoid touch with an opposite-sex friend.   

1. *I like to sit near an opposite-sex friend.   

1. *I like it when an opposite-sex friend hugs me.   

1. I dislike physical contact with other peoples’ children.   

1. I often find touching/being touched by other people intrusive.   

1. *I find touch by professionals (e.g., hairdresser, masseur) pleasant.  

1. I find it very unpleasant to be in contact with unknown people (e.g., in queues, on the bus). 

1. My confidence in touching and being touched by others is related to my participation in physical activity. 

 

20 Likert-type statements formulated with the instruction to “Fully agree” or “Fully disagree” with the statements on a scale from 1-7. Items with an asterisk (*) are reversed in the scoring, so that high scores indicated a higher level of touch avoidance.