It can be considered that clothing has the function of protection and ornament, being a fundamental part of life in society, as it is linked to the concept of identity, belonging and differentiation (OLIVEIRA, 2013). Callan (2007) understands clothing as the material expression of a social manifestation of a cultural context, that is, a changing reflection of how society engenders itself and its zeitgeist (spirit of time). This allows us to state that clothing can also be understood as a way of integrating the individual into society, which favors their social inclusion or exclusion (BROGIN; MERINO; BATISTA, 2014; GODINHO, 2017). Sousa, Xavier and Albuquerque (2017, p. 5) corroborate the above and maintain that:

Fashion needs to be an open door to inclusion, for this to happen it is enough that we have a perception of social inclusion as a rule of society, in all areas. Social inclusion must be prioritized [...] with clothes being another resource for this [...].

To achieve this inclusion, Sousa, Xavier and Albuquerque (2017) point out that clothing creators, fashion designers or stylists must respect the right of all consumers to dress with aesthetic and ergonomic quality. As examples of companies operating under this umbrella, Brogin, Merino and Batista (2014) cite Able to Wear, Cast Clothing, Lydda Wear and Xeni.

Brogin, Merino and Batista (2014) highlight that the positive results obtained by companies and creators of inclusive clothing are based on the design centrality of usability. Gonçalves and Beirão Filho (2008, p. 118) mention that, “[...] in relation to the usability of a product, in a time of globalization, this cannot be considered an added value, but an intrinsic value to the product [...]". This implies saying that usability is at the heart of inclusive clothing, however, it cannot be considered its end.

In addition to usability, Gonçalves and Beirão Filho (2008), Brogin, Merino and Batista (2014), Sousa, Xavier and Albuquerque (2017) and Krone, Oliveira and Rizzi (2020) argue that inclusive clothing must pay attention to design requirements such as efficiency, efficacy, satisfaction, accessibility, comfort, wearability, flexibility, sensory pleasure, metabolic capacity and neuromuscular ability, among other aspects deemed pertinent and under investigation, case by case. In particular, Brogin, Merino and Batista (2014, p. 10) argue that:

[...] these requirements must provide safety during the use of clothing, tactile and thermal comfort, freedom of movement, ease of handling and use, adequacy to the function proposed, durability and quality.

To meet the above requirements, Brogin, Merino and Batista (2014) advise that clothing should be designed based on the anthropometric measurements of the targeted users and studies on raw materials, trim, modeling and forms of maintenance, interaction and communication between the product, the medium and the intended target audience. In turn, Krone, Oliveira and Rizzi (2020) state that to make clothing even more inclusive, complementary accessories or specific treatments can be added to the pieces, such as sound devices and prints with salient textures. In addition to the material aspects that meet physiological or psychomotor needs, Godinho (2017) mentions that, in the design of inclusive clothing, the social longing for self-fulfillment of individuals must be taken into account, the paradigms of self-acceptance and the social signs articulated to the groups through which these users transit. The author adds:

[...] it is necessary an understanding that this social group [of people with disabilities] also requires due attention in relation to clothes, which not only offer functionality, but must also be made within an aesthetic that allows an increase in self-esteem, becoming a means of social inclusion (GODINHO, 2017, p. 94).

In this sense, it is considered that the lack of inclusive clothing aimed at adequately meeting the physiological, psychological and social needs of people with disabilities in the Textile and Apparel Industry is reflected in a form of exclusion by omission. Brogin, Merino and Batista (2014) inform that these individuals can be neglected or even marginalized due to the lack of options through the sector's offers. Godinho (2017) adds that clothing is an instrument of inclusion, exclusion, acceptance or social repulsion. Thus, it can be considered that the lack of inclusion of people with disabilities as consumers of clothing constitutes a type of discrimination, as pointed out in Article 4, cap II of Law no. 13,146, of July 6, 2015 (BRASIL, 2015, np):

1 Discrimination due to disability is considered to be any form of distinction, restriction or exclusion, by action or omission, which has the purpose or effect of harming, preventing or nullifying the recognition or exercise of the fundamental rights and freedoms of a person people with disabilities, including denial of reasonable accommodation and the provision of assistive technologies.

From this perspective, it is important to emphasize that, according to Decree no. 3.298, of December 20, 1999 (BRASIL, 1999, np), the deficiencies can be classified into:

I - physical disability - complete or partial alteration of one or more segments of the human body, [...] presenting itself in the form of paraplegia, paraparesis, monoplegia, monoparesis, tetraplegia, tetraparesis, triplegia, triparesia, hemiplegia, hemiparesis, ostomy, amputation or absence of a limb, cerebral palsy, dwarfism, limbs with congenital or acquired deformities, except for aesthetic deformities and those that do not produce difficulties in performing functions;

I - physical disability - complete or partial alteration of one or more segments of the human body, [...] presenting itself in the form of paraplegia, paraparesis, monoplegia, monoparesis, tetraplegia, tetraparesis, triplegia, triparesia, hemiplegia, hemiparesis, ostomy, amputation or absence of a limb, cerebral palsy, dwarfism, limbs with congenital or acquired deformities, except for aesthetic deformities and those that do not produce difficulties in performing functions;

II - hearing loss - bilateral, partial or total loss of forty-one decibels (dB) or more [...];

III - visual impairment - blindness, [...] low vision, [...] cases in which the sum of the visual field measurement in both eyes is equal to or less than 60o; or the simultaneous occurrence of any of the above conditions;

IV - mental disability – intellectual functioning significantly lower than average, with manifestation before the age of eighteen and limitations associated with two or more areas of adaptive skills [...];

V - multiple disability – association of two or more disabilities.

Thus, regardless of the type of disability, clothing needs to adapt to the needs of its users' bodies and ensure their autonomy. It is believed that, with this, it is possible to provide the physical, psychological and social comfort of this public, since not depending on other people to meet their basic needs is a matter of dignity. After presenting the concepts that supported this research, the methodological aspects of this study are presented below.

Personal data and the cause of the stoma, in relation to the respondents, can be accurately observed in Table 2. It is noteworthy that 16 people (72.7%) are female, while 6 people (27.3%) are of the male gender. As for the age group, 7 people (31.8%) are between 50 and 60 years old, 4 people (18.2%) are between 60 and 70 years old, 4 people (18.2%) are between 31 and 40 years old, 3 people (13.6%) are over 70 years old, 3 people (13.6%) are between 19 and 30 years old and one person (4.5%) is up to 18 years old. As for the type of ostoma, 13 people (59.1%) have a colostomy, 8 people (36.4%) have an ileostomy and one person (4.5%) has a urostomy. As for permanence, 12 people (54.5%) have a permanent stoma, while 10 people (45.5%) have a temporary stoma.

Table 2.
Respondent data
the authors (2021).

It was questioned how long these people had used their ostomy bags and the longest use time was 7 years and the shortest time of 1 month. After the questions about the individual and their ostoma, we moved on to the questions that involved the relationship of people with an ostomy to clothing. Thus, when asked about the amount of clothing changes per day (including nightwear), 11 people (50%) answered that they change clothes 3 times a day, 8 people (36.4%) answered that they change clothes 2 times a day, 2 people (9.1%) answered that they change clothes once a day and one person (4.5%) answered that they change clothes more than five times a day.

When asked about which criteria are important when choosing garments, 15 people (68.2%) answered comfort, 14 people (63.6%) answered hiding the bag, 9 people (40.9%) answered ease of dressing and undressing, 5 people (22.7%) answered fabric, 4 people (18.2%) answered protecting the bag and 4 people (18.2%) answered aesthetics (Figure 3). It should be noted that it was possible to select more than one answer for this question.

Figure 3.
Graph on the important criteria when choosing garments, according to the ostomized people
the authors (2021).

IMAGE DESCRIPTION: bar graph, in the following order: aesthetics (4 people, 18.2%), comfort (15 people, 68.2%), ease of dressing and undressing (9 people, 40.9%), fabric (5 people, 22.7%), pieces that “protect” the bag (4 people, 18.2%) and pieces that “hide” the bag (14 people, 63.6%). End of description.

When asked if they change their mind and change their clothes after starting to dress and, if so, why this occurs, some of the answers were: (I) “Yes. I never think the bag is properly accommodated”; (II) “Yes. I feel that the bag is exposed”; (III) “Yes, I'm afraid of being bullied because of the bag”; (IV) “Yes, because the scholarship cannot appear”; (V) “Yes, if I notice that you are marking the bag, I change”; and (VI) “Yes, because many of my clothes keep squeezing the bag and I feel as if it were going to leak”.

For a better understanding of the complaints of people with an ostomy in relation to clothing, Table 3 summarizes the responses obtained according to the number of times the item was mentioned. When asked if they stopped wearing any garment after surgery and, if so, the reason, some respondents stated that: (I) “Clothes that mark the waist, such as jeans and denim shorts. The waistband catches on top of the stoma”; (II) “Yes, jeans. It bothers because it is too hard”; (III) “Yes, underwear”; (IV) “Yes, jeans and my shorts. I have to leave the zipper open and cover it with a blouse”; (V) “Many. In order not to show the bag, I only wear a loose blouse and low-slung pants”; (Yes, I've seen that. The ones with lighter and more transparent colors”; (VII) “jeans, because I'm having a hard time finding pants that don't go over the ileostomy”; and (VIII) “Yes, beach and pool pieces”. When asked if they started to use any part after surgery and the reason, some respondents asserted that: (I) “Yes, gowns”; (II) “Yes, long blouses”; (III) “Yes, dresses”; (IV) “Yes, dresses and shorts and shorts with light cloths and high waistband. They make me more comfortable and don't mark the bag much”; (V) “Longer-covering blouses”; (VI) “Yes, skirts, as they are easier to adjust around the waist”; (VII) “Yes, pants with an elastic waist”; and (VIII) “Yes, I started using only sweaters”. long blouses”; (III) “Yes, dresses”; (IV) “Yes, dresses and shorts and shorts with light cloths and high waistband. They make me more comfortable and don't mark the bag much”; (V) “Longer-covering blouses”; (VI) “Yes, skirts, as they are easier to adjust around the waist”; (VII) “Yes, pants with an elastic waist”; and (VIII) “Yes, I started using only sweaters”. long blouses”; (III) “Yes, dresses”; (IV) “Yes, dresses and shorts and shorts with light cloths and high waistband. They make me more comfortable and don't mark the bag much”; (V) “Longer-covering blouses”; (VI) “Yes, skirts, as they are easier to adjust around the waist”; (VII) “Yes, pants with an elastic waist”; and (VIII) “Yes, I started using only sweaters”.

Table 3.
Answers obtained according to the number of times the piece was cited
the authors (2021).

After collecting the answers (Chart 3), the following question was asked: “Do you find it difficult to buy clothes after surgery? If so, which one and why?" Some of the answers obtained were: (I) “Yes, blouses are a problem, they have to be a little bigger so the bag doesn't appear and with dark colors or prints”; (II) “Yes, fair pieces due to the fact that they mark the bag”; (III) “Yes, I need loose clothes that don't 'stick' in the stoma”; (IV) “Yes, ready-made clothes have very restricted sizes and the modeling is very small”; (V) “Almost all the pieces are marked too much, if the bag is full, it is very visible”; and (VI) “Yes, high-waisted fashion is a problem for those who wear a purse, especially if it's a piece in jeans”. Finally, regarding clothing suggestions for people with an ostomy, some respondents mentioned that: (I) “Loose blouses — with thick elastic at the hem — and prints are great”; (II) “Shorts and pants with an adapted place to fit the bag. I feel I would have more security. If nothing is holding the bag, it moves”; and (III) “The shirt or shirt should have a pocket to adapt the pocket, so it would not be left out of the clothes”.

Based on the answers obtained from the questionnaire, the results were discussed and the booklet was prepared in order to meet the objective proposed in this article.

3.2 Discussion of results

It is considered that, despite the greater number of people with an ostomy being older than 50 years, there are men and women of different ages — as seen in Table 2 — who, while ostomized, do not feel well with their clothing. In this sense, the biggest complaints are in the tissues (jeans, for example) and in the modeling (slight pieces or pieces that squeeze the ostoma).

Among the responses collected, it was found that most of the ostomas originate from some type of intestinal cancer. Thus, it is believed that it is necessary to take into account that, in most cases, the individual is already psychologically shaken by the presence of cancer and by all the challenges he faces from the initial phase to the postoperative treatment phase. In other words, the ostomy not only alters your physiology, but also requires a certain psychological stability to be able to understand the situation and remain socially and physically active.

As an adaptation to clothing in order to meet the needs of ostomized individuals, it is recommended the use of fabrics with natural fibers, which do not tighten or choke the ostoma, and models that are not fair and do not show the bag collector. In addition, it is suggested to apply dark prints on garments, as these reflect less light and can help increase the confidence of these users since. In case of possible leaks, dark pieces easily hide what happened, in addition to disguising the bag — a need that was mentioned by some of the research participants.

It is also recommended that a spare band at waist height be attached to the garment. The band must present: (I) tissues that, as mentioned above, do not afflict the ostoma; (II) an adequate space to insert the bag; and (III) an aesthetic aspect that helps the user's perception of safety. For beach garments, it is suggested to create bathing suits or beach shorts with space to attach the bag or abdominal bands in the same color or print as the other pieces.

All of the above recommendations were brought together in a booklet, presented in Figure 4 in its preliminary structure and in the form of a leaflet. The booklet is intended to guide the development of garments for people with an ostomy and is aimed at apparel creators and people with an ostomy, as well as their family and friends. It is estimated that the booklet can promote the reduction of social exclusion that affects individuals with ostomy, as it encourages understanding and acceptance of their conditions and needs.

Figure 4.
Preliminary structure of the guide for the development of clothing for ostomized people
the authors (2021).

IMAGE DESCRIPTION: preliminary structure of a primer. The first face of the booklet has a yellow background, in addition to the first figure in this article and the explanation of what an ostomy is. The second side has an orange background and defines what you should be thinking about when developing clothing for people with an ostomy. The third face features a yellow background and the continuation of the topic on how to develop clothing for people with an ostomy. End of description.

Finally, as a research limitation, the sampling of participants and the theoretical contribution of the article's body of knowledge are cited. In this sense, it is suggested that new scientific itineraries include larger samples to support the accuracy of the study, as well as that other authors be investigated through the literature in the area.