Many individuals with disabilities and/or chronic conditions experience symptoms that may require intermittent or on-going medical care. However, healthcare is often overlooked as an area where accessibility needs to be addressed to improve physical and digital interactions between patients and healthcare providers. We discuss the challenges faced by individuals with disabilities and chronic conditions in accessing physical therapy and how technology can help improve access. We interviewed 15 people and found both social (e.g. financial constraints, lack of accessible transportation) and physiological (e.g. chronic pain) barriers to accessing physical therapy. Our study suggests that technology interventions that are adaptable, support movement tracking, and community building may support access to physical therapy. Rethinking access to physical therapy for people with disabilities or chronic conditions from a lens that includes social and physiological barriers presents opportunities to integrate accessibility and adaptability into physical therapy technology.
We present an ethnographic study of a maker community that conducted safety-driven medical making to deliver over 80,000 devices for use at medical facilities in response to the COVID-19 pandemic. To achieve this, the community had to balance their clinical value of safety with the maker value of broadened participation in design and production. We analyse their struggles and achievement through the artifacts they produced and the labors of key facilitators between diverse community members. Based on this analysis we provide insights into how medical maker communities, which are necessarily risk-averse and safety-oriented, can still support makers’ grassroots efforts to care for their communities. Based on these findings, we recommend that design tools enable adaptation to a wider set of domains, rather than exclusively presenting information relevant to manufacturing. Further, we call for future work on the portability of designs across different types of printers which could enable broader participation in future maker efforts at this scale.
The U.S. National Institute of Health (NIH) 3D Print Exchange is a public, open-source repository for 3D printable medical device designs with contributions from clinicians, expert-amateur makers, and people from industry and academia. In response to the COVID-19 pandemic, the NIH formed a collection to foster submissions of low-cost, locally-manufacturable personal protective equipment (PPE). We evaluated the 623 submissions in this collection to understand: what makers contributed, how they were made, who made them, and key characteristics of their designs. We found an immediate design convergence to manufacturing-focused remixes of a few initial designs affiliated with NIH partners and major for-profit groups. The NIH worked to review safe, effective designs but was overloaded by manufacturing-focused design adaptations. Our work contributes insights into: the outcomes of distributed, community-based medical making; the features that the community accepted as “safe” making; and how platforms can support regulated maker activities in high-risk domains.
Accessible design and technology could support the large and growing group of people with chronic illnesses. However, human computer interactions(HCI) has largely approached people with chronic illnesses through a lens of medical tracking or treatment rather than accessibility. We describe and demonstrate a framework for designing technology in ways that center the chronically ill experience. First, we identify guiding tenets: 1) treating chronically ill people not as patients but as people with access needs and expertise, 2) recognizing the way that variable ability shapes accessibility considerations, and 3) adopting a theoretical understanding of chronic illness that attends to the body. We then illustrate these tenets through autoethnographic case studies of two chronically ill authors using technology. Finally, we discuss implications for technology design, including designing for consequence-based accessibility, considering how to engage care communities, and how HCI research can engage chronically ill participants in research.
Kelly Mack*, Emma J. McDonnell*, Leah Findlater, and Heather D. Evans. In The 24th International ACM SIGACCESS Conference on Computers and Accessibility.
The COVID-19 pandemic upended college education and the experiences of students due to the rapid and uneven shift to online learning. This study examined the experiences of students with disabilities with online learning, with a consideration of surrounding stressors such as financial pressures. In a mixed method approach, we compared 28 undergraduate students with disabilities(including mental health concerns) to their peers during 2020, to assess differences and similarities in their educational concerns, stress levels and COVID-19 related adversities. We found that students with disabilities entered the Spring quarter of 2020 with significantly higher concerns about classes going online, and reported more recent negative life events than other students. These differences between the two groups diminished three months later with the exception of recent negative life events. For a fuller understanding of students’ experiences, we conducted qualitative analysis of open ended interviews. We examined both positive and negative experiences with online learning among students with disabilities and mental health concerns. Online learning enabled greater access – e.g., reducing the need for travel to campus–alongside ways in which online learning impeded academic engagement–e.g., reducing interpersonal interaction. Learning systems need to continue to meet the diverse and dynamic needs of students with disabilities.
Tactile maps can help people who are blind or have low vision navigate and familiarize themselves with unfamiliar locations. Ideally, tactile maps are created by considering an individual’s unique needs and abilities because of their limited space for representation. However, significant customization is not supported by existing tools for generating tactile maps. We present the Maptimizer system which generates tactile maps that are customized to a user’s preferences and requirements, while making simplified and easy to read tactile maps. Maptimizer uses a two stage optimization process to pair representations with geographic information and tune those representations to present that information more clearly. In a user study with six blind/low-vision participants, Maptimizer helped participants more successfully and efficiently identify locations of interest in unknown areas. These results demonstrate the utility of optimization techniques and generative design in complex accessibility domains that require significant customization by the end user.
Accessibility research has grown substantially in the past few decades, yet there has been no literature review of the field. To understand current and historical trends, we created and analyzed a dataset of accessibility papers appearing at CHI and ASSETS since ASSETS’ founding in 1994. Our findings highlight areas that have received disproportionate attention and those that are underserved— for example, over 43% of papers in the past 10 years are on accessibility for blind and low vision people. We also capture common study characteristics, such as the roles of disabled and nondisabled participants as well as sample sizes (e.g., a median of 13 for participant groups with disabilities and older adults). We close by critically reflecting on gaps in the literature and offering guidance for future work in the field.
Alternative (alt) text is a description of a digital images so that someone who is blind or low vision or otherwise uses a screen reader to understand image content. Little work examines what it is like to write alt text for an image. We created interface designs to support writing and providing feedback about alt text and tested them with people who write alt text and people who use alt text. Our results suggest that authoring interfaces that support authors in choosing what to include in their descriptions result in higher quality alt text. The feedback interfaces highlighted considerable diferences in the perceptions of authors and SRUs regarding “high-quality” alt text. We discuss the implications of these results on applications that support alt text.
Designing Tools for High-Quality Alt Text Authoring. Kelly Mack, Edward Cutrell, Bongshin Lee, and Meredith Ringel Morris. In The 23rd International ACM SIGACCESS Conference on Computers and Accessibility (ASSETS ’21). Association for Computing Machinery, New York, NY, USA, Article 23, 1–14.
The COVID-19 pandemic forced many people to convert their daily work lives to a “virtual” format where everyone connected remotely from their home, which affected the accessibility of work environments. We the authors, full time and intern members of an accessibility-focused team at Microsoft Research, reflect on our virtual work experiences as a team consisting of members with a variety of abilities, positions, and seniority during the summer intern season. We reflect on our summer experiences, noting the successful strategies we used to promote access and the areas in which we could have further improved access.
In order for “human-centered research” to include all humans, we need to make sure that research practices are accessible for both participants and researchers with disabilities. Yet, people rarely discuss how to make common methods accessible. We interviewed 17 accessibility experts who were researchers or community organizers about their practices. Our findings emphasize the importance of considering accessibility at all stages of the research process and across different dimensions of studies like communication, materials, time, and space. We explore how technology or processes could reflect a norm of accessibility and offer a practical structure for planning accessible research.