Abstract
Introduction
This study involved a systematic literature review to document the sources behind publications and citations that comprise knowledge about rates of braille usage/literacy among people with visual impairments in the United States.
Methods
Predefined search criteria were used to extract publications that potentially mentioned claims about braille literacy and usage rates, dating back as far as the early 20th century. Systematic analyses narrowed the set of publications to a collection of 95 articles and manuscripts that made specific statements about the prevalence of braille readership.
Results
The analysis revealed that even in peer-reviewed publications, many claims about braille literacy are made without citations to dependable sources. All identified citations used as the basis for braille literacy rates since the 1970s can be traced back to two primary sources: a National Library Service report from 1979 and the American Printing House for the Blind (APH) Federal Quota data (which should not be used as a source for braille literacy rates).
Discussion
This research explains the source of the often-cited “10%” statistic. The findings also challenge the field to question the bases for statements about braille literacy rates, including asking, “What do we mean by braille literacy?”
Implications for Practitioners
There is no current source of data that succinctly measures braille literacy rates in the United States, and there are no data that explain whether braille literacy rates are rising or declining. Making effective, data-based decisions requires asking the right questions and being informed readers of research in the field of visual impairment.
Keywords
For decades, articles in professional journals, as well as in the mainstream press, have warned about a decline in braille readership (Garber, 1995; Jacobson, 2016; Massoff, 2009; Silverman & Bell, 2018; Spungin, 1996). National Public Radio shared, “Braille literacy has fallen to around 10 percent for children” (Farmer, 2017, 1:54), and The Washington Post reported, “At its peak, half of all blind children in this country learned [b]raille. … That number began dropping in the 1960s…” (Tousignant, 2019, para. 4). This perceived decline and concern that braille is no longer being used by or taught to people with visual impairments (i.e., those who are blind or have low vision) have been reported as indisputable facts. But are they? The answers to “how many” and “what percent” are much more complex than they first appear and depend a great deal on who is asking and why the questions are being posed.
Up-to-date information about braille literacy rates could have a profound effect on policies and funding for schools, libraries, and various industries (e.g., food packaging, technology devices, and software). In a survey of teachers of students with visual impairments (TVIs) who provided braille instruction to dual-media learners, Herzberg et al. found over half of the 81 identified students received 90 minutes or more of direct braille instruction per week (2017). Barclay, Herlich, & Sacks (2010) shared case studies from the ABC Braille Study, in which early braille readers received 45–75 minutes of direct TVI instruction per day, in addition to time spent by TVIs preparing materials and consulting with classroom teachers. Knowing current and future numbers of braille readers could inform education agencies and personnel preparation programs to ensure enough TVIs are trained and employed to support students in the learning of braille, along with general and expanded core curricula.
Also, manufacturers might consider the potential market of braille-reading customers when making decisions about labeling. An opinion article in Pharmaceutical Journal asked, “The cost of being able to spare a blind person from asking for help with medicine identification [by adding braille labels] is astronomical. Is it worth the money?” (Lyftingsmo, 2013, para. 3). Similarly, the National Library Service for the Blind and Print Disabled (NLS, formerly the National Library Service for the Blind and Physically Handicapped), which oversees the distribution of accessible library materials through state library systems, determines production based on hypotheses about demand for various accessible formats. In 2016, An Act to Authorize the National Library Service for the Blind and Physically Handicapped to Provide Playback Equipment in All Formats was enacted, allowing the NLS to distribute electronic reading tools with refreshable braille displays as an alternative to the costly production and distribution of embossed braille. At the time, the NLS believed replacing paper braille delivery with electronic readers could save $10 million annually (U.S. Government Accountability Office, 2016); however, predicting actual costs and savings requires knowing how many current and potential NLS patrons would borrow or download brailled materials.
This study reports the results of a systematic literature search aimed at examining the various sources of published claims about numbers and percentages of braille readers in the United States. The findings describe how a limited number of misused or outdated primary sources have become the basis for decades of academic and mainstream media claims about literacy for people with visual impairments.
Definitions
One challenge to studying trends in statistics related to visual impairment is the inconsistency of relevant definitions. To follow the percentage of “blind people who are braille literate” over time, one must first define terms. Percentages are ratios, calculated by dividing one number (numerator) by another number (denominator). In the “percentage of blind people who are literate,” the denominator in this case is the entire population of “blind people,” and the numerator is the subpopulation of literate blind people. In academic research, “blind” has been used to describe people who are totally blind, have low vision, or are functionally blind, and even those three terms may have different meanings (Jones, 1961; Virginia State Department for the Visually Handicapped, 1991; Willis, 1979). Without agreeing about how to identify and count “blind people,” we cannot begin to estimate a rate of literacy or braille literacy among this population.
Definitions of Vision Loss
Within the United States, multiple definitions of vision loss have been used for program eligibility and data collection.
Since 1999, the U.S. Census Bureau has used a standard set of “yes or no” questions to identify persons with disabilities as part of the American Community Survey (ACS) and the Current Population Survey (CPS). The Affordable Care Act extended this standardization across all surveys sponsored by the U.S. Department of Health and Human Services (HHS), meaning that the Census Bureau’s disability questions are also now a part of the National Center for Health Statistics’ National Health Interview Survey (NHIS) and additional survey instruments (U.S. Department of Health and Human Services, 2011). Within the six disability questions, the question pertaining to vision loss is, “Are you blind or do you have serious difficulty seeing, even when wearing glasses?” According to HHS (2011), “Additional questions on disability may be added to any survey as long as the minimum standard is included. If the ACS changes the disability questions in the future, HHS will revisit the standard and modify as necessary” (Data Standard for Disability Status section).
The Washington Group on Disability Statistics developed a set of six disability questions for international use to increase comparability among countries’ censuses and surveys. The vision-related question is, “Do you have difficulty seeing, even if wearing glasses?” with the following response options: “No, no difficulty”; “Yes, some difficulty”; “Yes, a lot of difficulty”; and “Cannot do at all” (Washington Group, 2017b). The Washington Group recommends identifying someone as having a disability if the response to any of the six questions is “a lot” of difficulty or “cannot do at all” (Washington Group, 2017a). In the United States, the NHIS includes the Washington Group questions among other disability questions.
The NHIS includes another broader, two-part question for identifying persons with visual impairment: “Do you have trouble seeing even when wearing glasses or contacts?” and (if so), “Are you blind or unable to see at all?” (National Center for Health Statistics, 2018).
The World Health Organization records four levels of visual functioning based upon the International Classification of Disease, as revised in 2018: normal vision, moderate visual impairment, severe visual impairment, and blindness. Together “moderate visual impairment” (20/70 to 20/200) and “severe visual impairment” (20/200 to 20/400) are considered “low vision,” and blindness is defined as 20/400 to no light perception (World Health Organization, 2019a; 2019b).
For the U.S. Social Security Administration and many federal and state government programs, “legal” or statutory blindness is defined in sections 216(i)(1) and 1614(a)(2) of the Social Security Act,42, (2018). These sections define blindness as best-corrected, central, distance acuity of 20/200 or less in the better eye. The act also considers someone “legally blind” if the widest diameter of the visual field subtends an angle no greater than 20 degrees.
Under the Individuals with Disabilities Education Act (IDEA), a child with a disability refers to a child with one or more qualifying conditions “who, by reason thereof, needs special education and related services” (2018, §1401). According to 34 CFR §300.8(c)(13), “visual impairment including blindness” means an impairment in vision that, even with correction, adversely affects educational performance. The term includes both low vision and blindness. States can establish their own special education eligibility standards and do not have to use the precise definition of visual impairment provided in IDEA; however, they cannot use a narrower definition (Ryder, 2017).
Even more definitions exist. In a review of 12 federally funded, national surveys, Crews et al. (2012) noted a range of questions for classifying or measuring visual impairment, including 14 questions about eye conditions, 19 questions about impairment, 39 questions investigating activity limitations, 10 questions about a person’s environment, and 12 questions about participation. Questions ranged from, “How much difficulty, if any, do you have recognizing a friend across the street?” to, “Do you use any vision services such as job training, counseling, or training in daily living skills and mobility?” Each of these questions targets a somewhat different segment of the population of people who might be considered visually impaired or blind.
Definitions of Literacy
Answering a question like “How many braille readers are there?” requires a shared understanding of what it means to be a “reader.” As with “visual impairment,” there is also no single definition of “braille literacy,” or even “literacy.” According to the Institute for Education Sciences (n.d.), the National Assessment of Adult Literacy measures three types of literacy: (1) “Prose literacy, the knowledge and skills needed to perform prose tasks (i.e., to search, comprehend, and use continuous texts)” (para. 4); (2) “Document literacy, the knowledge and skills needed to perform document tasks, (i.e., to search, comprehend, and use non-continuous texts in various formats)” (para. 5); and (3) “Quantitative literacy, the knowledge and skills required to perform quantitative tasks (i.e., to identify and perform computations, either alone or sequentially, using numbers embedded in printed materials)” (para. 6).
The United Nations Educational, Scientific, and Cultural Organization describes four understandings of literacy around the world: “literacy as an autonomous set of skills; literacy as applied, practiced, and situated; literacy as a learning process; [and] literacy as text” (2006, p. 148).
The field of visual impairment has come to use “braille literacy” to focus on issues relevant to reading and writing through braille, yet the term still lacks a consistent definition. Does braille literacy imply the skills to read braille or that someone has been taught braille? Does the term imply braille as someone’s primary reading medium? Does the label require some level of efficiency with braille reading or frequency of braille use? Furthermore, when discussing the status of braille literacy and its changes over time, these statistics can be measured within many populations each of which may have multiple definitions. For example, braille literacy rates could be studied for students, children, adults, or older people. Braille literacy could refer to all people with visual impairments or exclude those with other impairments that affect their reading and writing skills, and it could be understood differently for those who learn braille in childhood versus later in life.
Current Understandings of “Braille Literacy” Rates
An oft-cited statistic is that 10% of people who are blind or have low vision read braille (Jernigan Institute, 2009 Penava, Prcić, & Iličić, 2017; Samuels, 2008). This percentage appears to come primarily from two sources. One source is the annual census organized by the American Printing House for the Blind (APH) as part of the Federal Quota system. Every year, APH collects information (including primary and secondary learning media) about students enrolled in educational programs below college level who are legally or functionally blind. Another source for the 10% statistic is a demographics article published by the American Foundation for the Blind (AFB, 1996), which stated that an “estimated 85,000 braille readers constitute fewer than 10 percent of the estimated number of people who are legally blind in the United States” (p. 287). However, this 10% estimate is problematic for several reasons.
The use of Federal Quota data to extrapolate the number or percentage of braille readers is a misuse of the information reported; in fact, APH’s annual report reminds readers, “Statements regarding student literacy, use of appropriate learning media, and students taught in a specific medium cannot be supported using APH registration data” (APH, 2020, p. 19). The census only gathers information about students who are eligible to benefit from Quota funding. These students must be legally or functionally blind to be registered by the APH ex-officio trustee in their states. Students who are not registered, even if they use braille, are not counted. When reporting a student’s primary learning medium, Quota Census respondents identify the medium each student uses most in his or her studies; for a student’s secondary or tertiary learning medium, the respondent reports any medium the student uses “to some extent” (2020 APH Federal Quota Census Completion Guide, 2020, p. 5). Neither response indicates a level of literacy or literacy instruction (e.g., approximate grade level of reading, or whether “reading” means using single words for labeling or connected text in stories). In addition, APH’s categories used to describe reading media have changed over the years, as has the population of students counted in the census. Before 1985, the four categories listed in the Quota Census were simply braille, large type, both, neither. After 1985, reading media categories were expanded to include braille, print, auditory, prereaders, and “nonreaders.” There has also been an increase in the number of adult learners in the annual census (B. Brasher, personal communication, 1991). Because of these demographic and categorical shifts, meaningful comparisons of braille readership rates cannot be made between current data and data collected in the 1960s.
The other source often cited for the “10% statistic” is a 1996 demographics report by AFB. This report suggested braille literacy rates by extrapolating data from a telephone survey conducted by AFB for the NLS (Berkowitz et al., 1979). The basis for the information reported in 1996 was already 17 years old and is now 4 decades old, too outdated to be reliable. Factors like technology and policy changes mean that today’s braille readers are likely different in important ways from braille readers of 1979. We cannot verify the 1996 estimate of 85,000 braille readers or replicate the earlier methods to calculate what percentage of people who are visually impaired read or use braille.
The Need for Meaningful Braille Literacy Statistics
Although braille literacy has multiple possible definitions, frequent discussions of this term in a variety of publications suggest a national interest in the population of braille readers. Articles in newspapers across the United States congratulating participants in the National Braille Challenge mention low or declining braille literacy to explain the importance of the competition (Oligschlaeger, 2015; Reynolds, 2015). In 1992, the U.S. Department of Education wrote about declining numbers of braille readers as part of its final funding priorities, stating: “In 1965 nearly half—48 percent—of all blind and visually impaired students read [b]raille. By 1989, this had dropped to 12 percent” (p. 14289). Assumptions about U.S. braille literacy rates even have international implications. Canadian news stories report estimates of braille literacy in the United States as a substitute for Canadian statistics (Alam, 2019; Mulholland, 2010), and researchers from other countries cite U.S. braille literacy estimates when describing background for research in international publications (Hatzigiannakoglou & Kampouraki, 2016).
As discussed previously, braille literacy information also interests school systems, engineers, designers, and technology developers who consider details about the braille-reading population when making development decisions.
Research Questions
The aim of this review was to determine braille literacy rates in the United States and how and by whom they have been reported. Two research questions guided the systematic search: (1) What percentage of people in the United States are literate in braille? (2) How many people in the United States read braille?
Methods
A systematic literature review involves specifying an a priori protocol for searching the literature. The protocol establishes the aims and methods of the review prior to searching the literature in an effort to avoid bias from the researcher or a handful of favored studies (Torgerson, 2003). This approach calls for explicit and transparent specification of the search approach, inclusion/exclusion criteria, and data extraction procedures, which are then stringently applied (Torgerson, 2003).
Search Strategy
The search included several phases to identify articles that potentially contained information about braille literacy rates. The first phase followed three search methods deemed least susceptible to selection bias (Torgerson, 2003). First, the third author and a research assistant found and screened relevant articles and books by searching electronic databases, with assistance from the first and second authors to locate items identified in the search that were not readily available through online databases. Also, the first author and a research assistant hand searched key, peer-reviewed journals in physical and online archives, including repositories at the Association for Education and Rehabilitation of the Blind and Visually Impaired (AER) and APH. The first three authors participated in extensive library and archive searches to find missing editions of the journals to be hand searched. Finally, these authors located articles from bibliographies of previous systematic reviews. Bibliographies of non-systematic reviews were not searched, as these were likely to be a biased sample of the literature (Torgerson, 2003).
The electronic databases searched included EBSCOhost, ERIC, PsychInfo, and Social Sciences Citation Index. Previous systematic reviews included the Comprehensive Braille Bibliography (Wormsley, 2013) and Forty Years of Literacy Research in Blindness and Visual Impairment (Ferrell, Mason, Young, & Cooney, 2006).
Specific search terms used to search electronic databases included blind, blindness, deaf blind, deafblind, deaf-blind, eye disorder*, vision disorder*, visual disabilit*, visual* impair*, visual* handicap*, vision handicap, partial* sight*, partial vision, vision loss, low vision, each paired with the terms braille read*, literacy, and braille literacy.
Several journals and sources were hand searched, emphasizing older editions that might have been omitted in the electronic search. This search included The Journal of Visual Impairment & Blindness (including under previous names: Outlook for the Blind 1907–1951, and New Outlook for the Blind 1951–1976), RE:view (including under previous names: The International Journal for the Education of the Blind 1951–1969, and Education of the Visually Handicapped 1969–1989), Exceptional Children, The New Beacon, American Association of Workers for the Blind Proceedings, American Association of Instructors of the Blind Proceedings, and AER position papers.
In total, 3,844 unique resources were identified from the electronic search of ERIC (488), PsycINFO (399), and ESBSCOHost (2,094) for all records through 2015. Searches of these databases primarily identified peer-reviewed journal articles and books, along with published dissertations, reports, and white papers. Existing systematic reviews provided 2,080 sources, and 22 sources were identified via hand search. Sources were screened by the third author and a research assistant (first stage screening) based on titles and abstracts, duplications were eliminated, and 194 articles were retained based upon the criteria of potentially addressing braille literacy rates in the United States during any time period.
Articles were then examined in detail by the third author and a research assistant and discarded if irrelevant to the research question (second-stage screening). Most articles were read by the assistant and reviewed by the third author, followed by discussions, as necessary, to reach consensus over differences. An additional 39 sources were identified through a review of the references cited in the initially retained articles. Three articles of interest could not be located in any library or other resource. Ultimately, 69 sources were identified as having mentioned or made assertions about braille literacy/reading rates.
In 2020, the systematic research protocol was repeated by the first and fourth authors to identify additional sources published from 2016 to 2019. The same search terms were applied to the same online databases, identifying 543 sources published in these three years. (The number of journals and databases included in EBSCO expanded between 2015 and 2020; thus, this second iteration likely drew from a wider range of potential sources.) Of these sources, 138 were selected for further analysis based on a review of abstracts. After reading each source, 12 additional articles were identified through a review of the references cited in the initially retained articles. Ultimately, 26 new sources were identified as having mentioned or made assertions about braille literacy/reading rates.
Data Extraction and Analysis
Following second-stage screening, data about each retained article were organized in a data extraction form, which had been developed for this project by the third author and was pilot tested with several sources by the third author and her research assistant. (This data extraction template can be obtained by contacting the first author.)
Results
Of the 95 sources that mentioned “braille literacy” rate in the United States, not counting the annual publication of APH Federal Quota data: ● 39 affirmed some braille literacy rate or crisis without citing a source; ● nine cited one or more of these 39 articles that did not provide sources for their braille literacy claims; ● 19 directly cited APH’s Federal Quota Census as their only source for claims about braille literacy; ● four cited the Braille Literacy Crisis in America (Jernigan Institute, 2009), which based braille literacy estimates on the NLS study and APH data; ● five articles, all published after Braille Literacy Crisis in America, cited “the National Federation of the Blind (NFB)” or an NFB spokesperson; and ● seven published primary source data.
Of all the non-APH primary sources identified, only the 1979 AFB/NLS study and a study by Josephson (1964) were subsequently cited in later publications identified through this search.
Tracing the cited sources for claims about braille literacy in each of the 95 articles back to any original primary, research-based, published data, the following pattern emerged: ● 41 articles’ braille literacy claims could not be traced to any primary, research-based, published data; ● 28 articles’ braille literacy claims depended only on APH data; ● seven articles’ braille literacy claims depended on a combination of APH and NLS data; ● seven articles based braille literacy claims only on expertise at NFB or National Braille Press (NBP); ● two articles’ braille literacy claims depended only on NLS data; ● three additional articles’ braille literacy claims depended on multiple bases; and ● only seven articles reported primary source data from the authors’ own research.
Figure 1 illustrates percentages of citations according to their primary source or sources of information. Sources for Claims about Braille Literacy: Number of Publications Found.
Primary Sources
Notably, no new primary sources were identified from the years 2016–2019. Of the seven primary sources published prior to 2016 (not including APH Federal Quota reports), only three provided national-level data or estimates. Bray (1960) published an analysis of NLS records, estimating that “less than one sixth” (p. 166) of NLS regional library customers read braille. Josephson’s (1964) “Report on Blind Readers” found that about one-third of 1,000 participants randomly selected from state registries of people who were blind reported being able to read braille. Finally, in 1979, Berkowitz et al. of AFB published the aforementioned lengthy analysis of the eligible user population for the NLS. One finding of that study was that, “braille … is used most frequently [as compared to other media] by only 2% of readers with NLS-eligible print limitations” (p. 31).
The remaining primary source publications included the following studies: ● Heyer (1935) reported that about one-third of 2,130 “blind” people (defined similarly to legal blindness) registered with the New Jersey Commission for the Blind “used one or more raised types,” (p. 114) (primarily braille); ● Moscrip (1941) reported 104 sight conservation classrooms and nine braille classrooms for students with visual impairments in New York City schools, with “braille classrooms” described as the default for students “with insufficient vision to function in a sight conservation class” (p. 196); ● Platt (1945) from the Lighthouse, New York Association for the Blind, found that 28% of the “Lighthouse blind read braille” (p. 76) and 3% read New York Point or Moon Type; and ● Craig et al. (2002) discussed the Missouri Blindness Literacy Survey finding that 19% of surveyed students meeting the state definition of blind or low vision (127 of 654) were braille readers.
Discussion
The results of this study could be considered a cautionary tale for the field of visual impairment on using old data and repeating unsupported information. Of the primary studies found in the literature search, most included local or state data rather than national estimates; the few national studies were decades old, and the methods used were not rigorous. Many of the articles located through our literature search repeated statistics with no citations at all. Definitions of “braille literacy,” “braille reader,” and “braille user” varied from study to study.
Without clear and consistent definitions and without recent data, the field of visual impairment faces real challenges ascertaining how many people with visual impairments in the United States have learned braille and use it regularly. Nothing found in this systematic literature review supports 10% as the proportion of braille readers among people who are visually impaired. This oft-quoted percentage appears to have been extrapolated from incomplete data as a best estimate and not an actual measure from a well-designed, replicable study. Because of shifting definitions and data collection procedures, we cannot reliably document braille reader populations over time. If there is or has been a braille-reading decline, investigators cannot easily determine the rate or cause of any decrease. For example, although the use of speech access may have increased as availability of audio equipment has become more widespread, the use of electronic braille devices is also increasing so that braille is now easier to produce and access.
Limitations
This literature review only examined data derived from strict parameters. Following the a priori specifications of the systematic search, this study did not intentionally seek reports of braille literacy rates in “gray literature” (e.g., reports, white papers, advocacy and opinion pieces, and other non-peer-reviewed articles). Some gray literature sources were identified, especially as we investigated the sources of braille literacy rates found in the reference lists of the initially identified articles. Discussions and dissemination of braille literacy estimates in mass media and other sources warrant further investigation.
Call to Action
This investigation into elusive statistics has implications for future research and advocacy. First, researchers must use data responsibly. The “10%” statistic most often cited in the documents found through this literature search is not supported empirically, and the sources from which this estimate was derived are problematic and decades old. Statistics implying numbers of braille readers or percentages of “literacy” must be presented not only with caution, but also with acknowledgment that precise information is unknown.
Second, inconsistent and unclear definitions of “blindness” and “literacy” have prevented comparisons among research findings. The Crews et al. (2012) study alone illustrated the vastly different terms used to gather data in federal studies, and our analysis of peer-reviewed articles indicates this inconsistency is widespread. Advocating for clear and consistent terminology may help gather data that can be tracked and compared over time. Other policy implications include the importance of routine, state-level data collection. States may have mechanisms for gathering information on students who use braille, such as records of standardized test formats requested each year. Legislation such as the proposed Cogswell-Macy Act would be instrumental in collecting more accurate information by requiring states to report on services received by students who are visually impaired. There may be a need for multiple ways to determine “braille literacy rates” for different purposes, for example, when examining methods through which people of different ages and characteristics learn and use braille. However, definitions should always be clear and not merely assumed.
Finally, our investigation opens lines of additional research and new ways to look at literature review data. Primary sources identified through our literature review suggest there was not a period when the “majority” of visually impaired people in the United States read braille. We have insufficient data to determine whether there has been a decrease in braille literacy rates over time, and, if so, the extent of the decline. As we have illustrated, comparisons are difficult because of inconsistencies in definitions and reporting. We suggest the more salient question is whether children and adults who could benefit from braille instruction are actually receiving it. This idea will be expanded in a future article with a closer examination of the gray literature.
Although we may not know the exact number or percentage of braille readers, none of this implies that braille is unimportant or less important now than in the past. Braille remains the only reading and writing system that allows independent access to information and personal communication for people who are blind without the use of electronics or intermediaries. Braille continues to prove its usefulness and modernity in countless ways.
Footnotes
Acknowledgments
The authors wish to thank Eric Caruso and Daisy Lei for their assistance in this project.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article, and do not have any financial interest in the results of this study.
