Use of computer assistive technologies by older people with sight impairment: Perceived state of access and considerations for adoption

Abstract

This study explored the perceptions of sight-impaired older people about the use of specialist equipment designed for computer users with sight loss – whether it was meeting their needs and their views on the opportunities for equality in access to computer technologies. The study employed case study research methodology: conducting observations in an Internet café specifically established for people with sight loss and semi-structured interviews with 20 participants who had sight impairments between the ages of 60 and 87 years. A thematic analysis was carried out on transcribed qualitative interview data. Qualitative analysis employed the use of NVivo version 10 for both open and axial coding. Related coded categories were eventually merged into four themes. Findings suggest that stereotyping associated with the use of assistive technologies such as screen readers and concerns about access to mainstream technologies are important factors for understanding acceptance, willingness to adopt assistive technology, or continued use of assistive technologies by sight-impaired older people. Participants perceived advancements in technology as not fully considering their needs. In conclusion, the study highlights important points for technology developers to consider for inclusive designs or cost-effective assistive technologies as social stigma remains a neglected construct for understanding acceptance, willingness to adopt assistive technology, or continued use of assistive technologies among sight-imapired older people.

Keywords

Assistive technology computer use disabilities older people sight impairment

Introduction

The population of older people is increasing globally, and ageing is sometimes associated with different disabilities which could affect how older adults use technologies (Arch, 2008). Age-related functional limitations that could affect computer use include sight loss, hearing loss, diminished motor skill, or cognitive decline (Arch, 2008; Wagner, Hassanein, & Head, 2010). For many computer users with sight impairments, an assistive technology such as a screen reader is usually needed to enhance access to the Internet. However, screen readers are limited in their capacity to interpret computer-based characters or images (Shimomura, Hvannberg, & Hafsteinsson, 2010). The difference in information presented on a computer using only one attribute (such as contrast, size, font, or depth) cannot be interpreted by a screen reader (Anderson, 2016). Screen readers cannot recognise or interpret such information because they are non-standard interface components with three-dimensional animations. This limitation makes it difficult for people with sight loss to use some computer applications, for example, photo-sharing, videos, and graphical illustrations.

Older adult Internet users are not a homogeneous group, and therefore, it might be expected that they use technologies differently (Dickenson & Gregor, 2006). With the nature of declining physical condition or co-existing medical conditions, it is possible that ageing and sight impairment could make certain computer devices less easy to use. This is because there are different types of disabilities associated with ageing, which affects people’s ability to use computers. In addition, the needs and aspirations, physical effort, and potential differences in factors affecting computer use vary significantly, based on the challenges posed by ageing and disabilities (Vicente & Lopez, 2010). This means that when investigating computer use, it is important to analyse disability trends by the type of disability condition to reflect the divergent situations faced by disabled people.

There is paucity of research on how such constraints influence decisions to use computers among people with sight impairment. This study explored perceptions about the state of access to computer assistive technologies among older people with sight loss and factors influencing acceptability of specialist equipment for sight-impaired computer users. This article also reports on participants’ perception on equality of access to computer technologies. Findings from this study add new knowledge to understanding how sight-impaired older people could be better placed to benefit from advancements in information communication technologies (ICTs).

Background

Assistive technological devices especially designed for the blind computer user include large keyboards with well-spaced keys which often bear large font alphabets inscribed as black texts on white keys, Braille embossers which transfer computer-generated text into embossed Braille output, Braille keypads, and screen readers. There are debates that the development and adoption of assistive technologies will be associated with public view of ageing and disability as problematic. Many of such arguments point out that assistive technologies could automatically define disability identity and may compound stigmatisation of disability because their designs are neither universal nor inclusive (Fraser, Kenyon, Lagacé, Wittich, & Southall, 2016; Gaffney, 2010; Hersh, 2013; Parette & Scherer, 2004; Rekkedal, 2012; Scambler, 2009).

Research suggests that many older people have never used the Internet (Niehaves & Plattfault, 2014; Office of National Statistics [ONS], 2013). According to a recent report by Age UK (2013), older people aged 60 years and over in the North of England are less likely to be online compared to those in the South. The report suggests that only 28% of older people in Tyne and Wear use the Internet. This contrasted sharply with their peers in Surrey, where 63% of older adults reportedly used the Internet. In other Southern parts of the country (such as Bedfordshire, Suffolk, Oxfordshire, and Buckinghamshire), not less than 50% of older people aged 65 years and over used the Internet. The Age UK (2013) report raised concerns over the North-South Divide and highlighted the need for the government, local authorities, and private organisations to help older adults to get online.

Although many studies have investigated the reasons for low Internet adoption among older people, there is paucity of research on sight-impaired older people’s use of computers and computer technologies. Specific factors which have been identified as affecting adoption decisions for older people include socio-economic barriers such as income, cost of computers and educational level (Eastman & Iyer, 2004; Juznic, Blazic, Mercun, & Plestenjak, 2006; Mattila, Karjaluoto, & Pento, 2003), the impact of prior experience with similar technologies (Agarwal & Prasad, 1999; Docampo Rama, 2001; Lu, Yu, & Liu, 2003), and lack of specific knowledge about computers (Compeau & Higgins, 1995; Rogers, Meyer, Walker, & Fisk, 1998; Venkatesh & Davis, 1996). Umemuro (2004) argues that the attitude of potential users towards the technology also determines its adoption.

Although many older people with a disability use assistive technologies, it is not yet clear what factors influence adoption or continued use of the devices for sight-impaired older people. Some attitudes among older people without impairments have been identified as indicators of a decision to adopt technologies. For example, within the technology acceptance model (Bagozzi, Davis, & Warshaw, 1992), perceived usefulness (a measure of the subjectively defined benefits of technology use) and perceived ease-of-use (a measure of the user’s degree of satisfaction with accessibility) have been argued to be strong determinants of older people’s rational intention to use ICTs (Ryu, Kim, & Lee, 2009). Davis (1989) defined perceived usefulness as the degree to which a person believes that using a particular technology would enhance his or her job performance and perceived ease-of-use as the degree to which a person believes that using a particular system would be free from effort (p. 320). In essence, the perceived relevance and benefits of technology use are important decisional factor among many older people (Melenhorst, Rogers, & Bouwhuis, 2006; Selwyn, Gorard, Furlong, & Madden, 2003; Sharit, Czaja, Perdomo, & Lee, 2004). However, older adults may also have strong emotional reactions, such as fear and anxiety to using technologies (Czaja et al., 2006; Ellis & Allaire, 1999). Such reactions have been identified in studies involving sighted older people as factors capable of influencing their decision to use and adopt ICTs (Czaja et al., 2006).

In adoption of ICTs between sight-impaired and sighted older people, research suggests that an emerging problem with potential to foster variation in technology adoption between the two groups is the pace of innovation in ICT revolution (Hillen, Barker, Lawrence, & Gagliano, 2012). For example, a typical characteristic of ICT use for sight-impaired people is that the narrowing of one technological gap is often quickly followed by the emergence of another gap (Hillen, Barker, Lawrence, & Gagliano, 2012). This is attributable to the rapidity of replacement of old technologies by new ones. The time lag between the emergence of a new technology and the availability of assistive devices that enhances its accessibility for the sight-impaired user is often too slow. Research addressing the digital inclusion of older people has highlighted the importance of understanding the process by which older users establish the benefits (Melenhorst et al., 2006; Sharit et al., 2004) and relevance (Dickinson & Hill, 2007; Selwyn et al., 2003) of ICTs to promote independent living.

Older adult computer users are not a homogeneous group, and therefore, it might be expected that they learn to use computers differently and for different purposes. With the nature of declining physical condition or co-existing medical conditions, it is possible that ageing and sight impairment could make certain computer devices less easy to use (Ryu et al., 2009). For such reasons, some authors have argued for a systems approach to training programmes designed to encourage uptake of computers among older adults (Mayhorn, Stronge, McLaughlin, & Rogers, 2004; Morrell, Mayhorn, & Echt, 2004). According to Mayhorn et al. (2004), the systems approach to training typically involves needs assessment which determines older adults’ computer learning goals, necessary skills that should be taught, and the characteristics of older adults who will benefit from training.

Some studies contextualise disability as a homogeneous concept, and there is usually less focus on how specific groups with specific disabilities cope with computer use (Best & Butler, 2012; Gell, Rosenberg, Demiris, LaCroix, & Patel, 2015). While the ability to effectively use ICT is increasingly becoming a necessity in today’s world, there is little insight into the dynamics, processes, and characteristics of computer users with sight impairment which could influence uptake and/or acceptability by the group. In discussing how disabled people can be integrated into society, via universal designs, Ellis and Kent (2011) acknowledge that disabled individuals have divergent ICT needs. What might be considered appropriate for a population group with one disability may not necessarily be suitable or useful for a different group. This does not suggest that it is entirely impossible for technology to be completely inclusive; rather, it suggests that there is a need to understand the communication preferences peculiar to each group for an inclusive strategy to work effectively. This study investigated a largely ignored aspect of the acceptability of assistive technologies for computer access among sight-impaired older people in order to reveal how they can be better placed to adopt ICTs for positive and adaptive responses to ageing and sight impairment.

Methods

Research design

The research framework used in this study is the qualitative paradigm (Creswell, 2007) – using a case study approach of mainly interviews and observations. The interviews were topic guided. This design was adopted in order to be able to explore other topics and questions as they emerged (Phillimore & Godson, 2004). The approach emphasises the understanding of meaning in context and that meaning is created through interaction with a conversational partner. The concepts of multiple experiences narrated by different respondents and the importance of contextualising reality based on respondents’ experiences are further characteristics of this approach (Moggridge, 2007).

The study site

The centre was a non-profit organisation and a social centre for people living with sight impairment in north-east England. Although there was no formal record of the number of older people who visited the centre on daily basis, there were more than 800 registered sight-impaired people who used the services at the centre. The services included Internet café for the blind, computer training classes, sight awareness training, and specialist information service. Befriending services and social events were also occasionally organised at the centre to promote socialisation among members. Computer classes on Internet use were provided to interested members in order to assist them in pursuing their interests with computer use. Access to the Internet café was granted to older adults with sight loss, who may not have had the opportunity to learn how to use the computer or those who may not have the means to purchase a computer or assistive device of their own. A typical computer class consisted of six sight-impaired individuals and was led by an instructor and two to four volunteers who also provided support to the participants. Each participant usually came in once a week to use Internet services. This schedule had been arranged to ensure that everyone had an opportunity to attend the classes and use the Internet, as there were a limited number of computers. The volunteers provided support on a part-time basis. The author was a volunteer at the centre and had keen interest exploring views and experiences of older adults with sight loss concerning access to computers using assistive technologies.

Sampling procedure

A face-to-face meeting was first held with the management and staff of the organisation (as the gatekeepers) of the drop-in centre for older people with sight impairment. During the meeting, an information brochure about the study and consent forms was shared with the facility’s representatives. The manager of the centre subsequently held preliminary discussions about the study with all potential participants, informing them about how their participation will contribute to an understanding of access to computers among sight-impaired older people. A second meeting was held with the manager in order to get feedback from her debriefing with the administrative team and eligible participants. Permission to recruit participants from the centre was granted after the second meeting. In total, 30 potential participants were contacted and 21 of them were both interested and available for the one-to-one interviews. During first 2 weeks, information about the study was again shared with potential participants, including what benefits the research might yield for people with sight impairment who used the Internet. One-to-one interviews were subsequently scheduled for consenting participants at agreed dates and times.

Participants

The sample for this study consisted of 21 respondents, all of whom were members of a voluntary organisation for blind people in north-east England. The participants were aged between 60 and 87 years. They comprised 12 women and 9 men. All participants had late-life sight impairment and had experience with the use of computers before diagnosis of sight impairment. Respondents possessed a wide range of age-related sight impairments and sight condition, varying from partial sight to total blindness. Participants who had cornea dystrophies and age-related macular degeneration (ARMD) were partially sighted, while participants with glaucoma and severe retinitis pigmentosa were totally blind. This was ascertained by asking participants’ questions about their levels of sight loss, rather than their registration status. In total, 16 participants reported comorbid conditions. Two participants mentioned having chronic back pains, five participants reported arthritis, another five participants reported having hearing impairment, and four participants mentioned that they were diabetic. All participants used text-to-speech assistive technologies (screen readers). The blind participants used Braille keypads and Braille embossers. The sample was not intended to be representative of the sight-impaired community but to be contextually sympathetic to the sight-impaired students at the centre at the time the research was conducted.

Procedure for data collection

Interviews and observations were conducted with participants over a period of 8 months. Interviews were conducted at the centre and were iterative. All interviews were audio recorded and transcribed verbatim. The repeat interviews were held about 4–6 weeks apart, enabling participants to reflect on what they said. In other words, the second interviews gave a potential for a more reflective interview (Seidman, 1998). Before the commencement of the second interviews, analyses of first interview transcripts were verbally reported to participants. This was to ensure that there were no misinterpretations (Polit & Beck, 2004). In this way, the iterative design was aimed at generating clearly guided and detailed data from participants (Bryman, 2008). Interviews focused on background information about the participants and their experiences with the use of assistive technologies to access the Internet and accomplish basic computer tasks. The open-ended nature of questions enhanced exploration of narratives (stories) of participants from their experiences and also helped to develop a rapport with them about the meanings they attached to Internet use.

Observations were conducted in an Internet café, managed by the centre for sight-impaired people. It was typically semi-structured (Bryman, 2008) and conducted for 2–3 hr three times weekly. Field notes were written discreetly, and the privacy of all participants was respected. Considering that this study concerned people whose Internet access was fraught with challenges caused by sight impairment (Craven, 2003), the purpose of the field observations was to explore how participants’ experiences with the use of assistive technologies influenced their perceptions. The opportunity afforded by the unstructured design of observations was used to explore many other related salient issues such as benefits and frustration with the use of assistive technologies among participants and how they coped with encountered difficulties using specialist technologies for computer access. Other issues observed included participants’ skills with computer use, learning techniques, and concerns with the use of assistive technologies. Pseudonyms have been used to preserve anonymity. Ethical approval for the study was granted by University of Northumbria, United Kingdom.

Data analysis

All interviews were audio recorded and transcribed. Interview transcripts and field notes were analysed in NVivo 10 (NVivo, 2010). Codes were identified by noting frequently mentioned ideas by participants and qualitative emphasis (how emphatically participant(s) communicated their responses) as well as revealing events embedded in the field notes (Braun & Clarke, 2006). Data were coded without trying to fit them into any preconceptions about how sight-impaired older adults used assistive technologies for computer access. Thus, the thematic approach to the study was data driven, and themes were mainly derived by searching across data (interviews and field notes) to find repeated patterns and meanings. Interview transcripts were read repeatedly to ensure familiarisation with data. Analysis of the field notes was conducted after each observation of activities, events, and participants’ behavioural responses to the use of computer assistive technologies at the centre. The preliminary analysis of field notes fostered self-reflection and facilitated the revelation of emergent themes. It also enabled the author to shift attention in ways that helped to further develop the investigation as some physically observed events at the centre were probed during the one-to-one interviews. An initial list of ideas was generated from the interview transcripts, and codes were developed from data. This process is often termed ‘open coding’ (Glaser & Strauss, 1967; Strauss & Corbin, 1998). The next phase, also known as axial coding (Braun & Clarke, 2006), focused on sorting identified codes into broader levels of sub-themes and collating them into themes by linking them based on their relationship. Related codes were categorised into sub-themes and interrogated further in relation to the coded extracts in that category. Previous entries under existing codes were reviewed to analytically compare the similarities or differences. This allowed the grouping of related sub-themes into themes. Finally, clear definitions and names for each theme were generated by analysing the specifics of each theme and the overall report within the findings.

Findings

This section presents the themes in particular reference to how participants’ experiences with the use of assistive technologies influenced their views on what factors promoted uptake or militated against adoption of computer assistive technologies and their concerns for digital inclusion. Four themes emerged, namely, ‘ease of use of computers’, ‘cost of newer assistive technologies’, ‘stereotyping’, and ‘pace of innovation’.

Ease of use of computers

It was observed that none of the participants had difficulties using the keyboard, but all of them had difficulty using the mouse, especially in clicking where they wanted to click because the icons and menus were not legible. Our participants relied on screen readers. Observations also revealed that keyboard shortcuts (such as CTRL + N) and arrow buttons were used for navigation and to scroll up and down the screen. Computing commands that were regarded as excessive or requiring good sight were conducted via keyboard shortcuts. The use of such keyboard shortcuts seemed to enable sight-impaired older people to improve their dexterity of computer use (Sayago, Sloan, & Blat, 2013) and reduce complexity. All participants reported that the use of the keyboard shortcuts was a helpful alternative to the use of mouse. Some of the participants also reported reduced finger control of the mouse due to arthritis, which affected their dexterity. They did not consider the use of keyboard shortcuts as unusual behaviour despite being aware that many sighted people often used keyboard for typing and not for navigation.

Participants who used large font sizes because they were severely sight impaired regarded the keyboard as a replacement for a mouse while those with mild to moderate sight impairment switched between use of mouse and keyboard for navigation. However, participants’ interview comments suggested that despite being not able to use the mouse, they did not want to be regarded as different:

Using the same computer device like others makes you feel more like everybody else, and it makes you feel as if you’re normal up and nothing’s wrong and you are independent. (Thelma, ARMD)

If you use the same equipment as others, you think – you are in a normal world like everybody else. (Sharon, cornea dystrophy)

Others simply reported their displeasure with the fact that they had resorted to use of assistive technologies which did not seem to make computer use any easier. One of the participants, Abigail, believed it was more difficult for a previously sighted computer user to learn how to use a screen reader. Her reason was that, as a sighted user, navigating a web page was faster because you do not wait for the commands. Abigail and Kevin, who had ARMD, described waiting for the commands and having to go through all the links as frustrating:

The designs are difficult for visually impaired people. The issue is actually getting from place to place and the number of times you have to press various buttons to get there and what happens is because of the way the websites are designed. (Abigail, cornea dystrophy)

Alfred and Kevin had hearing loss, and both participants held the opinion that the number of times a user should listen to the audio commands and make several clicks was a little difficult:

You must listen attentively to the voiced instructions. When you get to the bottom of the page and you press enter, so you choose groceries, you set up an account, you go to groceries, you press enter or whatever. It takes you all the way back to the first part of the page and you have to systematically manoeuvre all the way back to where you want to go which is may be a hundred odd clicks . . . this is quite difficult. (Alfred, glaucoma)

It’s not just that . . . it’s also difficult to learn, the buttons, the number of times you have to press the buttons and listen to audio instructions to get to the place you want to get to so, it’s the design of the web pages themselves. Even though there is something called accessibility options, it still doesn’t make life easy for the person without sight to learn how to navigate. (Kevin, ARMD)

Cost of newer assistive technologies

The cost of newer versions of assistive devices was a major perceived barrier to adoption of assistive technologies. Many previous studies highlighted this particular factor as one that hindered access to computer technologies for disabled people (Hollier, 2007; Williamson, Wright, Schauder, & Bow, 2001). However, all participants voiced concerns that they were more at risks of being digitally excluded if affordable technologies were not considered for older people with sight impairment:

I think there needs to be a good look at where equipment and assistive devices can be purchased at a lot more affordable prices for visually impaired people. The costs are outrageous. (Harold, glaucoma)

Everything is expensive . . . but if they integrate it to conventional technologies, hopefully, the demand will be so high that the prices will come down and it will benefit people with sight loss. (Vivian, glaucoma)

Many participants said that they were aware of some newer technologies that functioned better but that such technologies were expensive:

In my opinion, the voice recognition technology is good and user-friendly for visually impaired people. The modern day technology with easy internet access for visually impaired people isn’t really affordable and this making it more difficult for visually impaired people who want to go online for shopping or whatever. (Rosaline, advanced glaucoma)

Regina asserted that promoting universal designs could be a strategic approach to integrating disabled people and to also reduce the price. Their comments suggested that if the same designs were made for everyone, with accessibility options incorporated into mainstream technologies, manufacturers could effectively manage the cost of production and control the prices of specialist devices for people with sight impairment:

If the accessibility is built in to normal technologies, it will not just be there for blind people . . . it will be there for everybody . . . so hopefully the prices will come down actually. (Regina, glaucoma)

Some participants also pointed out the role of sight impairment centres in facilitating access the newer but expensive specialist equipment. They believed that government or privately funded sight impairment centres could address such artificial barriers (such as cost of assistive devices) by encouraging people who could not afford the costs of modern assistive devices to access them at the centres:

I’m colour blind. There are technologies to deal with this in computers but I can’t afford them. I would love to, but I think I’m going to wait till the end of the year and I would love to get the screen reader but it’s too expensive, so I come here to use it after I heard about the centre as I cannot afford one now. (Amanda, ARMD)

Stereotyping

Participants believed that if they used mainstream equipment, they would be respected rather than discriminated against for vision disability. Many of them had reservations for the use of assistive technologies and believed that if they were able to use same devices like everyone else, their disabilities would be de-emphasised, and a shift of public focus from stigmatising identities to their abilities will be promoted. Doris, whose blindness was caused by advanced glaucoma, said that by being able to access the Internet with same device as others, she felt a positive sense of self-worth and respect from others. Larry spoke of how the use of assistive technology could trigger stereotype and disparaging comments:

Sometimes when you meet people and they see you’ve got vision impairment, they think you have a mental impairment as well. At other times, when you say you are blind, they tend to speak louder and they think that your reasoning is gone as well. You know, it annoys me. I feel it’s not right. (Larry, macular degeneration and cortical blindness)

Larry’s comment suggested that he was aware of social stigma surrounding use of assistive technologies. The conscious awareness of such misconceptions and the potential for stigmatisation compelled Larry to have some reluctance about public use of computer assistive technologies.

Some other participants did not regard the act of using assistive technologies as a way of exposing themselves to stigmatisation, rather they believed it reinforced a positive perception of independence:

It just makes you believe in yourself. You can interact with people online the way everybody else does. I’m able to use the internet, like everybody else, knowing the terminology that people use. (Sharon, cornea dystrophy)

Although their Internet access was mediated with assistive computer technologies, they believed that it helped them to overcome self-criticism about being unable to use the Internet at all due to sight impairment:

Although the device is different, but it’s because we just can’t see properly. You can interact with people online the way everybody else does and no one will know you did so through assistive technology except you tell them. I don’t think it matters. (Sharon, cornea dystrophy)

At least, I’m able to use the internet, like everybody else, knowing the terminology that people use because you use it, that makes you feel like everybody else. (Sharon, cornea dystrophy)

Being able to use the computer with assistive technology was also regarded as a means to disprove the popular stereotype that they were dependent and technophobes because they did not grow with computers:

Many of us don’t mind doing it because we feel it enhances our independence and of course our self-esteem because some people think we are old, we can’t use computers . . . they say ‘you can’t teach an old dog new tricks’. We did not grow-up using computers but we can’t give up seeing what is happening now with computers everywhere. (Tim, complicated cataract and glaucoma)

In this way, participants reaffirmed their perceived sense of self-acceptance in the expectation that they should be respected rather than discriminated against due to sight impairment. The positive acceptance of self emerged from the emotional state of feeling pleased with their tenacity to overcome the challenges of using the Internet without sight.

Pace of innovation

Many comments by participants reflected their fears about being excluded from participating in the rapidly advancing ICT world. There was apprehensions that, as many technological devices take touch screen forms, it might eventually become difficult for people with sight impairments to use assistive technologies because they depended largely on being able to feel keyboards and Braille. They expressed concerns that such innovation with undifferentiated surfaces may marginalise them further and hinder adoption of assistive technologies:

You just got that touch screen things now . . . so my concern is if it all goes to touch things, you all happen to forget those who have difficulty with vision. I find that touch screen thing very difficult. (Samantha, cornea dystrophy)

The complexity of ICTs as technological advancements progresses rapidly was perceived by participants as an enormous challenge. All participants said that difficulties in remembering all the automatically dictated steps from their screen readers can be stressful. For this reason, they advocated simpler and more comprehensive design of websites with fewer links:

Internet pages should be made clearer. They’ve got advertisements everywhere. Many assistive technologies for visually impaired older people can’t read some websites because they’ve got too much, too busy for visually impaired people because it makes it confusing for us. It’s just too fussy. (Fred, glaucoma)

Fred believed that difficulties which hindered sight-impaired older people from having equal access to ICTs includes sophistications which often made little consideration for users with sight impairments and that such could potentially preclude opportunities for social integration of sight-impaired people.

Another reason, noted by participants, for poor acceptance of computer assistive technology was based on perceived changes in requisite competencies which resulted from rapid modifications of computer interface designs. Participants’ comments suggested that many websites still remained difficult to access for sight-impaired older adults because the pace of modification of assistive technologies lagged behind advancements in universal technologies. Some participants believed that the progress being experienced by sighted users as technologies are constantly modified and improved may not necessarily be regarded as progress for sight-impaired people:

I worked in a non-electronic age but seeing what is happening now, it’s quite frightening at times as well as the innovations. (Newton, ARMD)

The modern day technology with difficult access for visually impaired people isn’t really improving our lives and lots of technology is making it much more difficult. (Jennifer, ARMD)

All participants held the opinion that technology design professionals could be more inclusive in their design approaches by incorporating voice recognition devices into screen readers and all magnification software. In addition, participants believed that rather than making undifferentiated screen surfaces of some digital devices such as android phones, which could lead to usage difficulty for sight-impaired individuals who depended mainly on touch typing, developing inbuilt options for surface bumps (alphabets or Braille formats), voice recognition software, could foster inclusion.

Discussion

Findings are consistent with previous studies that have reported that use of assistive technologies could potentially generate a range of interpretations from users and non-users (Hersh, 2013; Parette & Scherer, 2004). For example, many of the participants voiced concerns that computer assistive technologies could be stereotypically viewed as a symbol of lost function and abilities. Participants were also aware of ageist stereotypes associated with technology adoption by older adults – such as reported in past studies noting the labelling of elderly people as ‘incompetent’ and ‘technophobes’ (Fiske, Cuddy, Glick, & Xu, 2002; Southall & Wittich, 2012). This echoes findings from previous studies that disability discourses and stereotypes impact negatively on older people’s adoption and use of assistive technologies (Fraser et al., 2016; Southall & Wittich, 2012). The finding suggests that social stigma remains an underlying and dormant construct negatively affecting acceptance, willingness to adopt assistive technology, or continued use of assistive technologies by sight-impaired older people. A previous study by Sodestrom and Ytterhus (2010) demonstrated that younger sight-impaired individuals regarded assistive technology as a symbol of restriction, difference, and dependency. Assertions by older participants in this study, however, underscore previous arguments that one major factor which explains the association between stigmatisation and use of assistive technologies for computer access is the societal attitude of paying more attention to functional incapacity of the sight-impaired person rather than the challenges posed by structural obstacles (Dovidio, Pagotto, & Michelle, 2011; Shinohara & Wobbrock, 2011). While the study by Sodestrom and Ytterhus (2010) showed that younger partially sighted persons were reluctant to adopt assistive technologies in order to pass as ‘ordinary’, some partially sighted older persons in this study, however, expressed displeasure with stereotypes associated with the use of assistive technologies and wished for inclusive technologies. Participants acknowledged that having computer access (albeit through using assistive devices) promoted their sense of accomplishment as computer literate members of the evolving ICT world. In addition, older people with sight loss regarded having Internet access via assistive computer technologies as a symbol of their resilience to be active participants despite being doubly disadvantaged by age and sight impairment. In this context, some of the participants acknowledged their self-worth and avoided self-denial.

Furthermore, findings show that while society continues to advance rapidly with ICTs, many participants in this study struggled to catch up and were aware of the technology-advancement gap. The older adult population with sight impairment feared being left behind and unable to benefit from use newer technologies. There have been debates, particularly among disability rights advocates, arguing that access to vital assistive technologies should not be based solely on one’s ability to pay for it (Carlson & Ehrlich, 2006). Proponents of such a solution contend that the majority of disabled individuals have very low incomes and depend on other sources of support (Carlson & Ehrlich, 2006). The contexts of inclusive technology that will promote integration were described by participants as those that not only afforded them ample opportunity for access to mainstream technologies but also involved technologies devoid of modifications or sophistications that gradually excluded them.

In this study, participants determined what application suited their communication needs and optimised such tools for their personal benefit. Many intervention strategies, such as digital inclusion programmes that encourage the uptake of Internet use among older adults, are often designed with a predetermined curriculum (Tsatsou et al., 2011). This resonates with the systems approach, in that designing digital inclusion programmes in such overly centralised manner may run the risk of denying sight-impaired older people the much-needed opportunity to adapt Internet use to their own circumstances. Thus, a predetermined technical approach may not fit the priorities of this population and would achieve little success in bridging the digital divide.

Participants who were partially sighted (e.g., those with ARMD and cornea dystrophy) found screen magnifiers helpful because they had residual vision. However, participants who were totally blind (due to glaucoma or retinal detachment) seemed to prefer using only screen readers. As observed among partially sighted and totally blind participants in this study, disabled individuals have divergent ICT needs. This echoes Ellis and Kent (2011) argument that what might be considered appropriate for a population group with one disability may not necessarily be suitable or useful for a different group. Findings from this study echo important points for product developers. The concept of inclusive technologies demands careful considerations on many fronts. First, there are fundamental issues as to how conventional technologies could be modified to enable universal access (Bilbao-Osorio, Soumitra, & Lan, 2004; Manyika et al., 2011). Second, there are issues about access to technologies with respect to cost and policies to enhance equal access. Finally, there are approaches and methodological issues that should be developed with the aim of guiding the design process, such as involving the end-users in the technology-innovation process (Ferguson, 2014; Sandler, 2012). Sight-impaired older people in this study believed that their concerns which were associated with the cost of newer assistive technologies may be alleviated, to a large extent, by the use of universal-type designs. Universally designed technological products could portray device use as normal, minimise the social stigma some older people associate with the use of assistive technology, and promote older people’s feelings of social integration (Cazini & Frasson, 2013; Gallagher, Murphy, & Fennell, 2012).

Limitations of study

The findings cannot be generalised due to the qualitative nature of the study and the small sample size. Findings, however, contribute to existing body of research on human–computer interaction, such as research areas that focus on sustaining older adults’ use of ICTs (Sloan, Atkinson, Machin, & Li, 2010) or rehabilitation of sight-impaired older people to lead independent lives through the use of assistive technology (Coleman, Gibson, Hanson, Bobowicsz, & McKay, 2010) and capturing their day-to-day experiences with the use of technologies (Turner & Turner, 2013). The study did not explicate how the different types of sight impairment could have played a role in participants’ ability to use screen readers or their dexterity with computer use. It is possible that the presentation of different kinds of sight impairment or the severity of sight loss may influence how participants used assistive device and/or their perceptions. Although gender and comorbidities could influence the use of technology (Gell et al., 2015), it was not explored because it was not the focus of the study. The study acknowledges a potential sampling bias, in that all participants belonged to voluntary organisation, and they all had previous computer experience and were all already attending an Internet café.

Conclusion and recommendations

This study explored sight-impaired older people’s perceived access to and use of assistive technologies. Some participants’ comments highlighted social stigma as a factor which they believed hindered accessibility to assistive technologies. Findings from this study stress the importance of understanding how sight-impaired older people perceive the ICT revolution, advancements in technology, and the role of such advancements in adoption of computer assistive technologies. In order to promote digital inclusion of sight-impaired older people, there is a need to ensure that assistive technologies are within their financial means. Participants in this study hoped for universal designs which they believed might not only foster access to mainstream technologies but also eliminate social stigma associated with using specialist technologies, reduce cost as well as promote their sense of inclusion.

Footnotes

Acknowledgements

I am grateful for the support of my Supervisors: Prof. Mima cattan, Dr. Monique Lhussier, and Dr. Catherine Bailey.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The research is part of a funded PhD project. Author(s) received no financial support for the authorship, and/or publication of this article.

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