Abstract
BACKGROUND
While it has been broadly agreed that there is a need for consolidated information about assistive technology, previous attempts have not been sufficient for detailed consumer demands.
OBJECTIVE
Researchers sought consumer feedback to determine what should be included in a comprehensive, accessible database of AT.
METHODS
We conducted focus groups with different stakeholder groups (people with diverse disabilities, practitioners, and circles of support). We used a framework analysis to map participant responses to the research questions using focus group transcripts and notes.
RESULTS
AT users are looking for quick access to certain information such as the cost versus benefit, reliability, funding, and compatibility. They expect to find this in a variety of formats (video, audio, text) with a collaborative element (reviews and recommendations) from other users.
CONCLUSIONS
In an AT product database, users want the option to search by activity rather than only disability category, as disability can fluctuate. Accessibility of the database is key, with people preferring modifiable and flexible formats for both adding and consuming information. A community of practice will foster the connections people require to confirm their decisions prior to purchase.
1. Introduction
Assistive technology (AT) encompasses products, equipment, systems, or software designed to enhance independence, participation, and inclusion for individuals with disabilities [1]. AT includes devices that are specifically designed for people with disabilities and are customized to meet individual needs (such as wheelchairs, hearing aids, and communication devices). They also can be mainstream devices not specifically designed for people with disabilities but used to reduce barriers and improve access (such as smart speakers, smartphones, and magnifiers). While AT plays a vital role in daily activities, researching and purchasing AT devices (ATDs) poses challenges, particularly for those in rural areas facing limited retail opportunities and professional support. Demographic factors, such as disability type, onset, educational attainment, income, age, race, and ethnicity, also contribute to disparities in AT access [2, 3, 4]. Rural communities are especially vulnerable to a lack of access to assistive technology because of reduced retail opportunities to learn about AT in person and fewer skilled and knowledgeable professionals in communities to support AT needs [5, 6]. This uneven distribution of retail and professionals results in a lack of awareness and knowledge about assistive technology devices. This makes it difficult for people to keep up with the fast pace of technology development and the information necessary to match devices to existing ecosystems and the potential user’s needs.
The purpose of this research is to address these challenges by developing a community of practice containing a searchable database called the Assistive Technology Network (AT Network). As a larger project beyond the scope of this initial research, this database will integrate knowledge from both practice and end-users to create a virtual space where practitioners, vendors, and people with disabilities can research reliable AT information from multiple stakeholders. This manuscript presents focus group findings from a key stakeholder group – people with disabilities – to better comprehend the experiences, barriers, needs, and preferences while researching ATDs before making purchases to inform the development of this database.
1.1. Background
Globally, over 2.5 billion people stand to benefit from assistive technology (AT), yet at least one billion lack access due to information and funding constraints [7]. Among adults living independently, estimates suggest that half to two-thirds utilize AT, but many still lack essential devices [4, 8, 9]. Demographic factors such as disability type, severity, education, income, age, and ethnicity contribute to this disparity [4]. In addition, as the population ages, so does the population of people with disabilities. Aging populations intensify the need for AT, with age-related functional changes more prevalent among people with disabilities [8, 9, 10, 11].
Historically, AT access has faced barriers such as cost, functional compatibility, and insufficient experimentation opportunities, leading to high dissatisfaction rates [12, 13]. The challenge extends to keeping pace with technological advancements and limited awareness of available AT [14, 15, 16, 17, 18]. While the AT Act has legislated a statewide program and increased awareness of AT, its reach remains limited, serving approximately 500,000 people annually compared to an estimated 42.7 million potential beneficiaries in the United States [19, 20]. This represents less than 2% of those who could benefit from AT, emphasizing the continued need for widespread information, technical assistance, and customization support for people with functional limitations.
1.2. Lack of awareness of AT
A consensus in global studies highlights that lack of awareness and knowledge are the most significant barriers to accessing assistive technology [21, 22, 23, 24, 25, 26]. Ineffective AT use stems from inadequate training, lack of external support, and having to navigate multiple information sources [26]. Additionally, insufficient awareness and information about AT options, limited access to professionals, and complex procurement processes impede effective AT access and utilization [23]. The awareness of AT options, the ability to explore new products, and access to adequate servicing and maintenance facilitate informed consumer choices [22, 23].
Historically, AT information sources lacked the dynamic and informative content, such as user feedback, needed to empower users [14, 16, 17]. A more comprehensive source is essential to empower people with disabilities and others needing assistive products for their activities of daily living (ADLs) [14, 16, 17]. Health, social work, vocational rehabilitation counselors, clients and family members, and education professionals can all identify AT needs. A better information source would enable clients, suppliers, manufacturers, rehabilitation professionals, and researchers to identify solutions, environmental barriers to AT use, and the need for product integration [14, 17]. Consistent terminology facilitates communication across all stakeholder groups and prevents misunderstandings [16, 27].
However, addressing the need for information is only the first step. People with disabilities and older adults require knowledge about the “quality, usability, effectiveness, and availability of these devices,” emphasizing evidence-based information [28]. Current resources often rely on readily available information or vendor-provided data. A selection process based on commonly recommended AT devices aligned with client goals may result in more appropriate and efficacious choices, reducing the likelihood of abandonment [10, 25].
To promote access and autonomy, a multi-pronged approach is necessary. Educating and raising awareness of options are vital components to overcome these barriers and empower individuals to make informed choices and advocate for their needs.
1.3. Shortcomings of existing information resources
Existing resources for assistive technology (AT) aim to raise awareness, provide additional information, and aid in selecting products that enhance independence and quality of life. Notable examples include the Global Public Inclusive Infrastructure (GPII)’s Unified Listing, the now defunct AbleData, the EASTIN database, AT.net, and LivingMadeEasy.org.uk. However, a comprehensive solution is lacking as these resources have distinct limitations.
GPII, while striving to centralize information on communication technologies, falls short in offering a complete listing of AT devices and technical assistance articles. Its focus on communication technologies excludes a holistic approach to AT awareness. AbleData impressively covered over 30,000 AT products and offered 60 technical assistance articles. The absence of standardized product classifications posed a challenge for users unfamiliar with AT. The EASTIN database, housing several international product catalogues, addressed this issue by classifying assistive product collections by the international standard, or ISO, codes [29]. Still, both systems lacked user engagement features such as comments, questions, and product reviews, hindering a community-driven learning experience.
AT.net, with data on over 22,000 AT products, allowed reviews and ratings but struggled with a cumbersome platform, akin to Wikipedia, limiting user participation. LivingMadeEasy.org.uk, with their search tool AskSara, presented a user friendly and accessible online interface for searching for assistive products, but again with the missing component of user participation and engagement [30]. In contrast, the proposed ATNetwork, inspired by popular social media platforms, will overcome participation barriers through user-generated reviews and a more accessible community interaction model.
Researchers emphasize the need for national assistive technology policies, evidence-informed policymaking, and collaborative efforts like the GREAT Summit and the Global Report on Assistive Technology. Maclachlan et al. [5] argue that national assistive technology policies are urgently needed to provide vision and direction. Øksnebjerg [31] notes that policy should be evidence-informed to allow for evidence-making. Partnerships and collaboration can also drive awareness and access. Scherer et al. [32] describe the Global Research, Innovation and Education on Assistive Technology (GREAT) Summit, which brought together stakeholders to address research and access gaps. Borg et al. [33] note that the Global Report on Assistive Technology engaged countries and experts worldwide to review the state of access. While these initiatives contribute to raising awareness, they fall short in providing a unified, interactive solution for addressing barriers related to awareness, availability, accessibility, and adoption of assistive technology [34, 35]. Indeed the Global report on assistive technology from the World Health Organization and UNICEF [1] confirms that while most countries have a department dedicated to assistive technology, the population access to AT is far from being met.
Recognizing these deficiencies, there is a compelling demand for a single, dynamic, and interactive AT resource. This resource should engage key stakeholders, including consumers, therapists, caregivers, vendors, and policymakers. Addressing crucial aspects such as what information needs to be included for informed decisions and how to establish credibility with users will be pivotal. Our ongoing research is dedicated to creating an inclusive platform that integrates these elements, bridging existing gaps in the AT landscape. To achieve this, we pursued the research questions: what information do people seek when searching for assistive technology, and how do they want to access that information?
2. Methods
To best learn how people wanted to access information and interact with one another to learn more about technology, we utilized a biopsychosocial approach to understand the interactions between these factors [36]. We used qualitative content analysis to gain insight into the needs of stakeholders, including AT professionals, potential users, and caregivers [37]. We conducted six semi-structured interviews and sixteen focus groups representing different populations of AT users and other stakeholders who assist with selecting and using AT. We also developed a taxonomy of populations needing representation and access to a resource such as AT Network. Towards that end, we recruited participants across disability type, gender, race/ethnicity, and which represented rural, urban, suburban, and rural remote communities.
2.1. Research design
Focus groups were structured discussions during which participants focused on a topic, often presented as a series of questions from a researcher acting as moderator [38]. Focus groups effectively studied consumer perspectives on products and processes, especially as group dynamics invited explanations for responses rather than short answers without context [39, 40]. The authors felt that, given the diversity of participants, a smaller number of focus groups and participants was sufficient to be representative of the population as a whole and include diverse perspectives [41]. The focus groups and interviews aimed to understand how different stakeholders search for and obtain information on AT for their clients and themselves. We were also looking for characteristics of resources that influence assistive technology decision-making processes and any use of online resources to meet these needs.
2.2. Participants
We used convenience and snowball sampling approaches to recruit participants. People were recruited primarily by reaching out to the existing networks of assistive technology professionals and users familiar with the Center for Inclusive Design and Innovation’s CIDI Consumer Network (CCN). We contacted five different state AT Act programs (Alaska, Colorado, Wyoming, Montana, and Texas) and the Association of AT Programs (ATAP) who shared our recruitment information with their users and practitioners. We asked the participants about their experiences using AT devices and mainstream devices such as smartphones, researching Assistive Technology Devices (ATDs), their challenges, and the resources that either helped or hindered them. People with different disabilities including low vision or blindness, Deaf or hearing difficulties, mobility impairments, or mental health conditions were recruited to participate in this study to represent a mix of sensory, mobility, and psychiatric disabilities. Focus groups were conducted online and arranged to include people with the same disabilities, or practitioners in similar vocations related to AT, so as to maximize common search criteria and discussions related to common tools and experiences. Interviews were held for participants who could not attend the scheduled focus group but felt strongly that their contribution be included. Assistive Technology practitioners from providers of state AT Act programs as well as representatives from the National Assistive Technology Act Technical Assistance and Training (AT3) Center also participated in focus groups and interviews. The research protocol was approved by the Georgia Institute of Technology Institutional Review Board. We obtained informed consent by sharing a consent form and verbally confirming participant consent before beginning the interviews and focus groups in the audio recordings.
2.3. Procedure
The researchers established a protocol ensuring consistency across five focus group moderators and interviewers through research discussions. The protocol featured open-ended prompts like “Where do you go to learn about assistive technology?” to elicit insights on preferred information, formatting, and accessibility for a potential assistive technology (AT) resource. The study comprised 16 focus groups and six interviews involving 35 people with disabilities and nine AT providers, totaling 44 participants. Recruitment prioritized in-depth knowledge about the envisaged AT database, aiming for representativeness over comprehensive coverage. Semi-structured focus groups, lasting about 90 minutes each, were conducted with privacy protection through Microsoft Teams, utilizing automatic transcription and segregating audio and video files. Sessions were recorded with participant consent and transcribed. Each focus group involved 2–5 participants, lasted 60–90 minutes, and was moderated by one of the four lead researchers. Note-takers, either other lead researchers or one of three graduate research scientists supporting data collection, captured additional elements not reflected in transcripts. Moderators outlined session objectives, allowed participant introductions, and utilized nominal group technique components for idea exploration without prioritizing consensus or establishing priorities [42].
2.4. Data analysis
In this research, we employed Framework Analysis for qualitative data analysis to identify, describe, and interpret key patterns within various data sets, including interview transcripts, focus group discussions, and notes taken during interviews [37]. Three members of the project team, including two focus group moderators, conducted the analysis. The process began with data familiarization, wherein we rewatched focus group recordings, revisited and edited transcripts, and extracted notes related to specific research questions and common ideas. This facilitated our nuanced understanding of content, context, and participant discussions.
Next we developed a thematic framework that encompassed questions asked across discussion groups, forming themes related to building the planned assistive technology database. Topics covered included facilitators and barriers to searching, sources of information, social network engagement, and research processes before purchasing technology. This framework organized responses and identified overarching concepts across participant groups.
Systematically applying this framework to the entire dataset, we consolidated related ideas and excerpts in a shared Word document. Collaboratively, the team analyzed patterns, relationships, and variations within and across themes, discussing connections, contradictions, and insights essential for answering research questions. Findings were documented with comments and tracked changes in transcripts and the shared framework document. We utilized the “grounded theory” approach to analyze focus group findings, extracting central themes and common threads. At least two coders coded data into emerging themes to ensure interrater reliability, with Cohen’s Kappa used to guarantee a minimum 90% agreement. This rigorous process ensured a comprehensive and reliable analysis of the qualitative data.
3. Results
In this section, we will describe our findings related to the information-seeking behaviors among people with disabilities searching for assistive technologies. Organized around six pivotal questions, our focus groups and interviews provided valuable insights into the diverse aspects of a user’s engagement with AT. We explored the demographics of AT use, elucidated the specific types of AT used, and discerned the criteria people employed when seeking information within a searchable catalog. Furthermore, our investigation delved into factors that rendered searches and database sites either user-friendly or challenging. This resulted in a more nuanced understanding of the interface design considerations crucial for optimizing accessibility. Lastly, we considered the deliberative processes people underwent before committing to the purchase of a system or technology to better understand the dynamics that shape decision-making. Thus, our analysis captures not only the richness of our findings but also offers a foundation for future research endeavors aimed at enhancing the information-seeking experience for people seeking guidance and information about the acquisition and uses of assistive technologies.
3.1. Question 1: Who is using assistive technology?
Understanding the assistive technology (AT) landscape requires a comprehensive understanding of its diverse user base. Each AT user possesses unique needs influenced by their disability and individual contextual factors. Participants in our research describe complex, dynamic disability diagnoses that impact daily activities, and emphasize the need for adaptable and evolving AT tools. Importantly, AT use extends beyond long-standing disabilities, addressing temporary impairments resulting from injuries, surgeries, or mobility issues. Users facing changing functionality seek quick access to AT solutions to minimize disruptions in their daily lives. Within this diversity, people pursue various goals with their AT, such as performing job tasks and daily activities, participating in hobbies, maintaining social connections, and enjoying entertainment. The demand for AT is as varied as the users themselves, prompting a call for adaptable and personalized solutions catering to multiple purposes, needs, and environments. In fact, many participants view AT as a facilitator for overcoming communication barriers, enabling seamless online shopping experiences, and enhancing daily activities. This focus shifts the emphasis towards empowering access rather than merely applying the tools to address disability-related challenges.
Considerations surrounding potential stigmas associated with specific challenges, such as psychiatric disabilities and mobility needs, significantly shape AT usage patterns. Some participants express reluctance to use ‘obvious assistive technology,’ preferring tools that resemble mainstream devices like smartphones and tablets. Additionally, not all users identify explicitly as people with disabilities, particularly when needs fluctuate with different treatments and contexts. The association between AT and disability can be limiting, hindering those with non-visible disabilities from seeking relevant tools and professional guidance.
There are challenges in determining whether people with congenital disabilities are more likely to use AT than those with acquired disabilities. While those with acquired disabilities often receive formal healthcare resources, including vocational rehabilitation, those with congenital disabilities develop a longer-running routine of seeking technology solutions. However, practitioners do note a confidence disparity, with those acquiring disabilities being less comfortable using complicated technologies than those with congenital disabilities who build competence over an extended period.
Consistent with Scherer both practitioners and users advocate for a shift in AT information focus, emphasizing matching tools with specific challenges rather than relying on disability labels [43]. Users report inappropriate recommendations based solely on labels, emphasizing their need to move towards activity-driven recommendations. Such a shift promises to connect more people with tools most suited to their needs, enhancing the relevance and accessibility of AT for a diverse user base.
3.2. Question 2: What kinds of assistive technology are being used?
The results of our focus groups shed light on the vast array of assistive technology (AT) devices commonly used by people with disabilities and the specific types of information they seek. As an example, for people who are blind or have low vision, screen readers, braille displays, and audio output devices are identified as critical tools for accessing digital content and information independently. Participants also express interest in navigation and orientation applications for smart devices that provide audio cues or tactile feedback to enhance mobility. These users often seek information regarding the latest advancements in screen reader software, accessible mobile applications, and technologies that facilitate reading printed materials, such as optical character recognition and digitization services.
For people who are Deaf or hard of hearing, the focus groups reveal a firm reliance on video relay services, live captioning, and text messaging applications to communicate effectively. Many participants desire AT solutions for real-time transcription and captioning services, particularly for video content. Additionally, they seek information regarding assistive listening devices, such as amplifiers and speakers, and innovations in captioning technology to ensure seamless access to audiovisual content.
For people with psychiatric disabilities, the focus groups highlight a growing interest in mental health apps that offer coping strategies, mood tracking, and self-management tools. Participants emphasize the importance of privacy and security features, given the sensitive nature of mental health data. Furthermore, there is notable interest in telehealth services for remote support sessions with providers, many of which are assisted by technology for access and engagement. These mentions underscore the importance of accessible and reliable mental health resources.
For people with physical disabilities, the focus groups highlight the importance of compatibility, both between devices as well as with the needs and physical requirements and preferences of the user. Participants described the importance of using familiar access methods or their existing access tools (such as switches, joysticks, eye gaze, or tactile input/output) to access new technologies.
Overall, these findings underscore the diverse range of AT solutions that cater to the unique needs of people with various disabilities and the critical role that current information plays in facilitating access to helpful AT devices. There is no one-size-fits-all solution when it comes to AT, and it is essential to stay informed about the latest advancements in technology to ensure that people with disabilities have the best possible access to the tools they need to lead independent and fulfilling lives.
3.3. Question 3: What might you look for in a searchable product catalog?
Respondents, regardless of disability, agree on multiple characteristics that a searchable website of AT products should have. First and foremost, such a site should be accessible, particularly for, but not limited to, people with vision-related disabilities. For people who are blind, websites should be compatible with screen readers and refreshable Braille displays and provide alternative text for all graphical content. Tables should be managed accordingly, as well. For people who have low vision or other vision-related disabilities, text should be scalable, with additional features such as reverse contrast included. For people with upper body and dexterity impairments that might preclude the use of a mouse or other pointing device, the website should be accessible using keyboard input. While not explicitly stated, such a website should conform to established standards and guidelines, including Section 508 standards and the World Wide Web Consortium’s (W3C) Web Content Accessibility Guidelines (WCAG) 2.1.
In terms of content, a number of key themes emerged from the interviews and focus groups. Consumers consider cost and insurance coverage for devices to be a key factor. A product’s interoperability or compatibility with existing AT products is also considered an important factor. For people with cognitive disabilities, having features of the technology described in an understandable way makes them more confident about the compatibility and functionality of a potential device. Trustworthiness of the source is also a crucial issue among respondents, who note that an AT products’ database should include authentic and real reviews of the products in question from actual users and, where possible, photos or videos of the product in use.
3.4. Question 4: What makes searches/sites/databases easier to use?
Research findings on factors contributing to the ease of use in searches, sites, and databases reveal a strong dependence on individual impairments and the corresponding assistive technologies employed. The ease of use is frequently impairment-dependent, with users’ functional abilities and the support provided by sites playing a crucial role. This dependency is particularly evident among individuals who are blind, utilizing either refreshable Braille displays or text-to-speech features. Websites must be coded to support these capabilities effectively, highlighting the importance of accommodating diverse needs in web design.
Another key aspect is the focus on access. Users emphasize the need for sites to be modifiable and flexible, allowing for customization within the site to enhance usability. The concept of optionality is a critical factor, indicating that users value platforms that offer choices and adaptability to suit their preferences and needs. This modifiability within sites is seen as a significant contributor to improved user experiences, especially as it relates to operability with external access device navigation such as joysticks or eye gaze for users with physical disabilities and preferred input tools. Moreover, responses highlight platform-specific preferences. Users, based on their impairments and AT, exhibit distinct preferences for certain platforms. They emphasize the importance of understanding and catering to the diverse needs of users across different platforms. Recognizing and addressing these platform-specific preferences will significantly contribute to creating an inclusive and user-friendly online environment for an assistive technology database.
3.5. Question 5: What makes searches/sites/databases more difficult to use? (barriers to information searching)
The findings from these focus groups shed light on three primary barriers to AT information searching. One prominent issue continues to be website formats that hinder user accessibility, especially for blind and low vision users. For example, relentless advertisements, pop-ups, and unlabeled website components create challenges for screen reader users, rendering the information more difficult and frustrating to access. One participant noted that, “The more advertising there is and the more peripheral stuff there is to wade through to get to what where the results are, the worse it is …and I’m always happy when I don’t have to wade through articles that have ads in between paragraphs that you have to sift through …Sometimes I use the Immersive Reader in Microsoft Edge to avoid some of that.”
While sometimes useful, pop-up virtual assistants generally interfere with relevant information gathering for those using screen readers and read-aloud features. These issues compound the difficulty of finding critical details about ATDs, including compatibility, troubleshooting information, and reliable user reviews. Another barrier that participants note is the lack of flexibility and simplicity in making information presentation more difficult to navigate. Outdated product catalogs, unmoderated content, and convoluted website organization are highlighted as problems that obscure helpful information. For example, “I have some assistive technology groups on there (Facebook) . . . Not only do you have to search them out, but you have to figure out how to navigate the web pages. And they’re horrible!”
These issues directly affect websites’ ease of use and intuitive nature, forcing users to wade through irrelevant or distracting content, thus increasing the physical and cognitive effort required. While much discussion on ease of use and intuitive site design came from people with vision impairments, the distracting nature of irrelevant content and disorganization also negatively impacts users with cognitive disabilities, who may prefer to leave the website if it is difficult to determine which information is important and which is interfering. The findings underscore the importance of making information about ATDs more accessible and straightforward to navigate, promoting a trial-and-error approach, and facilitating user experiences with AT searches, try-outs, and reviews.
Moreover, the focus groups reveal that participants often turn away from standard search engines such as Google towards alternative options like Edge and DuckDuckGo, which often help individuals overcome these challenges and find more relevant search results for their needs. This practice demonstrates the importance of providing flexible options and alternatives in information searching. Addressing these barriers may significantly enhance the usability of searches, sites, and databases, making them more inclusive and equitable for all users, especially across users with diverse disabilities.
3.6. Question 6: What do you consider before making a purchase?
When people contemplate making an Assistive Technology (AT) purchase, our focus groups discussed the various factors that come into play. Cost considerations play a pivotal role in the decision-making process. Participants carefully weigh the costs and benefits, justifying the purchase of expensive devices if they 1) deliver on their promises, 2) have multiple uses, and 3) are regularly used. Users want assurance that their investment will enhance their lives significantly enough to justify the cost. Other cost-related factors, such as the availability of replacement parts, repair services, and refund options, also influence their choices. Additionally, the ease of navigating funding sources and applications for expensive devices emerge as crucial to the decision-making process, reflecting the importance of an accessible and straightforward application process. As one participant asked, “is it fairly easy to learn? Although I’m not averse to learning something that’s difficult if it’s going to really do me some good …Will this product actually make my life a little bit easier or will I have fun using it?”
The following critical considerations for most participants relate to compatibility with other devices, such as computers and accessories. Users prioritize seamless integration with their existing technology ecosystems to ensure efficiency in daily tasks. Battery life is another vital aspect, emphasizing the need for dependable and long-lasting power sources to avoid disruptions. Repair and servicing availability also emerge as a significant concern. Users seek trust from vendors and manufacturers in the form of reassurance that the AT device they invest in can be maintained and repaired promptly. Furthermore, participants stress the importance of user-friendly setups. They also strongly favor a “try before I buy” option, emphasizing the need for hands-on experiences to ensure the device aligns with their needs and preferences, and which is reasonably intuitive to use. Overall, our focus group findings provide valuable insights into the multifaceted needs and concerns of individuals seeking information about AT and its uses before for making purchase decisions.
4. Discussion
Discussions on the accessibility of websites for individuals using screen readers to explore assistive technology (AT) uncover a crucial theme – the paramount role of trustworthiness in decision-making. Both practitioner and AT user focus groups highlight the complexity of determining source trustworthiness, with contributors’ disability types significantly influencing credibility. Users prefer information from people with similar disabilities, citing platforms like AppleVis as especially trustworthy due to ratings and reviews by users with visual impairments. Networking and community-building emerge as vital determinants of trust, providing firsthand insights and recommended resources. Establishing connections with trustworthy salespeople and vendors, both online and in-person, ensures a reliable network familiar with specific needs and current technology preferences. Trustworthiness discussions extend to source credibility, with Facebook seen as a valuable community-building tool but not a credible source for AT information. Reviews on various platforms play a pivotal role, with insights from peers holding greater weight than professional reviews that lack shared lived experiences.
Hands-on experiences and demonstrations emerge as invaluable tools for potential users. This work confirms how tactile engagement and firsthand exposure to AT functionalities significantly contribute to informed choices [35]. One participant who is blind says “for me to get to Boston is over 2 hours, almost three hours on the bus, so that I don’t really have access to those lovely stores where I could go and play with things. And you know, and it’s true that there are agencies [vendors] that will come to my house and show me technology.” Another notes the advantages of living near universities and colleges, saying, “you may not have the stores, but there may be colleges and universities in your town people are doing research there and you can be a part of that.”
Recognizing the importance of hands-on experiences for informed AT purchasing decisions, especially for those in rural areas without easy access to support services, we propose integrating accessible content alternatives. Video demonstrations, accompanied by detailed audio descriptions, can serve as a solution, bridging the accessibility gap and empowering potential AT users geographically distant from vendors. This enhances the field’s understanding of why direct experiences with technology may be so crucial for decision-making, and how an informational database could serve as an important resource for those in rural areas without hands-on access [23, 24]. This approach ensures a more comprehensive understanding of AT features and functionalities, fostering informed decision-making in the absence of traditional hands-on experiences.
The study findings underscore the need for more accessible and user-friendly information about AT devices (ATDs). Training and information dissemination for rehabilitation professionals and service providers are crucial, and for helping individuals with disabilities understand their ATD options and make informed purchasing decisions. The importance of hands-on experiences is evident in the challenges participants routinely confront online, especially in rural areas, that underscore the need for alternative accessible content solutions. The intersection of trustworthiness, networking, and hands-on experiences in AT information-seeking and making purchasing decisions emphasizes the multifaceted nature of this process and demands a more comprehensive and inclusive approach to support potential users in their journey towards finding and adopting assistive technologies.
A key strength of this research is the multi-stakehold-er perspective of the kinds of AT information different stakeholders search for. Another strength lies in the ability of users to gather multiple perspectives based upon their own specific functional abilities and desired uses for the technologies. While the study contributes valuable perspectives, several limitations warrant consideration. The sample, while rich in depth, may not be fully representative of the broader population of people with disabilities who utilize AT. Additionally, the study primarily focuses on preferences and experiences within social networks, and the generalizability of the findings to wider community settings may be limited. Furthermore, the research emphasizes preferences at a specific point in time, however the dynamic nature of technology and information dissemination suggests that preferences may evolve over time.
Algorithms, based upon large data sets, and the predictive analytics they provide, have been suggested as a means for making AT recommendations. However, such decision support tools are highly aspirational, and in the absence of adequate outcomes-based evidence, will be difficult to realize. While the generation of such algorithms are beyond the immediate scope of this research, our broader ATNetwork project will collect and analyze, quantitatively and qualitatively, how individuals describe and characterize their AT needs, how well AT addresses users’ needs and expectations, and any remaining unmet needs or expectations. ATNetwork’s planned online community of practices may be understood in this manner as a directed form of “crowdsourcing,” in the sense that that the research efforts of a group of people with varying opinions, when aggregated, can result in better information than a specific expert could come up with. These activities will eventually inform research and development into decision support.
5. Conclusion
In conclusion, this study took a deep dive into the preferences of end users regarding the provision and receipt of information, knowledge, and peer support for the adoption and use of assistive technology. The focus groups provided valuable insights into the multifaceted dynamics within social networks that contribute to the knowledge-sharing process among individuals with disabilities. Participants articulated their preferences for information sources, highlighting the significance of peer-generated content and the trust derived from shared experiences within specific disability communities. The findings underscored the importance of understanding the diverse needs and preferences of end users in shaping effective AT interventions.
As we move forward, the identified limitations offer avenues for further investigation. Future research should aim to expand the diversity of the sample to ensure broader inclusivity and explore variations in preferences across different disability communities. Additionally, longitudinal studies could capture the evolving nature of preferences and information-sharing practices over time. This study’s findings lay a foundation for the establishment of a community of practice, wherein ongoing dialogues and collaborations can address emerging needs and trends in AT use. This community-based approach promises to enhance the relevance and sustainability of AT interventions by fostering collective learning and support networks among individuals with diverse abilities and experiences.
Author contributions
Julie Eshleman: Analyzed and interpreted data; planned and wrote the original manuscript and core content; synthesized feedback and edited manuscript; produced final manuscript.
Nathan Moon: Contributed substantially to the conception and design of the study; collected, analyzed, and interpreted data; conducted and wrote the background literature review; developed findings content; feedback and editing to late-stage manuscript.
Frances Harris: Contributed substantially to the conception and design of the study; collected, analyzed, and interpreted data; developed findings content; feedback and editing to late-stage manuscript.
Maureen Linden: Contributed substantially to the conception and design of the study; collected and interpreted data; contributed additional intellectual details to late-stage manuscript; provided feedback and editing supervision to final manuscript.
Ethical considerations
This research was conducted according to protocol H21245 Web-based Interfaces for Consumer Support for Assistive Technology (start date 08/27/2021) and protocol H23281 Online Community of Practice on Assistive Technology (start date 08/24/2023), approved by the Georgia Institute of Technology’s Institutional Review Board.
Footnotes
Acknowledgments
Thank you to all participants who contributed to this work and to Dr. Zerrin Ondin-Fraser, Johan Rempel, and Dr. Kelly Kolman for their contributions to conducting focus groups, data analysis, and critiques of this work.
Conflict of interest
There are no conflicts of interest from the authors in conducting this research. This work was funded by the United States’ National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) of the Administration for Community Living (ACL), Department of Health and Human Services (HHS) under grant number 90DPGE0015. The opinions contained in this paper are those of the grantee and do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.