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Designing 4 Disabilities

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  • My thanks to Judy for inviting me to talk to you today.
    I will give an overview of an area of research that I have focissed on, namely Disability Informatics.
  • <number>
    First, a little bit on my background…
    I am a former post-doc fellow in Medical Informatics at OHSU
    From there, OHSU Webmaster for 5 years
    Moved to the OIDD to lead their research program in Technology and People with Disabilities
    I have a couple of great videos I would like to share with you, some may have already seen them
    The first is one that aptly describes what it is like to manage a large Web site like OHSU…
  • Before I continue, I have to warn you that like most people in a specialized field, I have a tendency to get a little carried away with the technology and its acronyms so I want take this opportunity to interrupt me for clarification should I use a term that you are not familiar with
  • <number>
    And this is equally applicable to acronyms
    Information Technology professionals such as myself are notorious for dropping acronyms like they are going out of fashion
    But I think they are equally rivaled by academics who will massage project titles until they create a catchy sounding name derived from the first letters of each word
    So…if you see “Alphabet Soups” that are not explained, yell “Acronym Alert”
  • <number>
    To be sure that someone explains them to you
  • Defining disability is fraught with conflicting statements, different use and definition of the same terminology.
  • The WHO tries to distinguish different terms; impairment vs. disability vs. handicap
    In reality, handicap Is an older term that has fallen out of favor, become politically incorrect.
    Disability has remained PC, but must be used in a person first manner. Person with a disability vs. Disabled person.
    Impairment is often used to describe a milder disability state, I.e. one that does not severely impact the individual enough to be legally disabled.
    Many people have impaired vision but today, assistive technology such as eyeglasses, contacts and the latest surgery can compensate or even correct the impairment.
  • So what about people with disabilities? Well it is a larger population than you might think. Disability is broadly broken down into physical, sensory (vision &hearing) and cognitive.
    In 2000 Census, ~50 million people in the US reported having a disability.That’s 1 in 5 or 20% of the population. The US Census Bureau defines disability as “a health problem or disability which prevents [you] from working or which limits the amount of work that [you] can do” - fairly inclusive. Interestingly, 14 million people over 65 reported a disability, That’s 42% of the seniors in the US.
    US Census statistics also showed that 8.1 million people have a visual impairment, with 1.3 million qualifying as legally blind. But 1.5 million of them are computer users
    The National Center for Health Statistics determined that ~20 million people or 8.6% of the US has a hearing impairment
    And it is estimated that ~15 million people, or 7% of the US have a cognitive disability. Closer to 20 million if you include mental health problems or diseases.
    Basically there are a large number of people with a wide array of disabilities within the regular population. These need to be taken into account when designing and creating content for the Web.
  • <number>
    So what is Disability Informatics?
    Informatics is the science of information use
    Medical Informatics- health care professionals
    Information Retrieval – Literature, Web
    Electronic Health Record (EHR)
    Radiological image Management
    Consumer Health Informatics- patients and consumers
    Disability Informatics- people with disabilities and those that provide services to them
    Health Care- Clinical Assessment / Evaluation
    Rehabilitation
    Occupational therapy
    Physical therapy
    Special Education
    Assistive Technology
    Replace function (Sensory, Physical)
    Train / Restore function (Cognitive)
    Wrote chapter in recent book in Consumer Health Informatics
  • So, why should we care about people with disabilities…
  • Tim Berners-Lee who should not need any introduction, recognized this in his vision for the Web in that it should be accessible to all, and not discriminate based on a person’s ability or disability.
    You would think that given that we are creating the Web in a post-ADA world, we would be sensitive to accessibility and careful to create an accessible environment from the start.
    And yet, due to a lack of awareness or concern about Web accessibility issues, we are re-engineering access barriers into the online world just as we did in the physical. [stats on the percentage of accessible Web pages on the Internet]
  • One of the main motivations for me for doing research in this area is really to address the increasing digital divide between those who have access to the online world in the information age and those who do not.
    Be it the general public trying to access health information in 1995
    Or people with disabilities trying to access online information in 2002
    The irony of it all is also that this results in inverse information accessibility as noted by an medical informatics colleague of mine, Gunther Eysenbach. Those who could most benefit from the information find it the most difficult to access it.
  • And one of the main motivations for me to be working in this area is really to address the increasing digital divide between those who have access to the online world in the information age and those who do not. People with disabilities represent one of the disenfranchised groups from the Internet.
    People with disabilities are less likely than people without disabilities to be online (43% v. 57%), and are less likely to be online from work (16% vs. 30%) because far fewer are working (Krane et al., NOD / Harris Poll, 2000)
    Paradoxically, the Internet has the potential for a greater positive impact on the lives of adults with disabilities because it provides resources and information, as well as opportunities for socialization and support.
  • Section 508 of the Rehab Act
    Title II requires State/Local Governments provide equal access to programs and services
  • Tyler v. City of Manhattan (1994)
    Student with a disability sued a university for failure to provide the reasonable accommodations needed to participate equally in school. The court decided that ADA had been violated, in part, because of its response to students on a case-by-case manner.
    Hooks vs. OKBridge (1999)
    Person with cognitive disability filed suit after his membership to a online Bridge Web site was terminated. Dismissed as OKBridge was unaware of the individual’s disabilty.
    National Federation of the Blind vs. AOL (2000)
    NFB filed against AOL based on public accommodation (Title III). Similar cases against Barnes & Noble and the Claire's Stores. All cases settled out of court.
    The UC Davis and UC Berkeley Settlement
    Students contended that their rights under the ADA had been violated by not providing reasonable help to deaf and hearing-impaired students.
    In court settlement, the two universities agreed to improve services for hearing-impaired and deaf students, to pay each of the five students in the suit $10,000, and to pay $1.1 million in lawyers' fees, but they did not admit fault.
    Southwest Airlines vs. Robert Gumson and Southwest Airlines vs Access Now (2002)
    individual who was blind sued under Title II since he was not able to effectively purchase an online ticket and that excluded him from special Web-only fares not available over the phone
    Surprisingly, the Judge ruled that the ADA public accommodation provisions apply only to physical spaces, such as restaurants and movie theaters, and not to the Internet.
    Martin vs. MARTA (Metropolitan Atlanta Rapid Transit Authority)
    Individuals sued MARTA claiming it failed to "make information available to people with disabilities" because they were unable to secure routes and schedules from their Web site (Title II - "effective communication”). MARTA countered that the plaintiffs could call for this information during business hours or ask ahead of their need and MARTA would print up Braille schedules.
    The Judge ruled that MARTA was, in fact, violating the provisions of the ADA.
    Spitzer Agreement (2004)
    New York State Attorney General Eliot Spitzer announced settlements with two major travel Web sites (Ramada.com, Priceline.com) that will make the sites far more accessible to blind and visually impaired users.
    National Federation of the Blind (NFB) vs. Target (2006)
    Settled out of court. $6million in damages, Target made website accessible
  • The principle of Universal Design
  • Universal design has 7 guiding principles
    Equitable Use: The design is useful and marketable to people with diverse abilities.
    Flexibility in Use: The design accommodates a wide range of individual preferences and abilities
    Simple and Intuitive Use: Use of the design is easy to understand, regardless of the user's experience, knowledge, language skills, or current concentration level
    Perceptible Information: The design communicates necessary information effectively to the user, regardless of ambient conditions or the user's sensory abilities.
    Tolerance for Error: The design minimizes hazards and the adverse consequences of accidental or unintended actions.
    Low Physical Effort: The design can be used efficiently and comfortably and with a minimum of fatigue.
    Size and Space for Approach and Use: Appropriate size and space is provided for approach, reach, manipulation, and use regardless of user's body size, posture, or mobility.
    These can equally be applied to the Web with the possible exception of #7.
  • >1990 – Terminal (TTY), Dial-up (Modems)
    1990-5  Graphical User Interface (GUI)
    Images without text description
    Barrier to people who are blind
    2000-5 Dial-up  Broadband (Cable, DSL)
    BB reaches critical mass in 2004
    http://www.pcw.co.uk/news/1157453 - Nielsen / NetRatings - >50% US Households
    http://www.connectedhomemag.com/HomeOffice/Articles/Index.cfm?ArticleID=42357 - InStat/MDR - >20%
    Video without text description
    Barrier to people who are deaf
    Today  Media Convergence
    Rich, complex Web interfaces
    Barrier to people with cognitive disabilities
  • Wherever possible, normal text is preferred to images with text since they can be spoken, and also enlarged by the browser for low vision users.
    Using alternate text, or ALT tags, is one of the easiest steps to take to make images & animations accessible to the blind, particularly when an image is used as a hypertext link or an image map.
    The more challenging problem is appreciating the linear nature in which the voice browsers operate and that graphically pleasing pages are often difficult or impossible to navigate. However, with a little foresight is design, it is often possible to avoid this.
    Tables are also a source of confusion when read line by line but there are techniques for improving the “speakability” of these as well.
  • Problems due to color blindness can be discovered by simply viewing graphics in black & white to ensure sufficient contrast in the color value. This principle also provides a good indication of the readability of colored text on a colored background.
  • Problems due to color blindness can be discovered by simply viewing graphics in black & white to ensure sufficient contrast in the color value. This principle also provides a good indication of the readability of colored text on a colored background.
  • Understand limitations of validation tools
  • Validate code to W3C standards.
    Validate both CSS and HTML/XHTML
    The WAVE validator is useful to linearize tables
    A-Prompt is a free downloadable tool to validate and fix errors for an entire website
    Bobby is now owned and marketed by Watchfire – it’s use as a free tool is limited
  • Accessibility is an approach to design, not a stamp of approval
    Emerging standards continue to make the Web accessible – stay tuned to new tools and best practices
    Separating content from layout is an essential strategy for accessible design
    Competing standards and different ideas about “accessibility” are widespread – do your best!
    Avoid retrofitting by planning for accessibility
  • <number>
    A wealth of accessibility information exists on the web – find it using google.com
    WebAIM.org is an excellent one-stop source for accessibility information
    The National Center on Accessible Media is another excellent resource
    Making Educational Software and Website Accessible
    Regional ADA Centers: 1-800-949-4232
  • Transcript

    • 1. Presented on Friday 11th September, 2009 Designing for Disabilities Richard J. Appleyard, PhD Clinical Assistant Professor, Medical Informatics, OHSU Business Technology Manager, City of Portland Holistic Technology Guru
    • 2. My Background • Webmaster, Oregon Health & Science University, www.ohsu.edu , appleyar@ohsu.edu • Director Disability Informatics, Oregon Institute on Disability & Development, www.oidd.org • Web Development Instructor, PSU • Holistic Technology Guru, www.enablingit.com , richard@enablingit.com • Business Technology Manager, Bureau of Development Services, City of Portland, www.portlandonline.com/bds
    • 3. Herding Cats
    • 4. Acronym Soup •If YDNUTA, •then AMAQ
    • 5. Acronym Soup •If You Do Not Understand The Acronym •then Ask Me A Question
    • 6. Overview • What are disabilities? • Why care about them? • How do I design technology for people with disabilities? • How do I design websites for people with disabilities? • What tools can I use in accessible Web design
    • 7. Defining Disability What are disabilities?
    • 8. Audience Poll • How many people have a disability? • How many people – have glasses/contacts? – have had corrective eye-surgery?
    • 9. World Health Organization • “An impairment is any loss or abnormality of psychological, physiological or anatomical structure or function; a disability is any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being; a handicap is a disadvantage for a given individual, resulting from an impairment or a disability, that prevents the fulfillment of a role that is considered normal (depending on age, sex and social and cultural factors) for that individual”
    • 10. Person:Environment
    • 11. Prevalence of Disability Disability Estimated Size (US population) Source Self-reported disability (unable to perform ADLs) ~50 million (20%); ~14 million > 65y (42%) U.S. Census Bureau, 2000 http://www.census.gov/main/www/ cen2000.html Visual Impairment 8.1 million (3.2%) 1.3 million legally blind 5 million > 65y (1 million severely) U.S. Census Bureau, 1994-95; U.S. National Center for Health Statistics, 1994,1995 Hearing Impairment ~20 million (8.6%), ~30 million > 65y (29%) U.S. National Center for Health Statistics. Vital Health Statistics, 1990-91 Cognitive Disabilities (MR, Brain Injury, Dementia / Alzheimer’s) ~15 million (~7%) ~20 million (8.6%), including Mental Health U.S. Census Bureau, 1990; NIH, 1998; BIA; Alzheimer's Association, 2003; Arc, 2004
    • 12. Disability Informatics “The discipline of science that researches the development and use of information, telecommunications and information technology, such that benefits may be derived from that information by the users, and more specifically people with disabilities”
    • 13. Rehabilitation Physiatry AAC Special Education Informatics Medical Public Health Consumer Health Bioinformatics Assistive Technology Interface of Fields Disability Informatics
    • 14. Importance of Accessibility Why Care?
    • 15. Web Accessibility "The power of the Web is in its universality. Access by everyone regardless of disability is an essential aspect." -Tim Berners-Lee, W3C Director, inventor of the World Wide Web
    • 16. Inverse information law “…access to appropriate information is particularly difficult for those who need it most.” –Gunther Eysenbach (BMJ, 2000)
    • 17. Digital Divide - Computer UsePercentageof workingageadults http://www.microsoft.com/enable/research/ (2003)
    • 18. Adapted from online article in Digital Web magazine, RIP! Excuses for Lack of Accessibility • It’s not something [we] want to think about • It is not really required (reasonable accommodation) • It’s the law but there’s none to follow • There is no immediate benefit • It’s just a technical problem • It’s too much work (reasonable accommodation) • It seems like a party pooper • Nobody complains / No students with disabilities • There is no leader to follow
    • 19. Web Accessibility Laws • Rehabilitation Act (1973, 1998) – Section 508 (June 25, 2001) requires federal agencies Web sites to be accessible • Americans with Disabilities Act (1985) – Title I: Employment – Title II: State/Local Government activities – Title III: Public Accommodations
    • 20. ADA Legal Cases • Tyler v. City of Manhattan [student] (1994) • Hooks vs. OKBridge [cognitive] (1999) • Natl Federation of the Blind vs. AOL [Title III] (2000) • The UC Davis and UC Berkeley Settlement [deaf students] (1999) • Southwest Airlines vs. Robert Gumson and Southwest Airlines vs Access Now [blind user] (2002) • Martin vs. MARTA (Metropolitan Atlanta Rapid Transit Authority) [Title II] (2002) • Spitzer Agreement / Travel Web sites [Title III] (2004) • National Federation of the Blind (NFB) vs. Target (2006)
    • 21. Web Developer Accessibility Survey • 55% of Web developers do not use Web development standards • Of the 45% that do, Only 20% use Web Accessibility guidelines or requirements  still a lack of awareness of the importance of Universal Web Design – Internet Professionals NW, May 2005
    • 22. Designing Accessible Technology How do I design technology for people with disabilities?
    • 23. Universal Design “The design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design” (The Center for Universal Design, NC State University)
    • 24. http://www.design.ncsu.edu/cud/about_ud/about_ud.htm Principles of Universal Design • Physical Environment – Equitable Use – Flexibility in Use – Simple and Intuitive Use – Perceptible Information – Tolerance for Error – Low Physical Effort – Size and Space for Approach and Use • Computer/Web Environment – Equitable Use – Flexibility in Use – Simple and Intuitive Use – Perceptible Information – Tolerance for Error – Low Physical Effort – Independence of computer platform / user agent or device / assistive technology
    • 25. Assistive Technology “any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities” – AT Act of 1998 (Section 508)
    • 26. Computer Assistive Technology (AT) • Input – Alternative, adaptive keyboards – Touch screens, tablets – Joystick, Trackball, Switch – Eye/Head tracking – Speech recognition
    • 27. [On/Off] Switch On-screen Keyboard
    • 28. Computer Assistive Technology (AT) • Output – Screen magnification – Print/refreshable braille – Speech synthesis
    • 29. Accessible Web Design How do I design websites for people with disabilities?
    • 30. Web History Accessibility Perspective • <1990 – Terminal (TTY), Dial-up (Modems) • 1990-5  Graphical User Interface (GUI)  Images without text description  Barrier to people who are blind • 2000-5 Dial-up  Broadband (Cable, DSL)  Video without text description  Barrier to people who are deaf • 2005-present  Media Convergence  Rich, complex Web interfaces  Barrier to people with cognitive disabilities • 2008-present  Mobile Web  Smartphones (Browser diversity)
    • 31. Principles of Universal Web Design Web Content Accessibility Guidelines (v.2, due Spring 2005….delivered December 2008!) 1. Perceivable. Ensure that all intended function and information can be presented in form(s) that can be perceived by any user - except those aspects that cannot be expressed in words. 2. Operable. Ensure that the interface elements in the content are operable by any user. 3. Navigable. Facilitate content orientation and navigation. 4. Understandable. Make it as easy as possible to understand the content and controls. 5. Robust. Use Web technologies that maximize the ability of the content to work with current and future accessibility technologies and user agents. http://www.w3c.org/WAI/
    • 32. Visual Impairments • Text is preferred to images • Adjustable font preferred to fixed font • Alternate text for images / visual content • Adjusting for linear processing – nature of text-to-speech browsers (JAWS) • Use CSS for layout instead of Tables • Accessible Tables & Forms
    • 33. Color Blindness • Affects 8 to 12% of males of European origin and about half a percent of females • Avoid using color to indicate something specific on a Web page • Avoid using red and green colors together • View Web pages desaturated (in grayscale) in order to determine their effectiveness
    • 34. Color Blindness • Affects 8 to 12% of males of European origin and about half a percent of females • Avoid using color to indicate something specific on a Web page • Avoid using red and green colors together • View Web pages desaturated (in grayscale) in order to determine their effectiveness
    • 35. Hearing Impairments • Initially not as badly impacted since the Web is a very visual environment • However, the Web is increasingly rich with multimedia and video with audio tracks – Transcripts of audio and sub-titles to video are needed to make them accessible (Section 508) – This will also be of benefit to • Speakers of other languages • Internet devices that are not sound equipped.
    • 36. Mobility Impairments • Many users have difficulty using the mouse and keyboard • Addressed by assistive technology (AT) hardware and software • It is worth being sensitive to mobility issues – avoid long navigation sections before main content, provide a “skip to main content” link – avoid image maps with extremely fine positioning, – always ensure that Web page elements can be navigated by keyboard (such as client-side image maps, Java, ActiveX)
    • 37. Cognitive Impairments • There are many types of cognitive impairments ranging from – severe, e.g., Alzheimer’s – mild reading and learning disorders • Few accessibility guidelines for cognitive disabilities – Lack of user interface research and empirical data • Benefit from general “usable” site design – maintaining the content at a 6-8 grade school level – the use of icons graphics and multimedia that aids in understanding http://www.webaim.org/articles/cognitive/
    • 38. The Web Challenge • Accessibility requirements for one group of users often conflicts with those for another, – Sensory disability, Cellphone, Search Engine emphasis on text-based – Cognitive or Learning disability, low literacy emphasis on image/video/multimedia- based
    • 39. Accessible Web site http://www.webaim.org/
    • 40. Inaccessible Web site http://www.fluwatch.com/ (RIP!)
    • 41. Web Design Tools What tools can I use in accessible Web design?
    • 42. HTML Validation • Many checks can be done without tools – Turn off images, sounds, and style sheets – Test site with a text browser/alternate devices – Consult users with disabilities – Set monitor to black & white But Watch Out! • Many checks cannot be performed by tools – Utility of ALT text
    • 43. Validation Tools • Built-in to many development tools – e.g., Dreamweaver • W3C HTML validator – http://validator.w3.org/ • WAVE (WebAIM) validator FREE – http://wave.webaim.org/ • A-Prompt (W3C) FREE – http://www.w3.org/People/Raggett/tidy/ • Bobby (Watchfire) – http://www.cast.org/products/Bobby/
    • 44. Web Browser Toolbars • Web Developer Extension (Firefox) http://chrispederick.com/work/firefox/webdeveloper/ • Web Accessibility Toolbar (IE) http://www.visionaustralia.org.au/ais/toolbar/
    • 45. JAWS • Full interface control – Windows OS – Many applications • Version 7.0 • Expensive – $900 - $1300 • Demo version available – 40 minute limit http://www.freedomscientific.com/fs_products/software_jaws.asp
    • 46. Perform Usability testing • Involve users early and often • Use an iterative process – design, test, design, test, etc. • Test early and often – The earlier usability issues are discovered… the easier and cheaper it is to fix them • Usability tests do not have to have huge samples of participants – using 5 testers -> 85% of the usability problems – using 1 tester with a screen reader -> 100% of the accessibility problems
    • 47. Final Thoughts • Accessibility is an approach to design, not a stamp of approval • Separating content from layout is an essential strategy for accessible design • Emerging standards continue to make the Web accessible • Many competing standards and different ideas about “accessibility” • Avoid retrofitting by planning for accessibility, awareness is the first and most critical step
    • 48. Building Airplanes
    • 49. Additional Resources • W3C Web Accessibility Initiative, www.w3c.org/WAI • WebAIM (Accessibility in Mind), www.webaim.org • Information Technology Technical Assistance and Training Center (ITTATC), www.ittatc.org • National Center on Accessible Information Technology in Education (ACCESS-IT), www.washington.edu/accessit • National Center for Accessible Media, ncam.wgbh.org – Accessible Digital Media, ncam.wgbh.org/publications/adm • Regional ADA Centers: 1-800-949-4232 • Useit.com (Nielsen), http://www.useit.com/alertbox/9706b.html • Google, www.google.com
    • 50. Thank you! Richard Appleyard appleyar@ohsu.edu richard@enablingit.com

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