Disability and Rehabilitation: Assistive Technology

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Expounding the rehabilitation service for acquired

visual impairment contingent on assistive
technology acceptance

Chung-Wei Russ Kan & Chung-Yen Wang

To cite this article: Chung-Wei Russ Kan & Chung-Yen Wang (2020): Expounding the
rehabilitation service for acquired visual impairment contingent on assistive technology acceptance,
Disability and Rehabilitation: Assistive Technology, DOI: 10.1080/17483107.2019.1683238

To link to this article: https://doi.org/10.1080/17483107.2019.1683238

Published online: 04 May 2020.

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DISABILITY AND REHABILITATION: ASSISTIVE TECHNOLOGY
https://doi.org/10.1080/17483107.2019.1683238

ORIGINAL RESEARCH

Expounding the rehabilitation service for acquired visual impairment contingent

on assistive technology acceptance
Chung-Wei Russ Kana and Chung-Yen Wangb
a
Digital Education Institute, Institute for Information Industry, Taipei City, Taiwan; bNational CareTech Association, Taipei City, Taiwan

ABSTRACT ARTICLE HISTORY

Purpose: Globally, approximately 285 million people have visual impairments, with over 39 million peo- Received 1 July 2019
ple having full blindness. Beginning in the late nineteenth century, assistive devices such as service dogs, Revised 12 October 2019
braille reading devices, and white canes have aided those with visual impairments. From the immense Accepted 17 October 2019
development of technology over the past two decades, traditional assistive devices have been supple-
KEYWORDS
mented with more technologically innovative assistive technologies. Despite this technological growth, Assistive technology;
many people with visual impairments have chosen to forgo the use of assistive technologies and con- accessibility design;
tinue to use traditional assistive devices instead. glaucoma; continental
Materials and Methods: We have devised a series of surveys and questionnaires to study the views of visual impairment; acquired
those with visual impairments towards assistive technologies. Our survey was given to 568 visually visual impairment
impaired people in Taiwan both in person and electronically; the data was cross-referenced with the
demographic information of the surveyors to find the disparities in user-preferences amongst different
levels of visual impairment, age, household income, and other demographic factors.
Results: Results drawn from the data concluded that while there was a large variation in whether or not
participants used assistive technology, those that did indicated that assistive technologies were purchased
to help them live life more independently.
Conclusions: While assistive technology provides a beacon of hope for the visually impaired to live more
independent lives, the data indicated that many visually impaired people were not aware of the new
assistive technologies and devices that have been entering the market; furthermore, many visually
impaired people are of lower income, and therefore cannot afford the technology.

ä IMPLICATIONS FOR REHABILITATION

 Determining differences between congenital and acquired visual impairments, and comparing how
the two types of visually impaired users have preferences over the assistive technology and devices
that they utilise.
 Experience of life without visual impairment disincentivizes visually impaired people from purchasing
new assistive technologies, whereas the appeal of an independent lifestyle incentivizes it.
 The visually impaired tend to purchase assistive technologies to operate rehabilitation more effect-
ively, and the use of assistive technology and assistive devices, respectively, encourage future partici-
pation in rehabilitation.
 Marketability and cost of assistive technologies are the largest deterrents from visually impaired users
from buying new technologies.

Background visually impaired people from utilising new technology such as

fear of security threats and afflictions with modern technology.
The purpose of our research is to understand the views and opin-
ions of visually impaired users in respect to assistive technologies From our demographics section we can better understand if cer-
and devices. Specifically, we would like to find what factors deter tain groups have stronger afflictions with assistive technology or
visually impaired users from purchasing and utilising new assistive assistive devices than other groups (congenital vs. acquired visual
technologies. We are not intending to use this survey as a impairments, older vs. younger age groups, lower vs. higher
method of gaining concrete user information, but rather to income groups, etc.). This demographic information, along with
glimpse into the lives of visually impaired people. Each of the the opinions of the surveyors will help for us to gain reasoning
questions asked, aside from the demographic section, are all sub- into the lives of visually impaired people.
jective and rely on honest feedback from the surveyors. This infor- To prepare for the study and questionnaire, and to best tailor
mation will help to understand what areas of assistive technology questions around our surveyors, we looked into numerous studies
are providing satisfying user experiences, and what areas could and references. The goal of looking through these references was
be improved upon to best aid the users. Additionally, we would to best understand the development of assistive technologies
like to know if there are inherent personal views that prevent from the turn of the century to today. Specifically, we used these

CONTACT Chung-Wei Russ Kan [email protected] Digital Education Institute, Institute for Information Industry, Taipei City, Taiwan; Chung-Yen Wang
[email protected] National CareTech Association, Taipei City, Taiwan
ß 2020 Informa UK Limited, trading as Taylor & Francis Group
2 C.-W. R. KAN AND C.-Y. WANG

resources to determine how the landscape of assistive technology conversely, in hypothesis three, we aim to find if people with vis-
development, public perception, and user experience has ual impairments purchase assistive technologies out of fear of the
changed over the past two decades. These references included unknown. Hypothesis four looks to see if the use of assistive tech-
sources from research studies, academic theses, textbooks, and nology and assistive devices, respectively, encourage future pur-
other published work. Having a range of sources helped us gain a chases of assistive technology. Hypothesis five looks to see
holistic view of both the challenges faced by people with visual whether robotic feedback or human-like feedback is more appeal-
impairments along with the technologies that are aiming to aid in ing to visually impaired users. Hypothesis six aims to find if assist-
solving those problems. The development of technology has not ive technology and assistive devices provide satisfying user
come in a linear path of constant progress, but has instead been experiences for their users. Lastly, hypothesis seven aims to
an area of imperfect innovation in which individual companies look at the marketability and cost of assistive technologies;
have developed their own products [1]. Additionally, each visually specifically, if cost and lack of advertising are the largest
impaired person has their own unique perspective and set of per- deterrents from visually impaired people from buying new
sonal needs and desires that can not be easily summed into gen- technologies. These hypotheses are not intended to limit the
eralization. These ideas are an important aspect of the study, as scope of information that can be derived from the survey nor are
we must look at our data, and the data of others, both numeric- they intended to express all possible reasons as to why some
ally and inquisitively. With this being said, from our sources, we visually impaired people are not accessing new technologies.
were able to find that the growth of technology has not necessar- Instead, these hypotheses act as guiding principles for the ques-
ily led to a substantial growth in the use of these assistive tech- tions and will help for us to formulate conclusions from the sur-
nologies. These initial observations and inferences from data have vey results.
led us to find the reasoning behind the lack of adaptation to
new technology.
Results
To find a large group of surveyors for our questionnaire, we
Materials and methods
offered the survey in both electronic and in person, face-to-face,
To research the topic of assistive technology, we found that a sur- formats to visually impaired people in Taiwan. The demographic
vey would be the most effective manner of delving into the user data for the survey showed fairly diverse data in terms of gender,
experiences of visually impaired people. The surveyors used in the age, educational background, employment, marital status, and
study all had some degree of visual impairment and voluntarily income. In total, we surveyed 568 visually impaired people, 213
agreed to take the questionnaire. The first section of the survey is male and 355 female. The demographic data showed a large
a demographics section which included questions regarding the spread in ages, with the majority of surveyors falling in the mid-
surveyors age, income level, level of visual impairment, whether dle age groups as the most prominent age group was 35-44 year
their condition was acquired or congenital along with other per- olds (201 people, 35.4%) followed by 18–24 year olds (118 people,
tinent information. We will utilise this information to show distinc- 20.8%). Our education level question showed us that the majority
tions between different groups of people to best understand our of people had completed some level of education, with 131 peo-
objective. This information can help guide future actions of assist- ple completing high school (23.1%) and 320 people completing a
ive technology providers to provide the best user experience to college/university degree (56.3%). Despite these relatively high
each visually impaired person’s needs [2,3]. In the following sec- figures, few visually impaired people went on to complete gradu-
tions, we derived approximately five to eight questions for each ate degrees with 31 people completing a master’s degree (5.5%)
hypothesis and have mixed the questions together to avoid hav- and zero completing a doctorate or PhD. In respect to professions
ing guided lines of questioning. The survey was largely comprised and job prospects of visually impaired people, a large percentage
of questions scaled from one to five along with one short answer of surveyors were unemployed and searching for a job (111 peo-
for each hypothesis. Each of the questions is aimed to understand ple, 19.5%) which nearly equalled the number of people with
the preferences and opinions of visually impaired users with gainful employment (142 people, 25%); other surveyors were stu-
respect to assistive technology. The information derived from the dents (120 people, 21.1%), in the military (60 people, 10.6%),
study, in conjunction with past research, will help to best under- unable to work (54 people, 9.5%), homemakers (41 people, 7.2%),
stand the views of visually impaired persons in regard to the tech- out of work while not actively searching new opportunities for
nology and devices that they utilise. Understanding this topic can labour (19 people, 3.3%), retired (12 people, 2.1%), or self
help aid others in creating products that can help these people employed (9 people, 1.6%). In terms of marital status, our data
live as well as possible. found that a large majority of surveyors were single, as only 107
Our survey comprised of ten demographic questions, thirty- people (18.8%), were currently married or in domestic partner-
three scaled questions on user preferences, and seven short ships. Income levels of those surveyed with visual impairments
answer questions to gain a holistic view of the opinions of visu- tended to be lower than the averages of people in Taiwan. Of
ally impaired people. In creating the survey, we chose to base our those surveyed, only two of the respondents (0.35%) reported
questions on a set of seven distinct hypotheses. These hypotheses earning 1,000,000–1,250,000 NTD (approximately
are aimed at finding what inclines or disincentives visually 33,330–41,670 US dollars) which was the highest earnings cat-
impaired people from purchasing new assistive technologies. Each egory. The most common response to the level of income ques-
of the hypotheses stem from the central question of understand- tion was that they were currently living off of government
ing why some visually impaired people are not inclined to adapt assistance (161 people, 28.3%); the majority of earners fell into
to new assistive technologies. Our first hypothesis aims to find if the lower income categories: 153 people earned 250,000–500,000
there is a distinct disparity between those with congenital and NTD (26.9%), 77 people earned less than 250,000 NTD (13.6%), 73
acquired visual impairments. In our second hypothesis, we looked earned between 500,000–750,000 NTD (12.9%), and 21 people
to find if people with visual impairments tend to purchase assist- reportedly earned 750,000–1,000,000 NTD (3.7%). Additionally, 81
ive technologies to help them operate more effectively; respondents (14.3%) noted that they have no income. These data
 ASSISTIVE TECHNOLOGY FOR THE VISUALLY IMPAIRED 3

figures helped us to gain insight as to the background of our sur- each of the questions [5,6]. In our study, these points tended to
veyors and from a larger perspective, some idea of demographic be closely grouped in the middle as there were no questions with
information about people with visual impairments. absolute agreement or disagreement. The minimum value
To supplement some general demographic data, we added a obtained from the survey was a 2.34 and the maximum was a
few questions that were specific for people with visual impair- 4.42. These values can be viewed both independently and in com-
ments. The first of which questioning whether their condition was parison with one another to see the responses to each question
acquired or congenital. 352 people noted that their condition was through quantitative measurement and deep analysis.
congenital (62%) and 216 had an acquired visual impairment
(38%). Additionally, our respondents had a range of visual impair-
Discussion
ments as 337 had severe levels of visual impairment, 135 had
medium levels of impairment, and 96 had low levels of impair- We were able to supplement our quantitative measurements with
ment. We also wanted to find how often people with visual qualitative information from our short answer questions. These
impairments utilise the internet on a daily basis. Our survey questions were posed to get more in depth information from our
recorded that none of our respondents avoided using the internet surveyors. This information can help to supplement our data to
completely and that our respondents used it in different levels. understand the lives of our surveyors in more intangible factors
The majority of people utilised the internet for more than three that did not come through in their demographic information or
hours a day, with many people using it for more than eight hours survey responses. The largest shortcoming in this form of ques-
a day. Our last question in the demographics section was more tioning is the lack of responses obtained from our surveyors.
opinionated and asked our surveyors to choose their level of pref- Because this survey did not rely upon paying our surveyors, we
erence between assistive devices and assistive technologies. The chose to make this section of the survey optional. This section of
responses were split fairly evenly, with the most common the survey had far less responses which inherently leads to a lack
response being indifference between assistive devices and assist- of complete information. It does not give an accurate representa-
ive technologies (219 people, 38.6%). Overall, more respondents tion of the entire group of surveyors and thus should not be con-
noted some preference to assistive technologies as 15% of people sidered a primary source of information. Nevertheless, this
swayed towards a preference of assistive devices, compared to information still has worth and can help to gain more insight into
46.4% of respondents that swayed towards assistive devices. the lives and opinions of visually impaired persons.
These specific questions to people with visual impairments
showed us that each surveyor is fairly different and that there is
Conclusions
no way to perfectly categorise people with visual impairments.
The demographic section of our study was only the first aspect The data retrieved from our questionnaire allowed us to more
of the survey; the larger aspect of the survey was surveying and fully comprehend the validity of our hypotheses. As noted earlier,
analysing the opinions of the visually impaired people. As noted the questions posed in the survey are based in the ideas of our
earlier, this section was largely comprised of scaled questions hypotheses and are intended to further our understanding of
from 1 to 5, with 1 representing strong disagreement and 5 repre- assistive technology, assistive devices, and the roles they play in
senting strong agreement. These questions gauged the opinions the lives of visually impaired people. The following research find-
regarding technology for those with visual impairment. These ings will follow in order from each hypothesis, followed by overall
numbers were thoroughly analysed to view overall trends in the conclusions from the survey.
views of people with visual impairments. Because much of the
study took place in person with polled voting, it was difficult to
Hypothesis 1
look at the data from a more narrow perspective in which we
could look at the opinions of certain groups. For example, we Our first hypothesis regarding differences in opinions between
could not look at the data of surveyors with certain demographic views of people with congenital and acquired visual impairments
traits as the polling took place in a less formal environment with was not answered by our data because we could not isolate
little technology in place. Nevertheless, the data pulled from the demographic factors when viewing the data. For this hypothesis,
survey can be used to find larger trends in the viewpoints of visu- we gave our surveyors brief descriptions of three new assistive
ally impaired people in regard to technology use [4]. technologies and asked how interested they would be in purchas-
Because of these inherent limitations, we looked at each ques- ing the technology. We intended on viewing this data from a split
tion from a generalised perspective, consolidating opinions to perspective of people with congenital impairments and acquired
median and mode values. Median values allowed us to best aver- impairments to note any differences [7]. We were not able to find
age the opinions of our surveyors and mode values allowed us to this information because most of our data came from polling.
easily see the dominant opinions regarding assistive technology Nevertheless, the information gained in this section helped guide
and assistive device use. To calculate the median values for each our opinions in later hypotheses and can be used in future stud-
of the questions, we totalled the number of responses for each ies regarding the purchasing tendencies of people with vis-
possible response (on our scale of one to five). After compiling ual impairment.
the data, we gave a multiplier for each of the responses corre-
sponding to its score; i.e., the number of people giving a score of
Hypothesis 2 and 3
1 would be multiplied by one, the number of people giving a
score of 2 would be multiplied by two. We then found the Our second and third hypotheses were inversely related as the
weighted median with our new values, and divided that by 113.6 former states that people with visual impairments tend to pur-
(This was calculated by dividing the total number of responses, chase new assistive technologies to solve their issues more effect-
568, by the number of possible answers to each question, 5). ively and the later states that people with visual impairments
From this we found our weighted median values between 1 and tend to purchase new assistive technologies out of fear. These
5 that could help to determine the average level of agreement to two hypotheses each had their own sets of questions, but can,
4 C.-W. R. KAN AND C.-Y. WANG

and should, be viewed together as the hypotheses are highly assistive technologies should enable both robotic and human voi-
interrelated. From the data, we found that both hypotheses have ces to accommodate all users. We wanted to expand upon this
some validity, but it appears that assistive technology does not question to understand our surveyors perception of current assist-
fully alleviate concerns of fear. The data shows that independence ive technologies. This was intended to find if components of
is very important to people with visual impairments [8], as most assistive technologies such as voice made users feel as if their
people agree or strongly agree that independence is their most needs were being adequately met. Most of our surveyors strongly
important value (median score of 4.28). Additionally, surveyors agreed that current assistive technologies put users’ needs first
found that assistive technologies generally aid their lives in living (median score 4.41). This was a very strong level of agreement
more efficiently and independently (median score of 3.79). when viewed in the context of other questions, and shows that
Visually impaired people have evident issues with living inde- visually impaired people needs are being met well by assistive
pendently and in many ways, assistive technology is seen as a technologies [12].
beacon of hope for living more independently. Despite these ben-
efits, it seems as though there are still large perceived risks and
fears that are not being completely alleviated. There was a high Hypothesis 6
level of agreement amongst surveyors that visually impaired peo- Building off of the questions of the fourth hypothesis, our sixth
ple are less secure while using the internet than people without hypothesis looked to further our understanding of our surveyors
visual impairments [9] (median score 4.01). When asked if assistive preferences regarding assistive technologies and devices. The
technologies have made their lives safer, visually impaired people questions for this hypothesis did not look to directly show
had fairly mixed answers but the average score still indicated that whether visually impaired people prefered assistive technologies
there was more disagreement than agreement (median score or assistive devices but instead looked into how they perceived
2.75). From our collected data, it appears as though visually each of the two. Surveyors strongly agreed that assistive technol-
impaired people tend to purchase assistive technologies more ogies are designed to be intuitive to use (median value 4.35) and
prevalently to live independently than to alleviate their concerns also found that they are generally not intimidated to purchase
as they do not find that assistive technologies mitigate their fears new assistive technologies. This further proved that visually
effectively. impaired users are in favour of assistive technologies and believe
that they are designed well [13]. To find any disparities between
Hypothesis 4 technologies and devices, we posed two statements: one noted
that “I am satisfied with the current assistive technologies on the
Our fourth hypothesis was intended to find if the use of assistive
market” while the other stated that “I am satisfied with the cur-
technologies and devices encourages visually impaired people to
rent assistive devices on the market”. Both of these questions gar-
use more assistive technologies and devices. The questions from
nered many responses of neither agree nor disagree and had
this section garnered very mixed responses from our surveyors as
nearly identical median scores of 2.87 and 2.88 respectively. These
most of the median scores were near three. Our first few ques-
responses somewhat contradict some of our earlier findings of
tions aimed to find if there was more of a preference to assistive
satisfaction with current products on the market, but nevertheless
technologies or assistive devices. The responses tended to indi-
prove that there is still room to improve the assistive technology
cate a general preference towards assistive technologies, with
and products for visually impaired people.
most people suggesting that they prefer to use both assistive
devices and assistive technologies in conjunction. We initially
believed that there would be a generally higher acceptance for Hypothesis 7
assistive devices as they are more traditionally accepted [10,11].
Our last hypothesis looks into some of the financial and market-
This proved to be false, as the surveyors tended to disagree that
ing reasons as to why visually impaired people do not access
assistive devices are easier to utilise than assistive technologies
more assistive technologies or devices. Our surveyors tended to
(median value of 2.44). When asked if surveyors prefer to utilise
agree that cost is the largest deterrent for them when purchasing
multiple assistive devices and technologies together, most agreed
with the statement, indicating some truth in our initial hypothesis new assistive technologies (median value 3.46). This sentiment
(mean value of 3.47). From this data, we generally found that was furthered in the following question in which surveyors
visually impaired people prefer to utilise assistive technologies tended to agree that they would purchase more assistive technol-
and devices together to find the most success. This shows us that ogies if the cost were to be reduced (median value 3.83). Along
visually impaired people have a wide range of problems that can- with the cost being a deterrent, it appears as though visually
not be easily solved with only one assistive technology or device. impaired people are not well aware of new assistive technologies
and devices that are entering the market. The surveyors tended
to disagree that they regularly hear advertisements for new assist-
Hypothesis 5 ive technologies and devices (median value 2.46). The data
Our fifth hypothesis aimed to find whether human feedback or obtained from the survey in this section validates our initial
robotic feedback was prefered for visually impaired people. This hypotheses and indicates that cost reduction or government aid
hypothesis was easier to validate than some of our other hypoth- for visually impaired people could help to increase sales and allow
eses as we could pose a more direct question to find their opin- visually impaired people to access more resources [14]. The demo-
ions. When we posed the statement: I prefer voice over graphic data found in the survey further backs this idea as the
technology that is robotic rather than a human voice, our sur- average income of people with visual impairments tends to be
veyors tended to disagree more than agree; this indicated that lower incomes of those without visual impairments. Additionally,
people generally prefer a human voice than a robotic voice the low amount of marketing to people with visual impairments
(median score 2.63). This question did not garner a very strong can further hinder the amount of assistive technologies and devi-
preference towards one or the other which could indicate that ces being purchased and utilised by visually impaired people.
 ASSISTIVE TECHNOLOGY FOR THE VISUALLY IMPAIRED 5

Acknowledgements Universal Access Handbook, Taylor & Francis; 2007. p.

369–385.
The authors would like to give a special thank you towards [8] Kane SK, Bigham JP, Wobbrock JO. Slide rule: making
Institute for Information Industry’s Digital Education Institute for mobile touch screens accessible to blind people using
supporting the authors in conducting this research, as well as multi-touch interaction technique. Proceedings of the 10th
thanking National CareTech Association for helping the authors international ACM SIGACCESS conference on computers
touch base with the disabled participants that filled out the ques- and accessibility; Scotia, Canada; 2008. p. 73–80.
tionnaire and survey. There was no funding during the conduc- [9] McGookin D, Brewster S, Jiang W. Investigating
tion of this research. touchscreen accessibility for people with visual impair-
ments. Proceedings of the 5th Nordic conference on
Disclosure statement human-computer interaction: building bridges; Lund,
Sweden; 2008. p. 298–307.
No potential conflict of interest was reported by the author(s). [10] Bonner MN, Brudvik JT, Abowd GD, et al. 2010. No-look
notes: accessible eyes-free multi-touch text entry. In:
Flore
en P., Kru
€ger A., Spasojevic M., editors. Pervasive com-
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