Comments on draft of Making content usable for people with cognitive and learning disabilities

Hello W3C task force,

Below are comments from PhD student Emma Dixon and myself based on our
research and our understanding of advocacy by people with dementia.



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   “3.2.2 Pattern: Use a Design that the User is Likely to Recognize and
   Understand” resonates well with our data, where individuals with dementia
   purposefully used older versions of software that had visuales and design
   they understood and recognized. For example, one person with dementia had
   his entire desktop formatted in a 1990s version of Windows, even though he
   was running a current version of the software. It may be worth noting that
   designs should match the mental model of users, which can sometimes
   involves previous versions of software.
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   “3.3.3 Pattern: Use a clear and understandable page structure” also
   resonates with our data. We found that people with dementia were able to
   continue to use recipe websites, even though they were visually
   overwhelming, because they all follow the same general structure (the
   author tells their story at the top and how they created the recipe and the
   recipe is at the bottom of the page). So, they were able to scroll right
   past the clutter and get to the recipe.
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   “3.4.1 Pattern: Use Clear Words” says that “For other groups, such as
   people living with dementia, learning new terms is not realistic or
   possible. Using uncommon words, that they do not already know, will make
   the content incomprehensible [unable to be understood] and unusable.”
   Recent literature, including our work, argues that learning can continue to
   take place, and this is a particularly important given that  the following
   example talks specifically about someone in the mild stages of dementia.
   Individuals with dementia can learn new things, it just may be much more
   difficult and they have to put in more work than they used to.
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   “3.4.10 Pattern: Use White Spacing”, “For those with cognitive
   impairments, white space has been shown to ease reading difficulties and
   improves understanding of content.”: It might be better to say plain
   background instead of white space, as we found that some individuals
   preferred a darker/yellow tinted background to help with eye fatigue.
   -

   5.1 Alison: An Aging User with Mild Cognitive Impairment
   -

      Scenario 2
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         Text to speech to read out content she has found she can hear her
         mistakes more easily… this process can make reading web pages
easier and
         less tiring. We have found that audio (e.g., audiobooks) can
be easier than
         written text.
         -

   5.5 Frank: a retired lawyer with dementia:
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      In scenario 3,
      -

         "Blocks of text with more white space around them would also be
         helpful so that he is not having to cope with such a mass of text." We
         refer to our point above, that white can be straining for the eyes for
         some- people may need different color backgrounds. But our
findings very
         much affirm the challenges with “masses of text”!
         -

         In the example you give of icons appearing when the groups are
         listed to differentiate the articles about fly fishing and
sea fishing I
         imagine these would be too similar for someone with dementia to
         differentiate. Icons were perceived as confusing for our
participants who
         instead wanted actual pictures representing what the
application was used
         for, because it’s easier to understand a picture than to decipher the
         abstract meaning of icons which often look similar. Past research has
         described issues with icons for people with dementia,
reporting that their
         participants with dementia preferred pictures to icons:
         -

         Kerkhof, Yvonne, Myrna Pelgrum-Keurhorst, Floriana Mangiaracina,
         Ad Bergsma, Guus Vrauwdeunt, Maud Graff, and Rose-Marie Dröes.
         “User-Participatory Development of FindMyApps; a Tool to Help
People with
         Mild Dementia Find Supportive Apps for Self-Management and Meaningful
         Activities.” DIGITAL HEALTH 5 (January 2019): 205520761882294.
         https://doi.org/10.1177/2055207618822942.


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   In Scenario 4:


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         We are glad that this scenario calls attention to the fact that it
         takes people with dementia a longer time to process
information spoken to
         them. We have also found that people with dementia, when
speaking to voice
         enabled smart home devices, wish the devices took more pauses when
         speaking, giving more time for the person to process the
information and
         their answer, as well as understood their feedback if it’s not phrased
         exactly correct.


-- 
*Amanda Lazar* | Assistant Professor
(she/her/hers)
University of Maryland | College of Information Studies (iSchool)
Hornbake South | Room 2117D | College Park, MD 20742
<http://www.ischool.umd.edu>www.ischool.umd.edu | lazar@umd.edu
<mhinckle@umd.edu> | (301) 405-8550