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MAKING TECHNOLOGY USABLE

- Keeping The Interface Simple -


THE VIEWS OF CONSUMERS WITH LEARNING DISABILITIES,
MENTAL RETARDATION, AND THEIR CAREGIVERS


Consumer Needs Assessment Project Year Five
Results of the Final Year of a Five-Year Study

Leonard G. Perlman, Ed.D.
August, 1993

Electronic Industries Foundation
Rehabilitation Engineering Center
919 18th Street, NW, Suite 900
Washington, DC 20006

Electronic Industries Foundation
Rehabilitation Engineering Center
Supported through a Cooperative Agreement with
The National Institute on Disability and Rehabilitation Research
U.S. Department of Education
Washington, DC

Grant# H133E80029

TABLE OF CONTENTS

Acknowledgements
Summary
I. INTRODUCTION
II. BACKGROUND INFORMATION
Mental Retardation
Learning Disabilities
III. RESEARCH METHODOLOGY
Focus Group Research Techniques
Participant Selection
Focus Group Composition
IV. RESEARCH FINDINGS
Sociological Issues
Interactions with Technology
Home Products and Recreation
Transportation
Work
Education
Product Needs and Adaptations
Common Needs for Home, Recreation, Education and Work
Transportation
If Wishes were Products
V. CONCLUSIONS
Endnotes
Appendix A

ACKNOWLEDGEMENTS

We wish to express our appreciation to the following people for providing
information and assistance in the development and implementation of this focus
group study:

Carrie Brown, Ph.D., The Arc, National Headquarters, Arlington, Texas

Dale Brown, President's Committee on Employment of People with Disabilities,
Washington, DC

Henriette Engelson, Learning Disabilities Association, Allentown, Pennsylvania

Janet Gormely, Association for Retarded Citizens, Lansing, Michigan

Stephanie Hnatiw, ARC of Lehigh and Northampton Counties, Allentown,
Pennsylvania

Joyce Laing, Learning Disabilities Association, Lansing, Michigan

Virginia Levitas, Council for Exceptional Children, Reston, Virginia

Joe Whitaker, Montgomery County ARC, Rockville, Maryland

Special thanks to Carolyn Ward, formerly EIF's Program Manager, Consumer
Research, for her work in identifying and initiating contacts with the focus
group organizers, and preparation of the focus group moderator's guides.

Finally, our appreciation extends to the focus group participants who so
willingly shared their ideas and opinions.

SUMMARY

This monograph represents the findings from the fifth year of the
Electronic Industries Foundation Rehabilitation Engineering Center's Consumer
Needs Assessment Project, funded through a cooperative agreement with the
National Institute on Disability and Rehabilitation Research. Eight focus
groups including 60 adult individuals with mental retardation, their
care-givers, and persons with learning disabilities were convened in the upper
Midwest and Mid-Atlantic regions of the country to discuss the impact of
technology on their daily lives.

The discussions were dominated by issues relating to accessible or
universal product design especially focussing on increased automation,
simplicity of product use, the need for easy-to-follow operational and
assembly instructions, and the importance to participants of self-reliance,
safety, and mobility. The level of simplicity or complexity built into a
product's technology (especially the user interface) can be the determining
factor in making that product usable or accessible to persons with cognitive
and perceptual disabilities. Frequently product design makes it impossible
for these individuals to make full use of the product, consequently barring
them from full and independent participation in the age of technology.

Specifically, consumers offered many suggestions for improving product
usability. These included clearly identifying control knobs and making them
easy to reach and grasp; reducing the number of controls, and the strength and
dexterity needed to operate them; keeping instructions as simple as possible,
with easy to follow diagrams wherever possible. Access to vehicles and public
transportation also was identified as a critical need.

Consumers with learning disabilities were most familiar with computer
technology, while individuals with mental retardation displayed scant
knowledge of computer products. The educational arena, where much of this
technology can and is being utilized, formed no part of the discussion by
mentally retarded focus group members.

As in previous years of this study, the potential of technology as an
enabler was a key issue of discussion. Most participants of this year's focus
groups expressed a strong desire to live as independently as possible, and the
frustrations they experienced were many. Unless technology can be designed to
be used more easily, many individuals with disabilities will remain dependent
on others to help them participate in the many activities of daily living.
The goal of ongoing technology design must be to maximize the number of
potential users by decreasing the number of necessary user interface options
and simplifying the ones that are required. As growing numbers of mass market
consumers frequently request, "Let's keep the complexity inside these products
and make the operational features as simple and usable as possible for all."

"It seems the more efficient the product is supposed to be, it ends up
taking forever to understand and learn how to use it. It may have more
gadgets, but it's less efficient for you to use because of the complexity."

Focus Group Participant

I. INTRODUCTION

The Rehabilitation Engineering Center of the Electronic Industries
Foundation (EIF) has completed the fifth and final year of its Consumer Needs
Assessment Project under a cooperative agreement with the National Institute
on Disability and Rehabilitation Research (NIDRR). The project has been
designed to study the technological needs of individuals with disabilities and
the impact of both mainstream and assistive technology on their activities of
daily living, using focus group research techniques.

The previous four years of the study have focused on a broad range of
individuals from diverse geographical regions throughout the country with
disabilities, sensory and physical limitations, and who are aging. The fifth
year study addresses the needs and opinions of individuals with cognitive and
perceptual impairments, specifically persons with mental retardation and those
who have learning disabilities. In addition, the fifth year study solicited
the opinions of care providers who frequently advise or make final decisions
for individuals in the target consumer groups regarding purchase and use of
products (technology) and services that support activities of daily living.
Services often include providing or arranging for transportation.

The focus group sessions are not limited to discussions of technology.
They frequently serve as opportunities for consumers to express their opinions
on unrelated issues that affect the quality of their lives, for example,
societal attitudes toward disability and persons with disabilities, safety
issues, and independence in daily activities.

Technology is a double-edged sword that can both assist and hinder
persons with mental retardation or learning disabilities in performing a
variety of tasks. At work, it can open doors to job opportunities and job
retention. In the home and elsewhere, consumer products and assistive devices
can reduce dependence on others and increase self reliance. Yet, the
often-complex user interface design of these products may prevent a person
with a functional limitation from using them at all or from using them to
maximum advantage.

The Year Five focus group sessions covered a broad range of topics (see
Appendix A) and, as in previous years, provided opportunities for consumers to
express opinions about product designs that either facilitate or impede their
use. In addition, these sessions provided a means to assess the experience of
persons with disabilities in activities of daily living.

A major purpose of the Consumer Needs Assessment Project is to
disseminate the data gathered. The findings included in this report continue
to highlight unmet needs. It is the ongoing hope of this project that sharing
information gathered from focus group participants about their functional
characteristics and product needs will promote the development and use of
appropriate technologies for their increased productivity, employment,
independence, and improved quality of life. Findings will be disseminated to
product researchers, designers, and manufacturers to help them identify
product ideas, problems, and guidelines for improved operational designs. The
findings also will be distributed to policy makers, consumers themselves, and
members of the general public in the hopes of facilitating positive change.

II. BACKGROUND INFORMATION

Mental Retardation

The Arc (A national organization on mental retardation), estimates that 3
percent of the U.S. population, 7.5 million people, have some degree of mental
retardation, with newborns with retardation increasing the number by slightly
more than 125,000 each year. Over 95 percent are considered to have mild to
moderate retardation.

Mental retardation is not a disease, The Arc notes, and should not be
confused with mental illness. People with mental retardation mature
intellectually at a below-average rate, function intellectually at
"significantly subaverage," and experience unusual difficulty in learning,
social adjustment, and economic productivity. Retardation exists concurrently
with deficits in adaptive behavior. Although performance and capabilities
vary widely, individuals with moderate cognitive abilities can develop
functional reading skills enabling them to read signs, simple forms, and
menus; they can perform basic self- care tasks and many household chores with
supervision; and they can follow two- and three-step directions.

Any condition that impairs development of the brain before birth, during
birth, or in the early childhood years may cause retardation. According to
The Arc, although more than 350 causes of mental retardation have been
identified, they account for only about one-fourth of all known cases. In the
remaining cases, the specific cause is unknown.

Learning Disabilities

Learning disabilities create hidden limitations, which only recently have
received significant attention from the rehabilitation community. The 1991
Amendments of Public Law 102- 119, the Individuals with Disabilities Education
Act, defines a learning disability as a "disorder in one or more of the basic
psychological processes involved in understanding or using language, spoken or
written, that may manifest itself in an imperfect ability to listen, think,
speak, read, write, spell, or do mathematical calculations." The law includes
perceptual handicaps, brain injury, minimal brain dysfunction, dyslexia, and
developmental aphasia as learning disabilities. It does not include learning
problems primarily arising from visual, hearing, or motor handicaps; mental
retardation; or environmental, cultural, or economic disadvantage. Learning
disabilities are marked by a severe discrepancy between a child's potential as
measured by I.Q. testing and his or her educational achievement.

According to the Council for Exceptional Children, varied estimates
indicate that from 1 to 30 percent of the general population have a learning
disability, perhaps reflecting variations in the definitions of the disorder.
The most widely agreed upon range is 2 to 3 percent of the general population.

Persons with learning disabilities may exhibit a wide range of traits
including poor reading comprehension, poor ability to express themselves
orally and in writing, that is poor verbal command, and poor reasoning
ability. They also may be hyperactive, inattentive, and have perceptual
coordination problems. Brain dysfunction can produce a variety of symptoms
including perceptual impairments, motor disorders, and such emotional
characteristics as impulsiveness, low tolerance for frustration, and
maladjustment. It is important to note these are traits, characteristics, or
symptoms but not learning disabilities in and of themselves.

Individuals with learning disabilities need ample opportunities to
practice the tasks and skills with which they have difficulties and ample
opportunities for interactive learning

III. RESEARCH METHODOLOGY

Focus Group Research Techniques

In the fifth year of the Consumer Needs Assessment Project, EIF's
Rehabilitation Engineering Center conducted focus groups in three cities in
the Upper Midwest and Mid-Atlantic regions--Allentown, Pennsylvania; Lansing,
Michigan; and metropolitan Washington, D.C. The study used focus groups for a
variety of reasons to gather information on the technological needs of persons
with mental retardation, their caregivers, and persons with learning
disabilities.

Focus groups bring together persons with similar characteristics to
discuss issues of concern to the convener. This qualitative approach enables
EIF to explore, under the guidance of a trained moderator, the specific needs
and concerns of identified groups of persons with disabilities in greater
detail than could be obtained through traditional quantitative methods,
surveys, for example.

Focus groups also make it possible to identify some of the subjective
elements group members consider in their decision making. Within the context
of a modified, open-ended discussion, the moderator can encourage participants
to voice opinions, identify personal concerns, and share suggestions for new
products or modifications to existing products that would increase their value
to group members.

Qualitative research cannot be used as a substitute for quantitative
research. But it is an accepted tool to use when little quantitative data
exist in a given area of research, as is the case in the issues under
discussion.

In the EIF focus groups, the moderator used guidelines, loosely
structured to allow for spontaneous interaction among group members, to
stimulate discussion (See Appendix A). Questions were open-ended and posed in
simple language to allow for maximum participation by all focus group members.

The focus group proceedings were recorded with the permission of session
organizers and participants. An analysis of transcripts of each session forms
the basis of this report.

Participant Selection

EIF sought and received significant assistance in recruiting focus group
participants from a variety of sources. Service providers and Arc
representatives were enthusiastic about using focus groups with individuals
with mild to moderate mental retardation and recommended national and local
contacts to help recruit focus group participants. With those good referrals,
EIF readily found program directors and staff members of locally funded
centers for persons with developmental disabilities and similar voluntary
organizations who agreed to serve as local hosts and organizers for the focus
group sessions.

Advocates from The Arc also suggested conducting focus groups with family
members and other caregivers for persons with mental retardation. They noted
that caregivers are often the gatekeepers to products and services used by
their family members and clients. EIF's Rehabilitation Engineering Center
agreed that caregivers' observations and thoughts would provide additional
insights into technologies and products that would enhance the independence of
consumers with mental retardation.

Local associations of and for persons with learning disabilities provided
similar levels of cooperation and enthusiasm. They organized individual focus
groups, arranged appropriate meeting sites, and coordinated timing of the
sessions with the focus groups planned for persons with mental retardation,
enabling the moderator to conduct all the focus group sessions with one trip
to each city.

In keeping with research procedures used in past years, participants were
not randomly selected. They were known to the local organizers through their
association with community programs and support groups or were active within
the disability community.

The Rehabilitation Engineering Center asked local organizers to recruit
individuals with the following two distinct disabilities: those with mild to
moderate mental retardation and those with a learning disability. In
Allentown and Washington, focus groups also were conducted with caregivers of
persons with mental retardation.

Focus group organizers in each city provided excellent cooperation and
hospitality. Recruits were eager to participate and provided useful insights
into their needs.

EIF requested that individual focus groups consist of eight to twelve
persons. Such factors as inclement weather, transportation difficulties, and
illness cut actual attendance to between six and ten participants per group.

Focus Group Composition

Sixty individuals participated in a total of eight focus groups as
follows: three focus groups with a total of 24 participants with mental
retardation; three focus groups with a total of 18 participants with learning
disabilities; two focus groups with a total of 18 participants who are
caregivers of persons with mental retardation. All participants were
addressed as consumers, potential consumers, or gatekeepers for consumers of
general and assistive technologies that could improve the everyday lives of
persons with cognitive disabilities.

Mental Retardation Participants in the three focus groups for people with
mental retardation ranged in age from 18 to 60 and represented a cross-section
of persons attending activity centers or other programs for the
developmentally disabled. One person in each focus group worked at an
entry-level job or in supported employment, and at least one-third worked
part-time in a voluntary capacity. Two-thirds of participants lived at home;
one-third lived in group homes.

The proportions of focus group participants working and living
independently were very low. While it is important to note this fact, it does
not diminish the validity of participants' comments. One simply needs to
consider that more comments are related to the resulting lack of independence
than might have been expected in a more broadly constituted group.

The participants were cooperative and sincerely wanted to assist in the
groups. However, about eight of the 24 participants were unable to
communicate adequately, and several questions posed to the groups elicited
minimal responses. Conversely, in each focus group, at least three persons
were extremely vocal and anxious to make their views known.

In general, the participants exhibited a limited attention span, and the
moderator found it necessary to repeat questions often. They also had some
difficulty focusing on the issues to be developed.

Most of the participants had some other functional limitation or
disability in addition to the mental retardation. They displayed difficulties
in communication, sensory perception, and mobility.

Nonetheless, participants in the three groups generally responded
adequately and their answers provided insights into their needs and wishes
concerning a wide range of consumer products and transportation modifications.
Participants also provided perceptive interpretations of the attitudes of the
general public towards persons with mental retardation.

Learning Disabilities Participants in the three focus groups for persons
with learning disabilities ranged in age from 21 to 50. One-third were
employed; the others were in training programs to prepare for work or were
seeking employment. At least one-third had attended college or were in
college at the time. One-third of the 18 participants lived with their
parents; two-thirds lived in their own apartments or homes.

The participants were actively cooperative and responded eagerly to the
questions. They spoke candidly about their problems and needs at home,
school, and work.

Many focus group members described difficulties with spelling, math,
reading and understanding instructions, language processing, penmanship,
peripheral vision, sense of direction, and spatial relationships. Their
disabilities interfere with their education and make it difficult for them to
learn basic information. Some admitted to becoming quickly impatient and
easily frustrated with their inability to perform activities integral to daily
living and learning.

Caregivers Seventeen of the eighteen participants were related to a
person with mental retardation. A parent or other responsible family member
frequently makes (or significantly influences) decisions about major purchases
and about the dependent person's ability to use appliances in the home, travel
independently, etc. Several of the caregivers had functional limitations of
their own.

Participants were cooperative and eager to assist in this needs
assessment. They were candid in describing the issues that confront them
daily.

IV. RESEARCH FINDINGS

Members of all eight focus groups were asked to discuss the products and
equipment they use in their daily lives. While there were significant
differences in the needs and wishes of the three categories of participants,
there were striking similarities as well. The recurrent themes also echoed
the needs and wishes expressed by participants in focus groups from earlier
years of the EIF Consumer Needs Assessment Project. In the following
sections, we will explore these issues and participant responses.

Sociological Issues

Common Concerns

Underlying the discussions of products and services that could improve
daily functioning for persons with cognitive disabilities were common themes:
how could those products and services increase independent functioning for
consumers, how could they improve the user's safety as he or she functioned,
or how could the products be made safer to use. Overarching concerns are
discussed in brief below. Specific comments are included in appropriate
sections of the report.

Independence Self reliance was critical to participants in all three
categories of focus groups. They were concerned not only with the ability of
cognitively impaired consumers to function independently within home, school,
and work settings but also with their ability to move independently from place
to place. The accessibility and convenience of pubic transportation and
appropriate modifications to private automobiles and vans were of particular
concern and interest.

In every area, the common wish was that products and services be made
easier to use and that instructions for use be made easier to follow so that
these special groups of consumers could accomplish more tasks and activities
and go more places by themselves. They are frustrated as adults who have to
depend on other adults for help in so many areas of their lives. "I want to
do it myself." "I want to be able to go by myself," were wishes repeatedly
expressed. One participant, although referring to a learning disability,
could have been speaking for everyone when he said, "I would say that the most
frustrating thing . . . is not knowing how to do something and to have to say
to someone, can you help me? I don't want to do that any more, I want to be
able to do things by myself!" Caregivers would like to give consumers more
responsibility and more independence but often find, as do the consumers
themselves, that the technologies meant to help users create barriers and
frustrations instead.

The desire for independence was also a common point of discussion in
earlier EIF focus groups with persons with physical and sensory disabilities
and with older consumers with a variety of functional limitations.

Safety Consumers with learning disabilities and the caregivers for
persons with mental retardation raised a variety of safety issues. The
caregivers focused most often on ways to reduce risks of fire or injury to
their adult relatives created through improper use of appliances in the home.
They also wished for a means to assure their relatives' safety as they move
about the streets, the dangers being related to inability to recognize risks
from moving vehicles or to maintain a sense of direction and location. One
caregiver noted, "My son will walk right out into the street, since he has no
fear that this big car coming at him could hurt him."

Persons with learning disabilities were most often concerned with risks
to themselves and others as they drive, risks posed by their problems with
spatial relationships, direction, and reading.

Public Acceptance It was clear from the discussions that many of the
participants with mental retardation felt a distinct lack of public acceptance
ranging from indifference to outright hostility. They felt it most often in
their dealings with public transportation employees. One person noted that
the dispatchers sometimes have "a nasty attitude." That person also suggested
that you "sometimes have to call more than once to make sure the taxi is
coming," and the two comments may be linked. This group also sensed rejection
in the job market. As one poignantly commented, ". . . they act like they
don't want to be bothered with you. I got to the point where I got tired of
filling out the applications because they don't want you."

Persons with learning disabilities also noted the public's generally
negative attitude towards anyone who needs extra help or who is perceived as
"different." The comments of persons with cognitive disabilities echo those
of EIF focus group participants from earlier years. Society has little
patience for persons who cannot move as agilely, function as effortlessly, or
think as quickly as the accepted norm.

Interactions with Technology

Home Products and Recreation

Common Concerns All focus groups discussed at length electronic
appliances commonly used in the home for cooking, cleaning, recreation, and
home hygiene: television sets with and without remote controls, stereos and
other radios, tape recorders, cassette players, the "Walkman", telephones and
answering machines; electric and gas stoves, microwave ovens, coffee-makers,
can openers, dishwashers, and popcorn poppers; electric clocks, vacuum
cleaners, automatic washers, and dryers. Their discussions most often focused
on difficulties the consumers had in using them, how complicated the products
were to operate, and how difficult instructions were to follow.

Not all individuals in all groups were able to use or had access to all
of the products. For some of the persons with mental retardation, an
additional limitation or disability (e.g., poor dexterity, coordination
deficits, muscle weakness, low vision, or blindness) made it difficult or
impossible for them to use the products without assistance. Those with
learning disabilities faced somewhat different problems. For individuals with
dyslexia, for example, knowing in which direction to turn controls and how far
to turn them was a problem. However, both groups and their caregivers
repeatedly mentioned the small size and lack of differentiation between
controls (knobs, buttons, etc.), the dexterity required to operate controls,
complicated sequencing steps (in operating a VCR, for example), knowing how to
use a control (push or pull, for example) and poorly written, poorly
illustrated, confusing or unnecessarily complicated instructions as obstacles
to product use. One participant, probably voicing the thoughts of nearly all,
stated, "Most of the gadgets that I've seen on the market are designed with
non- handicapped people in mind . . . whatever their intention. Wouldn't it
be better to have a dishwasher that the person with a handicap or disability
could use and, with a little more planning (on the part of the manufacturer),
make it easier for them?"

All groups learn about products from television advertisements, friends,
and relatives. Higher costs for added conveniences, like remote controls for
TV's, created barriers to access for consumers on limited income.

Electronic appliances generally described as "home entertainment" provide
the major source of recreation for consumers in this group. Yet the
difficulties they experience in using these products create frustration
instead of relaxation and enjoyment.

Persons with Mental Retardation Use of home products was limited for many
in these focus groups. Problems with manual dexterity or mobility made it
difficult for many persons to use the controls on appliances, TVs, and VCRs.
For example, one woman could use the stove, but someone else had to light the
burner for her. Short persons and those with limited reach had difficulty
reaching the knobs and buttons on washers, dryers and many stoves. Some could
not insert a tape cassette into the VCR. Some had a basic lack of
understanding of how the product worked that hampered their ability to operate
it. Many could not read well enough to understand most of the instructions
and diagrams provided with the products.

In general, there was minimal discussion of selection and purchase of
appliances and equipment as most of the consumers in this group relied on
their caregivers for many purchasing decisions. They usually were accompanied
by a friend or relative when they shopped for consumer products, such as small
appliances.

Many indicated the products they would like to buy (for example, a TV set
with remote control or a VCR) were out of reach due to the "high cost." Many
of these consumers live on minimal incomes and depend heavily on parents or
significant others who also may have limited funds for consumer products.
Reflecting this limitation, their comments included the following remarks.

"The only thing that stops people from buying a new electronic TV set is
the cost," and, "I wish they could make some of these things (products being
discussed) and charge less money."

Caregivers The caregivers noted their dependents are affected by a wide
range of impairments in addition to limited mental functioning that interfere
with their abilities to enjoy the fruits of modern technology. The problems
that product designs create for people with these physical disabilities have
been discussed at length in previous years' reports.

One parent's comment, however, illustrated clearly the impact of
cognitive impairment and the need to simplify operations and instructions: "My
son doesn't know how to do the hot or cold water faucets and he generally uses
only the cold water if he gives himself a shower."

Discussing consumer products, one parent noted, "My daughter likes to fix
her own meals, but the microwave oven is too tricky for her." The
pressure-sensitive buttons caused the problem in this instance. Others
labeled as obstacles to microwave cooking the complexity of instructions and
the difficulty in ascertaining which buttons to use for various types of food
preparation. Nearly every consumer product noted at the beginning of this
section presented problems for the consumers with mental retardation as noted
by the caregivers.

While caregivers were aware of some of the products and devices already
on the market that could help both caregiver and consumer, several said the
cost keeps them from being affordable. They understand the reason behind the
high costs, but that doesn't solve the problem. As one caregiver stated, "If
you go through magazines for handicapped persons you find that everything in
there is so expensive. That's because it's special and they don't make many
of these things. You may be getting better quality, but there is not as much
production of these things. I would like to get the latest type of hearing
aid, but I just can't afford it."

Persons with Learning Disabilities This group used tape recorders,
personal computers, and pocket calculators at home as well as the products and
appliances noted at the beginning of this section. This group readily
described how technology has assisted them in many area of life by
compensating for their deficits. Their comments on the benefits of technology
can be found in the section on "Education."

But they, too, experienced their share of frustrations, brought on by
what the human factors engineers call the "man- machine interface." One
person covered the issues of independence, product design, functional
limitations, and the extremes of understandable frustration in a single
monologue that may stand for the entire situation:

"I'm 34 years old and my parents get upset with me when I use the washer and
dryer. These appliances have little knobs that you have to turn back and
forth. Being as I have dyslexia, I may turn the knobs too far and they
(parents) get upset with me when I do that. I wish there was a way that, I
mean, I'm old enough to do my own laundry at this point, but they don't let me
do it because of those stupid little knobs."

This group of consumers relies on magazines and newspapers as well as
broadcast media for information about new products. At least one participant
had gone to trade shows to learn about new electronic equipment. One noted
that many new products of potential interest to people with learning
disabilities probably are available, but most of them don't know they exist.

Product useability and simplicity strongly influenced buying decisions.
One participant summed up the buying habits of the group as follows:

"When I look for new products to purchase, I look at the size. Is it bulky?
Is it complex? Does it have a lot of buttons? The more buttons it has the
more instructions it will have. How simple is it to use? Are the instructions
in charts or diagrams? The less reading for me, the better, since I don't
comprehend a lot of what I read. The color of the item also attracts me and,
of course, the price--can I afford it?"

One person said he always reads Consumer Reports before buying any new
products. Another noted, "I would care more about how easy it is to operate
first, and then I would look at the price later."

Transportation

Persons with Mental Retardation Most of the participants traveled by bus
or vans and usually relied on relatives or friends to take them to activity
centers, recreation, shopping, etc. The problem of transportation is a great
source of frustration to this group and its impact on their self-reliance and
independence was a frequent topic of discussion. One person noted, "I get
around myself--I like to go to the bank and to the food store myself. I don't
need anybody following me around." One said she needs help getting off the
bus, but sometimes "the drivers won't even try to help you." Other
participants complained that bus service was nonexistent in their
neighborhoods, making them dependent on friends or relatives. This is
particularly true in the suburbs and rural areas. Public transportation
services are curtailed on the weekends in many areas with expensive taxi
service the only available means of travel. As one noted, ". . . I think
(transportation) can be improved to where people can go to activities if they
want to and not have to wait for somebody to take them." Those with mobility
problems (including wheelchair users) mentioned they could only use public
buses that had lifts to help them get onto the bus.

Inability to drive a car was another topic of discussion. One individual
said he was too short to drive a "regular car" and was sent home by the state
trooper at the driver's test site for being too small to drive a car safely.
Another complained that he couldn't take the written test for the driver's
license as it was too difficult to read.

The lack of independent mobility hampers this group from participating in
recreational activities as much as it impedes their ability to shop, bank, run
errands or seek employment without relying on others.

Caregivers Concerns among this group focused on the safety of passengers
in public transportation--some of their charges cannot remember to buckle seat
belts in public vans and buses or are physically unable to do so themselves.
The primary barriers to driving for those with the intellectual capacity to do
so were physical limitations, the use of only one hand or arm or minimal grip
strength, for examples.

Persons with Learning Disabilities Participants in these focus groups
were well aware that their learning disorders impeded their ability to drive
safely. They noted that problems with peripheral vision can be dangerous.
Three who described problems with sense of direction said poor perception of
geographic orientation has led them to turn at the wrong intersection or turn
in the wrong direction (e.g., left instead of right). Many were concerned
with poor road signs, missing signs, and signs they described as too small to
read while in a moving auto. They described these problems as hampering their
ability to make decisions and impeding their judgment while driving.

Some persons had difficulty and became confused using equipment and
accessories in the car itself. One said, "I've had my car for about two and
one-half years and I still don't know how to turn on my halogen lights. I
know where they are but it's a little knob and I'm not sure whether to pull
out the knob and it is supposed to stay out or what - but I still don't know.
It is really

Work

Persons with Mental Retardation Only slightly more than one-third of this
group worked in paid or voluntary positions. Thus, for most of the group, the
issue was being able to work and finding a job. As one person stated, "I'm
doing volunteer work at the activity center, like filing or answering the
telephone."

Participants discussed work that involved collating, using copying
machines, answering telephones, and intra-office mail delivery. Their major
complaint involved difficulty in resupplying the copier with the correct size
paper.

Persons with Learning Disabilities Focus group participants discussed
on-the-job issues related to electronics and new technologies. The need to
learn several sequential steps or functions seemed to be a major source of
frustration in learning to use electronic equipment. For example, one woman
expressed frustration at being unable to use the telephone system at the hotel
where she worked.

Copiers stymied this group as well. One noted, "I have difficulty with
certain copier machines. Our old one was an easy little machine and our new
one was this high-tech monster. I asked my boss how to use it because it was
so complex. I should be able to use it in a few minutes, but I still can't
understand how to work the copier."

Cash registers also caused problems. One participant exclaimed, "They
put me on a cash register at work and I couldn't do it to save my life! I
mean it was the worst experience I've ever had. I was slow and couldn't
understand how the machine worked. Because of my visual problem I had to
stand over it to see what I was doing. I did this job for three months until
I couldn't stand it anymore."

Education

Persons with Learning Disabilities Only members of this group discussed
how their disabilities affect their use of consumer products in conjunction
with their education. In this regard, many were enthusiastic about the
assistance PCs, electronic typewriters, calculators, and similar devices offer
them in the classroom. But even readily available assistive technologies may
not adequately respond to some of their special needs. For example, one
individual exclaimed, "I've got an 80- case spellcheck on an IBM computer and
it can't figure out what I'm trying to spell." Another noted, "I can't spell
the word close enough to have it come up right."

One college student stuck colored tapes on his tape recorder and text
books, coding the materials to allow him to use them efficiently. Another
person uses an electronic typewriter to take class notes, to compensate for
poor handwriting. One participant called his PC "the best investment I ever
made. I use it to correct all of my writing and math," he explained, adding,
"I always carry a calculator with me because I am really poor in math."

In general, the complaints raised by these participants were closely
related to those of participants in the first four years of the EIF Consumer
Needs Assessment Project, namely, confusing, poorly designed instructions for
use of electronic equipment; small, identical control buttons and switches
that often are difficult to use and difficult to identify; and the lack of
visual cues to assist in sequencing the operation of equipment.

Product Needs and Adaptations

Common Needs for Home, Recreation, Education, and Work

The litany of requested changes, adaptations, improvements and new
product developments requested by focus group members indicate that dissimilar
problems (manual dexterity, low vision, muscle weakness, and cognitive
disorders) often can be overcome by common solutions. Many recommendations
were repeated frequently by participants in all focus groups and applied to
appliances and equipment found in the home, at work, and at school. While the
apparent issue is one of useability, it is clear to the discerning reader that
each change increases self- reliance as well. As one participant put it, "If
I want to go to the bathroom, I have to ask people to open the door for me
because it's too heavy. I keep arguing to get push button doors, and I'm not
giving up until they have done it."

It is no surprise that the recommendations corresponded directly to the
product complaints voiced most often by participants in these focus groups and
in those convened by EIF during the previous four years of the Consumer Needs
Assessment study. In brief, they were as follows:

Make buttons and knobs on equipment, appliances, remote controls, doors,
and elevators large and easy to grip. Mark their functions clearly. Provide
visual clues (color coding or sequential lighting, for example) to the order
and manner in which buttons are to be used (pushed, pulled, toggled left or
right). Make buttons, knobs, and switches easy to reach. Light them up,
(e.g., a green light indicating "start" and a red light indicating "stop") to
help persons who cannot differentiate the positions of the standard on/off
switch. Use different shapes for buttons with different uses.

Reduce the number of buttons, switches, steps, etc., to make the product
easier to use. "Better" should not translate as "more complicated." Perhaps
it is the increasingly complexity of product "improvements" that led one
participant to say,

"I like the old style blender with simple push buttons. I hope
that they keep things basic. You don't have to stop making the
newer fancy and complicated blenders for those who want to buy
them, but keep making the basic ones for those who don't want
the complicated ones."

The reference was to blenders, but it just as accurately could have referred
to office copiers, fax machines, clock radios, CD players, car stereos, and
electronic cash machines (once known simply as cash registers).

Affix braille labels on TV sets and other appliances. Provide talking
clocks (and put them in VCRs) for those who can't read the small numbers.
Develop voice-activated TVs, VCRs, PCs and typewriters. Provide audio
cassettes with step-by-step instructions, delivered in a pleasant voice, for
products with complicated operations.

Create a color-coding or number-matching system to simplify hook up of
stereos, computers, VCRs, and other sequenced electronics so that the red
wire on the VCR (or wire #1) would hook to the red terminal (or terminal #1)
on the TV.

Print instructions in larger type. Make operating manuals easier to
read; use simpler language and simpler directions. Make instructions for
products from foreign countries more understandable; simplify them for use in
the U.S. Use short paragraphs.

Use more pictures and diagrams in instructions, or, as one participant
said, "Pictures would be great, but the reading part, I mean that turns me
right off!" Provide color cues for people who have trouble with words:
Present each step of the instructions in different colors or color code
instructions to match buttons and knobs on the

Transportation

Not surprisingly, participants with mental retardation and their
caregivers identified different needs and adaptations to make transportation
more useable from those expressed by persons with learning disabilities. The
needs of persons who are mentally retarded were dictated more frequently by
their other disabilities than by their cognitive limitations.

Persons with Mental Retardation or their Caregivers Participants in
these focus groups suggested such improvements as automatically opening car
and van doors, automatic seat belts on buses (similar to those found in the
front seats of passenger cars), automobiles that take little strength or
dexterity to operate, wheelchair lifts for all buses and vans, a broader
network of bus routes (closer to their neighborhoods), and better weekend bus
service. One participant recommended an oral driver's license test and one
with pictures for people like himself (who have trouble reading).

Persons with Learning Disabilities Consumers in these focus groups
seemed primarily to want important visual information in the surrounding
environment and in their cars to be presented clearly and distinctly. They
recommended larger, more readily visible, and clearer street signs and
standard locations for street signs--always on the near left corner, for
example. They asked that red or green painted signs, lighted signs, and
Christmas decorations be distanced from traffic signals; proximity can
confuse the driver. They recommended clearly identified, color-coded, or
lighted knobs and buttons within their cars to help locate critical dashboard
items (e.g., emergency flashers, bright lights, defroster).

If Wishes Were Products

Throughout the duration of the EIF Consumer Needs Assessment study,
focus group moderators have asked participants to do some "blue-sky" wishing
about the products and services that could really make a difference in their
lives. They do this for three basic reasons: To provide greater insight into
the wishes and needs of focus group participants--untrammeled by their
expectations of the possible; to identify information gaps regarding
currently available products and technologies; and to provide a reservoir of
ideas for research and development. This year, if the buttons were larger,
the print were easier to read, and transportation were at one's beck and
call, the new product catalogs and stores would contain some products
uniquely suited to particular users and others that would benefit us all.

Persons with Mental Retardation Some of the products that participants
put on their "wish list" are available, but the respondents don't know they
exist. For example, one individual would like a TV set you can operate
"without getting up from a chair." He apparently was unfamiliar with remote
control. At least one wished for an augmentative communication board to help
him make himself understood in restaurants, shopping centers, and the work
activity center. Communication boards with voice synthesizers are in use by
nonverbal persons. Information needs to be disseminated as to where such
devices are available and whether they can be adapted for those with limited
intellectual capacity. Communication boards also were recommended in the
second year of the EIF Consumer Needs Assessment Project by consumers with
cerebral palsy, stroke, and traumatic brain injury.

Some participants knew of products that others had only dreamed of, but
the purchase price kept them as unattainable as if they were still figments
of the imagination.

With no constraints to limit the possibilities, this group of consumers
would like the following:

Home

a device to lift a person out of a

an easy to reach washing machine with simple to use push buttons
and knobs that don't come off;

a washing machine that would beep or flash a light if
it were overloaded with too much laundry;

an easy-to-use tape cassette player;

a tape recorder with braille-coded buttons;

talking clocks and talking clocks in VCRs;

voice activated TV's and VCR's; and

a larger microwave oven with easy to use buttons.

General Environment

color-coded or lighted buttons to open and close
elevator doors;

push-buttons or treadle-activation for doors to
restrooms, lobbies, and other especially heavy and hard
to open doors;

an electric shopping cart at the super market; and

a hearing aid to improve very poor hearing.

Transportation

a remote-controlled, hand-held, push-button device to
summon a taxi;

ramps or bridges across busy intersections to help slow
moving persons get safely across the street;

car doors with push-button automatic openers to
compensate for muscle weakness;

wheelchair lifts for all buses and vans;

small cars for very short drivers who can't reach the
pedals on standard cars;

lights on clothes and hats to make people crossing
streets at night visible to drivers.

Work

easy-to-use copiers with clear directions for how and
where to load different sizes of paper;

a job one could master; and

a job for pay.

Caregivers This group of participants wished for products that would
increase the safety of their family members or, consumers expand their
independence, and increase the freedom of both consumer and caregiver alike.
Nearly all of the products and adaptations they identified were linked to a
specific need they also had raised during group discussions. Duplicates of
wishes made by consumers with mental retardation are not repeated.

Home or Activity Center

an automatic body washer with a temperature control and
a timer to turn off the water for persons unable to
shower or bathe themselves;

a home fire and smoke alarm with a high-intensity
strobe light to arouse and alert persons with hearing
problems;

electronic exercise equipment for people with muscular-
skeletal and mobility problems;

An automatic sensor to turn off a stove burner if food
began to boil over;

an extra-easy to operate can opener for someone with
poor coordination and visual deficits;

an alarm clock with a strobe light for people with
hearing impairments;

a remote-controlled TV with a minimal amount of buttons
that are easy to read and understand;

video games that project larger objects on screen,
operate more slowly than current games, and are
designated for persons with visual deficits and poor
eye-hand coordination;

TV sets with large buttons with highly visible numbers
that can be seen from short distances for consumers
with low vision and mobility problems;

a message machine, similar to a telephone answering
machine but a separate appliance to be placed, for
example, in the kitchen. A consumer who could not read
could come home and listen to messages from the
caregiver who could leave home to run an errand;

an electric razor calibrated not to cut too closely to
protect persons with poor judgment who do not know when
to stop shaving;

a full-sized, battery-powered or battery-charged vacuum
cleaner to eliminate the cord that consumers often run
over;

A locating device to be worn by consumers who become
easily confused or lost so the caregiver can find them
if they wander away from home; and

electronic technology to help the individual find his
own way home.

General Environment

universally coded water faucets--blue for cold, red for
hot;

motion- or heat-activated water taps, emitting water
when a hand is held underneath the faucet and stopping
the flow when the hand is removed;

a stabilizer to help a person with balance problems
walk without crutches or a walker; and

a painless device for giving inoculations or drawing
blood because these procedures frighten many persons
with developmental disabilities who need such tests
often.

Transportation

automatic seat belts that buckle around persons who
forget to buckle up or are too disabled to do so; and

a car with easy-to-operate controls designed for the
intellectually able person with limited physical
capabilities.

Persons with Learning Disabilities This group defined its wishes more in
terms of categorical improvements (e.g., fewer buttons, color-coded wires)
than in terms of specific products. Many of its wishes have been expressed
in the preceding section on "Product Needs and Adaptations;" the wish lists,
therefore, are brief.

Members of these three focus groups also indicated more familiarity with
available resources, for example trade shows and Consumer Reports, to help
them find the products they need. Thus, it may not be surprising that one
suggested establishment of "a center for moderately handicapped individuals"
to help them learn about new products and give them a hands-on test before
purchasing.

Home and General Environment

an easy-to-use microwave oven with few buttons and
minimal instructions;

a voice-activated, automatic typewriter that would
spell accurately to assist persons who have difficulty
reading, writing, spelling, and typing;

a voice-activated computer;

a voice-activated ticket dispenser at airports and
railroad stations that provides the correct ticket
after a person inserts a credit card and tells the
machine where he or she wants to go;

a color-coded compass that would change color as the
user changed directions, for example, red for South,
blue for North, etc.; and

an educational device to help someone understand the
stock market and other financial events.

Transportation

a clear dashboard indicator displaying which gear the
car is in--particularly important for cars with
standard transmissions;

a device that helps one park a car;

an electronic direction finder to help one find and map
out the best route to a given destination;

a radar-type device with a warning beeper or flasher to
signal when one is too close to the car ahead or that
the car behind has driven too close; and

a computerized device that can guide a car
automatically from one city to another.

V. CONCLUSIONS

In all three sets of focus groups - for persons with mental retardation,
for their caregivers, and for persons with learning disabilities - issues
consistently focussed on simplicity of use, the need for easy-to-follow
instructions, and the importance of self reliance and mobility. The
recurrent discussion by persons with retardation and their caregivers of
automatic doors for homes, activity centers, and vehicles emphasizes the
importance of mobility to full human functioning.

People without specific disabilities give little thought to the critical
roles that easily usable consumer products and readily accessible
transportation play in supporting personal independence. Yet these same
issues emerged consistently in the initial four years of the EIF Consumer
Needs Assessment Project. Whether products help or hamper depends in large
measure on how useable they are, or, as currently described, how "user
friendly." The level of simplicity (or complexity) built into the product
either makes it accessible to persons with disabilities or creates barriers
to keep such persons from participating fully in the age of technology.

Participants in the focus groups provided ample prescriptions for
improving product useability. These can be expressed in brief as follows:

Make buttons, knobs, and switches large, easy to grasp,
easy to reach, clearly marked and readily identifiable
as to specific function. Provide visual cues to help
the user follow sequences and tactile or auditory cues
for those with visual impairments.

Keep it simple: Reduce the number of buttons,
switches, and knobs and the number of steps to operate
them.

Reduce the strength and dexterity necessary to operate
products and vehicles.

Make instructions simple, clear, easy to read well-
diagrammed and visual. Provide color coding to link
the instructions and the product.

Make vehicles easier to get into and out of and easier
to operate. Clear up the clutter of controls on the
dashboard and steering wheel. Provide more visual cues
to how and when a control should be used. Provide
better directional information within the car and on
the roadways. Improve public transportation services.

Caregivers and persons with learning disabilities also stressed consumer
safety as an important consideration. They covered the need to make products
safe to use by persons with diminished functional capabilities and the need
for products that enhance the consumer's safety in his or her environment.
Caregivers were especially vocal on this topic. Focus group participants in
the third and fourth years of the EIF project also had considered as
important safety features for home appliances and devices to summon help.

Participants with learning disabilities were the most familiar with
computer technology, which many already utilize in their daily lives. They
echoed concerns voiced in earlier EIF project years regarding the
double-edged sword of high technology. For example, year three participants
noted the liberating use of computers for persons with visual limitations but
identified the need to modify or simplify keyboards to increase their
accessibility for this group. Whether they used computers, PC's, and other
communication devices used at work, in study, or to augment daily activities,
year five consumers saw the primary role of these technologies as increasing
independence.

Focus group participants engaged in the discussions with enthusiasm,
good will, and the hope that their thoughts, needs, ideas, and
recommendations, coupled with those of prior year participants, will be used
to adapt devices already in production and to shape the research and
development process as new products are readied for market.

---------------------------------------------------------------
Correspondence regarding this document should be sent to
- naric@cap.gwu.edu OR:
- National Rehabilitation Information Center
8455 Colesville Road, Suite 935
Silver Spring, MD 20910-3319.
Voice/TDD: 800/346-2742
Voice/TDD: 301/588-9284
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Fax: 301/587-1967

NARIC disseminates documents from projects funded by the National Instititute
on Disability and Rehabilitation Research, U.S. Department of Education.
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