GRF 2nd One Health Summit 2013: Presentation by Jukka Limatainen, University of Jyväskylä, Finland

1. Enabling People With Disabilities
To Access Health And Safety
Assistance Via Mobile Technology:
Research Specifically Focused On
the Visually Impaired
Jukka LIIMATAINEN1, Helen T SULLIVAN1,2
1University of Jyväskylä, Finland
2Rider University, USA
UNIVERSITY OF JYVÄSKYLÄ
2nd GRF One Health
Summit 2013

2. Globally, there 1 billion people with disabilities.
Approximately 285 million are visually impaired.
A One Health approach must not neglect this
population.
This presentation addresses how innovative
technology can increase access to health and
safety information.

3. Introduction
• Today there are approximately 6.8 billion mobile phones and an
exponential growth in mobile tablet adoption (ITU: International
Telecommunication Union (2013). ICT Facts and Figures.)
• We see growing use of mobile devices and their apps used to deliver
timely health and safety information, but there remains little focus on how
to specifically ensure that such information is available and usable by
people with disabilities
• Our research work is focusing on the challenges faced by the visually
impaired and blind in receiving information and the solutions for
communicating in a non-visual manner that is currently under
investigation.

4. The Challenge
• With the help of mobile interactive technologies and accessible user
interfaces, end users have the potential to independently communicate
and obtain information about their surroundings
• The user interfaces of most mainstream mobile devices are, however,
highly visual, graphics-oriented touch screens which can make the
transmission (and translation) of information from a visual to a non-visual
modality challenging
• This challenge negatively affects the accessibility and usability of the vast
resource of timely health and safety information that can be brought into
the palm of a person with visual impairment
• Our approach is to effectively utilize the built-in interactive, haptic and
audio features of the mainstream mobile devices
• We employ iterative user-centered design principles and include selected
stakeholders in the design process

5. Research co-operation
•
•
Research co-operation includes University of Jyväskylä (Finland), Educational
Testing Service in Princeton, New Jersey (USA) and Finnish Federation of the
Visually Impaired (Finland)
Field tests have been conducted in Jyväskylä School for Visually Impaired and Blind
(Onerva, Finland)

6. Method
•
•
A user-centered design process allows the end users to participate in the early
stages of an application development cycle in order to ensure that the
resulting product is usable and meets the needs of the user.
The design process contains initial requirement, implementation and
evaluation phases, conducted in iterative cycles where design goals and
solutions gradually become more specific after each iteration.
Fig. 1: User-centered mobile application design process involving visually impaired and blind participants.

7. The mobile application prototype
•
•
•
•
The first version of the application was designed for Nokia 5800 touch-screen
mobile phone following user-centered design principles
Our participants included assistive technology professionals, information
technology researchers from the university and teachers and students from a
school for visually impaired and blind
The result was a way-finding application that allowed students with visual
impairments to interact with their environment through use of digital camera and
two-dimensional (2D) barcode reader technology, now available on most smart
and feature phones.
Accessibility features were implemented in the application user interface to
enhance the usability of the mobile device.

8. Case study1: Field tests
•
•
•
•
•
The research group organized a preliminary workshop for students (N=11) and
teachers at the school, where the features and the use of application was
demonstrated.
The research group organized the field tests at the school premises.
After the field tests the usability survey was conducted, with System Usability
Scale (SUS) as a measure for usability.
The results were analyzed and following improvements were made for
1)screen reader capability
2) better audio quality
3) improvements to the camera, and
4) enhancements to the starting and stopping of the application
The new features were designed for the iPhone® 4GS mobile phone. The second
field test and SUS-questionnaire was conducted at the school premises with the
same field test group (N=11).

9. Case Study 2: User-Centric field test
for haptic feedback
•
•
•
We applied a similar user-centric application development process for the second
case study.
The students concentrated on mathematics tasks where simple graphs and
geometric shapes were presented on touch-screen tablet with vibrotactile haptic
and audio cues.
Their task was to identify different shapes of symbols on the tablet screen.

10. Haptic Field Test Process
Introduction
• Verbal
introduction
• Preliminary
questionnaire
Haptic Field Test
• 20 tasks,
controlled by
Test
Supervisor
• Video/audio
recorded
Assesment
• SUSassesment
• NASA-TLX assesment

11. The Results: case study 1
•
We utilized the System Usability Scale (SUS) questionnaire for measurement of
application usability, where the usability score scale varies from 0-100. The higher
the SUS score, the better the perceived usability
Case Study 1
Field Test 1
57.75
Field Test 2
•
SUS-score
86.38
The SUS–assessment of case study 1 shows that we are able to increase the
usability of the game by 49% using our user-centric development process.

12. The results: case study 2
•
•
•
•
•
The results from this field test suggest that our approach of representing graphical
information using haptic feedback on a tablet can be an effective tool for students
with visual impairments.
Two of the test participants were able to identify 85% of the symbols and graphics
presented on the tablet touch screen.
The usability score was good (average score 70, N=3), with room for further
improvement.
The NASA-TLX results indicate average cognitive demand
These results are still preliminary, and continue testing with larger sample of
students.

13. One Health Concept
•
•
•
•
Our research focuses on how features common in consumer grade, mainstream
touch-screen smartphones and tablets costing less than USD$500 can be adapted
to provide effective delivery of complex visual information to individuals with
visual impairments.
By improving usability and accessibility of these devices, health information
providers and mobile application developers can introduce applications that meet
the needs of a broad range of end users, including those with visual impairments,
a population over 285 million globally.
For those who are visually impaired or blind, mobile applications can assist in safe
way-finding, recognition of objects, such as medications, or understanding
potentially complex health and safety advice and warnings, which can have
significant importance in everyday life and well-being
Access to health and safety information should not be restricted by poor design
and non-implementation of accessibility

14. Conclusion
1) With the help of user-centric development process, common
features in consumer grade phones and tablets may be further refined
to compensate for sensory impairments.
2) We have conducted studies and field tests to examine user
experience and behaviour in tasks that would otherwise be difficult or
impossible for individuals with visual impairments.
3) We have demonstrated how these tasks can be adapted using
common technological features in mobile devices so that they become
usable.
UNIVERSITY OF JYVÄSKYLÄ
2nd GRF One Health
Summit 2013

15. Questions?
jukka.t.liimatainen@gmail.com
hsullivanphd@gmail.com
UNIVERSITY OF JYVÄSKYLÄ
2nd GRF One Health
Summit 2013

16. Extra: WHO survey
• Visual impairment and blindness
• Fact Sheet N°282
Updated October 2013
• Key facts
• 285 million people are estimated to be visually impaired worldwide: 39
million are blind and 246 have low vision.
• About 90% of the world's visually impaired live in developing countries.
• 82% of people living with blindness are aged 50 and above.
• Globally, uncorrected refractive errors are the main cause of visual
impairment; cataracts remain the leading cause of blindness in middleand low-income countries.
• The number of people visually impaired from infectious diseases has
greatly reduced in the last 20 years.
• 80% of all visual impairment can be avoided or cured.