Community Health Toolkit

Designing for accessibility for people with disabilities

@maria and @erika recently asked an excellent question about whether or how we had thought about or worked on disability and accessibility in the CHT community. I wanted to share a few initial ideas and welcome a conversation if others have ideas or requests. I think there are many opportunities that we have yet to pursue related to disability and accessibility, but here’s a start:

Making health services more accessible for everyopne
Healthcare is more accessible for everyone, including people with mental and physical disabilities, when it can be provided in your home by a trusted neighbor who lives in your community. This has come up in several of our partnerships and it’s part of why we work and design technology in a way that has a point of view about how the underlying health system is designed. A related insight is that access to care is often worse for people with disabilities, and health systems can and should track such inequalities. People who build CHT apps have opportunities to build such metrics into care delivery apps and analytics dashboards. Phyllis Heydt and Hannah Kuper do great work on this front and we’ve advised on some of their research in the past. They wrote a post on access to care for people with disabilities in the COVID-19 context, it’s worth checking out.

Using technology to support services for people with disabilities
In some projects, the health services we support have a specific disability focus. For example, @beatrice led work on an mThrive app that integrated early child development into routine child health. This was based on the World Health Organizations Nurturing Care framework, which is great. New workflows included software-supported screenings for kids’ developmental milestones and counseling and referral workflows to help parents get the best possible support when their kids have special needs.

Making software more accessible for users with disabilities
I would say our work and progress on this front has been more modest. That said, a few years ago we noticed that health workers were squinting at their phones a lot, and in follow up fieldwork we realized that a lot of health workers have poorly corrected vision, across many health systems we support. This led to some UI improvements focused on making the app easier to use for people with poor vision, including larger font sizes, better spacing, better color contrast.

Nothing about us, without us
A final thing I’ll mention is that our work on human-centered design has emphasized participation in the design process. The Scandanavian tradition tradition of participatory design is probably the most significant influence in this work, see for example the Routledge Handbook of Participatory Design for more work from that research community. Another relevant point of reference though is that the disability rights and independent living movement in the US have advocated for many years that people with disabilities should be involved in designing solutions to their problems. “Nothing about us, without us” was long one of their slogans, and it’s a motto that resonates for people in many other situations too. I’ve benefited from reading about this communities work, and while it has been a major focus of work within the CHT community, I’d certainly welcome it if we found the right partners/contributors.

There are lots of other things I’d like to see us do from a software accessibility perspective. We designed the top tabs before the floating action button design pattern was common, and since then there’s been a lot of research that having key actions at the bottom of a smartphone/tablet screen is more ergonomically accessible for most people. I’m sure there are more things we’d discover if we did a thorough accessibility audit with the right partners. If anyone has ideas about other projects in this area that we could work on, I’d be interested to hear them!

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Thanks, @isaacholeman! This is really helpful background on what work has been done already and some directions for us to move in.

I think we can also consider how the analytics tools we use and the analytics products we produce can be made more accessible. This thread on Twitter about accessibility in data visualization points out that much of the work in this area has focused on color blindness but that other disabilities that affect using data visualizations are actually much more common and hardly ever accommodated. As we think more, in particular, about data-driven supportive supervision and making data-based insights accessible to health workers, these concerns seem especially relevant.

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Interesting thread! This tweet in that thread is exactly the sort of thing we were working on for poor vision and app usability generally:

Resources we could use more of (1/?):
Low vision (~30% of all people):
- High contrast text
- High contrast elements
- Using texture, shape, units
- Designing with zoom/magnification
- Using Hierarchy and Focus
- Using annotations or guides

— Frank ⌁ (@FrankElavsky) January 18, 2021

That thread also mentions Microsoft’s inclusive design guide, which is interesting and something I’d like to spend more time with. In general it seems worth revisiting accessibility, partly to improve app usability generally, and in particular like you say for the newer analytics tools we’ve been working on.

I know you have plenty already on your plate @erika, but if you or @beatrice, @helenelizabeth, @Nicole_Orlowski and others think of ways to get people working on this for the CHT community, that would be really great.

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