2003 Conference Proceedings

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Darren Booy and Rachel McCrindle
Department of Computer Science
The University of Reading
Berkshire, UK, RG6 6AY
Email: d.a.booy@reading.ac.uk 
Email: r.j.mccrindle@reading.ac.uk 

Julie Barrett and Geoff Cook
Research Group for Inclusive Environments
The University of Reading
Berkshire, UK, RG6 6AY
Email: j.barrett@reading.ac.uk 
Email: g.k.cook@reading.ac.uk 

Frank Arnold
Royal Berkshire Hospital
Reading, UK
Email: arnold_frank@hotmail.com 


Technologies such as the world wide web, digital television and DVD players are becoming increasingly prevalent in everyday situations such as the workplace, shopping, education and entertainment, and our reliance on them is growing accordingly. At the same time, effective use of such technologies is becoming increasingly dependent on the user being able to interact easily and effectively with such technologies often via an interface with a highly visual component.

Unfortunately, many of these interfaces, even when developed according to aesthetic design principles are often still too complex for the vast majority of users and resultantly less usable, less pleasurable and less effective [1] than they could be. Such problems are further exacerbated if users have some form of impairment. For example, there are at least 1.7 million people in the UK who are blind or partially sighted and approximately 20% of these users are unable to exploit fully the facilities offered by digital technologies [2]. In order to avoid a 'digital divide' and to satisfy new legislation [3, 4] it is important readdress how interfaces are designed and developed.

This presentation describes our work underway to develop software interfaces that can be used easily and effectively by as many people as possible people regardless of their age, disability, computer experience or native language. The presentation reports on the results and evaluations accruing from the development of an inclusive interface to date and describes its application to a hospital portal system for information, communication and entertainment.


Inclusive design may be defined as "the design of mainstream products and/or services that are accessible to, and usable by, as many people as reasonably possible on a global basis, in a wide variety of situations and to the greatest extent possible without the need for special adaptation or specialized design" [5]. Designing in this manner can be complex however, given the multiplicity of impairment/special requirement groups and the diversity of need within each group itself. For example, the level of visual impairment and image distortion of a computer screen can vary significantly depending on whether the impairment results from glaucoma, nystagamus, diabetic retinopathy or age-related macular degeneration [6].

Assistance technology devices such as Braille displays and digitised speech engines can be used in various ways to ease interaction with digital equipment [7]. However such devices often attract an additional cost and frequently require a number of different pieces of equipment to be connected together again limiting usability. It would be far simpler and more cost effective if interfaces could be designed from the outset to include as many members of the user population as possible.


We are currently conducting a structured programme of research and its application to the design of an interface to a hospital portal system for bedside information, communication and entertainment (offering features such as such as TV, radio, phone, e-mail and web services) such that it can be used by all patients regardless of their age, disability, computer experience or native language. In this respect we are:

  1. Gathering requirements with representative patient groups.
  2. Developing prototype solutions to meet identified requirements.
  3. Evaluating their utility with user groups from each category.
  4. Embodying the improvements within the hospital portal such that it becomes accessible to all patients.
  5. Examining the efficacy of such interfaces/systems in a hospital/related environment
  6. Disseminating the results and encouraging good inclusive design practices for all interfaces

Given the variability of the patients who will be using the system and the requirement for them to use the system immediately with very little instruction, this is a particularly good application on which to assess the needs and effectiveness of inclusively designed interfaces.

Our approach is to combine reviews of the literature and examples of current best practice [e.g. 8, 9, 10] with a highly user-focused study to elicit user requirements, opinions and feedback of what makes the most effective and pleasurable interfaces to use.


Trials to date have involved in excess of 100 participants in attendance at Low Vision Clinics at the Royal Berkshire Hospital and at Day Care Centres in Oxford and Reading. Clients of these centres had a physical or sensory disability and tended to be older people, some had multiple impairments and a small number were also cognitively impaired. Through a specially designed set of interfaces, participants were asked to give their views on preferred icon size, icon polarity, text size and foreground/background colour contrasts. Results were recorded unobtrusively through the use of an automated log file.

The results of the log files were processed using a statistical program (SPSS) and were analysed using Kendall's - Coefficient of Concordance. Very briefly, the results obtained showed that two thirds of the participants were able to see the smallest presented icon (93x93 pixels) clearly, there was a slight preference for an icon polarity of dark on light, just over half of the users were able to focus on a text size of (18pt), and a black background was the most popular, and yellow the least popular option.

Focus groups have also been undertaken with regard to further eliciting user requirements for computer interfaces and also to ascertain their personal experiences during their hospital stay particularly with regard to their requirements and desires for information, communication and entertainment facilities.

Our presentation will illustrate the facilities of the portal, show examples of the portal in use by patients within the orthopaedic ward at the Derbyshire Royal Infirmary, and explain in detail the nature and results of the user trials at the Royal Berkshire Hospital and Reading Day Care Centres and the subsequent focus groups.


We would like to thank the staff and clients at the above mentioned Centres, as well as the EPSRC and NESTA who have provided funding for our work, and our collaborators from the RNIB, Age Concern and the Department of Health and Social Care at Reading University.


[1] J. Neilsen's, Alertbox,: DVD Menu Design: The Failures of Web Design Recreated Yet Again, December 9, 2001 URL : http://www.useit.com

[2] Get the Message Online, Making Internet Shopping Accessible to Blind and Partially Sighted People, RNIB Campaign Report, 2001.

[3] Official USA Government website of Disability Discrimination Act, Section 508. URL : http://www.section508.gov/

[4] UK Government, The Disability Discrimination Act, Home Web Page, http://www.disability.gov/dda/dle/index.htlm

[5] The Center for Universal design at North Carolina State University, Official Website, URL : http://www.tiresias.org/guidelines/inclusive.htm

[6] National Eye Institute, Vision Problems in the US, http://www.nei.nih.gov/eyedata/photos.htm

[7] McCrindle, R.J., The Impact of New and Distributed Technologies on Disabled Users, IEE European Workshop on Digital Imaging, London, November 1999.

[8] RNIB (2002), Accessible Website Design, http://www.rnib.org/digital/hints.htm

[9] W3C (2000), Web Accessibility Initiative, http://www.w3.org/WAI

[10] J. Nielsen Usable Information Technology, http://www.useit.com

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