Why Is Assistive Technology Underused?

Citation

Johnson, D. (1999), "Why Is Assistive Technology Underused?", Library Hi Tech News, Vol. 16 No. 6. https://doi.org/10.1108/lhtn.1999.23916fad.001

Why Is Assistive Technology Underused?

Why Is Assistive Technology Underused?

David Johnson, Column Editor

[Ed: "EASI Access to Library Automation," a regular feature of Library Hi Tech News, examines new technology, information sources and services, and other news of interest to librarians concerned with providing quality services to their patrons with disabilities. EASI (Equal Access to Software and Information), in affiliation with the American Association of Higher Education (AAHE), is concerned with new and emerging technologies for computer users with disabilities.]

Introduction

A common complaint of librarians is that they buy expensive assistive technology (AT), such as CCTVs or reading machines, and then hardly anyone uses it. This is not a universal complaint, but it is common enough to raise the question of why this happens, and what can be done about it. I searched ERIC for research focusing on the problem of AT underutilization in libraries, and found none. (If any readers are aware of something I've missed, please let me know.) However, the problem of rejection, underutilization, and abandonment is widespread in the field of assistive devices, from prosthetics and orthotics to hearing aids, vision aids, and products for daily living. It has been widely discussed and researched, and many of the conclusions of this research can be applied to library AT. In this month's column I will talk about the results of AT underutilization research, and its implications for librarians.

Lack of Knowledge

One obvious reason for non-use of AT is lack of awareness that it exists. Not everyone with a disability is aware of all the AT that is available, and many who know about the existence of AT will not know that it is in your library.

Another fairly obvious reason for AT non-use is reluctance of people who haven't learned how to use it to even try. If people don't understand how to use a device, they will not get the maximum benefit from it, and rejection is the natural result. One solution is to make training available to users of assistive technology; another is to make sure that staff know how to use the library's AT, so that someone will be able to help patrons in using it. Some will refuse to try even if training or assistance are made available (20 years after the introduction of PCs, it is still not uncommon to meet older people who say they will never use a computer), but the number accepting AT should increase.

Beyond non-use due to lack of awareness or knowledge, there is also rejection and abandonment by people who know about devices and who may even have received training. In the early 1990s the National Institute on Disability and Rehabilitation Research (NIDRR) sponsored a major study of device abandonment, which was conducted by the National Rehabilitation Hospital (NRH) in Washington, DC. As part of this study, 227 adults with a variety of physical and sensory disabilities were surveyed about their use and abandonment of devices (Phillips and Broadnax, 1992; Phillips and Zhao, 1993). The NRH researchers did regression analyses relating use and nonuse to 12 possible factors, including device attributes, selection procedures, and modes of use. Four factors came out on top, three of which are relevant to libraries:

1. 1.

   Lack of consideration of user opinions in selection of the device.

2. 2.

   Poor device performance (not doing what it is supposed to do, or doing it less well than expected or desired, or being difficult to use).

3. 3.

   Change in user needs or priorities.

The National Rehabilitation Hospital study did not evaluate possible psychosocial factors, but other studies have done so. Two factors identified in this literature stand out as relevant to libraries:

1. 1.

   Feelings of stigmatization when using a device,

2. 2.

   Coping strategies in which people accommodate themselves to a disability by changing their preferences and lifestyles, rather than by finding ways to engage in desired activities despite the disability.

Lack of Consideration of Consumer Opinions

This factor was also identified as important by Stone et al. (1997), in a study that focused on the use of magnifiers by older adults with low vision. Stone et al. interviewed 15 elderly persons with a number of different eye conditions who were participants in the Rehabilitation Engineering Research Center on Aging (RERC-Aging) Consumer Assessment Study (CAS). These individuals all owned at least one magnifier but did not have one with which they were satisfied. After questioning them about their reasons for dissatisfaction, Stone et al. gave each the opportunity to examine and try a wide variety of magnifiers and lighting arrangements, with technical staff available to provide information. Each participant was then given the magnifier he or she found best, and shown how to use it. The result, according to Stone et al., was that "at least one satisfactory device was found for all but two of the 15 [participants]" (Stone et al., p. 173). They conclude that AT counselors helping low vision individuals should follow a procedure that includes giving consumers the opportunity to choose among many magnifiers, provision of training in device use, home trials, and examination of lighting.

Another study looked at patients discharged from an acute in-patient rehabilitation unit, comparing their views on AT with those of their therapists. Two major areas of discrepancy were found: Patients put more weight than did therapists on how they would look using AT, and compared to therapists they did not think that AT would require much change in their basic way of doing things (Scherer and Cushman, 1996, pp. 106-7). Librarians too may underestimate how concerned patrons are with how they look using AT, and patrons may well expect AT to be easier than it is, and therefore be inclined to give up too quickly. Scherer and Cushman suggest that consumers should be given a more realistic idea of what AT will require in order to be prepared for using AT after discharge; in libraries, this could be included in patron training.

The NRH and RERC-Aging studies were concerned with choosing devices for individuals, not for a large group such as library patrons, but the studies do lead to suggestions for librarians. The RERC-Aging study illustrates the fact that it is common for one individual with low vision to need a different device than another individual, and that individuals need to be exposed to a variety of assistive devices, so that they can pick the ones that are best for them. The fewer options you provide, the more patrons will fail to find what they need in your library and the less your AT will be used. (Of course, sometimes "providing more options" can mean providing a single device that offers more options.)

The NRH study suggests that consumers should be part of the AT selection process. For librarians choosing AT, this means that input should be obtained from patrons. Possible ways to get this input include surveys, contacting disability organizations, and forming a library consumer advisory committee with members having different disabilities. Also, as Courtney Deines-Jones suggested in the May EASI column, it would be helpful to have input from librarians who themselves have disabilities.

In the 1980s Marcia Scherer (then at Rochester Institute of Technology, more recently at SUNY/Buffalo) developed a Matching People with Technologies (MPT) model, with an accompanying assessment instrument, the Assistive Technology Device Predisposition Assessment (ATDPA), to help reduce technology underutilization (see Scherer and McKee, 1989; Scherer, 1996a, 1996b, chapter 8). The MPT model looks at characteristics of the person's disability, milieu, and personality and temperament, along with characteristics of the proposed technology. Scherer and Frisina (1994) contains a sample assessment form and an application of the model to individuals who are deaf or hard of hearing. Versions of the assessment have been developed for educational technology, as well as workplace AT and prosthetics/orthotics (Scherer and Frisina, 1994, pp. 65, 68). The educational technology instrument could perhaps be adapted for library use.

Poor Device Performance

One study used consumer focus groups (a Mobility Panel and a Sensory Panel) to choose criteria for evaluating five types of mobility technologies, three types of blind technologies, and three types of deaf technologies (Batavia and Hammer, 1990), and this study found that "effectiveness" was one of the top four consumer-chosen evaluation criteria for each class of technology. The major problem is not technology that doesn't work at all, but rather technology that works less well than the user would like. Even if a device enables people with disabilities to do something they could not otherwise do, it may not allow them to do it well, or easily, or comfortably. Often they would prefer to get help doing something or just not do it rather than use the enabling but difficult and imperfect AT.

Furthermore, the amount of difficulty people are willing to live with varies depending on their goals and purposes: Pleasure readers are apt to find the difficulties of CCTVs and scanners more repelling than people, such as students or researchers, who read to accomplish a task. For librarians, the practical implication is that they have to analyze what they expect patrons with disabilities to do with AT, and then judge whether the AT will enable them to accomplish it in a way the patrons would find sufficiently desirable. As suggested earlier, it is necessary to get the opinions of people with disabilities themselves rather than assuming that you can judge what they would want.

Again, for devices that are difficult to use (and this does include most high tech devices for those who are not yet familiar with them), it is important to offer training or assistance, because if people don't understand how to use a device, they will give up rather quickly.

Changes in Needs or Priorities

The NRH study found that, "not surprisingly, change in technology users' needs or priorities was a significant factor in device abandonment," including change in "functional abilities ... both improvements and declines" and change in "lifestyles and activities" (Phillips and Zhao, 1993, p. 43; the same passage is in Phillips and Broadnax, 1992, p. 23). "For example, one participant who used adaptive dressing devices found that when he returned to work, it saved time and energy to dress with assistance from his wife and reserve his strength for work activities. Dressing independently became less important than performing well at work ..." (Phillips and Zhao, 1993, p. 43; Phillips and Broadnax, 1992, p. 23) An example of adapting one's needs to a continuing condition is when someone decides to give up on reading after a decline in eyesight. This, of course, is not something a librarian should want to encourage. When outreach and publicity are designed, it needs to be kept in mind that many of the patrons with disabilities you want to reach have given up on reading and libraries.

Personality and "Coping Strategies"

A gerontologist suggests that some differences in AT utilization may be accounted for by a difference in personality between those who follow a "primary coping strategy [of] attacking the cause of distress" versus those who follow a "secondary coping strategy [of] accommodating themselves to the conditions or mentally reinterpreting the stressor as being less problematic" (Luborsky, 1993).

Scherer and Frisina found something similar in their study of hearing aid users: "In summary, some people adjust their preferences and lifestyles to accommodate their hearing loss. Others focus on ways to limit the influence of their hearing loss on desired activities" (Scherer and Frisina, 1994, p. 65). An important personality difference affecting reactions to adult-onset hearing loss, they suggest, is that between extroverts and introverts. Extroverts are "emotionally ready" for AT because they are motivated to master its difficulties, while introverts may prefer to withdraw from difficult group situations rather than put the necessary effort into learning to use hearing aids (Scherer and Frisina, 1994, p. 64).

Feelings of Stigmatization

The gerontologist Mark Luborsky also suggests that some people avoid using AT because they feel that using an assistive device marks them as disabled. He points to the example of polio survivors who had been stuck at home because of their need for ventilators, but who declined to use portable ventilators when they became available because going outside the home with a portable ventilator would have made them more visibly impaired (Luborsky, 1993, p. 73). Correspondingly, there must be persons with declining eyesight who do not go to the library because they would feel stigmatized by using a device like a CCTV or reading machine where other people can see them. Feelings like this are hard to deal with locally, because they are a result of many social experiences. However, anything that makes people feel comfortable with being seen to have a disability can help. That could include outreach efforts that make patrons feel that having a disability is accepted as normal by the library staff. In this light, it would be a mistake to try to accommodate fear of stigmatization by hiding AT.

Ways to Encourage More People to Use AT

A number of ways to encourage more AT use have come up so far. Let me list them here:

1. 1.

   Try to learn more about the needs and desires of your patrons or potential patrons with disabilities before purchasing AT, and try to match the AT to your patron's needs. The best source for learning more about the needs of patrons with disabilities is from people with disabilities.

2. 2.

   Make training and/or staff assistance available to patrons using AT devices.

3. 3.

   Reduce the fear of stigmatization through outreach and publicity, and through the supportiveness of a well-trained staff.

David Johnson is an Abstractor/ Information Specialist at the National Rehabilitation Information Center (NARIC). Readers with questions, comments, or suggestions may e-mail him at jdivad@aol.com