Accessible Information isn’t Easy: Shifting Practice and Production Perspectives of Information Accessibility
Melody M Terras1* and Dominic Jarrett2
1School of Education and Social Sciences, University of the West of Scotland, UK
2North Ayrshire Health and Social Care Partnership, UK
Submission: November 25, 2021; Published: December 06, 2021
*Corresponding author: Melody M Terras, School of Education and Social Sciences, University of the West of Scotland, Paisley PA1 2BE, UK
How to cite this article: Melody M T, Dominic J. Accessible Information isn’t Easy: Shifting Practice and Production Perspectives of Information Accessibility. Glob J Intellect Dev Disabil, 2021; 9(3): 555763. DOI:10.19080/GJIDD.2021.09.555763
Abstract
If self-determination, inclusion and participation are to become a reality for individuals with intellectual disabilities then accessible information must be provided to support them. However, current policy and practice concerning information provision have become stagnated and developmental progress is lacking due to a narrow focus of the perception and definition of the nature and format of accessible information. Easy Read information is frequently viewed as the most appropriate and thereby the preferred format. However, a rapidly developing empirical evidence base indicates that the perceived high face validity and reliability of Easy Read information is unfounded, with emerging evidence indicating that many of the aspects of Easy Read assumed to support accessibility such as the use pictures and simplified text may actually make the comprehension of the information more difficult, and thereby undermine the aim of accessibility. Therefore, in this article we recognise the difficulties associated with the production of accessible information; and offer a critical discussion and reflection of the current evidence base concerning Easy Read and accessible information, and consider how it may developed in the future by recognition of the wide scope of accessible information; increased multidisciplinary working; more meaningful participation of individuals with intellectual disabilities; and increased recognition of the cognitive load involved in comprehending information resources, to best support the health and wellbeing of individuals with intellectuals disabilities in the post Covid-19 environment.
Keywords: Intellectual disabilities; Accessible information; Inclusion; Easy read; Comprehension; Psychology; Multidisciplinary working; Evidence-based practice
Introduction
Information provision is a critical component of healthcare and the self-management of wellbeing [1]. However. the prevalence of communication and literacy issues in individuals with an intellectual disability, and the acknowledged gap between the health literacy levels of this population, and the general level of ability commonly demanded by health information resources [2] has resulted in the increasing provision of accessible information resources both off and online [3]. A highly salient example of the importance of accessible information to individuals with intellectual disabilities who are at increased risk from Covid-19 [4,5] is demonstrated by the difficulties in keeping up with the rapidly changing government guidance concerning lockdowns and social distancing restrictions as the government guidance tended to use highly complex terms and be legal in tone, with research indicating that individuals with intellectual Disabilities experienced a lack of available, understandable information and their carers struggled to support them due to insufficient information being available concerning personal protective equipment PPE and social distancing restrictions [6]. Given the importance of accessible information, in this article we offer a critical reflection and discussion of the current landscape concerning the provision of accessible information and how it may develop to best support the health and wellbeing of individuals with intellectuals’ disabilities in the post Covid-19 environment.
The Challenge of Providing Accessible Information
Considerable effort has been expended by professionals and supporters of people with intellectual disabilities on adapting information to maximise its use and benefit. This agenda is broadly labelled as Accessible Information (AI), which the Royal College of Speech and Language Therapists (RCSLT) define as “A supportive process of making information easier for people with learning [intellectual] disabilities, that firstly involves simplifying the linguistic message and secondly conveying the simplified message in different mode(s) of communication, i.e., not just the written word or spoken message” [7].
Easy Read information is a common form of information adaption promoted as part of the AI agenda, particularly in relation to people with intellectual disabilities. While the defining characteristics of Easy Read information can be variable, common features include the use of pictures (e.g., drawings or photographs) alongside short sentences containing simplified language, and a minimal use of technical language (commonly referred to within the field as ‘jargon’). Numerous sets of recommendations exist specifying these and other technicalities of Easy Read formats, such as font size, typeface, alignment, and use of white space [8,9].
However, there is an increasing acknowledgement that many of these specifications are not underpinned by a robust evidence base [10] and growing concerns are being voiced concerning the overall effectiveness of the easy read information currently being provided. A number of recent empirical studies systematically exploring the use and nature of easy read information, have demonstrated that many of the key elements of easy read which were assumed to make information more accessible and thereby aid understanding may actually be detrimental to comprehension and even create ambiguity and further difficulties [11]. For example, the highly advocated easy read practice of using images alongside the text may actually hinder understanding as the addition of images increases the processing demands (cognitive load) of the text [12] and may even induce ambiguity as images are open to interpretation [10]. More generally the oversimplification of the information provided may also result in the loss of essential detail [13]. Furthermore, Easy Read is often produced as a standalone resource, however in practice its use is often supported by carers and health care staff; and although the provision of such support is often welcomed and even advocated as good practice [14], this too may be problematic as while it may offer social support, it may do very little to actually aid the understanding of the information provided [12]. In addition, our own work has highlighted the value that individuals with intellectual disabilities, carers, and clinicians place in Easy Read resources, but also demonstrated the scope for variable responses to them, as well as the practical challenges that accompany their implementation and production [3,15]. An interesting observation that emerged from our exploration of the views and preferences of individuals with intellectual disabilities and their carers was the high degree of preference, engagement and positive responses expressed in relation to socially contextualized sources of information such as drama productions exploring bullying and discrimination and social stories focusing on mental health [3]. These information resources provide information in a highly contextual and relatable form which is in direct contrast to the decontextualised provision of the majority of easy read information. Finally, although co-production is widely advocated in relation to provision of Easy Read information, research suggest that the actual degree of meaningful involvement of individuals with intellectual disabilities remains limited [3,16].
It appears that current policy and practice concerning information provision have become stagnated and developmental progress is lacking due to a narrow focus on Easy Read as the preferred default provision despite the rapidly developing empirical evidence base indicating that the perceived high face validity and reliability of Easy Read information is unfounded as many of the aspects of Easy Read assumed to support accessibility such as the use pictures and simplified text may actually make the comprehension of the information more difficult thereby undermining the aim of accessibility.
Opportunities for the Future Design of Accessible Information
The provision of accessible information, particularly Easy Read information is no easy task given the variable needs of the target population and the complex and often nuanced nature of the information that needs to be conveyed. It is therefore advocated that such a complex task can be best addressed by recognizing that one approach will not fit all and that the wider scope and context of what makes information accessible requires more detailed consideration: accessible information is more than just Easy Read.
To ensure that the future provision of accessible information is fit for purpose, all forms of accessible information, and the future development of Easy Read in particular, should be explicitly grounded in an empirical evidence base. We advocate increased multidisciplinary working to ensure that the relevant professional expertise is brought to bear and increased meaningful participation of the target audience at all stages of the design process are necessary. It is essential to recognise that like text processing itself [17], accessible information provision is an interactive process that needs to accommodate the consideration of the character of the information resource itself; the abilities and skills of the person using it; and the context in which it is used [3].
These proposals are supported by the existing base. For example, the engaging and beneficial qualities of a range of information formats is well documented in the research literature such as the use of video and narratives (including drama) to support the provision of health information [18]; and the use of role play, and real-life experience have been advocated to support the provision of Easy Read resources [12]. Such narrativebased approaches allow for contextualization and the social construction of meaning which supports the understanding of abstract information. More discursive approaches also provide opportunities for social support which can help develop selfbelief and self-esteem in comprehension abilities [3] and are well documented enablers of self-determination and inclusive behaviour [19].
Information provision is highly complex, and we need to draw upon a varied skills mix to inform the design. The valuable contributions made by speech and language therapists is perhaps the most obvious and we endorse this and further call for the production of accessible information to be supported by an increasing pool of expertise [3]. Given the text-based nature of much accessible information, an understanding the skills of the user, the component processes of reading, and how visual and verbal based information is processed [12] is required to inform the design process. The increasing provision of information online necessitates appreciation of how online information is processed and comprehended [20], so psychological and learning technologist insight is essential. Accessible information resources are only effective if they meet the needs and preferences of the user. Rather than, user-based constraints may be derived from a subject expert, the primary source should be the end users themselves. The relatively low levels of meaningful involvement of individuals with intellectual disabilities is well recognized, and we endorse the numerous calls for this addressed [21,22].
Conclusion
Although the empirical evidence base concerning the design and effectiveness of accessible information is rapidly developing, it remains highly fragmented and increased integration is required to support robust evidence-based practice. We advocate that such integration can best be facilitated by enhanced recognition and use of a wide variety of information formats; increased multidisciplinary working; more meaningful participation of individuals with intellectual disabilities; and increased recognition of the skills of the user, especially their capacity to deal with the cognitive load involved in comprehending information resources. The provision of accessible information that meets the varied needs of all intended users is no easy task, however it can become a vibrant and all-inclusive reality ready to meet the needs of the 21 century users if all skilled and interested parties work together.
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