Does culture affect usability? A trans-European usability and user experience assessment of a falls-risk connected health system following a user-centred design methodology carried out in a single European country.

BACKGROUND: User-centred design (UCD) is a process whereby the end-user is placed at the centre of the design process. The WIISEL (Wireless Insole for Independent and Safe Elderly Living) system is designed to monitor fall risk and to detect falls, and consists of a pair of instrumented insoles and a smartphone app. The system was designed using a three-phase UCD process carried out in Ireland, which incorporated the input of Irish end-users and multidisciplinary experts throughout. OBJECTIVE: In this paper we report the results of a usability and user experience (UX) assessment of the WIISEL system in multiple countries and thus establish whether the UCD process carried out in Ireland produced positive usability and UX results outside of Ireland. METHODS: 15 older adults across three centres (Ireland, Italy and Israel) were recruited for a three-day trial of the system in their home. Usability and UX data were captured using observations, interviews and usability questionnaires. RESULTS: The system was satisfactory in terms of the usability and UX feedback from the participants in all three countries. There was no statistically significant difference in the usability scores for the three countries tested, with the exception of comfort. CONCLUSIONS: A connected health system designed using a UCD process in a single country resulted in positive usability and UX for users in other European countries.

Human centred design considerations for connected health devices for the older adult.

Connected health devices are generally designed for unsupervised use, by non-healthcare professionals, facilitating independent control of the individuals own healthcare. Older adults are major users of such devices and are a population significantly increasing in size. This group presents challenges due to the wide spectrum of capabilities and attitudes towards technology. The fit between capabilities of the user and demands of the device can be optimised in a process called Human Centred Design. Here we review examples of some connected health devices chosen by random selection, assess older adult known capabilities and attitudes and finally make analytical recommendations for design approaches and design specifications.

Telework rationale and implementation for people with disabilities: considerations for employer policymaking.

BACKGROUND: Telework has been promoted as a viable workplace accommodation for people with disabilities since the 1990s, when information and communication technologies (ICT) had developed sufficiently to facilitate its widespread adoption. This initial research and accompanying policy recommendations were prescriptive in nature and frequently aimed at employers. OBJECTIVE: This article adds to existing policy models for facilitating successful telework outcomes for people with disabilities. Drawing upon two studies by the Rehabilitation Engineering Research Center on Workplace Accommodations, we expound on employee-side considerations in the implementation of telework. METHODS: Our policy model utilizes established typologies for policy evaluation to develop a process model that considers rationales and implementation factors for telework among people with physical disabilities. RESULTS: Telework may be used as an accommodation for disability, but employee rationales for telework are more complex, involving work-life balance, strategies for pain and fatigue not formally recognized as disability, and expediency in travel and transportation. Implementation of telework as a component of workplace operations is similarly multifaceted, involving non-technology accommodations to realize job restructuring left incomplete by telework. CONCLUSIONS: Our model grounds new empirical research in this area. We also renew our call for additional research on effective telework practices for people with disabilities.

New technology-based functional assessment tools should avoid the weaknesses and proliferation of manual functional assessments.

BACKGROUND: Formal functional assessment tools for use with older adults have been in widespread use since the 1960s. Instruments have been designed to assess a wide range of different aspects of a person's everyday life. This article seeks to document the evolution of the tools used in such a way as to inform the development of the field. STUDY DESIGN AND SETTING: The Medline, CINHAL, and Science Direct databases were searched for relevant literature relating to the functional assessment of older adults. After analysis of initial results, a second-stage search was conducted to find literature relating to the use and validation of instruments found initially. RESULTS: Four categories of functional assessment instruments were identified for the purposes of this article: basic activities of daily living (ADLs), instrumental ADL, global health scales, and performance-based tests of functional ability. These categories and several of the most widely used tools therein are discussed chronologically to document the evolution of the field. CONCLUSIONS: With the advancement of technology has come the possibility to perform functional assessments in new ways. This outline of the evolution of functional assessment should be of considerable use as researchers seek to design new functional assessments for older adults.

Wireless technologies and accessibility for people with disabilities: findings from a policy research instrument.

The near universal deployment in the United States of a wide variety of information and communications technologies, both wired and wireless, creates potential barriers to use for several key populations, including the poor, people with disabilities, and the aging. Equal access to wireless technologies and services can be achieved through a variety of mechanisms, including legislation and regulations, market-based solutions, and awareness and outreach-based approaches. This article discusses the results of policy research conducted by the Rehabilitation Engineering Research Center on Wireless Technologies (Wireless RERC) using policy Delphi polling methodology to probe stakeholders' opinions on key access barrier issues and to explore potential policy responses. Participants included disability advocates, disability/wireless technology policy makers, and product developers/manufacturers. Respondent input informed subsequent development of potential policy initiatives to increase access to these technologies. The findings from the Delphi suggest that awareness issues remain most important, especially manufacturer awareness of user needs and availability of consumer information for selecting the most appropriate wireless devices and services. Other key issues included the ability of people with disabilities to afford technologies and inadequacies in legislation and policy making for ensuring their general accessibility, as well as usefulness in emergencies. Technical issues, including interoperability, speech-to-text conversion, and hearing aid compatibility, were also identified by participating stakeholders as important. To address all these issues, Delphi respondents favored goals and options congruent with voluntary market-driven solutions where possible but also supported federal involvement, where necessary, to aid this process.

A retrospective analysis of recommendations for workplace accommodations for persons with mobility and sensory limitations.

Many studies of workplace accommodations have primarily focused on a particular disability or functional limitation. The need exists for a broad-based study of the types and frequency of accommodations recommended for a variety of functional limitations, including multiple limitations. The researchers conducted a retrospective analysis of 266 persons who received vocational rehabilitation assessment to determine the frequency and types of recommended workplace accommodations. Computer systems/components and special tools/furnishings were the most frequently reported types of recommendations, regardless of functional limitation, whereas adaptive strategies were least likely to be suggested. In general, most job accommodation recommendations targeted the individual work space and were intended to assist in the completion of specific job tasks. Findings indicate that recommendations for workplace accommodations were surprisingly similar across all functional limitation groups.

Barriers to evidence based practice in accommodations for an aging workforce.

According to a recent Government Accountability Office report, the number of workers over age 55 is projected to increase significantly over the next twenty years, with this demographic group projected to comprise as much as twenty percent of the workforce by 2015 [12]. Accommodating the functional limitations of a large number of older workers may prove challenging for employers; however, policies and practices shaped over the course of the next few decades could allow aging workers to remain a valuable part of the US economy. Given these considerations, it is useful from a public policy perspective to determine the degree to which employers are currently addressing the accommodation needs of older workers. This paper presents the results of a study that attempted to determine the extent to which a sample of Fortune 500 employers was currently accommodating older workers. The study's methodology (in particular, its use of semi-structured telephone interviews) is reevaluated and new options (such as anonymous online employer surveys) are considered for the valid and reliable collection of data on accommodations for older workers.

Virtual exclusion and telework: barriers and opportunities of technocentric workplace accommodation policy.

Teleworking, a restructuring of the manner in which work occurs, based on information communication technologies (ICTs), is a promising way of further integrating people with disabilities into the workplace. In contrast to telecommuting, in which the work is primarily shifted in locale, telework is a restructuring of the tasks to be accomplished within the larger work setting which could result in "work" being done remotely, or collaboratively with coworkers (remotely or not) using ICTs. Drawing upon a review of the literature, this paper explores the relationship between telework and people with disabilities. While the advent of telecommuting and subsequently "teleworking" might open increased opportunities for the hiring of people with disabilities, it may also place severe constraints on the type of work, workplace environment and interactions, and accumulation of social capital for people with disabilities. Whereas much of the prevailing literature on telework and disability is often proscriptive in nature and is written with an audience of employers in mind, it is just as important to consider policy options from the standpoint of the employee as well. This paper proposes a number of policy approaches for the creation of an inclusive work environment for teleworkers with disabilities that can minimize, as much as possible, the social isolation faced by teleworkers with disabilities while maximizing their participation within the workplace community. Policy objectives for enhancing telework for people with disabilities fall into three general categories: 1) research, 2) outreach, and 3) interventions.

Disabilities and impairments: strategies for workplace integration.

This article argues that disabilities are, within many of the U.S. debates, best understood as certain kinds of impairment affecting a person's capabilities to perform socially defined roles and functions within specific environments. We also argue that it is not the impairments per se that lead to claims about what we ought to do or ought not do for people with disabilities. Rather, it is only within the context of capabilities being linked to the concept of freedom--almost universally valued in the current U.S. socio-political environment--that disability issues take on an ethical tenor. Additionally, we link the notion of disability to that of social capital. In particular, we argue that any social organization that discriminates against people with disabilities by attenuating their opportunities within that environment also decreases the social cohesion that exists within that organization. Such corporate climates promote organizational structures and processes that fail to optimize facilitation of the mutual benefits of the members. Finally, we discuss three different kinds of accommodation strategy: assistive technologies, systemic personal change, and universal design. We suggest a case-based (casuistic) approach to problems caused by disabilities. Using methods from both philosophy and public policy, we then build policies for accommodations incrementally, based on an application of those methods to the cases, and resulting in a more nuanced process enabling the creation of policies that take account of the experiences of both disabled and non-disabled people.