Original article
ICT support for visually impaired individuals
2025 Volume 24 Issue 2 Pages 12-20
Details
2025 Volume 24 Issue 2 Pages 12-20
Background and Objective: Visually impaired individuals face significant challenges in accessing information due to difficulties in reading, writing, and mobility, resulting in an information disadvantage. The advent of assistive technologies such as PC-Talker and audio browsers in the 1990s, and smartphones with accessibility features like VoiceOver since 2009, has improved information access. This study aims to evaluate the effectiveness of intermediate outreach ICT support provided at the Low Vision Clinic.
Method: The study included 75 participants (34 females, 41 males) aged 7-84 years (mean: 41.6 ± 25.6 years) who received ICT support at Niigata University Medical and Dental Hospital from January 2018 to December 2020. A total of 144 sessions were conducted over 34 months. Personalized support, including device setup and accessibility adjustments, was provided by staff from the Niigata City ICT Support Center and Certified Orthoptists. Statistical analyses, including chi-square tests with Bonferroni adjustments, were performed using SPSS (p < 0.05).
Results: Of the 144 support cases, 52 were in 2018, 50 in 2019, and 42 in 2020. iPad-related support was most common in 2018 (87 cases, 53.0%), while smartphone support increased significantly in 2020 (49 cases, 46.2%). By age group, iPad usage was highest in the School-age group (88 cases, 51.5%), whereas smartphone and smart speaker usage were predominant in the Elder-age group (53 cases, 51.0%). Middle-age participants utilized personal computers and AI tools more frequently.
Conclusion: Intermediate outreach ICT support enhanced service delivery by integrating personalized assistance within clinical settings. Its implementation alongside medical care shows promise for improving access and usability of assistive technologies.
Many visually impaired individuals experience difficulties with reading, writing, and walking [1,2], which often makes it challenging for them to obtain the necessary information, leading to information disadvantage. The development of assistive technology such as PC-Talker and audio browsers in the 1990s, however, enabled visually impaired individuals to use personal computers and the internet, facilitating the process of obtaining information.
Since the introduction of the iPhone with VoiceOver in 2009, numerous applications (hereafter referred to as “apps”), including optical character reader (OCR) apps, various social networking service (SNS) apps, walking assistance apps, and cashless payment apps, have been developed and are now widely used in various aspects of daily life. These apps not only improve the quality of life for individuals with normal vision but also promote “universal design for information” [3] by providing accessibility to individuals with disabilities. Effective utilization of Information and Communication Technology (hereafter referred to as “ICT”) devices can facilitate easier information access and ensure a high quality of life.
Kristin et al., have reported that the acquisition and utilization of smartphones by older adults with visual impairments lead to enhanced psychological well-being and diminish barriers to participation in the information society [4]. This indicates that age does not limit the benefits derived from utilizing ICT. However, visually impaired individuals who are unable to effectively use ICT devices are deprived of these benefits, resulting in an information disparity. To facilitate learning of smartphone and other ICT technologies among visually impaired individuals, a personalized and step-by-step training approach is recommended [5]. This is due to the significance of considering the degree of visual impairment and age. ICT support education for visually impaired individuals is conducted by special support schools, welfare facilities, and organizations supporting visually impaired individuals. In the context of ophthalmic care for low vision, patients requiring ICT support are typically referred to external facilities that offer such assistance.
This current situation poses an obstacle to ICT utilization for individuals with visual impairments.
At the Low Vision Clinic of Niigata University Medical and Dental Hospital, ICT support is provided through intermediate outreach support [6] by inviting external support staff to the hospital. The implementation of intermediate outreach support for visually impaired individuals has not been widely reported internationally, and even within Japan, such initiatives are scarce [6,7]. To date, this form of support has not seen widespread adoption.
This study aims to summarize and examine the current state of ICT support incorporating intermediate outreach assistance.
This study retrospectively investigated the implementation of ICT support incorporating intermediate outreach assistance through an examination of medical records. The objective is to summarize and examine the current state of ICT support, with a focus on its application and outcomes.
1. Subjects
The subjects of this study consisted of 75 individuals who received ICT support at the Low Vision Clinic of Niigata University Medical and Dental Hospital. The gender composition was 34 females and 41 males, with the age at the start of ICT support ranging from 7 to 84 years, and the mean age being 41.6 years (mean ± standard deviation of 25.6 years). The primary causes of visual impairment were glaucoma in 23 individuals, followed by retinitis pigmentosa in 17 individuals, and optic neuropathy in 13 individuals, identifying these conditions as the main causes (Figure 1). The visual acuity of the better eye of the subjects ranged from 0.02 to 1.0 in decimal visual acuity, and all cases had visual field impairments.
2. Survey period and survey method.
The survey period spanned three years, from January 2018 to December 2020. During this time, the clinic was closed for two months, from May to June 2020, due to the spread of COVID-19. Over the course of 34 months, 75 individuals received a total of 144 instances of ICT support.
Patients eligible for ICT support were those continuing care at the Low Vision Clinic of Niigata University Medical and Dental Hospital, specifically those who expressed a desire to utilize ICT tools such as smartphones or were recommended by their primary care physician to use such technology. Additionally, through the hospital’s community collaboration, patients referred from other medical institutions and scheduled by appointment were also accepted.
Support staff from the Niigata City ICT Support Center were invited to the Low Vision Clinic on the last Friday of each month, where they, alongside Certified Orthoptist, provided ICT support in the low vision rooms. Throughout the three-year duration of this study, the ICT support staff and a Certified Orthoptist consistently maintained their roles. Notably, the assessment of patients’ needs for ICT support was conducted in advance by a different Certified Orthoptist.
ICT support begins with a thorough inquiry into the devices and applications the patients regularly use, the issues they encounter in various situations, and what they wish to accomplish. Following this initial assessment, the decision on whether to primarily utilize visual or auditory functions is made based on the individual patient’s visual capabilities. Subsequently, adjustments to the device’s accessibility settings are made, such as enabling voice input and output for emails on smartphones, tailored to meet the patient’s needs. Given the importance of customizing ICT support to suit each patient’s unique requirements, individualized instruction is provided, typically lasting about one hour.
For patients desiring continuous ICT support, follow-up appointments are scheduled accordingly.
3. Intermediate outreach support
Intermediate outreach support refers to a form of assistance that occurs between specialized institutions, such as healthcare facilities and support centers, and the individuals or communities that require their services. This support model is characterized by professionals and support staff coming from outside to provide targeted assistance, services, information, and training or education tailored to specific needs, differing from direct medical or caregiving service provision.
In contrast, Traditional Outreach involves support staff visiting the individual’s home directly to provide personalized support and services. This method is convenient for individuals who find it difficult to leave their home. However, the time required for support staff to travel can limit the number of services they can provide. Additionally, visits need to be planned in advance, making it difficult to respond in emergencies. Regular type support occurs when support staff provide services at a single facility or center, with individuals visiting this location to receive support. This method allows individuals with similar challenges to interact with each other. However, not all individuals can easily access these centers due to transportation issues or distance. Intermediate Outreach serves as a middle ground between Traditional Outreach (home visits) and center-based outreach services (Figure 2) [7].
In our initiative, we have incorporated intermediate outreach support for ICT assistance for individuals with low vision. This involves professionals specialized in ICT visiting ophthalmology clinics or other venues where individuals with visual impairments receive diagnosis and low vision care, to offer consultation, information, and guidance related to ICT. This model serves as an intermediate between traditional outreach (home visits) and center-based outreach services (Figure 2) [7].
For individuals with visual impairments, this model enables them to receive specialized ICT consultation and instruction in the familiar setting of their regular ophthalmology clinic. For welfare services, it provides a mechanism to reach individuals with specific needs.
4. Data processing
We compiled the annual and age group-specific counts of support cases. Statistical analyses were performed using SPSS Statistics version 18 (SPSS Japan Inc., a subsidiary of IBM). A chi-square test was conducted to examine the relationships between categories. Adjusted residuals were calculated to identify significant associations between specific categories. To control for Type I errors due to multiple comparisons, the Bonferroni method was applied when evaluating the significance of the residuals. The significance level was set at less than 5% (p < 0.05) after Bonferroni adjustment.
Compliance with Ethical Standards
The authors declare no conflicts of interest. This study was approved by the Medical Ethics Committee of Niigata University (Approval number 2021-0133) and conducted in accordance with the principles of the 1964 Declaration of Helsinki and its later amendments.
1. The number of support cases
The number of support cases was 52 in 2018, 50 in 2019, and 42 in 2020. The age groups at the start of support were 55 individuals in school age (7-22 years), 53 in middle age (23-64 years), and 36 in elderly (65 years and older). The number of support sessions per person was 1 for 42 individuals, 2 for 13 individuals, 3 for 6 individuals, 4 for 9 individuals, 5 for 3 individuals, and 6 for 1 individual. The average number of support sessions per person was 1.92.
2. Support contents by year (Table 1)
In 2018, the most frequent support was related to setting up and demonstrating applications on iPads with 87 cases (53.0%), followed by setting up and demonstrating smartphone applications with 27 cases (16.5%), and demonstrating smart speaker usage with 16 cases (9.8%). In 2019, the most frequent support was related to setting up and demonstrating applications on iPads with 52 cases (36.4%), followed by setting up and demonstrating smartphone applications with 44 cases (30.8%), and setting up magnification, mouse pointers, and sound settings on personal computers with 14 cases (9.8%). In 2020, the most frequent support was related to setting up and demonstrating smartphone applications with 49 cases (46.2%), followed by setting up and demonstrating applications on iPads with 21 cases (19.8%), and demonstrating smart speaker usage with 11 cases (10.4%).
Multiple comparisons revealed that iPad usage significantly increased in 2018 and significantly decreased in 2020. Conversely, smartphone usage was significantly lower in 2018 and significantly higher in 2020. Additionally, the utilization of event information was significantly greater in 2019 compared to both 2018 and 2020.
3. Support contents by age group (Table 2)
In the School-age group, the most frequent support activity was setting up and demonstrating applications on iPads, with 88 cases (51.5%). This was followed by providing information about school and learning, with 28 cases (16.4%), and setting up and demonstrating smartphone applications, with 26 cases (15.2%). In the Middle-age group, the most frequent support activity was also setting up and demonstrating applications on iPads, with 53 cases (38.4%). This was followed by setting up and demonstrating smartphone applications, with 41 cases (29.7%), and configuring magnification, mouse pointers, and sound settings on personal computers, with 16 cases (11.6%). In the Elder-age group, the most frequent support activity was setting up and demonstrating smartphone applications, with 53 cases (51.0%). This was followed by demonstrating smart speaker usage, with 20 cases (19.2%), and setting up and demonstrating applications on iPads, with 19 cases (18.3%).
Multiple comparisons revealed that iPad usage was significantly higher in the School-age group and significantly lower in the Elder-age group. In contrast, both smartphone and smart speaker usage were significantly lower in the School-age group and significantly higher in the Elder-age group. Personal computer usage was significantly higher in the Middle-age group compared to both the School-age and Elder-age groups. Furthermore, “providing information about school and learning” was significantly more common in the School-age group, while it decreased significantly in the Middle-age and Elder-age groups. Other tools (AI-related visual aids) were used significantly more in the Middle-age group compared to both the School-age and Elder-age groups.
The results of multiple comparisons revealed distinct trends in device usage and information provision by year and age group. The increase in iPad usage in 2018, followed by a decline in 2020, can be attributed to the initial demand for ICT implementation in educational settings under the GIGA School Program [8]. However, the decline in 2020 may have been influenced by restrictions due to the COVID-19 pandemic [9]. The rapid expansion of remote education and work during the pandemic likely accelerated the adoption of smartphones as a primary tool for communication and information access. As a result, smartphone usage showed a significant increase in 2020. Additionally, demonstrations for smartphone settings and applications surpassed those for iPads, which can be attributed to the improved accessibility features [10] and enhanced usability of smartphones for visually impaired individuals.
The significant increase in the use of event information in 2019 can be linked to the occurrence of numerous ICT-related events and educational programs, such as the comprehensive event for visually impaired individuals, “Site World” [11]. These events likely played a role in promoting social participation and educational support for visually impaired individuals.
The significantly higher iPad usage in the School-age group and its significantly lower usage in the Elder-age group align with the use of iPads for education and learning among younger individuals. In particular, students with visual impairments benefit from learning support that leverages features such as screen magnification and text-to-speech. The development of educational support applications like “UD Browser” [12], which enables text-to-speech and enlarged display of images and charts, has further promoted the use of iPads in educational settings. On the other hand, the significant increase in smartphone and smart speaker [13] usage in the Elder-age group reflects the active adoption of these devices for daily life and social participation. The portability of smartphones and the voice-operated features of smart speakers are well-suited to meet the needs of older adults.
Personal computer usage was significantly higher in the Middle-age group, suggesting that individuals in this age range use PCs for work and productivity. Features such as screen magnification and customizable mouse pointers, which cater to visual impairments, are particularly valuable in this context. The significantly higher provision of “information about school and learning” in the School-age group underscores the importance of ICT in educational support. For visually impaired students, the provision of appropriate information is a crucial factor in ensuring equal learning opportunities.
The significantly higher use of other tools (AI-related visual aids) in the Middle-age group indicates the adoption of new technologies for daily life and work. AI-driven support technologies, such as image recognition and voice assistants, have proven to be highly beneficial for visually impaired individuals in this age group.
ICT support for visually impaired individuals is expected to become increasingly important in the future. Many iOS applications are designed with accessibility features in mind, ensuring that visually impaired users can efficiently utilize these apps. Consequently, we recommend using iPads and iPhones to support individuals with visual impairments. The development of visual support systems utilizing AI and AR technologies [14,15] is progressing, and more advanced support is anticipated. The intermediate outreach support provided in this study has proven effective as a mechanism to connect visually impaired individuals with the ICT support they need. Without outreach, visual rehabilitation facilities are unable to identify the presence of visually impaired individuals or their associates. In other words, there is a gap between those seeking services and those providing them. This intermediate outreach support serves as an excellent system for bridging this gap [6].
This study highlights that the ICT support needs of visually impaired individuals vary by age and life stage. ICT support significantly enhances the daily lives and social participation of visually impaired individuals [16]. Technologies such as AI and AR promote independence and improve digital accessibility in society. As a result, these technologies are expected to enhance information access, education, and foster greater social diversity. Moving forward, such support is anticipated to enable visually impaired individuals to participate equally across all sectors of society.
We would like to express our heartfelt gratitude to all the staff members at the Niigata City ICT Support Center for their invaluable support and assistance.
