According to the most recent survey by the World Health Organization (WHO), the number of visually impaired (VI) people in the world is 285 million, where approximately 39 million people are blind (Mariotti, Reference Mariotti2012). Visual impairment includes both low vision and blindness (WHO, 2007). The majority of people with visual impairment (about 90%) live in developing countries and about 65% are aged 50 or above (Mothiravally, Ang, Baloch, Kulampallil, & Geetha, Reference Mothiravally, Ang, Baloch, Kulampallil and Geetha2014). Only 14% to 20% of people in developed countries suffer from disabilities in general, and these people have greater opportunities to take advantage of ICT-aided tools (Hogan, Kyaw-Myint, Harris, & Denronden, Reference Hogan, Kyaw-Myint, Harris and Denronden2012).
Numerous studies have been conducted focusing on people with disabilities from a sociological point of view. McAnaney and Williams (Reference McAnaney and Williams2010) suggest using action research methods for disability management. Hogan et al. (Reference Hogan, Kyaw-Myint, Harris and Denronden2012) contend that people with disabilities face significant inequity of remuneration, globally, due to the perception of a lack of skills and employment accommodations for particular roles. Niehaus and Marfels (Reference Niehaus and Marfels2010) identify the key competencies of disabled people by using factor analysis and investigate the scope of their integration into the workforce and mainstream society. However, there are insufficient studies in the specific domain of ICT applications for VI people and its potentially positive effect for VI people in the workforce.
Until now, various intervention programs have been conducted for VI people, and the diverse applications of ICT show promise in using ICT-aided tools. Governments in both developed and developing countries are finding ways to empower VI people through education, where a better quality life may be achieved by introducing new technology-related interventions. A pertinent question to ask is whether all countries should follow a ‘one-size-fits-all’ view of ICT-aided technologies or should countries attempt to build theories and frameworks based on their own cultural and sociopolitical and socioeconomic contexts. ICT scholars have suggested that the theories practised and the frameworks established in developed countries should be adopted in the ICT programs of under-industrialised or developing countries so that local researchers can work under the guidance of those frameworks (Ciborra, & Navarra, Reference Ciborra and Navarra2005; Heeks, Reference Heeks2001; MacKenzie, Podsakoff, & Podsakoff, Reference MacKenzie, Podsakoff and Podsakoff2011; Mbarika, Okoli, Byrd, & Datta, Reference Mbarika, Okoli, Byrd and Datta2005; Melville, Reference Melville2010; Musa, Meso, & Mbarika, Reference Musa, Meso and Mbarika2005). At the same time, it would seem essential to have a context-based, holistic view of the issues with ICT integration for VI people in order to find new perspectives and opportunities within the purview of those frameworks.
Many studies show that the use of ICT, such as the use of assistive technology, improves the productivity of people with a physical disability. Usually an assistive technology product can be equipment or a device, usually electronic or mechanical in nature, that helps disabled people to maintain their independence or improve their quality of daily life. Although most of the studies provide promise in maximising the benefits for the physically disabled or otherwise challenged people, studies related to the use of ICT for VI people are relatively less well documented in the academic field. Due to the rapid growth of professional publications, the identification of relevant studies and the synthesis of key concepts have become difficult. To overcome such problems during the identification and synthesis phase in our study, we conducted a systematic literature review (SLR) using specific search strategies. Our central focus is to understand the existing state of ICT-related products and discern the specific outstanding issues in the application of ICT for VI people. Therefore, this study aims to (a) analyse the existing research findings on ICT's role in the lives of VI people, and (b) identify the core ICT accessibility issues addressed in the existing literature.
Systematic Literature Review
The SLR is ‘a means of evaluating and interpreting all available research relevant to a particular research question or topic area or phenomenon of interest’ (Brereton, Kitchenham, Budgen, Turner, & Khalil, Reference Brereton, Kitchenham, Budgen, Turner and Khalil2007). A SLR mainly focuses on the difficulty of aggregating empirical evidence that might be procured by someone using widely different contexts and techniques (Webster & Watson, Reference Webster and Watson2002). Tranfield, Denyer, and Smart (Reference Tranfield, Denyer and Smart2003), Keele (Reference Keele2007), and Dieste, Grimán, and Juristo (Reference Dieste, Grimán and Juristo2009) identify the techniques for conducting an SLR, including selecting appropriate sources and keywords, combining the most favourable keyword strings using logical operators, identifying search areas for articles, and executing the search process to identify relevant empirical studies through screening based on specific inclusion and exclusion criteria.
Evaluating and following the guidelines of different SLR techniques (Chiarini, Ray, Akter, Masella, & Ganz, Reference Chiarini, Ray, Akter, Masella and Ganz2013; Dieste et al., Reference Dieste, Grimán and Juristo2009; Kitchenham, Reference Kitchenham2004; Racine et al., Reference Racine, Tousignant-Laflamme, Kloda, Dion, Dupuis and Choinière2012; Stuck et al., Reference Stuck, Walthert, Nikolaus, Büla, Hohmann and Beck1999; Vichitvanichphong, Kerr, Talaei-Khoei, & Ghapanchi, Reference Vichitvanichphong, Kerr, Talaei-Khoei and Ghapanchi2013) in our review included three steps: (a) searching for the initial list of studies, (b) relevance appraisal, and (c) extracting data. The search process was implemented for seven specific databases to capture scholarly journal articles and conference proceedings across disciplines for the period 2010 to 2015 (see Table 1).
TABLE 1 Keyword Database Searching Sumary
Note: * Total number of articles found by relevant keyword search in the period 2010 to 2015.
** Articles searched using all search criteria fields with full text and limited access.
A thematic analysis was then conducted to find the main outcomes and contributions of these selected articles. Thematic analysis is often a subjective study and generally consists of in-depth information presented in the form of words (Wong, Reference Wong2008). We used NVivo 10 qualitative data analysis software to find the clusters according to the similarity of most used words and phrases using constant comparison analysis, classical content analysis, keyword-in-context, word count, domain analysis, taxonomic analysis, and componential analysis (Leech & Onwuegbuzie, Reference Leech and Onwuegbuzie2011).
Searching for the Initial List of Studies
According to the International Statistical Classification of Diseases, Injuries, and Causes of Death (10th Revision) the definitions of low vision and blindness are as follows:
‘Low vision’ is defined as visual acuity of less than 6/18 but equal to or better than 3/60, or a corresponding visual field loss to less than 20°, in the better eye with the best possible correction. ‘Blindness’ is defined as visual acuity of less than 3/60, or a corresponding visual field loss to less than 10°, in the better eye with the best possible correction. ‘Visual impairment’ includes both low vision and blindness. (WHO, 2007)
These definitions helped us to understand the broad area of research.
We used the following keywords search in each database so that the search result would provide articles containing the word ‘technology’ along with ‘disabilities’. We used the following logical queries to search the full text of the journal articles and conference proceedings, where query intelligence is able to manage variations on words such as ‘disability’ and ‘disabilities’, ‘impaired’ and ‘impairment’ (i.e., ‘disability’ or ‘visual impair’, and ‘information communication technology’ or ‘information technology’, or ‘information system’ or ‘technology’, and ‘impact’ or ‘result’).
Seven online databases were searched for articles published from 2010 to 2015 to find the initial list of potentially relevant articles. The titles, keywords, abstract and full text were then carefully screened. The search query returned a total of 465,086 articles on disabilities but ultimately returned 6993 articles on ICT, VI, and the impact of ICT on VI people (see Table 1).
Relevance Appraisal
Relevant articles were then manually selected from the initial list and irrelevant articles were excluded by studying the titles, keywords, abstracts and full text. Articles that were removed from the list had one of the following exclusion criteria:
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• The articles did not focus on technology.
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• The articles were irrelevant to the VI community.
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• The articles were duplicates.
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• The articles did not agree with the inclusion criteria.
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• The articles did not demonstrate empirical evidence.
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• The articles were non-English articles.
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• The articles were not published between 2010 to 2015.
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• The outcomes of the articles were not related to VI people.
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• The full text of the articles was not available.
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• The articles did not meet the objective of our study.
Extraction and Analysis of Data
In the extraction stage, key details are considered to further identify articles based on inclusion and exclusion criteria for identifying relevant studies (Borg, Lantz, & Gulliksen, Reference Borg, Lantz and Gulliksen2014; Chaudhry et al., Reference Chaudhry, Wang, Wu, Maglione, Mojica, Roth and Shekelle2006; Racine et al., Reference Racine, Tousignant-Laflamme, Kloda, Dion, Dupuis and Choinière2012; Stuck et al., Reference Stuck, Walthert, Nikolaus, Büla, Hohmann and Beck1999), including deleting duplicate articles, year of publication, adoption, area of application, geographical area, type of communication, outcome measures, and results. Subsequently, 37 articles were identified and selected for further analysis (see Figure 1 for the exclusion steps).
FIGURE 1 Steps in the inclusion and exclusion criteria.
The NVivo 10 software was used to identify the most frequently used words, and to cluster the 37 articles into autogenerated subthemes (see Appendix A). The subthemes were:
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• assistive technology
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• electronic accessibility
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• mobile learning
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• virtual interface
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• access to the information
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• robotic technology.
These subthemes were grouped into the three key themes for our research: (a) assistive technology, (b) e-accessibility, and (c) virtual interface (see Table 2 for subthemes).
TABLE 2 Key Themes Derived From the Retrieved/Selected Articles
Note: AT = assistive technology; ICT = information communication technology; VI = visually impaired; WCAG = web content accessibility guidelines.
Results and Discussion
This SLR synthesised the findings of the 37 separate studies (see Table 2) that met our inclusion criteria. Most of the selected studies are qualitative in nature (see Appendix B). Overall, the concepts of the selected studies varied: issues of awareness, usability, impact to the issues of personalisation, design and ease in accessibility (see Appendix A). Therefore, to aid the presentation of our synthesis of the existing research findings on ICT's role in the lives of VI people, and identifying the core ICT accessibility issues, our findings are provided in three key categories: (a) assistive technology, (b) e-accessibility, and (c) virtual interface. During the discussion of our findings from these articles, we highligh the impact, demands, research gaps and limitations in the existing literature relevant to our research.
Assistive Technology
Assistive technology is any tool used to assist and improve the lives of people with disabilities. It is a broad concept (Grönlund, Lim, & Larsson, Reference Grönlund, Lim and Larsson2010) and can be defined as ‘any item, piece of equipment, product or system, whether acquired commercially, off-the-shelf, modified or customised, that is used to increase, maintain or improve functional capabilities of individuals with cognitive, visual, physical or communication disabilities’. Assistive technology can improve the functional abilities of disabled people and help in rehabilitation. It can aid VI people by enabling them to interact with the environment using pointing devices, screen keyboards, dictionaries, and voice recognition systems. However, several studies have argued that such interactive devices can be more effective if designed according to the user's individual needs, strengths, weakness, and their sense of self-identity (Anuar, Karim, Shattar, & Ali, Reference Anuar, Karim, Shattar and Ali2015).
The study of Söderström and Ytterhus (Reference Söderström and Ytterhus2010) suggests that the use of assistive technology positively affects VI people's self-identity and increases self-esteem when used with assistive technology–enabled tools (such as mobile apps, electronic braille systems) to overcome the barriers in accessing information. However, individual VI users may accept or reject an assistive technology device based on their own perception. Kanık (Reference Kanık2014) suggests that every library and information centre should provide assistive technology to VI people (as such, many Turkish libraries use assistive technology for VI people and find it to be valuable and useful). Pal and Lakshmanan (Reference Pal and Lakshmanan2012) suggest that there should be government initiated subsidies or open-source assistive technology based on an in-depth study that identified prospects of assistive technology (such as social, educational, and workforce integration). Likewise, Borg, Larsson and Östergren (Reference Borg, Larsson and Östergren2011) advocate that it is an international and national responsibility to ensure that VI people can access and avail themselves of assistive technology. Therefore, access to assistive technology is important in the education of VI people.
Assistive technology–enabled devices can ease the difficulty in navigation for VI people (Lhotska, Stepankova, Pechoucek, Simak, & Chod, Reference Lhotska, Stepankova, Pechoucek, Simak and Chod2011). The literature indicates that the use of multiple responses obtained through assistive technology–enabled sensory inputs can assist persons in engaging in everyday activities (e.g. supporting children as they take part in various activities, reducing the negative impact of their impairment, and aiding them to yield better learning outcomes). In addition, some devices can provide information on the activity patterns of individual VI people. Grönlund et al. (Reference Grönlund, Lim and Larsson2010) highlight the positive impact on the quality of life of VI people when assistive technology is used in inclusive education. However, assistive technology is still expensive considering the socioeconomic conditions of developing countries and as such assistive technology projects require both government and non-government funding, and active monitoring.
While learning is very challenging for VI people, there exist various types of learning software and assistive technology–enabled educational content for specific educational processes for VI students. VI students show eagerness in computing courses using assistive technology even though many of their educational facilities do not offer courses on computing (S. Ludi & Reichlmayr, Reference Ludi and Reichlmayr2011). However, Aziz, Mutalib, Sarif, and Jaafar (Reference Aziz, Mutalib, Sarif and Jaafar2013) argue that computer-based learning applications are not designed well enough for effective learning among VI students. Technologies such as screen readers and vocal synthesis are useful for VI people, albeit too generic.
Robotic technology also has become popular as an aid to VI persons. Assistive robots are being adapted for use by VI people. There are various research projects that are involved in the designing, constructing, implementing and testing of robots to guide VI people through daily tasks; some e-learning technologies aim to automatically generate accessible content for VI students.
Co-Robotic Cane (CRC), an ICT project for VI, has been established to develop a co-robotic navigation aid that will improve a VI person's independent mobility and quality of life (S.L. Ludi, Ellis, & Jordan, Reference Ludi, Ellis and Jordan2014). Bee-Bot, a programmable toy, has been found to be suitable for VI students (Kabátová, Jašková, Lecký, & Laššáková, Reference Kabátová, Jašková, Lecký and Laššáková2012). A device named BrainPort is being developed by neuroscientists and will be used for visual data collection through a small digital video camera. A new technology, a bionic eye or an artificial eye, which is a retinal system designed to restore vision, has the potential to improve the lives of VI people.
Even though the concept of a personal guidance system has existed since the 1970s, scientists have not yet perfected the technology for practical use (Fernandes et al., Reference Fernandes, Conceição, Paredes, Pereira, Araújo and Barroso2012). A device known as Trekker, which uses a global positioning system (GPS) to guide VI people in moving, is not sufficiently reliable because GPS is not available everywhere. Trekker is not easy to use and has to be used along with a white cane (Pathy, Noh, Moslin & Subari, Reference Pathy, Noh, Moslin and Subari2011). In another study, Dakopoulos and Bourbakis (Reference Dakopoulos and Bourbakis2010) argue that assistive technology–enabled navigation systems are in a prototype stage, but are not reliable. Researchers are working on a low cost smartphone version that a blind person would use when walking around a building. Another study by Calder (Reference Calder2010) stresses that there is poor collaboration among therapists, caregivers, trainers, programmers, and engineers who contribute to the design and development of such devices for VI people.
E-accessibility
E-accessibility is an effective tool at individual, community, national, and global levels. Access to information helps disabled people to manage their social contacts, coordinate their social events, and share their experiences and feelings. It has been reported that personalised and affordable e-accessible technologies support the learning process for people with visual impairment (Laabidi, Jemni, Jemni Ben Ayed, Ben Brahim, & Ben Jemaa, Reference Laabidi, Jemni, Jemni Ben Ayed, Ben Brahim and Ben Jemaa2014; Singh, Reference Singh2013; an internet library project was designed to provide access to online information and services for VI persons). Isaila and Nicolau (Reference Isaila and Nicolau2010) argue that e-accessibility offers many opportunities for people with special needs that are unavailable through other media, and that VI people using this media can be effectively integrated into the education system, labour market, and greater society.
Research shows that e-accessibility can act as an agent to transform the teaching and learning process to empower VI people. Singh (Reference Singh2013) finds that e-accessibility can assist VI people in transportation and communication. This study shows that the digital divide in e-accessibility can be decreased using optimised font size, colour and contrast, test recognising software, integrated GPS systems, screen readers, clear audio, text to speech books, and large button phones. The United Nations Educational, Scientific and Cultural Organization (UNESCO) has always advocated for the importance of the ‘intangible’ components of ICT, such as policies and capacity-building. Addressing these components can fundamentally minimise the digital-disparity in learning for VI people (Samaniego, Laitamo, Valerio, & Francisco, Reference Samaniego, Laitamo, Valerio and Francisco2012).
Singh and Moirangthem (Reference Singh and Moirangthem2010) suggest that libraries, as a source of information and knowledge empowerment, need special initiatives to ensure services for VI students. Pascual, Ribera, Granollers, and Coiduras (Reference Pascual, Ribera, Granollers and Coiduras2014) also found that VI users have better experiences and find self-confidence when websites are optimised to be used by them independently; however, web designers are less interested in such design due to cost and VI users do not complain if websites are not designed for them because of ‘learned helplessness’. Another study reveals that VI students show great attraction to online courses because they are not identified as different from others. Unfortunately, website designers rarely offer web access optimised for VI people because of economic and financial barriers (Bonavero, Huchard, & Meynard, Reference Bonavero, Huchard and Meynard2014a).
Armano, Capietto, Illengo, Murru, and Rossini (Reference Armano, Capietto, Illengo, Murru and Rossini2014) found that software such as LaTex, BlindMath, Texeasier, LAMBDA and LeanMath offers better e-accessibility experiences and solutions to VI people through access overlays, speech synthesis, and hotkey techniques that ultimately make users more independent and self-confident. However, radios, voice recorders, CDs and talking books are less costly solutions for e-accessibility (Bonnah, Nkansah, & Unwin, Reference Bonnah and Unwin2010).
Kulyukin and Kutiyanawala (Reference Kulyukin and Kutiyanawala2010) found that even though some devices assist VI people in relation to in-store navigation and product shopping, none of these meet all requirements. Further, VI people are less interested in buying newer technology to replace devices they are already using. VI travellers state that during travel they have to preplan extensively and they have to depend on others for information. A study in Malaysia shows VI travellers find it helpful when websites are user friendly and optimised for them (Mothiravally et al., Reference Mothiravally, Ang, Baloch, Kulampallil and Geetha2014).
The advent of e-learning has brought more prospects in e-accessibility for VI people. It provides an open and flexible learning environment for VI people who have limited mobility; however, there is currently a lack of platforms optimised for VI.
In the process of providing e-accessibility, teachers also require training to make the technology available and useful for VI students (Ramos & Andrade Reference Ramos and de Andrade2014). Carrière (Reference Carrière2012) emphasises the cooperation between teachers and students necessary for the effective use of e-accessibility where mobile-based education is a new strategy for learning and teaching VI people. E-accessibility can ensure equal opportunity for VI people, and the provision of different and customised mobile learning approaches shows promise. Also, mobile tools and platforms are lower in cost than computer-based platforms. In another study, Şimşek, Altun and Ateş (Reference Şimşek, Altun and Ateş2010) stress the importance of enacting governmental regulations to ensure e-accessibility.
Virtual Interface
Virtual interface or virtual environment is a significant medium through which VI users can interact with the web and the world. Until recently, there has been an apprehension that equality in accessibility was not being reached, and that graphical information in particular was not easily accessible to blind users. Some researchers suggest that a virtual environment is potentially suitable to explore greater scope for VI users, reducing their dependency on guides, and aiding in the development of more accurate spatial maps. Virtual environment techniques such as BlindAid enable VI people to learn about new environments on their own. Likewise, locomotion interfaces for VI users show improved performance in walking (Patel & Vij, Reference Patel and Vij2010). A study by Strumillo (Reference Strumillo2010) shows that the use of GPS receivers or electronic compasses to provide a virtual environment can aid VI people; however, such guidance systems need to be optimised separately for different VI users, and information received through other senses should fulfil the lack of the visual channel at the perceptual level.
Wu and Adamic (Reference Wu and Adamic2014) show that VI Facebook users have an equal eagerness to participate in social interactions. By using virtual interfaces on web pages, VI people can access information using a standard web browser with a Java virtual machine. Therefore, website designers need to incorporate accessibility criteria to ensure that VI people can access their websites. Aziz, Isa, and Fadzir (Reference Aziz, Isa and Fadzir2011) point out the need for governmental regulations to serve the interest of VI users by enforcing web content accessibility guidelines (WCAG) to provide a special user interface.
Kane et al. (Reference Kane, Morris, Perkins, Wigdor, Ladner and Wobbrock2011) found that access overlay and improved spatial understanding can provide a better user interaction when using a touch screen. Buzzi, Buzzi and Leporini (Reference Buzzi, Buzzi and Leporini2012) suggest that designing customised and optimised user interfaces for mobile devices and applications will increase the inclusion of VI people. A study by Jadán-Guerrer (Reference Jadán-Guerrero2014) finds that AINIDIU (intelligent agent for VI children) can create an entertainment–education environment that improves the learning and the user experience of VI people. Also, different electronic travel aids using 3D virtual environments show promise; however, these devices are not yet commercially available (Bujacz, Skulimowski, & Strumillo, Reference Bujacz, Skulimowski and Strumillo2011).
Conclusions
Based on the selected 37 articles, a mix of dynamic findings (see Appendix B) have been identified that fall into three distinctive technical themes (Appendix A). These themes are derived from our literature analysis using thematic analysis, which required categorising and analysing articles according to themes that were relevant to the goals of a study. According to our research goal, we reviewed the article findings from the perspective of ICT's role in the lives of VI people, and identifying the core ICT accessibility issues, such as issues related to economic and social barriers.
Our review finds that the study of ICT for VI people still requires further research and investigation, although our systematic review provides evidence of increasing interest in further research. In adiditon, from the information gained from international conferences, researchers and various bodies, there has been emphasis on ICT accessibility for VI people, such as making friendlier websites (Fuglerud, Reference Fuglerud2011; Wanniarachchi & Jayathilake, Reference Wanniarachchi and Jayathilake2012), which has highlighted the need for a greater development responsibility for web content providers.
Our study identifies various advancements and issues related to the application of ICT for VI people. It is difficult to provide definitive conclusions and recommendations that apply to the entire VI community because there are various and ever-changing social contexts in which VI people live (Söderström & Ytterhus, Reference Söderström and Ytterhus2010). For example, assistive technology helps to bring equal opportunities and minimise digital-disparity by using ICT-led technologies; however, economic disparity in developing countries may limit this minimisation process of digital-disparity. Therefore for future research, it would not be appropriate to compare, contrast and superimpose the results and issues found in our study across all developing countries.
Our review shows that assistive technology can affect a VI person's self-esteem, and the adoption or rejection of the technology depends on the social conditions and perceptions of its specific users (e.g., in some countries the use of technological devices is considered to be a symbol of ‘high status’). Therefore, while making plans and policies for the use of assistive technology, we should strive to change such perceptions so that devices are deemed as essential devices to be used by all types of people.
This study reveals that VI people show less interest in purchasing a new device to replace devices with which they are already familiar. In such cases, it might be useful to distinctly and easily show opportunities to use such devices and discuss benefits that any new device might provide to the VI device user. We also found that development of assistive technology for VI people is relatively slow and governments in developed countries should formulate and approve policies to expedite research and development of assistive technology for VI people.
In the case of e-accessibility, the main concern is the cost that impedes the wider availability of e-accessibility in developing countries where unequal distribution of resources is traditionally predominant. It is essential to explore how government can play a vital role to ensure the affordability of e-accessibility. Additionally, mobile learning platforms are of great interest to VI people; however, there is currently a lack of professional expertise in this field to further develop these platforms. Virtual interfaces also can reduce dependency on guides for VI people and help them with more accurate spatial maps and strategies. Such technology requires a wide coverage of GPS systems and cheap internet access, which in turn requires governmental support.
This study has not quantitatively assessed the impact of ICT on the lives of VI people; for example, this study has not determined the percentage of VI people who have benefited from the adoption of ICT, the percentage of their increased involvement in the workforce, or the increment in productivity, income, and contribution to the economy. However, our study provides the basis for researchers and policymakers to identify the important aspects of the planning and materialising of ICT projects that are aimed at improving the quality of life for VI people.
Last, but not least in our opinion, is the understanding of ‘contextual analysis’ in future research that is essential prior to the deployment and provision of technologies for VI people (Vidhya & Kumari, Reference Vidhya and Kumari2015). For instance, a society should accept and recognise the expertise of a VI person who learns through computer-aided technology in the rural settings of a developing country. Therefore, existing technologies can serve as a good starting point for further research to investigate how ICT-led innovation and adoption into the life of people with VI is considered in different countries.
Appendix A
Sources Clustered by Word Use and Frequency, and Themes
We clustered the most used words and their frequency in the selected 37 articles in NViVo10. This clustering is illustrated in Figure A1 by the different colour coding of author(s).
FIGURE A1 Clustered articles to similar words/concepts.
Appendix B
Summary of ICT Application and Its Impact on Visually Impaired People
