"I Choose Assistive Devices That Save My Face" A Study on Perceptions of Accessibility and Assistive Technology Use Conducted in China
Franklin Mingzhe Li, Di Laura Chen, Mingming Fan, Khai N. Truong
““I Choose Assistive Devices That Save My Face”
A Study on Perceptions of Accessibility and Assistive Technology Use Conducted in China
FRANKLIN MINGZHE LI,
Carnegie Mellon University, USA
DI LAURA CHEN,
University of Toronto, Canada
MINGMING FAN,
Rochester Institute of Technology, USA
KHAI N. TRUONG,
University of Toronto, Canada
Despite the potential benefits of assistive technologies (ATs) for people with various disabilities, only around 7% of Chinese withdisabilities have had an opportunity to use ATs. Even for those who have used ATs, the abandonment rate was high. Although Chinahas the world’s largest population with disabilities, prior research exploring how ATs are used and perceived, and why ATs areabandoned have been conducted primarily in North America and Europe. In this paper, we present an interview study conducted inChina with 26 people with various disabilities to understand their practices, challenges, perceptions, and misperceptions of using ATs.From the study, we learned about factors that influence AT adoption practices (e.g., misuse of accessible infrastructure, issues withreplicating existing commercial ATs), challenges using ATs in social interactions (e.g., Chinese stigma), and misperceptions about ATs(e.g., ATs should overcome inaccessible social infrastructures). Informed by the findings, we derive a set of design considerations tobridge the existing gaps in AT design (e.g., manual vs. electronic ATs) and to improve ATs’ social acceptability in China.CCS Concepts: •
Human-centered computing → Empirical studies in accessibility .Additional Key Words and Phrases: Assistive technology, Accessibility, People with disabilities, Qualitative study, Interview, China,Misperceptions
ACM Reference Format:
Franklin Mingzhe Li, Di Laura Chen, Mingming Fan, and Khai N. Truong. 2021. “I Choose Assistive Devices That Save My Face”: A Studyon Perceptions of Accessibility and Assistive Technology Use Conducted in China. In
CHI Conference on Human Factors in ComputingSystems (CHI ’21), May 8–13, 2021, Yokohama, Japan.
ACM, New York, NY, USA, 22 pages. https://doi.org/10.1145/3411764.3445321
China has the world’s largest population with disabilities (83 million) [26], which is twice as large as that of the US[21, 70]. From many Chinese people’s perspective, having a disability is linked to past wrongdoings [12], and they viewdisability as a problem that needs to be “fixed” or pitied [69], which creates a barrier in social interactions betweenpeople with disabilities and the general public [12]. Prior work has reported that Chinese people with disabilities arelargely invisible from the public in both urban and rural areas [16], and have limited education and presence in theworkplace. Such a large population with disabilities also severely lacks the care offered by trained professionals. Forexample, China has only 1/185 as many physiotherapists per person as Europe [26]. Given the large number of peoplewith disabilities and the serious shortage of trained professionals that can offer help to people with disabilities in China,
Permission to make digital or hard copies of part or all of this work for personal or classroom use is granted without fee provided that copies are notmade or distributed for profit or commercial advantage and that copies bear this notice and the full citation on the first page. Copyrights for third-partycomponents of this work must be honored. For all other uses, contact the owner/author(s).© 2021 Copyright held by the owner/author(s).Manuscript submitted to ACM 1 a r X i v : . [ c s . H C ] J a n HI ’21, May 8–13, 2021, Yokohama, Japan Li et al. assistive technologies are viewed as an appealing solution to assist people with disabilities. However, only about 7% ofthe Chinese with disabilities have had an opportunity to use ATs [71].The practices and challenges surrounding AT and design considerations for improving the social acceptability andadoption of ATs have been the subject for many research studies in the past (e.g., [3, 4, 8, 46, 53, 65]). However, thesestudies were conducted primarily of North America [46, 53, 65] and Europe [3, 4, 8]. Given the large population withdisabilities in China, the shortage of trained professional caregivers, the low usage rate of ATs, and different culturalcontexts from North America or Europe, it is important to examine the practices and challenges surrounding ATacceptability and adoption within China specifically. In this work, we sought to answer the following two overarchingresearch questions (RQs): • RQ1: What are the practices and challenges surrounding AT use by people with various disabilities? • RQ2: What are the design factors that influence the adoption and social acceptability of ATs?To answer the research questions, we conducted a semi-structured interview study with 26 participants with variousdisabilities: eight with visual impairments, eight with hearing loss, eight with motor impairments, and two with cerebralpalsy. From the study, we articulated current problems with AT adoption (e.g., misuse of accessible infrastructure, issueswith replicating existing commercial ATs) and challenges of using ATs in social interactions (e.g., Chinese stigma). Wethen revealed existing misperceptions about ATs (e.g., ATs should overcome inaccessible social infrastructures, ATswith more functionalities are better) and compared our findings with misperceptions about ATs in North America [65].Informed by the findings, we further showed a set of design considerations for improving the social acceptability ofATs, and bridging the existing gaps in AT design (e.g., manual vs. electronic ATs, mainstream technologies vs. ATs). Bycompleting a study, similar to previous research, with participants in China specifically, we contribute an understandingof the practices and challenges surrounding AT use by people with various disabilities and provide associated AT designrecommendations under the Chinese context.
Despite China’s rapid urbanization, the majority of people with disabilities still reside in rural areas [69]. AlthoughChina has the largest population with disabilities, people with disabilities are rarely seen in public spaces [16]. Chinesewith disabilities also have limited education compared to other countries [26]. In 2016, nearly 20% of Chinese withdisabilities were either illiterate or had no schooling [69]. Furthermore, Kim et al. compared special education betweenChina and the United States from national educational statistics [36, 48, 49]. Around 48% of people with disabilitiesin China went to special schools instead of studying in regular schools with able-bodied students in 2017 [36, 49]. Incontrast, this number was less than 3% for people with disabilities in the United States [36, 48].In terms of employment, China adopted multiple methods, such as employment by proportion, concentratedemployment, and non-profit job allocation to support the employment of people with disabilities [24]. However, only28% of Chinese with disabilities were working in 2017 [69]. Due to the existence of prejudices in the workplace, manypeople from the general public assume that people with disabilities cannot productively contribute to the economicgrowth or the society, and should have specialized career paths (e.g., visually impaired individuals trained to bemassagers) that often separate them from the general public [69].People with disabilities in China, for a long time, were referred to as “can fei,” a combination of two charactersmeaning “incomplete or deficient” and “useless.” Starting from the 1990s, people started using the word “can ji,” changing Study on Perceptions of Accessibility and Assistive Technology Use Conducted in China CHI ’21, May 8–13, 2021, Yokohama, Japan the latter character to one meaning “disease or sickness.” However, the term “can ji” implies that people with disabilitieshave some kind of incurable ailment that renders them abnormal. Unfortunately, this term is still widely used todayeven though the term “can zhang” has been suggested (replacing the second character with one meaning “obstacle orbarrier”) [16]. Some Chinese parents still consider having a child with disabilities as linked to wrongdoings in the past[12]. In sum, it is not uncommon that many Chinese people still hold a stigmatized view that disability is a problemto be “fixed” or pitied. In our work, we explore how the traditional Chinese stigma affects the AT adoption in socialinteractions.
Given the large number of people with disabilities and the shortage of trained professionals that could offer helpto people with disabilities in China, ATs can be an appealing solution to help people with disabilities improve dailyfunctioning, enable a person to successfully live at home and in the community, and enhance independence [63].According to the national sample survey of people with disability in China, only 7% of the population with disabilitiesin China has ever used an AT [71]. Within this 7% of AT users, over 20% of them abandoned their owned ATs [73].As a result, it is important to understand how people with disabilities use ATs, why they abandon certain ATs, andthe challenges that they encounter when using ATs. To investigate the reasons for AT abandonment, prior researchexplored the social and personal factors that influence AT adoption and usage [17, 33, 37, 51, 52, 65]. To improve theATs’ adoption rate, it is important to involve AT users in the entire design process [52, 58] or empower them to “DIY”their own AT devices [27]. In terms of the AT design, Riemer-Reiss and Wacker [58] conducted a survey study with 115individuals with various disabilities and concluded that ATs must meet an important functional need to improve theadoption rate, similar to what Kintsch and DePaula found [37]. Other factors, including frustration tolerance, minimizedstigmatization, and willingness to incorporate ATs into daily routine, could help to reduce technology abandonment[37]. Deibel [17] further presented a generalized heuristic model for understanding various factors that influence theadoption and usage of ATs, such as device necessity, task motivation, physical effort, and cognitive effort. Differentenvironments, such as workplaces or social interactions, also affect the choice of ATs [13, 65, 72]. In our work, weintroduce AT adoptions in China through factors that affect AT choices and the unique needs for AT customizations.Mainstream technologies, such as mobile devices, have been explored for accessibility purposes (e.g., [7, 20, 23,32, 33, 35, 38–40]). However, challenges and concerns surrounding the adoption of mainstream technologies stillexist [14, 32, 33, 54, 60]. Kane et al. [33] conducted a qualitative two-method study with 20 participants with visualand motor impairments to examine how people select, adapt, and use mobile devices in their daily lives. The studyprovided guidelines to design more accessible mobile devices (e.g., increasing configurability and contextual adaptation).Furthermore, the evolving needs of users should also be considered to increase the adoption of ATs [60].AT adoption conditions also vary in countries with different levels of income [19]. People who live in low-incomecountries may have limited access to ATs [19] and lack sufficient knowledge and research on ATs [45]. For example,Rodrigues et al. [60] examined smartphone adoption in Western countries and found that some people with visualimpairments continue to use their old feature phones with the availability of other ATs. In contrast, people with visualimpairments in Bangalore started to switch to smartphones [50] due to the lack of existing ATs or old feature phones.In our research, we discuss the similarities and differences of ATs and mainstream technologies adoption for peoplewith various disabilities between China and other countries. HI ’21, May 8–13, 2021, Yokohama, Japan Li et al.
Researchers found that lacking considerations of users’ opinions is one key factor of AT abandonment, in addition to thepoor performance of ATs and the change in user needs [52]. Users’ opinions and preferences of ATs might change basedon social contexts [64]. For example, depending on social contexts, people with disabilities may feel either self-consciousor self-confident when using ATs [66]. To understand how social contexts affect AT use, Shinohara and Wobbrock [65]conducted an interview study and found existing misperceptions that pervaded AT use:
ATs could functionally eliminatea disability , and people with disabilities would be helpless without their ATs . These findings inspired later research totake social interactions into AT design consideration [53]. To reduce the misperceptions surrounding ATs, researchersproposed participatory design [41], design for social accessibility [66, 67], and collaborative accessibility [6, 9, 74].Moreover, to reduce unwanted attention surrounding ATs, prior research has also advocated integrating accessibilityfeatures into mainstream technologies [47, 65]. In sum, social acceptability has been demonstrated to be important forAT design. However, prior research was mostly conducted in Western cultures, and cultural background [59], level ofeducation [34] and access to information services [62] may affect AT adoption. China has a different social and culturalcontext for people with disabilities. However, there is a lack of exploration on how social interactions affect the usesof ATs in China. Although some past works have explored AT adoption in developing countries from the design andthe user’s prospectives [50], these research did little to investigate how the social context affects AT adoption and theexisting misperceptions of using ATs in these countries. Thus, in this work, we examine whether and to what extentprior reported causes and solutions of social acceptability of ATs apply to the practices and challenges with AT use inChina.
We recruited 26 people with various disabilities through local disability communities and conducted semi-structuredinterviews with them to understand their practices and challenges with using ATs. Interview sessions took placeat various local disability communities and lasted approximately 60 - 90 minutes. Interviews were audio-recorded,transcribed, and translated for further analysis. The whole recruitment and study procedure was approved by theinstitutional review board (IRB).
Previous research has provided an understanding of the perceptions and misperceptions associated with ATs. Thesefindings were uncovered through studies focused mostly on people with visual impairments. However, Phillips andZhao [52] found that mobility-related ATs had the highest rate of abandonment. Thus, to better understand the practicesand challenges of AT use for people with various disabilities, we interviewed eight participants with visual impairments,eight participants with hearing impairments, eight participants with motor impairments, and two participants withcerebral palsy. To recruit participants, the researchers reached out to the China Disabled Persons’ Federation (CDPF),the largest government authorized organization for Chinese with disabilities, to distribute the study advertisement topeople with disabilities. All participants were registered population with disabilities in the CDPF. To understand thepractices and existing challenges of using ATs, we recruited participants who had experiences with ATs. Participantswere between 19 and 61 years old (mean = 38.7, SD = 9.7). Table 1 shows detailed information regarding the their age,gender, disability, occupation, and the list of ATs that they have used. Participants were compensated 100 CNY aftercompleting the interview. Study on Perceptions of Accessibility and Assistive Technology Use Conducted in China CHI ’21, May 8–13, 2021, Yokohama, Japan
Table 1. Participants’ demographic information.
Participant Disability Age Gender Occupation Assistive Technology1 Born with low vision,lost sight 10 years ago 34 M Massager white cane, PC screen reader, smartphone screen reader, magnifier,Huawei smartphone, iPhone, slate and stylus, radio, blind poker cards2 Cerebral palsy 19 M Student standing bed, wheelchair, walking frame, iPhone3 Spina bifida 36 F Self-employed car, iPhone, electric tricycle, sporting wheelchair, crutches, wheelchairtrailer4 Deaf 36 F Community cen-tre staff iPhone, Xiaomi smartphone, voice-to-text software, lighting doorbell,artificial cochlea, SIEMENS hearing aid5 Congenitally blind 44 M Massager e-reader, smartphone screen reader, slate and stylus, white cane, iPhone6 Upper-extremity am-putations, no forearm 61 M Retired mechanical artificial arm, electric artificial arm, motorcycle, PC, smart-phone7 Lost sight due to med-ical accident 15 yearsago, totally blind 35 F Software dealer iPhone, Android phones, Nokia phones, PC screen reader, radio, smarthome appliances, smartphone screen reader8 Deaf 30 M Unemployed hearing aid, artificial cochlea, vibration band, OPPO smartphone9 Motor impairmentdue to spinal cordinjury 13 years ago 40 M Information tech-nology wheelchair, crutches, iPhone, computer, wheelchair trailer, extendedclamp10 Spinal cord injury dueto medical accident 7years ago 25 F Call center tele-phone operator wheelchair, wheelchair trailer, Huawei smartphone, extended clamp11 Motor impairmentcaused by polio 60 M Lottery service crutches, motorcycle, electric tricycle, sporting wheelchair, iPhone12 Congenitally blind 42 M Massager white cane, book reader, PC screen reader, smartphone screen reader,slate and stylus, Xiaomi smartphone13 Motor impairmentcaused by polio 29 M Call center tele-phone operator crutches, wheelchair, hand-propelled tricycle, electric tricycle, smart-phone14 Deaf 44 M Website operator voice-to-text software (Shenghuo, Xinsheng, Luyinbao), smart watch,iPhone, hearing aid, iPad, PC, lighting doorbell15 Cerebral palsy 50 F Vegetables salesat grocery store standing bed, wheelchair, crutches, walking frame, iPad16 Deaf 44 F Unemployed hearing aid, lighting doorbell, voice-to-text software, Android smart-phone17 Congenitally blind 42 F Massage instruc-tor slate and stylus, talking watch, white cane, book reader (Dushulang),smartphone screen reader, Huawei smartphone, PC screen reader, APP(Didi)18 Congenitally blind 41 M Massager white cane, smartphone screen reader, navigation APP (Baidu Map),slate and stylus, Braille board, Braille book, e-reader, Xiaomi smartphone19 Low vision 45 M Massager monocular, magnifier, radio, PC screen reader, white cane, e-reader,iPhone, smartphone screen reader20 Motor impairmentcaused by polio 43 M Information tech-nology hand-propelled tricycle, extended clamp, motorcycle, car, crutches,smartphone21 Spina bifida 31 F Video editor wheelchair, electric tricycle, smartphone, APP22 Deaf 28 F Unemployed hearing aid, iPhone, iPad, voice-to-text software23 Congenitally blind 44 M Massager Sunshine screen reader, iPhone, white cane24 Deaf after 2 years old 30 M Teacher hearing aid, Huawei smartphone, voice-to-text software, APP25 Deaf 44 M Community cen-tre staff hearing aid, lighting doorbell, vibration alarm clock, smartphone, voice-to-text software26 Hearing loss 40 F Teacher hearing aid, iPhone, voice-to-text software HI ’21, May 8–13, 2021, Yokohama, Japan Li et al.
To understand the perceptions of ATs, we adapted the questionnaire from Shinohara and Wobbrock [65] and extendedit to learn about the participants’ perceptions of mainstream technology (e.g., what types of mainstream technologiesdo they use? What do they like about them? What mainstream technologies do they want to try the most, but arenot currently accessible?), and the differences between mainstream technology and AT (e.g., how does mainstreamtechnology help you compared to AT under different circumstances?).We first asked participants about their demographic information, the condition of their disabilities, and theirexperiences with ATs. We then asked them to compare their previous ATs with the current ones that they are using,if they have used multiple versions of functionally similar ATs. We then asked them to share their experiences andfeelings when they use their ATs in social and work contexts. Furthermore, we asked participants to talk about anymisperceptions about ATs that they had encountered from the general public, any previous misperceptions that theyhad themselves, and if they feel self-empowered or self-conscious while using ATs. Additionally, we asked participantswhat ATs they would like to have in the future, what they think are the most important factors of successful ATs, andtheir perspectives on how ATs compare with mainstream technologies.
All interviews were conducted in Mandarin by the first author, who is a native Chinese speaker. We audio-recorded allinterviews with participants and transcribed the recordings verbatim. We then translated the transcripts into Englishfor analysis. Two coders independently performed open-coding [15] on the transcripts. In the open-coding process,Cohen’s Kappa equals to 0.85 for the inter-rater reliability between the independent coders initially. Then, the codersmet and discussed their codes. When there was a conflict, they explained their rationale for their code to each otherand discussed to resolve the conflict. Eventually, they reached a consensus and consolidated the list of codes. Afterward,they performed affinity diagramming [25] to group the codes and identify the themes emerging from the groups ofcodes. Overall, we established 10 themes and 21 codes. The results introduced in the next section are organized basedon these themes, and we clustered the themes that overlap.
In this section, we present the AT adoption practices reported by our participants, the challenges they encounteredwith using ATs in social interactions, and common misperceptions they faced about disabilities and ATs.
In the interview, we found that participants’ choices of AT are affected by many factors, includingself-esteem, limited resources for consultation, advice from people with a similar disability, limited space, socialinfrastructure, and subsidy coverage. First, participants felt that ATs signaled the severity of disabilities and thus tendedto choose to use particular ATs that could signal to others their self-care abilities with minimal assistance fromATs . For example, participants preferred crutches over wheelchairs because the former indicates that they could stillwalk to some extent. This behavior relates to the concept of “face” in Chinese culture, which is an individual’s contingentself-esteem [28], and affects their decisions on whether to adopt certain ATs. We found that some participants withmotor impairments used their crutches until they were warned by their doctors to stop using them due to the risk of Study on Perceptions of Accessibility and Assistive Technology Use Conducted in China CHI ’21, May 8–13, 2021, Yokohama, Japan spinal scoliosis caused by their body weight. P20 commented on the reasons for continuing to use crutches until 35years old before switching to the wheelchair:“...You may ask me why I do not just use an electric wheelchair instead of crutches every day; the keyreason is that I want to show other people the ability of my abled body parts—especially the upper body.I do not want other people to think that I am a useless person, I want other people to still think thatalthough I lost the control of my legs, I still have the ability to move with my arms and shoulders. Usingmy crutches helps me to save face when I walk on the street. This is the reason why I continued usingcrutches until 35 years of age when my doctor told me that I was too heavy to use the crutches...”In China, maintaining “face” means that “shameful” family affairs cannot be disclosed to outsiders. Due to somenegative perceptions on disabilities, the family of a child with disabilities may be reluctant to seek supportive services[55]. From our study, we found that most participants sought information about what skills they could learn and whatATs they could use by primarily consulting family members and friends around them . However, their familyand friends often do not have the same disabilities and cannot offer accurate information about what people withcertain disabilities could learn or what ATs would be the best fit for them, which limits their understandings of whatATs they could or should use. Consequently, 88% of participants reported that they did not know what they could learnor do when they were young, and their primary information source was limited to their family members and friends.In our study, we found that this circumstance in China delayed the process of learning what people who acquired acertain disability later in their life could use to become more independent. We also discovered that some people wouldstart with a very pessimistic view on how to live independently once they acquired a certain disability. "It took me yearsto know that I could still work in IT and live independently. There lack professional consultants that I could ask when Ijust had the accident, and it really made me feel desperate initially" , said P9. Therefore, it would be beneficial to haveconsultants who could provide precise and customized advice to people who just acquired a disability regarding whatATs they could use and career planning. “I did not know that I could use smartphones until I met a person with a similar impairment who used the smartphoneevery day” , continued P9. When people saw that others with the same disability could do certain things, they startedto realize that they can use certain ATs too. Participants mentioned that seeing and knowing what people with asimilar disability can do gives them the confidence to also learn to use particular ATs. P20 commented that knowingsomeone with an even more severe motor impairment who can drive a car inspired him to learn how to drive:“...When I did not know what I can do, everything was hard for me. However, I realized later that thereare so many things I could do. This made lots of changes; I started to become more optimistic abouteverything. I wish I knew what I could do at the beginning. After I found that other people with evenmore severe motor impairments could drive cars, I bought mine, and I own two cars now...”The surrounding space that participants interacted with also impacted their decisions on what ATs to use. Wefound that most of the home environments our participants lived in required special accessible modifications to be fullyaccessible. One potential reason is that many Chinese people live in apartments or condos due to the high density ofthe population, which is different from people who live in many areas in North America [22]. Seven participants alsomentioned that they have to live in older apartments for the lower rent, but these apartments are not accessible orrequired further modifications. For some participants, their bathroom size was too small to roll a wheelchair in. P11mentioned the problem of his bathroom and kitchen: HI ’21, May 8–13, 2021, Yokohama, Japan Li et al.
Fig. 1. Misuse of accessibility infrastructures by members of the general public. Left: the tactile paving was blocked by the car. Right:the ramp was blocked by locked electrical bikes. “...Most of the apartments were not initially aimed to be designed for people with disabilities. I found thatnearly all of them need some modification, such as increasing the door size or reducing the height of thekitchen stove. Even so, I still cannot move around with my wheelchair in the bathroom. This forced me touse the crutches while I was using the bathroom. But it is more dangerous...”In addition to the home environment, participants also revealed that inaccessible public places usually forcedpeople with disabilities to use specific ATs. Ten participants mentioned that they are used to visiting specific accessiblepublic places in the city, even though it may require a long commute. However, they often have to visit unfamiliarplaces for various reasons, where the accessibility of the new environment is unknown to them beforehand—such astraveling in a different city, hanging out with friends, or visiting a customer. “I always bring my crutches with me when Ivisit unfamiliar places because they either do not have an elevator or the washroom is not accessible” , said P11. Even ifparticipants tried to always visit accessible places, there are still constraints which forced them to stay at inaccessibleplaces. For example, P9 complained about the washroom he experienced at work:“...The washroom in my office building is not accessible to me. The door is not even as wide as mywheelchair. More importantly, there is a small step in each unit of the washroom. It forced me to usecrutches instead of my wheelchair. Using the washroom at work is the hardest task for me every day...”In our study, we also found that social infrastructures that are supposed to help people with disabilities engage insocial interactions, such as the tactile paving and the wheelchair ramp, are widely constructed in public. However,participants reported that the misuse of accessibility infrastructures by members of the general public posedeven more safety concerns than without any infrastructures, which forced people to use certain ATs. For example,people locked their bikes on the ramp or placed random objects on the tactile paving (Fig. 1).Finally, financial conditions varied among people with disabilities and affected their choice of ATs. Most participantsmentioned that they could not get their desired ATs because of financial concerns. Other than general financial conditions,some participants who have insurance or subsidy to buy ATs explicitly mentioned that the subsidy coverage is oftenrestricted to certain brands or models of ATs , which may not necessarily match their needs. P8 commented onthis: Study on Perceptions of Accessibility and Assistive Technology Use Conducted in China CHI ’21, May 8–13, 2021, Yokohama, Japan
Fig. 2. (a,b) Self-made crutches which lack careful design and engineering considerations. (c) Accessibility modifications made to acar by a third-party company for a participant with motor impairment. (d) Self-modified brake and accelerator of the motorcycle ofP6 (no forearm). “...My current hearing aid is really ugly and always have a loud noise that annoys me all the time, I knowthere is a [brand of] hearing aid that is much lighter and better designed than my current one, but it istoo expensive, and my insurance does not cover the cost for that brand...”Beyond the subsidy to buy ATs, we found that the high cost of the maintenance fee is not covered by thesubsidy , which also affects the choice of ATs. Similar to what Armstrong et al. [2] found in Afghanistan, even if peopleobtained certain ATs through subsidy or donation, the AT maintenance problem and the lack of replacement parts stillaffect the adoption of ATs in developing countries. “I can use my subsidy to buy my electronic artificial arms, but it istoo expensive to repair it, and my subsidy does not cover the maintenance cost. That is one of the reasons for using mymechanical artificial arms now” , said P6.
We found that most participants used ATs that were constructed by themselves,family, or friends (Fig. 2). From the interview, we observed two main practices of “do-it-yourself” (DIY) ATs: replicatingexisting commercial ATs and modifying inaccessible mainstream technologies. Unlike the purpose of “DIY” ATs inNorth America [10, 27], which leveraged fabrication tools to create new customized ATs or to make AT functionalattachments, many of the participants’ customized ATs aimed to replicate existing commercial ATs (Fig. 2(a,b)).Different from using 3D printers or other fabrication tools in North America, most of the customized ATs that welearned about were created through handcrafted or traditional ways. For example, crutches or canes were crafted fromwooden sticks (Fig. 2(a)). The key reasons behind it are financial concerns, lack of AT designers, and the knowledge gapabout the available ATs and how to use them. P13 commented on a hand-propelled tricycle made by his father:“...When I was young, I used to craft my ‘crutches’ from the wood found in the forest in our rural village.One of the key reasons was the high cost of a wheelchair or crutches. Later, my dad modified andmade a hand-propelled tricycle for me due to the slow movement of my ‘crutches.’ Other than financialconsiderations, none of my friends or family have the same impairment as me, which made it hard for meto know what assistive devices suited me better...”Although “DIY” ATs were functional to some extent and were often economical as reported by participants, these“DIY” ATs typically lacked careful design and engineering considerations, and therefore often posed health risks. For HI ’21, May 8–13, 2021, Yokohama, Japan Li et al. example, using crutches with an inappropriate length over time can cause lumbar spine distortion or periarthritis. P11commented on his “DIY” crutches:“...When I was young, there did not exist anything called assistive technologies; all I used was just woodencrutches crafted by my parents. The left crutch was slightly shorter than the right one. It made my leftshoulder feel really painful when I used it for a long time. Later, my doctor told me that I had periarthritis.Even now, it has never recovered...”Beyond constructing ATs from scratch, people also modified some inaccessible mainstream technologies (Fig.2(c,d))—such as cars and motorcycles—to make them accessible. Participants reported that most of the automobilecompanies do not support any modifications for accessibility in China. As a result, they had to ask their friends orother third-party companies to modify their vehicles. Such modifications, however, are often done by non-professionalsand pose safety concerns for both users and the general public. Fig. 2(c) shows the modification of a participant’scar by adding hand controllers for the brake and the accelerator. Similarly, P6 asked one of his friends to add a foot-controlled brake and accelerator onto his motorcycle to overcome the loss of his forearms. Although these modificationsfunctionally allowed people to use these devices, the poor quality of the modifications and the lack of engineeringconsiderations could potentially be dangerous for people who use them. P6 commented on his experiences and safetyconcerns of his motorcycle:“...I like my motorcycle; it allowed me to visit different places. However, it took me lots of effort to getit modified. Initially, I visited the original motorcycle company, and they told me that they did not offerany type of accessible modifications to their products. Then, I talked to one of my friends, who was amechanical technician. He then modified my motorcycle and added the red button to allow me to acceleratewith my foot. I think the design and the placement of the brake and accelerator need to be improved. Igot injured in the past when I tried to reach the foot accelerator, which might be too high for me, and itcaused the whole motorcycle to become unbalanced. I am glad the speed was not too fast, but it still mademe fall off the motorcycle and bruise my leg...”
Participants discussed the negative impact of stigmatization of using ATs, which could have beencaused by Chinese traditions, infrastructures, and the knowledge gap from the general public. In traditional Chineseculture, the Buddhist belief of karma caused the negative perspectives on disabilities: it is regarded as punishment forthe parents of people with disabilities or past life sins [18]. The negative perspectives give social stigmas to people withdisabilities through social interactions. Currently, traditional Chinese stigmatizing terms are still being used torefer to people with disabilities. For example, “long zi” refers to people who are deaf or hard of hearing, “xia zi” refersto people with visual impairments, and “que zi” refers to people with motor impairments. These traditional terms wereused throughout Chinese history and have derogatory connotations and sound humiliating to people with disabilities.96% of participants recalled having past memories of being referred to using these terms. P7 described her feelingswhen she heard a conversation between a mom and a son beside her about her blindness:“...I was walking on the street, and I did not say anything or ask anyone for help. Maybe I was walking alittle bit slow. There was a mom and a son beside me; the son asked his mom about why I walked slow. Iheard the whisper from the mom: ‘she is a ‘xia zi,’ she cannot see us.’ I was really depressed because ‘xiazi’ sounds like I did something wrong and I am a useless person...” Study on Perceptions of Accessibility and Assistive Technology Use Conducted in China CHI ’21, May 8–13, 2021, Yokohama, Japan
Participants mentioned the high usage of these derogatory terms in some slang and public shows, which poseddifficulties to eliminate the use of these terms in the general public. Beyond being called derogatory terms, participantsrecalled being stigmatized by others who call attention to and limit their AT usages. P13 described his embarrassmentof being called out by the subway station general announcement to turn off some functions of his wheelchair trailersthroughout the whole subway station:“...I remember that I got called out in the subway, and it made me feel really embarrassed. A staff announcedon the public speaker: ‘the person with the electric wheelchair, please turn off your automatic functionalitieswhen you are on the train.’ This made all other people stare at me, and I felt really self-conscious...”It can be perceived as good intent by the general public to allocate designated areas for people with disabilities.However, such settings may make people with disabilities more self-conscious. For example, in movie theatres, peoplewith motor impairments are limited to sit or park their wheelchairs in a front area where everyone else can see them.Participants typically wanted to blend into the general public when they are in public settings and did not want to becalled out or draw people’s attention. P20 commented on this:“...I like that some places now have accessible areas for people with disabilities. However, it is still restrictedto a certain area. These areas are either at the front or at the entrance. I found that it caused a lot ofattention...”The existing stigmatization from the general public affected people with disabilities in social interactions and alsoinfluenced their choices of using their AT devices.
In general, we found that our participants encountered various challengesfrom employment, such as transportation to work, the inaccessible working environment, and unwanted attention.In our study, 65% of our participants chose to work where the majority of employees have similar disabilities. Forexample, P5 and P18 worked at a massage clinic called “mang ren an mo” in Chinese, which means “blind massage.”All the employees in that clinic are people with visual impairments. Another example is a cafe where P16 used towork at, where all employees are people with hearing loss. This clustering effect reduced some of the concerns ofunwanted attention or the inaccessible working environment for people with disabilities. However, it may also reducethe interactions between people with disabilities and the general public, which may further cause misperceptions.In China, the State Taxation Administration [1] has the policy of tax reduction if a company employs over a certainnumber of people with disabilities. However, our participants mentioned that they still have a hard time finding a jobwhere the majority of employees do not have the same disability. We found that participants with various disabilitieshad some difficulties using their ATs while working due to two potential problems: feeling self-conscious due totheir unique office workstation setup , and incompatibility of accessibility features on work devices . P9 talkedabout his concerns about the incompatibility between his wheelchair and the office desk:“...My ATs do not affect me much during work. As far as I know, for most people with motor impairments,like me, our work mostly relies on our upper body. The only part that made me uncomfortable is theheight of my table at work. As you know, most of the wheelchairs are not capable of adjusting the height.And we are shorter than other people who sit on a normal chair, that made me really uncomfortable,and my manager bought me a new desk with a lower height. However, it made me look different in thecompany; I felt self-conscious when other people walked by my desk...”P7 reported the problems of using different screen readers that made her customers lose patience: HI ’21, May 8–13, 2021, Yokohama, Japan Li et al. “...My work required me to use my computer to record customer and product information. At the first time,I was trying to use my screen reader on the company’s computer. Since my screen reader only supportedan old Windows system and was not compatible with the system that my company used, I ended up usinganother screen reader from another software company. Different computer systems and screen readersreally delayed my work, and my customer complained to my manager about that...”
In this section, we further elaborate on the existing knowledge gap between people withdisabilities and the general public, and the associated consequences (e.g., misperception, unwanted help). In China,around 48% of people with disabilities went to specialized schools instead of regular schools; however, this numberis less than 3% in the US [36, 48, 49]. Most of our participants with congenital disabilities went to specialized schoolsfor professional skills training, such as massage. This separation of schooling caused mutual misperceptions betweenpeople with disabilities and the general public. Participants mentioned that the general public’s lack of knowledge onaccessibility sometimes posed threats and dangers to people with disabilities. For example, the misuse of tactile pavingis dangerous to people with visual impairments which prevent them from walking on the street.Due to the separation of education between people with disabilities and the general public, the general public lacksunderstanding on how to offer help appropriately. Therefore, some people tried to offer unwanted help which maylead to safety concerns. For example, some people pushed the wheelchairs from behind without being asked to do so,which can be very dangerous. P20 mentioned his experiences when he was on the street with his wheelchair:“...first, I want to say that I am delighted that other people offered me help. However, they lacked somebasic knowledge. For example, many wheelchairs do not require someone to push from the back. If youpush someone with a wheelchair, they may feel uncomfortable, and it might be dangerous when there is abump...”In addition, some people may choose to lift a wheelchair to a bus without asking for their user’s permission. Thiscould have a potential negative impact on the wheelchair user’s dignity. “I know other people wish to help me, but beinglifted in public made me feel so bad and embarrassed,” said P20. It suggests that although many ATs are viewed primarilyas personal devices, some ATs also have a “social” aspect that invites people to offer help. For example, wheelchairsare often used by people with disabilities and their caregivers in many social settings, such as hospitals and airportterminals. Thus, when designing ATs, the social aspect of ATs should be considered so that their designs offer clearaffordance and signals to invite proper use.
Previous research has identified several misperceptions under a North American context: ATs could functionallyeliminate disabilities, and people with disabilities would be helpless without their ATs [65]. In this section, we presentthe similarity of the misperceptions and new findings from this study (e.g., “ATs should overcome inaccessible socialinfrastructures” and “ATs are symbols of permanent disabilities”).
Similar to Shinohara and Wobbrock’s findings [65], the misperception “ATs could functionally eliminate the disability”also exists in China for ATs used by people with motor impairments, hearing impairments, visual impairments, andcerebral palsy. For example, participants pointed out that other people thought wheelchairs could allow people withmotor impairments to move freely. However, even with the wheelchair, there are still many obstacles, such as having a Study on Perceptions of Accessibility and Assistive Technology Use Conducted in China CHI ’21, May 8–13, 2021, Yokohama, Japan hard time entering narrow spaces and climbing stairs. Notably, many participants with hearing impairment mentionedmisperceptions related to the hearing aid—that it allows them to hear the sound clearly. However, they claimed thatmost of the hearing aids could only allow them to recognize whether there is a sound or not. P14 felt annoyed whenother people tried to speak close to his ear very loudly and repeat multiple times:“...Having a hearing aid does not mean that I can hear the conversations of other people. I can use thehearing aid to locate the sound source, but not understand what a person is talking about. I felt extremelyannoyed when some people tried to repeat something to me multiple times and with increasing volume!All I can hear is the noise! I just could not understand, and it annoyed me...”Furthermore, participants mentioned that some people have the misperception that cutting-edge healthcare systemsshould completely eliminate disabilities. According to P2, “When I was having my lunch at the school cafe, I heardsome students whispering: ‘our healthcare system is way more advanced than 30 years ago, why are there still peoplewith disabilities?’" . P2 continued: “because people with disabilities are largely not visible in public due to inaccessibleinfrastructures, the general public have fewer opportunities to learn about and understand our lives.”
This situation madethe misperception hard to resolve.Beyond the misperception that “ATs could functionally eliminate the disability,” our findings agree with anothermisperception that “people with disabilities would be helpless without their ATs” [65], which was found in the Westerncontext. Our participants with visual impairments mentioned their experiences of attracting unwanted attention whenusing their mainstream devices. “They were surprised that I could use iPhone X to call an Uber! Some people said I couldnot do anything without my cane. However, I can use my iPhone to do lots of things without me physically being there” ,said P7. Moreover, we found that people with disabilities tend to rely on specialized ATs less often than before due tothe introduction of mainstream technologies with accessibility features. Our participants are already using their smartdevices to order food delivery, shop online, contact friends and enjoy entertainment without the need for ATs, such ascanes or wheelchairs.
Making infrastructures universally designed or modified[30] for accessibility purposes would help eliminate the need for designing ATs, which are often secondary solutions toinaccessible infrastructure. For example, public transit systems in North America, such as the Toronto subway, werebuilt with accessibility issues considered, which requires that the horizontal gap between the subway train and theplatform be less than 89 mm for accessibility purposes [61]. In contrast, some subways in China were not built withaccessibility in mind, having gaps of over 100 mm between the train and the platform (Fig. 3 Left). As P11 expressed, “Ihate the local subway; my wheelchair just cannot move through the gap. When I talk to people, most of them focused onhow I should modify my wheelchair rather than how to make the subway system fully accessible.”
Furthermore, some participants commented that the general public in China thinks modifying social infrastructureswill take more effort than modifying individual ATs to adapt to social infrastructures. In particular, they mentionedthat many of the old buildings were not designed to be accessible when it was built, and the building structure mayneed to be changed to make it accessible (Section 4.1.1). “Some people think that individuals with disabilities shouldcompromise or even sacrifice for the society” , said P9. Overcoming different social structure barriers by modifying ATsmight eventually make the ATs more complicated.The design of certain park entrances is another example of the challenge involved in overcoming inaccessible socialinfrastructures. For instance, the S-shaped metal gates of the park entrance (Fig. 3 Right) was intended to block vehiclesor bicycles from entering, but also accidentally blocked out people with disabilities who use wheelchairs. HI ’21, May 8–13, 2021, Yokohama, Japan Li et al.
Fig. 3. (Left) Local subway system has a gap of over 100 mm between the train and the platform which can decrease the accessibilityof the subway system to wheelchair users; (Right) the entrance gate of a park blocks wheelchair users.
We found that the general public tends to assume that people whouse ATs have permanent disabilities. This is a misperception because many people who use wheelchairs may recoverfrom their temporary disabilities. People with broken legs or any other injuries with the lower body may require awheelchair. Furthermore, participants reported that people thought that if they use certain ATs, they would need it forthe rest of their lives. P15 commented on this:“...I use my standing bed and walking frame every day to recover from my disability. Some people thoughtI might need them for the rest of my life. However, once my condition gets better from rehabilitation, Imay switch to new ATs that give less assistance...”This misperception points to the importance of designing for people’s practical needs. “People with temporaryimpairments do not need to think about independence, but we do” , commented P20.
Participants reported that the general public often thinks that ATs withmore functionalities are better for people with disabilities. For example, participants with motor impairments mentionedthat they were asked why they did not just use a multi-functional electric wheelchair. As we introduced before, peoplemight prefer using certain ATs over others because of the following factors: signaling to others their remaining abilitiesand financial considerations (Section 4.1.1). P20 mentioned the importance of considering practical needs in the ATsdesign:“...I found that so many existing ATs try to add as many fancy functions as possible. Do we really needthem? These manufacturers really need to think from the user’s perspective...” Study on Perceptions of Accessibility and Assistive Technology Use Conducted in China CHI ’21, May 8–13, 2021, Yokohama, Japan
In the results section, we described 1) the unique findings of AT adoptions practices employed by people with variousdisabilities in China (e.g., factors that affect the choice of ATs, “DIY” ATs), 2) challenges with using ATs in socialinteractions (e.g., stigmatization and employment challenges), and 3) existing misperceptions about disabilities and ATsin China (e.g., ATs should overcome inaccessible social infrastructures). Based on our findings, we present the followingquestions for researchers and designers to consider pertaining to challenges surrounding AT adoption and design.
From the interview, we found that there are roles for both manual and electronic ATs, and people with disabilities needboth of them in their lives (Section 4.1.1). Some participants mentioned the existing misperception from the generalpublic in China that it is more preferable to use more electronic ATs and less manual ATs. We found that both manualand electronic ATs have their own situational uses. Electronic ATs may have the benefits of faster movement speed andimproved safety. However, people with various disabilities chose to also use manual ATs. Potential reasons includefinancial concerns, exercise, and signaling to others their remaining abilities to maintain “face” as discussed in section4.1.1.When designing electronic ATs, it is essential to ensure that the appearance of ATs can communicate to others theabilities of their users. For example, the wheelchair could be designed with foldable components to support users tostand up briefly if they could do so, and be able to signal this affordance to others clearly. It is also important to designelectronic ATs to encourage people with disabilities to exercise as much as possible. For example, potential electricwheelchairs could be designed to force the users to roll the wheelchair for more than a certain number of strokes beforethey can turn on the automatic function.In our interview, we found that participants with motor impairments preferred using manual wheelchairs overelectric wheelchairs. However, a recent article revealed that the general public might view a manual wheelchair asa more stigmatizing AT than an electric wheelchair in Norway [8]. Boiania et al. [8] found that the general publichas more negative perceptions towards manual wheelchairs in terms of comfortability, aesthetics, and enjoyability.Therefore, designers should take feedback from both people with motor impairments and the general public intoconsideration, such as using participatory design or co-design methods.In terms of manual ATs, we found that each device is mainly used for a single situation or purpose. For example, thecane is always and only required when people with visual impairments needed to walk outside. Unlike manual ATs,electronic ATs are more centralized—smart devices become multi-functional. People with visual impairments used tocarry a book reader and a radio to acquire information, and a slate and stylus to share their own thoughts with otherpeople. As smartphones became more accessible, people with visual impairments can simply install screen readers ontheir smartphones to accomplish the tasks that they may have needed several devices to accomplish before.In our study, participants with motor impairments mentioned the misperception that “more functions are alwaysbetter” in ATs design. For example, P9 mentioned the experiences of unwanted pushing from the back, and he removedthe handle at the back of the wheelchair. This problem does not only exist in China; Low [42] reported that a wheelchairuser from the UK put spikes on the handles to prevent the unwanted pushing. Furthermore, some participants commentedon the bulky design of some multi-functional ATs. We can conclude that multi-functional ATs are not always betterthan the ones with a single function. ATs designers should take into consideration whether or not add-on functionswill cause unwanted interactions. On the contrary, we found that most participants with visual impairment preferred HI ’21, May 8–13, 2021, Yokohama, Japan Li et al. having more functions on their canes, such as integrating the navigation function on the cane. We see that people withdifferent disabilities may have varying preferences on functionalities of different ATs.
In China, people with disabilities generally lack support from trained professionals [26]; it is hard for them to finda professional AT designer for ATs that suit their special needs. As 3D printing and quick prototyping technologiesare being increasingly used in many aspects of our daily lives, these techniques might allow people with disabilitiesto design their ATs by themselves. As the costs for personal fabrication technologies keep decreasing, it might bepossible to consider how to enable people with disabilities to leverage technologies to customize their ATs [5, 11, 31, 57],especially how to enable these fabrication technologies in rural areas where AT users lack access to technologies.Furthermore, collaborative design of ATs by empowering people with disabilities to design for themselves may reduceconcerns of functionalities and aesthetics [9].Participants commonly mentioned that their ATs lacked design considerations of where and when these devicesare used. This includes using ATs indoors, outdoors, at daytime, at night, and by people with various conditions ofdisability. To incorporate ATs into daily routines to improve AT adoption [37], the AT designers should take where theuser may use the ATs into consideration. For example, users might use crutches outside when the ground is slipperywith ice. Beyond different locations, users may also use the same AT during the daytime and at night. P18 mentionedthat he was hit by bicycles several times when he used his cane at night. Although some of the canes have reflectivestrips, it may not be enough for people to use canes in dark environments.Therefore, it is important to take the user’s contextual information into consideration while designing ATs. In futurework, it would be interesting to create a set of design metrics on how different contextual information may affect designdecisions. Once we collect the users’ individual AT usage contexts, we could customize their ATs based on the usages.
We observed the practice of consulting family members and friends on what ATs to use and the benefits of knowingwhat other people with a similar disability are using (Section 4.1.1). There are now over 83 million Chinese people withdisabilities [26], but online resources with related information are lacking. Current online information sources tend toprovide general information, such as what a person with spinal cord injuries should and could do. However, differentpeople may have different severity of disabilities. In the interview, 19 participants mentioned that seeing what theirpeers use is the most common approach to learn about what ATs are available and how to use them. These participantsall commented that it is tremendously helpful for them to learn what they can do and how they can use certain ATsfrom a larger community where people with similar disabilities are setting examples. In China, there are very few onlineplatforms for the population with disabilities to acquire information related to their disabilities. More importantly, mostof these platforms [29] are operated by the government and are often designed to increase the public’s knowledgeabout the disabilities rather than supporting interactions among users. Interactive platforms, such as StackOverflowand Github, allow people with common interests but different levels of expertise to interact and share their experiencesand questions, which benefit the growth of users. On the other hand, we also see such communities for people withvisual impairments emerging, such as on Reddit [56]. Creating channels for people with disabilities to know what theirpeers do could potentially open new opportunities for them and make them feel self-empowered and encouraged by theexcellent performance of their peers. At the same time, due to widespread stigma, it is also challenging to design such Study on Perceptions of Accessibility and Assistive Technology Use Conducted in China CHI ’21, May 8–13, 2021, Yokohama, Japan online communities so that people with different levels of disabilities would feel comfortable to share their experiencesand questions without being judged.In addition to government support, the disability movement and Disabled Persons’ self-help Organizations (DPOs)have recently begun to emerge in China [75]. In addition to supporting DPOs in promoting social and policy changes,our findings also show that it is worth considering to build online platforms that allow people with disabilities to sharetheir successful stories and what they can do with their peers so that the community can inspire each other and allowthem to understand potential opportunities that they would otherwise have no access to. More research should beconducted to understand the features, functions, and the interaction mechanisms that such platforms should provide.Emerging types of social media may also provide more opportunities and resources to share information on ATs andcareer development among people with various disabilities. Recently, live-streaming platforms have been explored toshare knowledge [44] and even promote intangible cultural heritage [43]. Live-streaming has fewer physical constraints,which may cause fewer mobility concerns for people with disabilities, and the monetary gifts that the live-streamingaudience sends may generate additional income to cover their daily costs. In the future, it is worth exploring ways toleverage existing live-streaming social media platforms or create new live-streaming social media platforms for peoplewith disabilities to share their stories and to potentially reduce misperceptions held by people with disabilities and thegeneral public.
As smart IoT devices play a more prominent role for people with disabilities in China, participants started to reduce oreven replace their traditional ATs. For example, participants with visual impairments commented that they used the caneless often after they could order food delivery and shop online on their smartphones. Our findings verified Shinoharaand Wobbrock’s [65] predictions around 2011 on the trend that people with disabilities would use more mainstreamtechnologies with accessible features. In Shinohara and Wobbrock’s [65] study, more than half of the participants didnot use smartphones. However, we found that all of our participants now use different kinds of smartphones for dailypurposes.Participants with different disabilities mentioned the frequent uses of various smart devices, such as smart speakers,smartphones, smart curtains, and smart rice cookers. We found that participants used smart devices to mostly completeInstrumental Activities of Daily Living (IADL) [68], such as shopping, paying bills, and cooking, by reducing the effortof movement, searching, and physical actions. Most participants expressed strong interest in trying new smart IoTtechnologies. This generates opportunities and concerns for smart IoT designers to consider when designing accessiblesmart IoTs. We found that participants have an open mind about new technologies and innovations. For example,participants with visual and motor impairments showed strong interest in self-driving vehicles. The enjoyment ofsmart technologies and the open-mindedness for emerging technologies by people with disabilities in this study isdifferent from the findings of the recent research conducted in Bangalore (India) that showed people with disabilitiesthere adopted smartphones over feature phones because they had no choice due to the increasing market share ofsmartphones in the society [50]. It would be interesting to examine what caused this different attitude toward smarttechnologies among people with disabilities in two countries in the future.Although smart devices helped people with disabilities throughout IADL, there are also concerns related to thesesmart devices. We found that most smart devices our participants used are commercial products from the general publicwithout any accessible modifications. Our participants reported that they highly rely on these smart devices every day,and it would be better if these products can be more accessible when completing an activity that contains multiple HI ’21, May 8–13, 2021, Yokohama, Japan Li et al. actions, instead of only a single action. For example, P7 complained about the complex actions of cooking rice everyday: “...I am happy that my rice cooker allows me to start cooking and receive notifications through my phone.However, the hard task for me is to find my uncooked rice, measure the amount, and add the appropriateamount of water before cooking. If all of these procedures could be automatic, it would save me lots oftime and effort...”In our study, we found that most participants rely on accessibility features, such as screen reader or voice-to-textsoftware, to use mainstream technologies. However, most participants mentioned that the slow update on accessibilityfeatures affected the use of mainstream technologies. Specifically, participants with visual impairments complainedthat the third-party applications’ fast updates are not always compatible with their screen readers and can render theirscreen readers useless. This problem becomes more critical as some people depend on these mainstream technologies formost of the daily activities. Currently, although people with visual impairment could use certain apps to communicatewith their friends and shop online, many apps (e.g., games, augmented reality, and virtual reality) are still not accessibleto certain groups of people. Future work should have a mechanism to detect the accessibility of software and libraries,especially when the software and libraries are updated.
In this work, we studied practices and challenges surrounding ATs use as well as the perceptions and misperceptions ofATs from the perspectives of people with disabilities in China. Most of our participants were from the same province inChina. Thus, our participant sample may not generalize to the 83 million people with disabilities across all of China.However, we do think that our work provides an understanding of these matters from a specific context in China, whileexisting research on these issues have been conducted primarily in North America and Europe only. An additionallimitation is that it is also essential to understand the perceptions and misperceptions of ATs from people who donot have disabilities. These two complementary perspectives could provide a more holistic picture to understand theissues that prevent ATs from being socially acceptable. Toward this end, it is worth exploring the perspectives ofpeople without disabilities about ATs and contrast the findings with that of our study as well as prior research to betterunderstand how to make ATs more socially acceptable and how to make people with disabilities feel more inclusive.We intentionally interviewed people with a wide range of disabilities to cover a broader range of practices andchallenges that they have encountered when using ATs. Despite the broader coverage of the types of disabilities, westill have not yet covered all possible disabilities and different severity levels of the disabilities, such as people withcognitive disabilities and the different severity levels of physical disabilities. The particular type of disability and itsseverity level could shape the way in which people with such a disability use and perceive their ATs. As a result, futurework should extend our current study to cover a broader range of disabilities and levels of severity to examine whetherand to what extent the findings still hold or need to be extended. Furthermore, due to our limitation of recruitment, wewere only able to recruit participants who had experiences with ATs. However, some people with disabilities mighthave never used ATs in the first place, and it is important to explore their reasons in future research.This study revealed the practices and challenges of ATs use and perceptions and misperceptions surrounding ATs inChina to some extent. Although we have contrasted our findings with related work that was conducted in North Americaor other regions, we have not conducted a thorough comparative study to systematically compare the similaritiesand differences of these issues between China and other countries. Thus, even though the similarities and differences Study on Perceptions of Accessibility and Assistive Technology Use Conducted in China CHI ’21, May 8–13, 2021, Yokohama, Japan found through our study shed light on this line of research, they are by no means exhaustive. Future work shouldconduct comparative studies to more systematically compare the similarities and differences in the use, perception, andmisperceptions of ATs across countries and cultures.
We have presented a semi-structured interview study conducted in China with 26 people who have various disabilitiesto understand the practices and challenges surrounding the use of ATs and their perceptions and expectations of ATs.We found that participants with disabilities choose AT devices and “DIY” their ATs to signal to others their remainingabilities while also considering functional and financial constraints. Our study further identified the challenges thatparticipants encountered with using ATs in social interactions. It is not uncommon for the general public to misuseinfrastructures that are designed to help people with disabilities, use traditional stigmatization terms, offer unwantedhelp, or even pose safety threats. For the few who worked, their working environments also unintentionally posedchallenges. Lastly, we also reported the misperceptions that people with disabilities felt others hold about their use ofATs. Specifically, our findings confirmed that previously found misperceptions in a North American context [65] alsopervade in China today: ATs could functionally eliminate a disability. Moreover, we found additional misperceptions:ATs should overcome inaccessible social infrastructures; ATs are symbols of permanent disabilities; and ATs with morefunctionalities are better.Based on these findings, we recommend designers and researchers to take the following aspects into considerationwhen designing ATs: consider the advantages of both manual and electronic designs; consider both multi-functionaland single-functional designs; understand users’ personalization needs and use emerging prototyping technologies (e.g.,3D printing, emerging fabrication) to better integrate aesthetics and customization into AT design; consider in-situ useof ATs and make ATs (both hardware and software) easy to update. Additionally, we found the following two issuesthat the general public needs to address: avoid misuse of the infrastructures designed for people with disabilities; andlearn to offer help to people with disabilities appropriately by considering the “social” aspects of ATs. Furthermore, weoffer the following design considerations to reduce misperceptions that people with disabilities hold about themselves:build online and offline platforms dedicated to people with disabilities, such as discussion forums and live-streamingplatforms, to engage them to communicate and share knowledge and skills that they could learn so that others withsimilar disabilities could be aware of and encouraged by what they could actually learn and do.
ACKNOWLEDGMENTS
We would like to thank Hebei Disabled Persons’ Federation and Shijiazhuang Shi Disabled Persons’ Federation, inparticular the following people, for their help in recruitment: Jian Gao, Hongtao Zhen, Yunfeng Shi, Jie Zheng, YangXue and Anshi Yu. This work was supported in part by the Natural Sciences and Engineering Research Council ofCanada (RGPIN-2016-06326).
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