We saw in the previous article how adopting an inclusive approach to design reaps benefits for the broader population, but there are other reasons why designers should be giving this matter more urgent thought. For example, the UK population is growing at speed (currently 65.6 million) and is projected to continue growing, reaching over 74 million by 2039. In parallel to this growth, Britain has already entered the age of the aged with 18% aged 65 and over and 2.4% aged 85 and over. Globally today almost 1 in 10 people are over 60 years old and that is set to rise to 1 in 5 by 2050. This means that people aged over 60 will outnumber children aged 0-14 by 20501. With this aging population comes the burden of the diseases of old age and multiple comorbidities including loss of vision, reduced strength, reduced dexterity and other challenges. So, even if you’re not currently designing for users with reduced capabilities, there is every chance you soon will be.
So – what’s the best way to practice inclusive design and what resources are available to help a designer create an inclusive product?
There are many different legislations and standards, however the differences between legislation (regulations that MUST be complied with) and standards (which describe best practice) are quite fundamental and always a good place to start. In terms of legislation there isn’t a great deal of regulation on inclusive design in Europe or the USA that you are required to comply with. The key legislation in the USA is the ADA, or American’s with Disabilities Act but this legislation is intended to cover access to services and facilities and doesn’t really help to define what inclusive design looks like when applied to a product. Likewise, the Equalities Act in the UK is mainly focussed on services and access to the built environment. However, the UK is signed up to the UN Convention on Rights for Persons with Disabilities and Article 4 of the convention states research and promotion of the design of goods services and equipment to be accessible to persons with disabilities2. All well and good, but not that helpful.
Switching to standards, there is a greater wealth of information to draw upon. ISO IEC Guide 71:2014 is an ISO design guidance document intended to help technical committees write better standards to produce more accessible designs. IEC 71 contains many recommendations and challenges to the writers of such standards and some very useful guidance on procedures, including the importance of getting input from your target population.
However, IEC 71 contains no real examples of what inclusive design looks like. For this information the designer or engineer requires CEN ISO 22411:2008, which provides ergonomics data and guidelines for the application of IEC Guide 71. ISO 22411 provides a wealth of information on matters as diverse as how to present information in multiple forms (to ensure deaf or blind users aren’t compromised), how to combine colours effectively, acoustic design and sensitivity to vibration.
In recent years there has also been an increasing focus on good human factors design, especially in the area of medical devices. IEC 62366:2007 and AAMI/ANSI HE75:2009 are the two main standards outlining good practice to follow. A lot of work has been done to harmonise the processes outlined within these standards and now they are at their foundation aligned and reflect simply good design. These should now help the process of inclusive design.
The challenging part can be fully understanding the capability challenges of your potential users and in parallel defining the level of inclusion that is appropriate and realistic for your product. Capability loss is a spectrum and not a linear one at that. There are many aspects to understand, take visual capability loss for example – ageing and various eye conditions cause the function of the eye to deteriorate, which can result in blurry vision, reduced contrast sensitivity, and loss of vision at the centre or the periphery of our vision. Therefore, where do we go to understand which aspects of capability loss may affect your potential user base?
There are two fundamental sources of information – desk-based research and user studies. Both sources are valid and extremely useful at different points throughout the design and development process.
There are several types of desk-based research, which are predominantly utilised within the preliminary analysis stages of a programme.
Capability data – this can help define the size of a feature or the force required to interact with that feature. Good sources of this type of data are BSI ergonomic data, DTI strength guidelines3 for ageing populations, etc.
Knowledge databases – these provide an understanding of the difficulties and challenges users face, either through subjective experiences from actual users or reported known use errors that occur with like devices e.g. research forums and blogs or adverse events databases like MAUDE.
Use case risk assessments – a fundamental tool to thoroughly explore and identify areas of potential use error. A PCA (perception, cognition, action) risk assessment approach can be especially useful as part of an inclusive design approach as it helps those doing the assessment to really focus on what capability demands are put on the user for a given task.
As outlined in IEC 62366 and the FDA guidance, testing with users throughout the development is essential and should be done as much as time and budget allows. This user interaction aids the whole development process from helping define the user profiles and use scenarios within the preliminary analysis stage, through design evaluation and iteration all the way to final validation. You will always learn something from every touch point with users, and this is especially true when trying to achieve an inclusive design. This is the best way to really understand and appreciate the challenges users may face. More importantly though it will help you understand more about potential coping strategies a user may adopt and where their motivations lie, to help you make those inevitable design trade-offs. For example, convenience and safety are often at odds with each other.
User research is often seen as expensive and time consuming and it can be, but it doesn’t have to be. Informal, ‘quick and dirty’ formatives are possible. Going along to a support group or the reception area of a clinic where you can target multiple people within your user profile can just take an hour or two and cost no more than the price of some good snacks! Obviously, permissions and consents are required, but this is not unsurmountable. Telephone interviews with health care professionals (HCPs), with or without the ability to share visual information can help answer some questions that a designer or engineer simply doesn’t have the knowledge or experience to definitively answer. However, it isn’t always possible to gather user feedback at the point in time when you need it. In which case simulation tools may be another valuable option. Many moons ago Kay was involved in the infancy and definition of the University of Cambridge inclusive design toolkit. The aim of this toolkit is to help designers and marketeers to understand the challenges faced by users with capability loss in the form of many examples and exercises, a design process to follow aligned with 62366 and the FDA guidance, as well as simulation tools. The simulation tools within this toolkit include:
Online simulation software tools – these consist of vision and hearing impairment simulators that enable you to apply simulated vision impairment to images of your own designs or to listen to audio from your design with simulated hearing impairment.
Physical simulation tools – there are simulation gloves to demonstrate how limitations in hand movement can affect product use, such as limitations caused by conditions like arthritis. There are simulation glasses to provide insight into the effects of various types of vision loss on product use. Therefore, these devices can help designers experience first-hand what it is like to use their device concepts with their users’ type and level of capability loss.
The other very helpful tools that an inclusive design toolkit provides are exclusion calculators. These are resources to help you estimate the proportion of the British population who would be unable to use your product or service because of the demands it places on your users’ capabilities. The main exclusion calculator involves estimating demands on a range of capabilities, including vision, thinking and dexterity. This tool obviously has its limitations – primarily as it is based on data from 1997 and on UK population data only, however this remains the best capability data available. As mentioned one of the key differences with an inclusive process is being cognisant that every design decision has the ability to include or exclude potential users. This tool helps you understand the impact of those design choices and enables you to define the level of inclusion that is appropriate and realistic for your product, by helping you quantify accessibility and therefore prioritise improvements.
One last thing to say on being thoughtful and sensitive to the impact your design choices have on including or excluding potential users – ensure you keep this mindset across all aspects of your product; i.e. the device, the instructions, the packaging, accessories, the online support or app, etc. One of the most commonly used examples to promote the value of inclusive design is the Oxo Good Grips range of kitchenware. Originally founded by Sam Farber to help his wife who had mild arthritis and was frustrated with the unwieldy potato peeler she owned. The resulting rubberised black-handled peeler has become an iconic design, winning many awards. However, on the shelf it was packaged in a standard heat-sealed blister pack, which is unopenable without a tool and even then, many people with arthritis still struggle. This highlights how important it is to look at the whole system and to keep the inclusive design mindset at the heart of all design decisions to prevent excluding a potential user or making them struggle unnecessarily. Designs that are inclusive are imperative for those with capability loss, essential for the growing ageing population and fundamentally better for everyone now as we all experience scenarios of short-term capability loss. Designing inclusively is simply good design and there is no excuse, there are many tools out there to help designers realise a more inclusive world.