People rely on online information for important life tasks such as managing personal finances and understanding medical symptoms. However, due to its intrinsically language-focused nature, online search poses considerable difficulties for people with language impairments. Currently these difficulties are poorly understood. We report findings from an observation of the information search behavior of 12 people with aphasia. We identify a wide range of difficulties and strategies aimed at combating them, spanning the entire information search process. Findings include previously unreported difficulties and strategies that highlight the importance of designing search technologies to better support the complex needs of people who find language challenging, such as by facilitating word finding cueing strategies, error prevention and recovery, browsing, appropriation, text interpretation and and by decreasing reliance on language competency in general. This has the potential not only to benefit searchers with language impairments, but to make information search easier for all.

Audiovisual media is integral to modern living, yet is not always accessible to all. Modern accessibility interventions, such as subtitles, support many, however, communities with complex communication needs are largely unconsidered. In this work, we envision future accessibility interventions from the ground up with one such community – people with aphasia. Over two workshops and a probe activity, we problematise the space of audiovisual consumption by people with aphasia, and co-envision directions for development in accessible audiovisual media. From low-fi diegetic prototypes to mid-fidelity solutions, we explore new visions of accessibility interventions for complex communication needs – notably enabling high levels of content manipulation and personalisation. Our findings raise open questions and set directions for the research community in developing accessibility interventions for audiovisual media to support users with diverse needs in accessing audiovisual content.

People with language impairments, such as aphasia, use a range of total communication strategies. These go beyond spoken language to include non-verbal utterances, props and gestures. The uptake of videoconferencing platforms necessitated by the Covid-19 pandemic means that people with aphasia now use these communication strategies online. However, no data exists on the impact of videoconferencing on communication for this population. Working with an aphasia charity that moved its conversation support sessions online, we investigated the experience of communication via a videoconferencing platform. We report a study which investigated this through: 1) observations of online conversation support sessions; 2) interviews with speech and language therapists and volunteers; and 3) interviews with people with aphasia. Our findings reveal the unique and creative ways that the charity and its members with aphasia adapted their communication to videoconferencing. We unpack specific, novel challenges relating to total communication via videoconferencing and the related impacts on social and privacy issues.

Visual creative forms, such as painting and sculpture, are a common expressive outlet and offer an alternative to language-based expression. They are particularly beneficial for those who find language challenging due to an impairment – for example, people with aphasia. However, being creative with digital platforms can be challenging due to the language-based barriers they impose. In this work, we describe an accessible tool called Inker. Inker supports people with aphasia in accessing digital creativity, supported by previously created physical artistic work.

Creativity and humour allow people to be expressive and to address topics which they might otherwise avoid or find deeply uncomfortable. One such way to express these sentiments is via comics. Comics have a highly-visual format with relatively little language. They therefore offer a promising opportunity for people who experience challenges with language to express creativity and humour. Most comic tools, however, are not accessible to people with language impairments. In this paper we describe Comic Spin, a comic app designed for people with aphasia. Comic Spin builds upon the literature on supporting creativity by constraining the creative space. We report both the design process and the results of a creative workshop where people with aphasia used Comic Spin. Participants were not only successful in using the app, but were able to create a range of narrative, humorous and subversive comics.

Multimedia digital content (combining pictures, text and music) is ubiquitous. The process of creating such content using existing tools typically requires complex, language-laden interactions which pose a challenge for users with aphasia (a language impairment following brain injury). Tangible interactions offer a potential means to address this challenge, however, there has been little work exploring their potential for this purpose. In this paper, we present CreaTable a platform that enables us to explore tangible interaction as a means of supporting digital content creation for people with aphasia. We report details of the co-design of CreaTable and findings from a digital creativity workshop. Workshop findings indicated that CreaTable enabled people with aphasia to create something they would not otherwise have been able to. We report how users' aphasia profiles affected their experience, describe tensions in collaborative content creation and provide insight into more accessible content creation using tangibles.

Personas are powerful tools for designing technology and envisioning its usage. They are widely used to imagine archetypal users around whom to orient design work. We have been exploring co-created personas as a technique to use in co-design with users who have diverse needs. Our vision was that this would broaden the demographic and liberate co-designers of their personal relationship with a health condition. This paper reports three studies where we investigated using co-created personas with people who had Parkinson's disease, dementia or aphasia. Observational data of co-design sessions were collected and analysed. Findings revealed that the co-created personas encouraged users with diverse needs to engage with co-designing. Importantly, they also afforded additional benefits including empowering users within a more accessible design process. Reflecting on the outcomes from the different user groups, we conclude with a discussion of the potential for co-created personas to be applied more broadly.

Creative activities allow people to express themselves in rich, nuanced ways. However, being creative does not always come easily. For example, people with speech and language impairments, such as aphasia, face challenges in creative activities that involve language. In this paper, we explore the concept of constrained creativity as a way of addressing this challenge and enabling creative writing. We report an app, MakeWrite, that supports the constrained creation of digital texts through automated redaction. The app was co-designed with and for people with aphasia and was subsequently explored in a workshop with a group of people with aphasia. Participants were not only successful in crafting novel language, but, importantly, self-reported that the app was crucial in enabling them to do so. We refect on the potential of technology-supported constrained creativity as a means of empowering expression amongst users with diverse needs.

The World Wide Web Consortium's (W3C) Web Content Accessibility Guidelines (WCAG 2.0) have become widely accepted as the standard for web accessibility evaluation. This poster investigates how the mobile version of these guidelines caters for people with aphasia (PWA) by comparing the results from user testing against that of an audit using the guidelines. We outline the efficacy of the guidelines in the broader context of how they cater for various impairments and offer some recommendations for designing for people with aphasia.

This paper reports the experience of participating in usability testing from the perspective of a person with aphasia. We briefly report adaptations to classic usability testing to enable the participation of people with aphasia. These included the use of short, direct tasks and physical artefacts such as picture cards. Authors of the paper include Ian, a user with aphasia who participated in adapted usability testing and Abi, a speech and language therapist researcher who facilitated sessions. Ian reports that these methods allowed him, as a person with aphasia, to engage with the usability testing process. We argue that such adaptations are essential in order to develop technologies which will be accessible to people with aphasia. This collaborative report provides a case for both how and why these adaptations can be made.

Trust is a significant factor in user adoption of new systems. However, although trust is a dynamic attitude of the user towards the system and changes over time, trust in intelligent systems is typically captured as a single quantitative measure at the conclusion of a task. This paper challenges this approach. We report a case study that employed a combination of repeated quantitative and qualitative measures to examine how trust in an intelligent system evolved over time and whether this varied depending on whether the system offered explanations. We discovered different patterns in participants' trust journeys. When provided with explanations, participants' trust levels initially increased, before returning to their original level. Without explanations, participants' trust reduced over time. The qualitative data showed that perceived system ability was more important in determining trust amongst with-explanation participants and perceived transparency was a greater influence on the trust of participants who did not receive explanations. The findings provide a deeper understanding of the development of user trust in intelligent systems and indicate the value of the approach adopted.

We report a novel and accessible questionnaire designed to examine levels of technology use in adults with severe aphasia and to assess the impact of a co-designed computer-delivered gesture therapy (GeST) on participants' wider technology use. The questionnaire is currently being used in a group study of 30 participants with severe aphasia. Early outcomes indicate that people with severe aphasia are able to use the questionnaire effectively to report levels of technology use. Data from 11 participants suggests low levels of use for many items of everyday technology prior to therapy. Presented work will further examine the effect of GeST therapy on individuals' reported technology-use and also examine correlations between questionnaire outcomes and three other factors: performance on measures of cognition; and the amount and diversity of GeST-use.

People with aphasia experience difficulties with all aspects of language and this can mean that their access to technology is substantially reduced. We report a study undertaken to investigate the issues that confront people with aphasia when interacting with technology, specifically 3D game environments. Five people with aphasia were observed and interviewed in twelve workshop sessions. We report the key themes that emerged from the study, such as the importance of direct mappings between users' interactions and actions in a virtual environment. The results of the study provide some insight into the challenges, but also the opportunities, these mainstream technologies offer to people with aphasia. We discuss how these technologies could be more supportive and inclusive for people with language and communication difficulties.

This article investigates how activity theory can help research a constructionist community. We present a constructionist activity model called CONstructionism Through ACtivity Theory (CONTACT) model and explain how it can be used to analyse the constructionist activity in knowledge building communities. We then illustrate the model through its application to analysing the Wiki-supported community associated with a computer game. Our analysis focuses mainly on two perspectives: individual and collective actions, as well as individual and collective mediations. Experiences and challenges from the analysis are reported to demonstrate how CONTACT is helpful in analysing such communities.

Concern has been reported about the safe use of medical abbreviations in documents such as handover sheets and medical notes, especially when information is being communicated between staff of different specialties (BBC 2008 BBC. 2008. Available from: http://news.bbc.co.uk/1/hi/health/7171453.stm [Accessed 23 September 2010] [Google Scholar], Sheppard et al. 2008 Sheppard, J. E. 2008. Ambiguous abbreviations: an audit of abbreviations in paediatric note keeping. Archives of Disease in Childhood, 93: 204–206. [Crossref], [PubMed] , [Google Scholar]). This article describes a study to investigate whether the use of symbols in handover documentation that is shared within and between multidisciplinary teams (MDTs) has similar safety implications. We asked 19 healthcare professionals from a range of specialties to identify 45 different combinations of 38 individual symbols. The symbols and combinations of symbols were extracted from 102 handover sheets taken from 6 different healthcare contexts in 4 London hospitals. Three symbols proposed in Microsoft's Common User Interface guidelines for alert symbols were also included. Results reveal that while some symbols are well understood, many others are either ambiguous or unknown. These results have implications for the safe use of symbols in medical documents, including paper and electronic handover documents and Electronic Patient Records (EPRs), especially where teams comprise individuals from different professional backgrounds, i.e. MDTs. We offer initial suggestions for standardisation and further research.

Handovers are a specific kind of multi-disciplinary team meeting. Shift handovers and transfers are both regular features of hospital work but there is currently great variation in how such handovers are conducted, presenting a challenge for those seeking to develop technology to support handover. This article presents the ConStratO model of handover, which captures aspects of the context that influence how the handover is conducted, a range of different handover strategies relating to different aspects of the handover and possible outcomes of handover. The model is based on detailed data collection in a range of clinical settings. We present the model as a tool for developing and evaluating technology support for handover.

New wireless, networked, and sensor-based technologies are increasingly pervasive within health care. We are seeing a growth not only in the availability of hardware and software solutions for heal...

This paper reports an investigation of older adults’ needs and preferences concerning online social support. We focused our analysis on seven different aspects of online support: Self disclosure, Deep support, Light support, Community building, Information/Facts, Off topic, and Technical issues. For each aspect we were interested in how older adults perceive this aspect of support, what they think are the similarities and differences of this aspect of support in online settings vs offline settings, and what they perceive are the advantages and disadvantages of communicating this aspect of support online. We did this by conducting detailed interviews with three groups of older adults (31 people in total) with different levels of expertise in using the internet and online communication (older adults who do not use the internet, older adults who use only email, and older adults who participate in online support communities). Interviews were transcribed verbatim and analyzed. Our findings describe older adults’ perception of different aspects of support and identify their motivation for turning to online support and the reasons for any reluctance to do so. Thus, our findings give insight into how online support communities could best be utilized to improve older people’s experience with online support.

Drawing on data from a multi-site case study of a range of clinical settings, this paper explores the form of nursing handover sheets and the processes through which they are created and updated. We argue that these documents function as both public and private documents, having relevance for the whole ward while also acting as a personal workspace. Such dual functionality needs to be supported by any technology that seeks to provide for the work of handover, if the handover sheet is to continue to act as a space for work, rather than just a repository of information.

Technologies introduced to support complex and critical work practices merit rigorous and effective evaluation. However, evaluation strategies often fall short of evaluating real use by practitioners in the workplace and thereby miss an opportunity to gauge the true impact of the technology on the work. This article reports an in use, in situ evaluation of 2 cognitive artifacts that support the everyday work of handover in a healthcare setting. The evaluation drew inspiration from the theoretical viewpoint offered by distributed cognition, focusing on the information content, representational media, and context of use of the artifacts. The article discusses how this approach led to insights about the artifacts and their support of the work that could not have been obtained with more traditional evaluation techniques. Specifically, the argument is made that the ubiquitous approach of user testing with its reliance on think-alouds and observations of interaction is inadequate in this context and set an initial agenda for issues that should be addressed by in use, in situ evaluations.

Large, shared displays are used in support of many forms of col-laborative work and are generally assumed to benefit the work. We investigate this in a qualitative study of an intervention to introduce such a display to support the work of shift handover in a medical setting. Results suggest that the consequences of introducing a shared display can be more subtle than expected. In particular, we highlight the fact that the common distinction between private and public information is too coarse-grained and discuss the importance of considering how access to public information is initiated. We briefly touch upon implications for interaction design.

The importance of an early and on-going focus on users in interactive system design is widely accepted. However, in practice, involving users poses many problems and requires designers to balance conflicting demands. Various factors can hinder or ease the involvement of users. This paper reports a case study involving the design of a bespoke application and gives a detailed account of the obstacles and facilitators to user involvement encountered during the design activity. The obstacles and facilitators are presented in terms of issues such as contacting and selecting users, motivating users, facilitating and mediating meetings and offering points of focus for user contributions. We report and contrast the views of various stakeholders in the design process, and supplement these with our own observations as non-participant observers. Finally, we discuss issues raised by the study and draw out a number of lessons for the CHI community.

A production system based User Interface Management System (UIMS) is discussed. The UIMS, called Viz, has been designed and implemented in a windowed workstation environment, and (a) capitalises on the graphical facilities of the workstation while (b) being designed for both textual and graphical applications. The paper considers interaction, the appearance of Viz generated interfaces, and dialogue descriptions which parameterise Viz.