Co-design is not merely a set of design activities, but is grounded in the belief of equitable access and input in design. However, a common assumption in co-design is that participants can use their hands, easily communicate, and are able to actively participate in a timeframe based on the researcher’s agenda. These assumptions can exclude underserved populations, including participants with motor and communication disabilities. We present Aligned Co-Design (ACD), a multi-modal, temporally flexible method grounded in communication theory and interdependent relationships. ACD requires the researcher to address their assumptions, communication, and role in co-design. We provide a proof-of-concept of ACD in practice, demonstrating multi-modal communication techniques and how those techniques align understanding and an equitable partnership in co-design. ACD achieves co-design’s theoretical commitment to establish an interdependent partnership with a currently under-represented population in co-design, adults who have motor or communication disabilities, thereby increasing equity and inclusion in co-design.

Voice-based Conversational Agents (CAs) are increasingly being used by children. Through a review of 38 research papers, this work maps trends, themes, and methods of empirical research on children and CAs in HCI research over the last decade. A thematic analysis of the research found that work in this domain focuses on seven key topics: ascribing human-like qualities to CAs, CAs? support of children?s learning, the use and role of CAs in the home and family context, CAs? support of children?s play, children?s storytelling with CA, issues concerning the collection of information revealed by CAs, and CAs designed for children with differing abilities. Based on our findings, we identify the needs to account for children’s intersectional identities and linguistic and cultural diversity and theories from multiple disciples in the design of CAs, develop heuristics for child-centric interaction with CAs, to investigate implications of CAs on social cognition and interpersonal relationships, and to examine and design for multi-party interactions with CAs for different domains and contexts.

OBJECTIVE: People who experience marginalization, including Black, Indigenous, People of Color (BIPOC) and Lesbian, Gay, Bisexual, Transgender, Queer, Plus (ie, all other marginalized genders and sexual orientations) people (LGBTQ+) experience discrimination during healthcare interactions, which negatively impacts patient-provider communication and care. Yet, scarce research examines the lived experience of unfair treatment among patients from marginalized groups to guide patient-centered tools that improve healthcare equity. MATERIALS AND METHODS: We interviewed 25 BIPOC and/or LGBTQ+ people about their experiences of unfair treatment and discrimination when visiting healthcare providers. Through thematic analysis, we describe participants' immediate reactions and longer-term consequences of those experiences. RESULTS: We identified 4 ways that participants reacted to discrimination in the moment: Fighting, Fleeing, Excusing, and Working Around Bias. Long-term consequences reflect 6 ways they coped: Delaying or Avoiding Care, Changing Healthcare Providers, Self-prescribing, Covering Behaviors, Experiencing Health Complications, and Mistrusting Healthcare Institutions. DISCUSSION: By describing how patients react to experiences of unfair treatment and discrimination, our findings enhance the understanding of health disparities as patients cope and struggle to speak out.To combat these problems, we identify 3 future directions for informatics interventions that improve provider behavior, support patient advocacy, and address power dynamics in healthcare. CONCLUSIONS: BIPOC and LGBTQ+ patients' perspectives on navigating unfair treatment and discrimination in healthcare offers critical insight into their experiences and long-term consequences of those experiences. Understanding the circumstances and consequences of unfair treatment, discrimination, and the impact of bias through this patient-centered lens is crucial to inform informatics technologies that promote health equity.

OBJECTIVE: We explore the telehealth experiences of adults who use augmentative and alternative communication (AAC) and clinicians who work with people using AAC. MATERIALS AND METHODS: We conducted semistructured, online interviews with 6 adults who use AAC and 8 clinicians who provide telehealth services to people who use AAC between July and September 2020. Participants were located in the United States and the United Kingdom. All participants had engaged in 2 or more telehealth visits in the past 6 months. We used an inductive, thematic approach to analyze the interview data. RESULTS: Our findings reveal that (1) telehealth is an essential service, (2) technology causes barriers, (3) policies meant to protect actually inhibit, and (4) remote monitoring devices have the potential to mitigate risks. DISCUSSION: Telehealth systems created for persons without disabilities do not provide equitable access to everyone. Telehealth should be flexible enough to allow patients to use the communication modality that best meets their needs. We suggest that healthcare systems think of the healthcare ecosystem as one which includes a variety of telehealth options in addition to traditional in-person clinical visits. CONCLUSIONS: The benefits of telehealth for people who use AAC are substantial and should be an option for ongoing health care. However, the accessibility of telehealth technologies needs to be improved. Designers should view telehealth as part of a broad healthcare ecosystem, which includes in-person, telehealth, and remote health monitoring technologies. Designers should also include AAC users in the design and development process. Telehealth policies should encourage multimodality access to health care and address funding concerns.

The COVID-19 pandemic forced many people to convert their daily work lives to a “virtual” format where everyone connected remotely from their home. In this new, virtual environment, accessibility barriers changed, in some respects for the better (e.g., more flexibility) and in other aspects, for the worse (e.g., problems including American Sign Language interpreters over video calls). Microsoft Research held its first cohort of all virtual interns in 2020. We the authors, full time and intern members and affiliates of the Ability Team, a research team focused on accessibility, reflect on our virtual work experiences as a team consisting of members with a variety of abilities, positions, and seniority during the summer intern season. Through our autoethnographic method, we provide a nuanced view into the experiences of a mixed-ability, virtual team, and how the virtual setting affected the team’s accessibility. We then reflect on these experiences, noting the successful strategies we used to promote access and the areas in which we could have further improved access. Finally, we present guidelines for future virtual mixed-ability teams looking to improve access.

When trying to understand people's perspectives, qualitative researchers in HCI often use methods which assume participants can easily communicate verbally. There are few dedicated resources in HCI which provide an overview of qualitative methods to effectively gather the perspectives of people who cannot easily communicate verbally; specifically, people who use Augmentative and Alternative Communication (AAC). As a result, AAC users might be excluded from studies using methods such as interviews or focus groups, even if they fit the researcher's target population. To address this problem, I review literature from both HCI and therapeutic AAC research fields to discuss methods used with AAC users. In addition, I present relevant case examples from my own qualitative research and propose a framework to guide HCI researchers on choosing appropriate methods when involving AAC users as central research participants. I also identify design opportunities for HCI researchers to innovate on the tools and methods used for qualitative research with AAC users. This paper provides an easily accessible overview of qualitative methods HCI researchers can use with AAC users as participants.

Smart speakers have become pervasive in family homes, creating the potential for these devices to influence parent-child dynamics and parenting behaviors. We investigate the impact of introducing a smart speaker to 10 families with children, over four weeks. We use pre- and post- deployment interviews with the whole family and in-home audio capture of parent-child interactions with the smart speaker for our analysis. Despite the smart speaker causing occasional conflict in the home, we observed that parents lever-aged the smart speaker to further parenting goals. We found three forms of influence the smart speaker has on family dynamics: 1) fostering communication, 2) disrupting access, and 3) augmenting parenting. All of these influences arise from a communally accessible, stand-alone voice interface which democratizes family access to technology. We discuss design implications in furthering parenting practices and behaviors as the capabilities of the technology continue to improve.

We investigate how families repair communication breakdowns with digital home assistants. We recruited 10 diverse families to use an Amazon Echo Dot in their homes for four weeks. All families had at least one child between four and 17 years old. Each family participated in pre- and post- deployment interviews. Their interactions with the Echo Dot (Alexa) were audio recorded throughout the study. We analyzed 59 communication breakdown interactions between family members and Alexa, framing our analysis with concepts from HCI and speech-language pathology. Our findings indicate that family members collaborate using discourse scaffolding (supportive communication guidance) and a variety of speech and language modifications in their attempts to repair communication breakdowns with Alexa. Alexa's responses also influence the repair strategies that families use. Designers can relieve the communication repair burden that primarily rests with families by increasing digital home assistants' abilities to collaborate together with users to repair communication breakdowns.

Many traditional HCI methods, such as surveys and interviews, are of limited value when working with preschoolers. In this paper, we present anchored audio sampling (AAS), a remote data collection technique for extracting qualitative audio samples during field deployments with young children. AAS offers a developmentally sensitive way of understanding how children make sense of technology and situates their use in the larger context of daily life. AAS is defined by an anchor event, around which audio is collected. A sliding window surrounding this anchor captures both antecedent and ensuing recording, providing the researcher insight into the activities that led up to the event of interest as well as those that followed. We present themes from three deployments that leverage this technique. Based on our experiences using AAS, we have also developed a reusable open-source library for embedding AAS into any Android application.