People who are blind face accessibility and usability barriers every time a digital image author omits or creates uninformative alternative or “alt” text. Often, content creators are simply unaware of screen reader users’ experience and accessibility best practices; there is also a lack of research knowledge about how to design accessible image-dense media, like pictorials. We present (1) a content analysis of 149 pictorials, (2) a thematic analysis of three think-aloud sessions with an expert screen reader user, and (3) practical lessons learned from a co-design workshop with three blind scholars. Our research finds that pictorials are increasingly accessible, but they are still far from providing a usable experience. We identify nine “malicious” alt text patterns that riddle pictorials and three novel accessible alt text patterns to guide authors of image-dense media.

Mental health activities conducted by patients between therapy sessions (or "therapy homework") are a component of addressing anxiety and depression. However, to be effective, therapy homework must be tailored to the client's needs to address the numerous barriers they encounter in everyday life. In this study, we analyze how therapists and clients tailor therapy homework to their client's needs. We interviewed 13 therapists and 14 clients about their experiences tailoring and engaging in therapy homework. We identify criteria for tailoring homework, such as client skills, discomfort, and external barriers. We present how homework gets adapted, such as through changes in difficulty or by identifying alternatives. We discuss how technologies can better use client information for personalizing mental health interventions, such as adapting to client barriers, adjusting homework to these barriers, and creating a safer environment to support discomfort.

Psychosocial therapies play a crucial role in effectively treating anxiety and depression. An integral aspect of these therapies involves setting goals that clients engage in outside therapy, known as therapy homework or between-session goals. Yet, clients overwhelmingly do not complete between-session goals. This study explores mental health therapists' and clients' challenges in collaborating to set and manage engagement with between-session goals and discusses how technology could better support them. We interviewed 13 therapists and 14 clients about their experiences with between-session goals. We identified therapists' needs for information to support their clients, challenges in collaboration, and how technology can support client-therapist collaboration. Therapists need in-the-moment information about clients' engagement with goals to inform their decision-making. Clients may feel reluctant to share information due to a lack of trust, embarrassment, or not knowing what to share. Clients could use technology to asynchronously communicate about sensitive topics with their therapists. Technologies could facilitate gathering in-the-moment data that supports client-therapist collaboration on goals.