Author: Jane Bringolf

Go-Along neighbourhood research

The “Go-Along” research method is a way of observing people in their local neighbourhood to see the streets from their perspective. It allows participants to tell their stories about the things they like and don’t like when getting out and about. 

The “go-along walking” method has been used with people with dementia. The findings provided insights into how people get around and their need to feel safe. 

A similar project was undertaken in Copenhagen focused on older people. The data was gathered using a Go-Pro camera and interviews.  Social interaction turned out to be the overall reason for going outdoors. Footpaths, seating and sheltered places were the most important design elements. Of course, these are not limited to older people. A case of “necessary for some and good for others”.

Three mobility device users meet at the widest street corner. It serves as a meeting point for neighbours. Go-along walking research.
Image from the article. A wide corner is a meeting place for neighbours.

Photographs tell the personal stories and illustrate some of the findings.

 

 

The title of the article is, Going along with older people: exploring age-friendly neighbourhood design through their lens.  Springer Link has not granted open access, but you can request a copy from ResearchGate. It was published by the Journal of Housing and the Built Environment in 2020.

Abstract

Neighbourhoods are extremely important to older people, as this is where a great deal of their everyday life is spent and where social interaction happens. This is particularly the case in deprived neighbourhoods, where people with limited economic resources or physical limitations find it challenging to venture outside the neighbourhood.

A growing body of research suggests studying age-friendly neighbourhoods from a bottom-up approach which takes the diversity of the age group into account. This paper aims to investigate how the go-along method can serve to co-construct knowledge about age-friendly neighbourhood design in a deprived neighbourhood of Copenhagen with a diverse group of older people.

Sixteen go-along interviews were carried out with older people aged 59–90. The participants took on an expert role in their own everyday life and guided the researcher through the physical and social environments of their neighbourhood.

The go-alongs were documented with a GoPro camera. The data were analysed using situational analysis and was grouped into thematic categories. Our findings conclude that social interaction is the overall motivator for going outdoors and that dimensions of pavements, the seating hierarchy, the purpose of lawns, sheltered spaces and ‘unauthorised’ places are all neighbourhood design elements that matter in this regard.

The findings suggest to consider age-friendly details as the starting point for social interaction, to target the appropriate kind of age-friendly programs and to enhance empowerment through physical spaces. The go-along interview as a research method holds the potential for empowering older people and appreciating their diversity.

 

Inclusive healthcare practice

Almost everyone finds themselves in hospital at some time whether as a patient or a visitor. Consequently, we are talking about the whole of our diverse population. But how well is diversity, equity and inclusion considered in healthcare practice? If the statistics are anything to go by, we are not doing well. Marginalised groups experience poorer health outcomes. The conditions in which people live – referred to as the “social determinants of health” – are the main reason for this.

Thirteen people were involved in devising 12 Tips for Inclusive Practice in Healthcare Settings.

A man in a white hospital shirt is wearing a blue face mask and has a stethoscope around his neck. He is looking into the camera and is posing with a thumbs up sign.

Appropriate terminology is a major feature in the list of 12 tips. Non-judgmental factual terms are preferred. Labels such as “obese” or “schizophrenic” can imply blame or non-compliance. And some patients will want to use non-binary gender terms when referring to themselves. Using the person’s preferred terms is recommended in all situations as these can vary. For example some people say they are autistic and others will say they have autism. Then there are people with multiple identities (intersectionality).

The 12 Tips for Inclusive Practice

Here is a brief outline of the the 12 tips.

Tip 1: Beware of assumptions and stereotypes: An individual might have multiple diverse characteristics. In the absence of early information it is easy to assume some things by default. A wheelchair user might conjure up assumptions about the health and ability to make decisions. A person accompanying a patient may be assumed to be a partner or family member.

Tip 2: Replace labels with appropriate terminology: The main point here is to keep up to date with best-practice terminology. For example, guidelines for preferred language for First Nations people is shifting and evolving. Some terms considered derogatory are now embraced by some (queer, autistic).

Tip 3: Use inclusive language: words can exclude and “other” people when they deemed to be different to oneself.

Tip 4: Ensure inclusive physical spaces: Accommodating physical, sensory and cognitive needs improves patient experience. Inclusive design goes beyond legislated minimum access requirements for buildings. For example gowns, furniture, and blood pressure cuffs, should accommodate all sizes.

Tip 5: Inclusive signage and symbols: A rainbow flag or First Nations flag will make people feel welcome. However, the use of these signs needs to be accompanied by inclusive care to avoid disappointment.

Tip 6: Appropriate communication methods: This is where body language and auditory input come into play. Not everyone processes these cues well and sometimes information is better put in writing.

Tip 7: Adopt a Strengths-Based Approach: This approach avoids stereotyping and acknowledges patients’ capacity for resilience and builds on their strengths.

Tips 8 – 12 focus on the health system and healthcare delivery and encourages health workers to advocate for improvements.

The title of the Australian open access article is Inclusive Practice in Healthcare Settings.

Abstract

This paper outlines practical tips for inclusive healthcare practice and service delivery, covering diversity aspects and intersectionality. A team with wide-ranging lived experiences from a national public health association’s diversity, equity, and inclusion group compiled the tips, which were reiteratively discussed and refined. The final twelve tips were selected for practical and broad applicability.

The twelve chosen tips are: (a) beware of assumptions and stereotypes, (b) replace labels with appropriate terminology, (c) use inclusive language, (d) ensure inclusivity in physical space, (e) use inclusive signage, (f) ensure appropriate communication methods, (g) adopt a strength-based approach, (h) ensure inclusivity in research, (i) expand the scope of inclusive healthcare delivery, (j) advocate for inclusivity, (k) self-educate on diversity in all its forms, and (l) build individual and institutional commitments.

The twelve tips are applicable across many aspects of diversity. They provide a practical guide for all healthcare workers and students to improve practices. These tips guide healthcare facilities and workers in improving patient-centered care, especially for those who are often overlooked in mainstream service provision.

The 12 tips for inclusive healthcare with five underpinning concepts: diversity, equity, inclusion, intersectionality, strengths based approach.

Who do we include in co-design?

Traffic light icon with Problem in red, Analysis in Yellow, and Solution in Green. Academics talk about “vulnerable groups” based on ethics approval language. But what they mean is, people who have difficulty participating because they have a disability, illness, or some other condition. Indeed, some ethics requirements are so protective of “vulnerable groups” that they make it difficult to include them from research projects. Consequently their voices are silenced. So how do we include them in co-design and when?

While co-design is the new buzz word, participatory design has been around in academia for many years. Involving communities in decision-making is now recognised as being responsive to community needs. That means going beyond a one-size-fits-all approach to design. 

Participatory design

Participatory design, or co-design, is about genuine inclusion. That is, not just informing the design, but being participants in the design process. However, involving people with complex needs poses some challenges. It’s easy to make assumptions about their capacity to participate and collaborate. However, this comes down to the way the participation process is designed. 

Participatory design and the inclusion of vulnerable groups is the topic of an article from Finland. They use three projects to compare how participatory design might work best. The first explored co-design activities with people with intellectual disabilities living in supported housing. The second focused on culturally diverse young people experiencing crisis situations. The third dealt with nursing students with learning disabilities adapting to work in the health sector.

Challenges and power dynamics

The article covers the challenges, the power dynamics and their methodology. Each of the three projects is documented in detail. The findings show some similarities between the projects, but when it came to users, there were different outcomes and processes. Participatory design became more challenging when there were more pronounced differences in power dynamics.

These three projects provide good information for involving vulnerable groups in participatory design processes. Questions of equality and genuine inclusion is about both the design activities and how the entire project is planned. 

The title of the article is, Whom do we include and when? participatory design with vulnerable groups

From the abstract

This article makes three contributions to participatory design (PD) research and practice with vulnerable groups:

    1. A framework for understanding stakeholder engagement over the course of a PD project.
    2. Approaches to making user engagement and PD activities more inclusive.
    3. An analysis of how the design and power dynamics of PD projects affect vulnerable groups’ participation.

A map of engagement evaluates stakeholder involvement from initial problem definition to design outcome. 

The first looks at codesign activities to support decision-making in the context of intellectual disabilities. The second looks at culturally diverse youth navigating crisis without adequate assistance from public services. The third examines nursing students adapting to work in the health sector without accommodations for learning disabilities.

Comparing the projects reveals patterns in project planning and execution, and in stakeholder relationships. The article analyses how users are defined, engaged and supported in PD; how proxies shape vulnerable groups’ involvement and PD projects as a whole; and opportunities for greater inclusion when the entire PD project is taken into account.

Do web accessibility overlays work?

Accessibility Overlays - What are they & why are they so bad? - YouTube
First screen of the YouTube video

This site has a web accessibility overlay or add-in widget. It’s the circle icon next to our logo on the website. If you click on it, it has a dropdown accessibility toolbar. That’s because the platform, WordPress, isn’t inherently accessible. So like the tacked on ramp to a building, it is an afterthought. But really, it advertises that the website platform isn’t really accessible and there are good reasons why. 

Website add-ons for accessibility go back to the 1990s with products like Browsealoud and Readspeaker. They added text to speech capabilities on the website. More products arrived in the market with similar aims. To the layperson these features seem beneficial, but their practical value is overstated. That’s because the people who need these features will already have the software on their devices to access the web and other software. The Overlay Fact Sheet by Karl Groves explains more: 

Overlay Fact Sheet logo - black background and an orange circule.
From the overlay fact sheet

“It is a mistake to believe that the features provided by the overlay widget will be of much use by end users because if those features were necessary to use the website, they’d be needed for all websites that the user interacts with. Instead, the widget is —at best—redundant functionality with what the user already has.”

Do overlays meet compliance?

While an overlay might improve compliance in some respects, full compliance cannot be achieved using this method. That’s because the products are unable to “repair” all possible issues. In some cases, the overlay can conflict with the users software and cause problems. And ironically, some overlays are inaccessible. So that means it’s back to the programmer and designer to get it right. 

The video below gives examples of overlays and graphically shows how they don’t work. You only need to look at the first three minutes to get the idea. 

We all have a responsibility to make our digital information accessible. Beware any web developer who says they’ve solved the accessibility problem with an overlay or widget. Indeed, you are showing your inaccessibility by having an “accessibility” overlay and icon on your site. 

Web designers might think the international web standards are sufficient. But they are not – just like the standards for access and mobility in the public domain are not enough. 

By the way, CUDA uses the WordPress platform’s free version and continues to do so because we do not receive financial support for the website and want to keep it open access. As with everything universal design – it is a work in progress. “Do the best you can with what you have at the time and strive to improve next time.” 

 

Planning inclusive communities: Stage 1

Planning inclusive communities begins with asking the right questions. For example: What makes an inclusive community? What stops communities being inclusive? When we say community, what do we mean? And what does inclusive mean?

Lisa Stafford’s research project sought to answer those questions and more. Her research heard from 97 people aged from 9 to 92 years. Some had a disability or long term health condition, and others were their family members or allies. The findings are presented in a reader friendly format rather than an academic article. 

People standing in front of large paper with graphic harvest (drawings) from community chat about inclusive communities
Image from Planning Inclusive Communities website

Findings from Stage 1

The thoughts and experiences from participants with and without disability shared many aspects in common. Here are some of the points in brief.

An inclusive community is about people where everyone is valued and belongs. Everyone is valued and respected regardless of their culture or background. That means communities must be planned for all people – built for equity, fairness and accessibility. Inclusive communities are happy places where people have choices and safe spaces to have fun and socialise. So how do we make it happen?

The answer is planning together from the very beginning. People with disability, diverse groups, government and urban planning practitioners should all be involved. 

The Planning Inclusive Communities website explains the project in plain language with lots of graphics. There is also a link to an Easy English explanation of the project. The video below also gives an overview.

The title of the full report is What Makes Inclusive Communities? Meanings, Tensions, Change Needed and is downloadable in Word. It gives more detail about the background to the research and the findings. 

Stage 2 of this research project will identify people who want to help make change and create a plan for inclusive communities. 

https://youtu.be/s9LFt8LZ81k

Here is a quote from the website that has more information. 

“I feel like it’s all about everyone being able to equally engage in the environment in the community. For people with disabilities there is a lot of restraint and they can’t engage as much as other people. It’s also like equality is not enough, it should be equity so everyone has what they need to be able to engage in that community. Because I feel like a community is about people and engagement, but also being able to access and work around a community.”

Planning Inclusively: Make Communities Just for All

View from high building in Brisbane overlooking building roofs and the Brisbane river and bridges. Jacaranda trees can be seen in the street.Urban planning is a highly contested and politicised area to work in. The talk is that planning is about people, not roads and buildings. But when do users – people – get a say in planning? Only at the end when plans are put on exhibition. Then you need to be an expert to understand them. Planning inclusively is to make communities just for all. 

Lisa Stafford, in a briefing paper, asks how well do we consider human diversity in planning cities and regions?  Planners and bureaucrats would rarely even consider the concept of “Ableism” in their designs. That’s why we still have marginalisation by design. The lens of the average or the “normal” person is rarely put aside for a lens of diversity. 

Graphic with four circles: one each for exclusion, separation, integration and inclusion.Social planning can drive inclusive communities because it operates from a justice framework. Participatory planning is one way to work towards inclusion. 

The tile of Lisa Stafford’s paper is, Planning Inclusively: Disrupting ‘Ableism’ to Make Communities Just for All.  She has four recommendations at the end of her easy to read paper. Briefly they are:

      1. Adopt an approach of planning for all
      2. Apply spatial justice thinking to planning
      3. Embed universal design as a core planning principle
      4. Re-emphasise the social in planning

Editorial Introduction 

“Disabled people continue to experience exclusion by design in our everyday spaces, infrastructure and services, which has been magnified through the COVID-19 pandemic. Now, more than ever, there is an opportunity for urban and regional planning practitioners, researchers and disabled people to come together to advocate for and create inclusive, sustainable communities for all. However, to make this transformative, we must first critically question how well do we really consider human diversity in planning cities, towns and regions? This question is examined in this briefing paper by contesting entrenched challenges like ‘ableism’ before providing fundamental starting points for planners in planning more inclusive and just communities for all.”

 

New mobility and universal design

On one hand, new mobility technology increases opportunities to improve transport systems. But on the other, the technology is unevenly distributed in terms of access and inclusion. This means many will be left out, especially those with reduced mobility. 

The new technology can create unintended barriers: physical, technological, economic and mental – each one a challenge to universal design. Public policy also has a role to play in reducing barriers to mobility.

Norway has a whole of government universal design policy and has done good work in making public transport accessible. However, many advancements require digital skills in using smartphone apps and electronic ticketing. And that’s just one universal design challenge. 

The challenges to universal design and new mobility are discussed in a book chapter by Jørgen Aarhaug. The chapter title is, Universal Design and Transport Innovations: A Discussion of New Mobility Solutions Through a Universal Design Lens. It’s open access.

From the abstract

Most technological advances in mobility result in better accessibility for many, yet the benefits remain unevenly distributed. New and improved mobility technologies typically result in increased mobility. However, most new technologies create both winners and losers. Who wins and who loses depends on how the mobility solution in question is introduced to the mobility system.

This study finds that many of the new mobility technologies that are introduced, though not directly relating to universal design, strongly affect the universality of access to mobility.

The chapter aims to give insight into how certain new mobility solutions affect different user groups, and to highlight how the outcome is a function of the interplay between technology and its implementation. The paper concludes by pointing to the need for regulation to align the objectives of the actors behind new technologies and an inclusive society.

Automated vehicles: mobility and accessibility

The transportation and mobility sector has a design history focused on infrastructure efficiencies. User perspectives are being introduced in other sectors and it is time for the mobility sector to catch up. 

An article from Norway discusses the issues introducing universal design and co-creation.  The author uses three vignettes to highlight some of the issues users encounter. 

The title of the article is, Automated Vehicles Empowering Mobility of Vulnerable Groups – and the Pathway to Achieve This.

From the abstract

Many people in Europe still have limited access to transportation modes overall. Socio-economic constraints, and cognitive, sensory and physical impairments affect everyday life, posing challenges to accessing mobility services.

Technologies for vehicle automation have advanced in recent decades. Yet, the implementation and use of automated and autonomous vehicles (jointly referred to as AVs) entails chances but also hurdles regarding accessibility and inclusivity of vulnerable groups.

This concerns both the use of the vehicle by humans as well as the interaction between humans and vehicles as participants in road traffic.

In this chapter, we identify opportunities and risks narrow down the vulnerable social groups we are looking at. Subsequently, we present the benefits that co-creation and universal design can have in overcoming or, in the best case, avoiding these obstacles.

Detailed recommendations for action cannot be given within this framework, but suggestions for solutions are outlined.

 

Law schools and universal design

Aerial view of a large public library with long desks around a central console. Law schools teach law and introduce the values that students take into the legal profession. Unless law schools embrace universal design, they will continue to be inequitable and pose barriers to people who might be good lawyers. This is the basis of an article by Matthew Timko where he says the place to introduce universal design is through law libraries.

Timko says the law library is the ideal testing ground for changes that assist student comprehension and testing. Beginning with the library services, the value of universal design will gradually become apparent to all stakeholders. From there it will enter the legal academy, legal education process and legal profession.

Timko uses the 7 Principles of Universal design as the framework for his proposition. This shows how flexibly the principles can be applied. He then discusses the role of disability legislation in the United States and the supports available. 

Photo of the sign on the grey stone building of The Royal Courts of Justice. Ethical and professional standards provide another opportunity to support individuals. Timko argues that most accommodations pose menial burdens on institutions but provide great benefit to individuals. However, they need to be provided as a general rule, not just when they are asked for. This is the underlying tenet of universal design for learning. 

The article goes into more detail about the role of legislation and how it should apply to law schools. In the conclusion, Timko states:

“Universal design offers the key to not only increased access to legal education and legal knowledge but also a more fundamental shift in the perceptions and thinking that have plagued disability laws and design habits over the last 30 years.”

The types of universal design features discussed can be introduced into the law library gradually and in cost-effective ways. 

The title of the article is, Applying Universal Design in the Legal Academy. 

From the editor

I was invited to participate in a question and answer interview for the Law Society Journal with Features Editor, Avril Janks. I was encouraged to find that universal design has entered the realms of the legal profession and happy to participate. 

We discussed universal design broadly and then how it might be implemented in legal workplaces. Universal design can be applied to the office design, office systems, and employment practice. So plenty of scope for the profession to be more inclusive. If you want to read the article published in the March 2023 edition, contact journal@lawsociety.com.au 

Jane Bringolf

Home modifications: a clash of values

Publicly funded home modifications are a regular feature of My Aged Care and the NDIS schemes. NDIS participants seeking independence and desires to age in place are increasing, but our housing stock is not fit for this purpose. Consequently, homes need adaptation as people age or acquire a disability. However, there is a clash of values between what the client wants, what the funder wants, and what the occupational therapist (OT) deems functional. That’s a finding from researchers at the Hopkins Centre.

Our homes are not designed for disability and ageing. Consequently, modifications are essential for remaining safely and independently at home. They are an essential part of the NDIS and My Aged Care schemes.

The chart shows the key overarching themes from the research

Graphic showing the three values; aligning values and expectations, and quantifying value for money.

Researchers interviewed OTs experienced in prescribing home modifications. They wanted to gauge their experiences in the assessment process. They found that clients (homeowners) value aesthetics and property values. On the other hand, funding bodies value the cheapest option, and OTs are looking for the most functional outcome. OTs are also confronted with different decision making criteria across the various schemes.

Consequently, it is up to the OT to balance the desires of the client with those of the funder using their professional knowledge. Not an easy task, and unlikely to lead to optimum outcomes. And OTs become de facto bureaucrats in this process, which can also be a challenge to their professional values.

But what is “value”?

The research paper discusses the various aspects of value from different perspectives. The best outcomes are achieved when there is open discussion between the client, the funder and the OT. This encourages a better alignment of values.

While this paper is focused on the OT professional, it links closely with the notion of disability and ageing stigma. The idea of having a grab bar or a ramp appears to be an affront to one’s dignity. Older people see this as the beginning of the “downhill run” of life. The new Livable Housing Design Standard will help minimise this stigma by providing a step free entry and better bathroom design. Until we have sufficient stock, OTs will continue to provide home modification assessments.

The title of the paper is, Valuing home modifications: The street-level policy work of occupational therapists in Australian home modification practice.

There is also a webinar on the Hopkins Centre website that discusses client perspectives of home modifications. In a nutshell, they see modifications as value for money if they meet their specific needs to a high standard. Also, the process of getting a modification has to be straightforward without wasting time and money.

Phillippa Carnemolla’s research showed the number of care hours saved and improved quality of life with appropriate modifications.

Future-proofing is best

For those who can afford to renovate their home now, it is worth considering future-proofing, rather than leaving it “until the time comes”. The Livable Housing Design Guidelines are a good reference for anyone updating their home at any point in their life. This Guideline is the basis of the mandated Livable Housing Design Standard, but has more useful information for homeowners.

Train station design

The Design Council in the UK has published a full report of the work they did on train station design. The aim of the project was to find a generic train station design that could be rolled out on the various rail networks. For this they undertook some serious community engagement. 

A concept image of the train station design. It's an aerial view showing how the station fits into the existing residential area.

The majority of rail stations are small to medium size situated in the heart of local communities. This is why they have to deliver more than just trains for commuters. 

The community engagement process gave architects design concepts that work as a whole or a kit of parts. This works well when upgrading existing train stations. Key design elements are

The clocktower – acts as a beacon to help identify the station and orientate people.

The welcome mat – extends the public space outside the station. It creates space between people and cars, inviting people to spend time here.

The activity framework – can be adapted to the needs of each place. Provides space for local communities and small enterprises alongside station facilities.

The photovoltaic canopy – even the smallest stations will include a timber framed platform canopy with integrated PV panels.

The pods – create extra shelter under the platform canopy or activity framework. These can include space for passenger facilities such as waiting rooms, toilets or a ticket office. 

Train stations are evolving from a focus on rail infrastructure to a focus on passengers and the local community. This is how you do universal design – with a focus on users.

The full report of the process and the outcomes is documented in Explore Station: Building momentum for a future passenger hub.

 

8-Inclusion needs to prevent discrimination

The 7 Principles and the 8 Goals of universal design have their roots in the built environment and people with disability. We have moved on since their inception to thinking about including other marginalised groups. With this thinking comes intersectionality where an individual can be a member of more than one of those groups. For example, a female refugee with a disability.

The 8-Inclusion Needs framework sits alongside the classic 7 Principles and the practical 8 Goals of universal design. Together they provide a more holistic view of the real lives of people.

A human head shape with a montage of photos of many different people.

The framework seeks to provide a new perspective for shifting the focus from a list of identities to addressing the needs of all people. As such it provides a guide for inclusive designs and interventions that eliminate discrimination. It also provides another perspective on the amorphous term “diversity”.

The 8-Inclusion Needs of All People framework

The results of the literature review formed the basis of the 8-Inclusion Needs framework. Briefly, they are:

1. Access – Ensuring all people can see and hear, or understand via alternatives, what is being communicated; and physically access or use what is being provided.
2. Space – Ensuring there is a space provided that allows all people to feel, and are, safe to do what they need to do.
3. Opportunity – Ensuring all people are provided opportunity to fulfil their potential.
4. Representation – Ensuring all people can contribute and are equally heard and valued.
5. Allowance – Ensuring allowances are made without judgement to accommodate the specific needs of all people.
6. Language – Ensuring the choice of words or language consider the specific needs of all people.
7. Respect – Ensuring the history, identity, and beliefs of all people are respectfully considered.
8. Support – Ensuring additional support is provided to enable all people to achieve desired outcomes.

Individual identities – a list

Identities included in the analysis of research on the lived-experience of underrepresented identities:

    • Gender
    • Race/ethnicity
    • Socio-economic status/class
    • Indigenous
    • LGBTQI+
    • Disability
    • Religion
    • Age
    • Immigrant
    • Illness (physical or mental)
    • Refugee
    • Veteran
    • Neurodiversity

The title of the article is, The 8-Inclusion Needs of All People: A proposed Framework to Address Intersectionality in Efforts to Prevent Discrimination. Published in the International Journal of Social Science Research and Review.

From the abstract

This paper begins by highlighting the current state of inclusion, and then reviews research on the application of intersectionality to address discrimination.

The literature review includes an overview of existing models designed to assist the application of intersectionality in reducing discrimination.

An analysis of research was carried out on the discrimination on 13 individual identities and 5 intersectional identities. A new framework called the 8-Inclusion Needs of All People is based on 8 common themes.

The framework is illustrated with recommendations for application in government and policy making, the law, advocacy work, and in organizations. This goal is to provide a useful framework for expediting social justice and equitable outcomes for all people.