"SOLUTIONS FOR ELDERLY VISUALLY IMPAIRED PEOPLE USING THE INTERNET" By Mary Zajicek & Sue Hall

Solutions for Elderly Visually Impaired
People Using the Internet
Mary Zajicek & sue Halit

This paper is concerned with problems that elderly visually impaired users
encounter when using the World Wide Web for the first time. It reports
the results of an evaluation, conducted with BrookesTalk (a Web browser
for blind and visually impaired people), with special reference to the
problems experienced by elderly visually impaired users. The authors seek
to identify the source of their problems and describe a software solution
that offers support for those with fluid memory loss, and low levels of
confidence.

Keywords: elderly users, visual impairment, memory loss, World Wide Web,
interface, speech.

1 Introduction
This paper addresses problems encountered by elderly visually impaired people
using the Internet. It is based on interdisciplinary work carried out in the School
of Computing and Mathematical Sciences, where a Web browser specially for the
elderly visually impaired has been built, and on research based in the Department of
Family and Lifespan Studies in the School of Health Care.

The studies described below show that elderly visually impaired users
experience great diffculty in getting going on the Internet when they have
no previous experience in computing. Studies of Age Associated Memory
Impairment (AAMI) show how disadvantaged elderly people are when using
computer applications. This coupled with their visual impairment demands a new
interface modality to support elderly visually impaired people learning to use
computer applications.
This paper describes preliminary studies carried out with a specially modified
Web browser for the blind, which speaks out instructions to the user as they use the
application. The idea is to reduce reliance on 'fluid' memory, the most significant
age associated memory loss and to support the users' development of strategies and
processes until they become resident in the 'crystalline' memory. Instructions can
be switched off as processes become understood and of course, if necessary, all
instructions can be switched on again. The authors also looked at the effect of
personal support in getting elderly visually impaired users up and running with the
World Wide web.

2 Difficulties Experienced by Elderly First Time Users on the
Internet
The difficulties experienced by elderly visually impaired users were demonstrated
during trials using a function key driven, Web browser for the blind and visually
impaired, developed within our research group. The system called BrookesTaIk was
distributed free to over 200 blind and visually impaired users and an evaluation
of how users were interacting with the browser was performed using an online
questionnaire and follow-up telephone interview (Zajicek & Arnold, 1999).
Browser uptake by elderly visually impaired first time users was very
disappointing, 82% of this group were unable get up and running. Analysis of
their interaction showed that they were unable to build useful conceptual models of
the functionality of BrookesTaIk or of the workings of the Web. Their confidence
in making the decisions needed for the construction of conceptual models was low
and they became confused and frustrated. For example some subject users were
unsure as to the functionality of a link. Sighted users are able to see the link, how it
is placed in the page, and how it relates to other text on the page. They could also
follow the link to reinforce their concepts and easily return to their original position.
It is not as easy for visually impaired users to try out a link, see what happens, and
learn from the experience. In addition, elderly users find difficulty in remembering
sequences of actions they have previously performed.
These users also found difficulty in understanding the way a computer
application works. Some 'borrowed' the model of a video recorder and expected
one press of a button to make everything 'happen'. They were afraid that they would
'break' the software if they did something wrong. The concept of dialogue and
learning to use a language at the interface through trial-and-error was very new to
them. Other problems stemmed from a lack of understanding of the relationship
between the function keys and functions they represent and the concept of mapping
the task in hand onto the appropriate sequence of functions to achieve a goal.

Elderly visually impaired users interviewed on the telephone appeared not have
the skill or confidence to try out functions to see how they work in order to build up
a conceptual model of the system. Impaired memory as described below seriously
interferes with exploratory activity that involves remembering many combinations
of actions and outcomes.
Poorly developed conceptual models of the Web, as distinct from the browser,
also form a major impediment to successful Web use, for blind and visually impaired
users. Sighted users rely on complex and contextual, conceptual models and many
visual clues to help them find information on the Web (Zajicek et al., 1998a).
Four important inter-relating conceptual models were identified for Web search:
• The model of the workings of the search engine.
• The model of the results page of a given search engine.
• The model of the Web site being visited.
The model of the page.
Elderly visually impaired users find difficulty in constructing any of these
models for the reasons established above.
3 Difficulties Faced by the Elderly
3.1 Memory Loss
Age related memory changes and their effects on learning are no doubt at the heart
of the difficulties which older people have in accessing the Internet. It is generally
agreed that old age is associated with a decline in intellectual skills which affects the
absorption of new information. (Stuart-Hamilton, 1999). This is not a global decline;
some skills are not affected by ageing and research has shown that certain types of
memory are unaffected by ageing (Marighetto et al., 1999; Park, 1998). Others have
shown that Age Associated Memory Impairment (AAMI) is associated with damage
to different areas of the brain such as the hippocampus (Marighetto et al., 1999) or
the frontal lobe (Rabbitt, 1997). These changes take place at a sub-clinical level in
'normal' elderly subjects as part of the general ageing process.
The importance of these changes for the older would-be Internet user is that
while the 'crystalline' memory — i.e. fixed, pre-learned and unchanging knowledge
and skills — is relatively unaffected, the 'fluid' memory is more likely to be subject
to AAMI. Fluid memory is described by Stuart-Hamilton (1995) as "the ability to
solve problems for which there are no solutions derivable from formal training
or cultural practices". This definition fits precisely the 'suck-it-and-see' type of
learning required for Internet use, described elsewhere in this paper and it can
therefore be hypothesised that the request for a button to press for the right answer
represents not only a need for familiar technology but for a learning method which
makes the user feels more confident in their own ability to learn. Other research
shows that older people are less able to retrace and navigate a route than younger
people (Wilkniss et al., 1997). This can be seen as analogous to using the Internet
which features a navigational system for information organisation.

Stuart-Hamilton also found that older people develop a range of strategies to
compensate for AAMI, acquired through years of experience. This is illustrated in
the BrookesTalk study described in Section 2, by the efforts of the older to identify
a similar type of technology which they can relate to, i.e. the reliance on the VCR as
the nearest model to a computer application.
It is generally agreed that older people are still able to learn but knowledge of
the effects of AAMI indicates the need for a different type of interaction, which uses
aspects of cognition that are less likely to be impaired.

3.2 Perceptions of the Internet
Given that the older person is capable of learning to use the Internet, what are the
barriers which cause resistance, and sometimes fear of learning to use it? Although
there is at present little hard research into the impact of the explosion of new
technology into the lives of older people, much can be deduced from the way in
which the Internet is marketed and reported in more traditional media. (Some of
the following material is taken from an interview with an older non-user who was
responding to the question ' 'Why don't you use the Internet?"
To begin with, older people do not. generally see the Internet as being for, or
relevant to them. Conceptually and technologically, the information super-highway
has not been explained in terms which they are familiar with and one has only to
look at the range of literature and magazines available on the topic to realise that
they are unlikely to appeal to the older reader. Television and newspaper advertising
features children and younger adults. Instead, they are likely to see newspaper stories
featuring Internet stalking, fraud and crime, bringing the threat of events which
they already fear into their own homes. Even non-computer owners express fears
of having their personal details made available on the Web.
McMellon et al. ( 1997) coined the term 'Cyberseniors' and describe two groups
of Internet users — the technology lovers, indulging a lifelong fascination with
technology and the technology users who are pragmatic and see computers as another
tool to achieve what they require. However this ignores the far greater group who
are either technophobes who fear the power of the Internet, or who cannot see any
gain to be made from using it rather than their traditional modes of communication.
Proponents of the Internet tend to emphasise its convenience and find it hard to
understand why older people do not embrace the opportunities to reduce travelling
and use of the telephone. However this shows a lack of understanding of how
much an older person's world may be reduced already. Physical, psychological and
social factors combine to shrink the available options. Retirement, loss of income,
disability and sensory impairment, decrease independence and control over one's
environment. As our informant pointed out, the contact with the bank clerk, post
office worker or doctor's receptionist may be the only human contact of that day,
and the trip to the shop or the bank may be the only physical exercise that the
older person gets. 'Convenient' technology therefore becomes counter-productive.
Gardner & Helmes (1999) report a study in Australia which illustrates the complexity
of the relationship between physical and mental well being and the willingness of the
ability to learn. Internal locus of control — the individual's sense of control of their
own life and environment has, for a long time, been seen as an indicator of well-
being, but the authors comment that self-directed learning readiness was a better
predictor of well-being than locus of control.

3.3 Technology Acceptance
Technology Acceptance Models (TAMS) have been developed for looking at the
factors that affect the uptake oftechnology (Zajicek & Arnold, 1999). The perception
of the usefulness of the technology weighed against the time taken to learn it is a
major factor.
Allied to this is the fear of failure. Learning to use the Internet represents a
considerable investment of time and energy. According to our informant there is
a fear that the failure to learn sufficient skills to be able to use the Net efficiently
is a waste of a limited amount of time and energy. Is it worth the expenditure?
The amount to be learned is also an important factor. Many learners would have
to master keyboard skills before attempting to master the Internet. The 'qwerty'
keyboard appears illogical and difficult to follow, and for many older people typing
is not an essential tool; it may be seen rather as a dauntingly skilled occupation.

4 A Partial Solution
We see that several factors affect the take up of the Internet by elderly visually
impaired people. The authors decided to concentrate on compensating for memory
loss and visual impairment in the partial solution provided. Users' confidence in
their own abilities was also studied, by offering individual help to half the subject
users in the study described below.
Users' perception of the Internet and their levels of confidence and technology
acceptance are important factors, but not easy to control at the interaction level.
It was assumed that the subject users have a reasonably high level of technology
acceptance as they, or their family, had originally requested a trial copy of
BrookesTa1k.
At the interaction level difficulties can be attributed to two interrelated factors
which interfere with conceptual model development, age associated memory
impairment and visual impairment both of which reduce the user's ability to benefit
from visual clues and contexts. To accommodate of memory loss and visual
impairment, a speaking front end was built onto BrookesTaIk. The idea is to support
the user in their construction of conceptual models by 'talking' them through their
interaction. For each possible state of BrookesTaIk an optional spoken output is
provided. The user is informed as to where they are in the interaction and which
actions are possible at this point. Optional further details are also available to
describe the consequences of each action. After listening to the message the user
chooses an options presses the appropriate function key and then receives another
message describing the new state of the system.
The spoken output for those who have just started up BrookesTalk would be:
Welcome to BrookesTaIk your speaking Web browser. There is
currently no page loaded. Would you like to:
Enter the URL of a page, press Fl.
Start an internet search, press F2.
Change the settings of the browser, press F7.
Hear more details about options available to you, press F3.
Repeat the options, press return.
With these messages reinforcing the users' knowledge of the state of the system
and explaining to them what they can do next, it is hoped that the development
of conceptual models will be supported through repetition and that the user will
no longer need to rely on memory. The user can function initially with virtually
no conceptual models at all, by using the system in a similar way to a telephone
answering system and simply responding to questions.
The aim of the speaking front end was to familiarise the user with the steps
needed to achieve Web interaction goals so that eventually the spoken instructions
would be superfluous and the user would 'know' which function key to press for the
required result.
5 A Pilot Study to Evaluate the Solution
The aim of the study was:
• To determine whether the presence of personal support plays a significant role
in the uptake of the Internet.
• To determine whether it is possible to increase uptake of the Internet by elderly
visually impaired users by offering the computer based support described
above.
• To determine, if users can use the Web with the support provided, whether
they are able to wean themselves off the support and use the browser unaided.
To carry out the first aim Of the study, the enhanced version of BrookesTalk
was piloted with two groups of four elderly visually impaired users. All the subjects
were drawn from the group who had been unable to get going with the non-enhanced
BrookesTaIk in the previous large-scale study.
Group A was given written instructions for using the enhanced version of
BrookesTalk and were observed as they carried out a set of Internet search tasks
prepared for them.
Group B attended a demonstration of the use of the enhanced version of
BrookesTalk and then were observed as they carried out the same set of Internet
search tasks as Group A, with a helper in attendance for each person.
The helper provided support by answering 'yes' or 'no' to users' questions. In
this way users could confirm decisions they were making at the interface and talk
through strategies as they developed. This was assumed to increase confidence in
the development of conceptual models. Further support than yes or no answers, was
considered too difficult to monitor for consistency.
The set of tasks was performed in three one-hour sessions, completed within a
week. Every effort was made to match individuals in the two different groups for
intellectual ability, memory, level of family support and level of visual impairment.

At the end of the period of observation, users were rated on their level of use of
BrookesTalk and hence their level of use the Web, as follows:
I. Not able to use the enhanced BrookesTalk unaided at all.
2. Able to use the enhanced BrookesTalk unaided.
3. Able to use non-enhanced BrookesTalk adequately.
4. Able to use non-enhanced BrookesTalk successfully.
The authors fully acknowledged that a user's rating gives a very crude
measurement of the richness of interaction that was observed as they struggled to
use the Web. However, the purpose of the study was to indicate whether personal
support, or the speaking front end enhancement, appeared to be able to increase
uptake of the World Wide Web for users who had previously been unable to use it.
Users' ratings are shown in Table I.
5.1 The Effect of Personal Support
Average ratings for those who received personal support were 2.75 compared to 1.5
for those who worked unaided. These figures indicate that individual support can
make the difference for some users between getting up and running on the Web or
not. These findings are in line with other work (Zajicek & Arnold, 1999; Zajicek
et al., 1998b) which discovered other user groups who are unable to use computers
unaided and for whom offline support was essential.
It is unclear at this point which aspects of the personal support offered
were most valuable, the software demonstration or the confidence afforded by the
availability of individual help. The nature of the support and how it should be
incorporated into user requirements is a complex issue but must be addressed if this
type of user is to participate in information technology.

5.2 The Effect of the Speaking Front End Enhancement
The rating of 2 for Subject 5 and Subject 7 in Group B, those who did not receive
individual support, represent an improvement in their ability to use the Web due
to the enhancement. They had been unable to use the non-enhanced BrookesTaIk
previously. These results indicate that the 'talking the user through' approach has
something to offer and enables users to achieve interaction where it had previously
been impossible. The authors plan to experiment to find optimum sentences, and
voices, for talk through which may improve ratings still further.

5.3 The Ability to Move to Non-enhanced BrookesTalk
The rating of subjects I, 3 and 4, who received individual support indicates that the
enhanced BrookesTaIk does go some way to enabling users to build 'crystalline'
conceptual models i.e. models that work without re-evaluation.
However we see that users who did not receive individual help were unable to
progress on to non-enhanced BrookesTaIk. These results need further investigation.
Possibly the time spent practising with set tasks was too short for this group.

6 Conclusion
The results of the pilot study indicate that personal support is very important for
elderly visual impaired users using a computer application for the first time. They
also indicate that application 'talk through' has a part to play where memory
impairment precludes the building of strategies and experimental learning at the
interface. The combined effect of these two factors appears to be significant although
the level of their individual effects is unclear at the moment.