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Designing A Dementia-Friendly Website

Some well-established web design basics: minimize the number of choices that someone has to make; create self-explanatory navigation tools; help people get to what they’re looking for as quickly as possible.

Sounds simple enough? Now consider this… An ever-growing number of web users around the world are living with dementia. They have very varied levels of computer literacy and may be experiencing some of the following issues: memory loss, confusion, issues with vision and perception, difficulties sequencing and processing information, reduced problem-solving abilities, or problems with language.

Further Reading on SmashingMag: Link1

Just when we thought we had inclusive design pegged, a completely new dimension emerges.

Designing websites for people living with dementia has thus far been relatively unexplored in the web design world. However, we at On Our Radar5 had to face up to the challenge of dementia-friendly design last year when creating “Dementia Diaries”6: a project to encourage people living with dementia to record audio diaries of their experiences, achievements and challenges through a customized 3D-printed mobile phone. The collection of audio stories is hosted on the site where they are curated for media campaigns or used to provide insights for services and organisations who work with people with dementia.

We wanted to make the website as accessible as possible for people with dementia so that they could listen to the stories submitted by their peers and share advice or support. With the help of full-stack web developer Rory Gilchrist7, we set about building a site that would be as inclusive as possible, while still being an engaging platform.

We included people with dementia in the design process. We listened to their feedback to make the website work for them. The Dementia Education and Empowerment Project8 also helped us during this time.

In this piece, we’ll share some lessons we learned along the way about making a dementia-friendly9 front end on a tight budget.

What Is Dementia? Link

The word dementia describes a set of symptoms that may include memory loss and difficulties with processing information, problem-solving or language. Dementia is caused when the brain is damaged by diseases, such as Alzheimer’s disease, or a series of strokes. Dementia is progressive. With the passing of time, the symptoms will gradually get worse. Some of the lesser known symptoms10 include hallucinations, sensory impairment, insomnia and mood swings.

Tommy Dunne, a person living with dementia in Liverpool, UK11

Tommy Dunne, a person living with dementia in Liverpool, UK. (Image credit: Dementia Diaries6658545047413532252112) (View large version13)

At the end of 2015, there were an estimated 46.8 million people worldwide14 living with dementia. The number of people living with dementia will almost double every 20 years, reaching 74.7 million in 2030, and 131.5 million in 2050. There are 3.3 billion internet users worldwide15, and as the number of people with dementia continues to rise, so too will the proportion of internet users living with the condition.

The New Frontier Of Designing For Dementia Link

Why Is This Relevant? Link

Organizations and businesses, especially those with a large user base of people over 60, risk alienating a large portion of their website users if they fail to adapt.

Many people with dementia find using computers and the internet more difficult as their dementia progresses16 (PDF). Although many people living with dementia use the internet to access information or communicate with peers, friends or family, actually navigating these digital spaces can become increasingly problematic.

Many websites provide services, products or information for people living with dementia, but are effectively useless if they aren’t designed with this user group in mind. Though other people can – and often do – help those with dementia access this information, this reduces the independence of people with dementia17, which is central to maintaining emotional wellbeing.

Social Media Link

Older people and people with dementia are especially vulnerable to loneliness and social isolation18. Loneliness is also associated with an acceleration of cognitive decline19. Improving online practice to enable elderly people and people living with dementia to interact and share information online can have incredible benefits.

Tommy Dunne, a person living with dementia in Liverpool, UK20

Tommy Dunne, a person living with dementia in Liverpool, UK. (Image credit: Dementia Diaries6658545047413532252112) (View large version22)

Key Features Of A Dementia-Friendly Website Link

Content Link

Make it clear what your website is doing, and why you’re doing it.

Though print is in decline and digital is ever present, a combination of the two can really support people living with dementia. Make your content printable so that people living with dementia can print out and read your content in their own time and space.

If you can include people with dementia, and their voices, in what you present then you’re on to a winner, particularly if it’s directly related to their condition. It is common for other people to speak on behalf of people with dementia, but this perpetuates the stereotype that they are not capable of completing ordinary, or even exceptional, tasks23.

Key Lessons Link
  • Be explicit: what does your website do and why are you doing it? Avoid complex wordplay and generic calls to action (e.g. ‘Get involved’).
  • Content must be clear and arresting.
  • Printable content is useful for people who have issues with vision and perception.
  • The language used on websites is even more important than the language used in printed materials: avoid generalizations and make the text as easy to understand as possible.
  • Avoid jargon or language that is too technical or scientific.
  • When relevant, stories and tips from people with dementia themselves are very helpful.
In Their Words Link

“When you have dementia, it’s pretty hard to concentrate on things a long period of time, especially if you’re just sitting there.”

—Paul Hitchmough

“Reading is difficult, no question about that. Retaining what you’ve read is difficult. Remembering the book you’re reading is difficult, even the title of the book… Sometimes I’ll pick a book up and I can’t remember if I’ve read it or not.”

—Keith Oliver

By clicking the large “print” button, a printable stylesheet is made available24

By clicking the large “print” button, a printable stylesheet is made available. (Image credit: Dementia Diaries6658545047413532252112) (View large version26)

Layout, Navigation And GUI Link

Make your navigation explicit and signpost a route back to the homepage.

There has been a surge in tablet computer use among older people27, so designing digital technology for these groups28 must take this into account. This means websites targeted at older people need to be responsive to these devices.

Five years ago the Pew Internet and American Life Project indicated that older users with chronic illnesses are also more likely than their peers to participate in online discussions and seek out new communities29. Bearing in mind that Facebook is the most popular social network for over-50s30, you may want to make it as easy as possible for people to share your content there. Keep your buttons big and explicit.

Key Lessons Link
  • Avoid splitting tasks across multiple screens if they require memory of previous actions (as pictured below).
  • Make the breadcrumbs clear so that it’s easy to navigate back and forth.
  • Don’t use hamburger menus, like “See menu” and “Close menu”.
  • Use a “Home” button. Do not rely on having to click or tap a logo to get back home.
  • Make sure hyperlinks are clear.
  • Use clear buttons for sharing content that are large enough for use on tablets.
  • Use clear line breaks. Clearly define sections with strong lines and headers so that the split is obvious.
  • Make changes gradually. If something is working, don’t tinker unnecessarily.
When you click on the button “Ask Elaine Stephenson a question” (see left side), the question box appears below on the same screen as the story itself (see right side), so that it’s easy for the person asking a question to refer back to the original story.31

When you click on the button “Ask Elaine Stephenson a question” (see left side), the question box appears below on the same screen as the story itself (see right side), so that it’s easy for the person asking a question to refer back to the original story. (Image credit: Dementia Diaries6658545047413532252112) (View large version33)
We avoided hamburgers and tried to make the menu headings as simple as possible.34

We avoided hamburgers and tried to make the menu headings as simple as possible. (Image credit: Dementia Diaries6658545047413532252112) (View large version36)
In Their Words Link

“I am losing my ability to sequence… Because I live alone, this is becoming quite a challenge.”

—Agnes Houston

“You’ve got to keep forms simple. Your head gets confused. Do it wee bits at a time. Read it slowly.”

—Archie Latta

“Our brains need more time to process information in our 100 strings of Alzheimer’s, different for all, but we probably all recognise anxiety, confusion, planning, double checking – everything.”

—Anne MacDonald

Colors And Contrast Link

Living with dementia can manifest itself in the form of visuoperceptual difficulties (problems that affect both vision and perception) or sensory challenges37. The specific difficulties a person experiences will depend on the type of dementia they have. This is because each type of dementia can damage the visual system in a number of different ways.

These include:

  • Decreased sensitivity to differences in contrast (including color contrast such as black and white, and contrast between objects and background).
  • Reduced ability to detect movement.
  • Changes to the visual field (how much you can see around the edge of your vision, while looking straight ahead).
  • Reduced ability to detect different colors (for example, a person may have problems telling the difference between blue and purple).
  • Changes to the reaction of the pupil to light.
  • Problems directing or changing gaze.

With this in mind, it is very important to get your color and contrast ratios38 right by following the Web Content Accessibility Guidelines (WCAG)39.

Key Lessons Link
  • Use a color scheme with high contrast levels to make the pages more readable.
  • The suggested WCAG ratios for contrast are 7:1 and 4.5:1. Due to the fact that our website is specifically designed for people with dementia, we tried to go even further than the recommended specifications.
  • Use clear text, without overlaying against images.
  • Use plain backgrounds to avoid distraction.
1) Blue theme colour with white text: contrast ratio - 7.4:1 2) Black text on white background: contrast ratio - 9.45:1. 3) The titles of each piece are located below the image, rather than being overlaid. You can click on the title or on the picture to be taken through to the post.40

1) Blue theme colour with white text: contrast ratio – 7.4:1 2) Black text on white background: contrast ratio – 9.45:1. 3) The titles of each piece are located below the image, rather than being overlaid. You can click on the title or on the picture to be taken through to the post. (Image credit: Dementia Diaries6658545047413532252112) (View large version42)
In Their Words Link

“I am now home with some perspex coloured overlays, prisms in my glasses to reduce the experience of double vision, to try and help with the jumping up of type and print.”

—Agnes Houston

It is important to note that high contrast can also be a problem for some people living with dementia who live with certain eye conditions. The symptoms of dementia are varied and, unfortunately, it is not always possible to account for everyone’s needs. However, high contrast is a good starting point for many people with dementia, and with customizable website contrast ratios, you can attempt to provide accessibility for as many people as possible. The Alzheimer’s Society offer the most comprehensive set of customisable accessibility options43 (text, font and letter spacing are all customisable).

Text And Fonts Link

Keep it clear and keep it simple!

Sans serifs are typefaces that do not have the small projecting features called serifs at the end of strokes. Modern and minimal, sans serifs are widely established as the go-to fonts for the web44, particularly when the message is short and punchy. Though they are less visually distinctive, the simplicity of the sans letter shapes makes them more readable on all computer devices.

If you combine sans serifs with a clear dementia-friendly message, then you are going to make it easier for people to follow. Being able to alter the size of the text is a really nice touch, if your budget allows it.

Finally, forgetting names, events, dates and other day-to-day necessities is common for people with dementia. It is important, therefore, not to assume that people with dementia will recognize commonly used abbreviations or acronyms. Even if you signpost these earlier in the text, the person reading may not remember this a paragraph, or even a few lines later.

Key Lessons Link
  • Don’t use abbreviations or acronyms.
  • Use a large font size, or give people the option to alter text sizes, if possible.
  • Use a clear sans serif font. We used Source Sans Pro45 (an open source typeface intended to work well in user interfaces).
  • Use bold text, alongside clear, concise statements, to highlight important information.
  • Avoid using multiple fonts or elaborate designs as this may be confusing.
In Their Words Link

“If you enjoy reading books and that becomes difficult, use a Kindle and you can choose your own font. That makes a lot easier reading.”

—Jo Bennett

“It is important to know that people with younger-onset dementia are much less likely to have memory problems than older people with dementia. Instead, they may experience problems with language, vision and behaviour or personality.”

—Tommy Dunne

An example of font size alteration, (small) as implemented on dementiadiaries.org. The text size alteration feature is positioned in the top right hand corner of the site46

An example of font size alteration, (small) as implemented on dementiadiaries.org. The text size alteration feature is positioned in the top right hand corner of the site. (Image credit: Dementia Diaries6658545047413532252112) (View large version48)
An example of font size alteration (large), as implemented on dementiadiaries.org. The text size alteration feature is positioned in the top right hand corner of the site49

An example of font size alteration (large), as implemented on dementiadiaries.org. The text size alteration feature is positioned in the top right hand corner of the site. (Image credit: Dementia Diaries6658545047413532252112) (View large version51)

Images Link

This one is a contradiction of sorts. Pictures increase shareability52. Pictures add color to your site. Pictures tell a story. But pictures can also be disorienting and distracting for people living with dementia. This can present in the form of problems locating people or objects, even though they may be in front of the person: this may be because of other distracting visual information (such as patterned wallpaper) or because of a lack of color contrast. People can also misinterpret reflections: this may manifest as seeing an intruder or refusal to go into a bathroom because reflections make it appear occupied. In some cases, people living with dementia mistake images on the TV for real people. Many of these issues are due to an inability to consistently recognize objects, faces and colors.

Though these issues represent an obvious challenge to decisions around the use of pictures, pictorial clues can strengthen the relationship between the user and the content, so it is certainly important to include them where relevant. The key is simplicity and relevance. A good example of this is that if you have audio playing, consider providing pictures of the person who is speaking.

Key Lessons Link
  • Keep images relevant and closely related to the copy.
  • Try to avoid overly abstract illustrations.
  • Make sure the pictures add to the story rather than distract from it.
A headshot of the person talking is displayed while audio plays. The accompanying transcript is clear and meets the Web Content and Accessibility Guidelines.53

A headshot of the person talking is displayed while audio plays. The accompanying transcript is clear and meets the Web Content and Accessibility Guidelines.. (Image credit: Dementia Diaries6658545047413532252112) (View large version55)
In Their Words Link

“We especially liked the little photos and illustrations that explained the process so clearly and was much easier to understand than just paragraphs of text.”

—Carol Forse, wife and carer of Chris Forse

Using Multimedia Link

As with photos, it’s about finding a balance between style and simplicity. Video and audio can be engaging, if used in the right way, but unexpected autoplays, pop-ups or elaborate graphics can be confusing.

Although you may wish to hold a person’s attention and create mood, it is worth bearing in mind that if you have sensory challenges then multiple media can be disorientating. Music can stimulate the senses in a positive way, but keep the volume of background music low and make sure it can be switched off easily.

Key Lessons Link
  • Use autoplay on a page where audio or video is the only focus, but not immediately on the landing page of the site as this may shock or surprise the reader.
  • Provide subtitles or transcripts alongside video or audio content when possible (see video examples56).
  • Include very simple and familiar playback controls for audio or video so that it’s easy for the user to understand how to play and pause or adjust the volume.
Although the audio is uploaded using Soundcloud, we’ve used a different audio player that is cleaner and simpler.57

Although the audio is uploaded using Soundcloud, we’ve used a different audio player that is cleaner and simpler. (Image credit: Dementia Diaries6658545047413532252112) (View large version59)
In Their Words Link

“Background noises… can make it very difficult for the person with dementia to follow. My hearing has been heightened almost to the point of painfulness60. In this society do we need to be bombarded with loud intrusive stuff? It’s just a thought. It’s not that I don’t like it, it’s that it’s so loud I cannot think, I cannot coordinate. I’m even staggering to the side. It just seems to take over my brain and I don’t know what I’m supposed to be doing.”

—Agnes Houston

“Music seems to reach parts of the damaged brain in ways that other forms of communication cannot.”

Tommy Dunne61

The Personal Touch Link

People living with dementia can feel alienated from society. There is still an element of stigma attached to the condition, so it’s important to make it clear you’re on their side and, when relevant, that your staff are trained appropriately. If possible, build in features such as a dedicated support line for those who are having difficulties and make it clear you’re willing to offer flexible personal support to support people with dementia.

Because our project is audio-based, we have developed a remote transcription tool which allows volunteers to transcribe the audio stories submitted by people living with dementia. This is a very focused task, with a simple user interface62, so people living with dementia can do it. Importantly, we provide feedback to each individual who chooses to complete this process. We do this personally via email (as this is required when submitting a transcript). We also celebrate the involvement of remote volunteers by publicly thanking them for supporting the project in this way.

Key Lessons Link
An example of an audio report which was transcribed remotely by a volunteer. Notice the short “thanks” beneath the transcript.65

An example of an audio report which was transcribed remotely by a volunteer. Notice the short “thanks” beneath the transcript. (Image credit: Dementia Diaries6658545047413532252112) (View large version67)
In Their Words Link

“I don’t say right away that I’ve got dementia; I say I’ll just get someone else to phone. If I do get really frustrated I’ll say to them, ‘I’m sorry, but I have dementia, so if you could just bear with me and speak a bit more slowly back to me then I’ll try and explain to you. It’s not rocket science, what I’m speaking to you about. I’m not stupid.’ And they’ll go ‘Oh, I’m sorry to hear that.’”

—Carol Ovenstone

“Being able to talk face-to-face might help – for example, by Skype. People could pick up on body language. They could see that I was still there, and getting my thoughts together – and they wouldn’t need to keep prompting as they could see I was trying to give an answer. On the phone I feel compelled to give a speedy answer, so I’m more likely to just agree – or say anything, right or not – just to give an answer and bring the call closer to a finish.”

—Chris Forse

If In Doubt, Ask Link

This is perhaps the most important.

Spend time talking to people to understand their needs and perspectives. When we designed our website prototype, we had no idea how complex it would be to cater to everyone’s individual needs. Over time, we consulted roughly 20 people with dementia and made a few necessary alterations to our site. If you can, budget in some time for co-design and feedback.

Key Lessons Link
In Their Words Link

“Those of us with dementia are experts in our own conditions and have invaluable information to share. It is important to involve us at the early stage of design for what is right for each of us… There are many gadgets around. With patience and help, I’m willing to try new things. We do not bite!”

—Anne MacDonald

Conclusion Link

People living with dementia do not expect web designers to cure the symptoms, and many people recognize that it isn’t always possible to apply each dementia-friendly web design lesson when building a site. But the combined use of some of these lessons can help many people live well with their conditions. It is important to remember that dementia presents in many different forms, its symptoms are varied, and many of these symptoms are also common to other degenerative illnesses, in particular, conditions which hinder the social inclusion of the elderly.

By making websites more accessible to a growing group of users who are so often excluded from the benefits that the internet has to offer, designers are not only supporting people living with dementia, but also those with similar accessibility challenges.

(hp, og, il)

Footnotes Link

  1. 1 https://www.smashingmagazine.com/2015/05/designing-for-explicit-choice/#further-reading-on-smashingmag
  2. 2 https://www.smashingmagazine.com/2016/10/how-to-build-honest-uis-and-help-users-make-better-decisions/
  3. 3 https://www.smashingmagazine.com/2015/02/designing-digital-technology-for-the-elderly/
  4. 4 https://www.smashingmagazine.com/2014/10/color-contrast-tips-and-tools-for-accessibility/
  5. 5 http://www.onourradar.org/
  6. 6 http://dementiadiaries.org/
  7. 7 http://rorygilchrist.co.uk/
  8. 8 http://dementiavoices.org.uk/
  9. 9 https://www.alzheimers.org.uk/dementiafriendlycommunities
  10. 10 http://www.buzzfeed.com/tomchivers/things-you-didnt-know-happened-in-dementia#.gaGqzanWNQ
  11. 11 https://www.smashingmagazine.com/wp-content/uploads/2016/05/01-dementia-opt.jpg
  12. 12 http://dementiadiaries.org/
  13. 13 https://www.smashingmagazine.com/wp-content/uploads/2016/05/01-dementia-opt.jpg
  14. 14 http://www.alz.co.uk/research/statistics
  15. 15 http://www.statista.com/statistics/273018/number-of-internet-users-worldwide/
  16. 16 http://dementiavoices.org.uk/wp-content/uploads/2013/11/DEEP-Guide-Creating-websites.pdf
  17. 17 https://www.alzheimers.org.uk/site/scripts/documents.php?categoryID=200349
  18. 18 http://www.nhs.uk/Livewell/women60-plus/Pages/Loneliness-in-older-people.aspx
  19. 19 https://www.alzheimers.org.uk/site/scripts/news_article.php?newsID=2418
  20. 20 https://www.smashingmagazine.com/wp-content/uploads/2016/05/02-dementia-opt.jpg
  21. 21 http://dementiadiaries.org/
  22. 22 https://www.smashingmagazine.com/wp-content/uploads/2016/05/02-dementia-opt.jpg
  23. 23 http://www.buzzfeed.com/lukelewis/inspiring-tales-coping-with-dementia
  24. 24 https://www.smashingmagazine.com/wp-content/uploads/2016/05/03-dementia-opt.jpg
  25. 25 http://dementiadiaries.org/
  26. 26 https://www.smashingmagazine.com/wp-content/uploads/2016/05/03-dementia-opt.jpg
  27. 27 http://www.theguardian.com/media/2014/apr/29/tablet-computer-web-browsing-older-generation-surges
  28. 28 https://www.smashingmagazine.com/2015/02/designing-digital-technology-for-the-elderly/
  29. 29 http://www.pcworld.com/article/204330/4_Reasons_Why_Older_People_Are_on_Social_Networks_Now.html
  30. 30 http://www.telegraph.co.uk/goodlife/11751851/Facebook-is-the-most-popular-social-network-for-the-over-50s.html
  31. 31 https://www.smashingmagazine.com/wp-content/uploads/2016/05/04-dementia-opt.jpg
  32. 32 http://dementiadiaries.org/
  33. 33 https://www.smashingmagazine.com/wp-content/uploads/2016/05/04-dementia-opt.jpg
  34. 34 https://www.smashingmagazine.com/wp-content/uploads/2016/05/05-dementia-opt.jpg
  35. 35 http://dementiadiaries.org/
  36. 36 https://www.smashingmagazine.com/wp-content/uploads/2016/05/05-dementia-opt.jpg
  37. 37 http://alzheimer-europe.org/News/Living-with-dementia/Sunday-11-October-2015-Agnes-Houston-writes-about-her-Dementia-and-Sensory-Challenges-project
  38. 38 http://webaim.org/resources/contrastchecker/
  39. 39 https://en.wikipedia.org/wiki/Web_Content_Accessibility_Guidelines
  40. 40 https://www.smashingmagazine.com/wp-content/uploads/2016/05/06-dementia-opt.jpg
  41. 41 http://dementiadiaries.org/
  42. 42 https://www.smashingmagazine.com/wp-content/uploads/2016/05/06-dementia-opt.jpg
  43. 43 https://www.alzheimers.org.uk/site/scripts/user_settings.php
  44. 44 http://www.webdesignerdepot.com/2013/03/serif-vs-sans-the-final-battle/
  45. 45 https://www.google.com/fonts/specimen/Source+Sans+Pro
  46. 46 https://www.smashingmagazine.com/wp-content/uploads/2016/05/07-dementia-opt.jpg
  47. 47 http://dementiadiaries.org/
  48. 48 https://www.smashingmagazine.com/wp-content/uploads/2016/05/07-dementia-opt.jpg
  49. 49 https://www.smashingmagazine.com/wp-content/uploads/2016/05/08-dementia-opt.jpg
  50. 50 http://dementiadiaries.org/
  51. 51 https://www.smashingmagazine.com/wp-content/uploads/2016/05/08-dementia-opt.jpg
  52. 52 https://contently.com/strategist/2015/05/28/infographic-how-images-make-social-content-more-shareable/
  53. 53 https://www.smashingmagazine.com/wp-content/uploads/2016/05/09-dementia-opt.jpg
  54. 54 http://dementiadiaries.org/
  55. 55 https://www.smashingmagazine.com/wp-content/uploads/2016/05/09-dementia-opt.jpg
  56. 56 http://dementiadiaries.org/tag/door-into-dementia
  57. 57 https://www.smashingmagazine.com/wp-content/uploads/2016/05/10-dementia-opt.jpg
  58. 58 http://dementiadiaries.org/
  59. 59 https://www.smashingmagazine.com/wp-content/uploads/2016/05/10-dementia-opt.jpg
  60. 60 http://dementiadiaries.org/entry/2981/my-hearing-has-been-heightened-almost-to-the-point-of-painfulness
  61. 61 http://dementiadiaries.org/entry/929/tommy-dunne-3
  62. 62 http://dementiadiaries.org/volunteer
  63. 63 http://dementiadiaries.org/entry/3907/how-easy-or-difficult-to-use-new-gadgets
  64. 64 https://www.dementiafriends.org.uk/
  65. 65 https://www.smashingmagazine.com/wp-content/uploads/2016/05/11-dementia-opt.jpg
  66. 66 http://dementiadiaries.org/
  67. 67 https://www.smashingmagazine.com/wp-content/uploads/2016/05/11-dementia-opt.jpg
  68. 68 http://dementiadiaries.org/entry/2235/its-a-huge-move-forward-to-involve-service-users-in-designing-a-new-facility
  69. 69 http://www.telegraph.co.uk/technology/internet/11200872/10-ways-to-help-older-people-use-the-internet.html

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Laurence Ivil is both a multimedia journalist and Editorial and Engagement Coordinator at On Our Radar, an organisation that trains and supports citizen journalists from marginalised and remote communities. Recently, at On Our Radar, Laurence has covered the Nigerian elections, the Ebola crisis in Sierra Leone and has supported people with dementia and young homeless people in the UK to share their stories.

Paul Myles is an investigative journalist, filmmaker and Editorial Manager at On Our Radar. In the past he worked as an investigative reporter for Channel 4's Dispatches programme. He worked as an undercover reporter for Channel 4's Cruises Undercover and The Great Ticket Scandal – his views are his own.

  1. 1

    Stomme poes

    May 17, 2016 2:26 pm

    “Don’t use abbreviations or acronyms.”

    I assume this one should be particularly context-dependent, no? Americans may recognise IRS quicker than Internal Revenue Service and the Dutch would know CBR in context of drivers’ licenses quicker than Centraal Bureau Rijvaardigheidsbewijzen.

    Maybe this really means “don’t use unusual or jargon-related abbreviations or acronyms”?

    Or does research show the full names are in fact more readable?

    2
    • 2

      Trotse fietser

      May 20, 2016 5:24 pm

      CBR is not immediately clear to me, a Dutch bloke in his thirties without a drivers license.

      0
  2. 3

    Alastair Cox

    May 17, 2016 6:26 pm

    Interesting article Laurence and Paul. I know Agnes and Anne from workshops north of the border and I’m currently running a project looking at the issue of website accessibility for people living with dementia. Although a co-designed website will be the conclusion of the project, the main aim is to identify everyday obstacles that affect how people with dementia use web-based technologies and engage with the web design/development community to address these. It would be great to hear more about how you engaged with your users when building the site and what you learned from the process.

    1
  3. 4

    Robert Cagna

    May 17, 2016 8:49 pm

    Thank you so much for taking the time to address this important issue in a caring and thorough way.

    4
  4. 5

    Katherine Delorme

    May 17, 2016 9:49 pm

    I read this early today and left the article open in a browser tab during work to allow myself to process it throughout the day and peek back. I enjoyed this piece. I’m getting more interested in what can be done for accessibility in web design, aside from the common known practices, and hadn’t really stumbled on something so deep on dementia. I was a bit taken back at myself when I realized I hadn’t even thought about dementia. Nice work.

    3
  5. 6

    Chris Adams

    May 18, 2016 12:26 am

    This is an important topic as the population continues to age in many countries and I’m glad to see it being covered here. I also think this is a great example of an area where accessibility changes also benefit people who may not have the same or permanent disability to a lower extent — it’s easy to imagine many of these being appreciated by someone who is sleep deprived, ill, trying to accomplish something in a distracting environment, etc.

    The video section made me curious about the combination of video and subtitles or moving transcripts. This has become rather easy with modern browsers — I created a simple synchronized subtitle library awhile back and it’s tiny — but now I’m wondering whether the benefit of having the text available to scan is undercut by the distraction of motion in two separate elements. Has anyone seen research on this?

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    Andreas Weber

    May 18, 2016 5:48 am

    Thank you very much for this thorough and thoughtful article!

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    Stan Rogers

    May 18, 2016 5:57 am

    As a dementia sufferer (and a former developer) who also has the sort of poor eyesight that tends to go along with age-associated causes of dementia, I can’t think of a worse font for readability than Source Sans Pro. It’s designed to make individual characters easily distinguishable, but it achieves that at the expense of word shapes and spacing. (And please, please don’t get me started on the light weights.) I haven’t yet seen the perfect compromise between character identification and overall readability yet in a typeface, but I can say that Source Sans Pro definitely ain’t it. It loses the reader in a sea of alphabet where the actual words are much harder to discern than they should be. If I can’t fix a site that uses Source Sans with a user style sheet at my end (because the layout won’t work, f’rinstance), then I’ll stop using it. Most users my age wouldn’t have a clue how to attempt a fix.

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      Just out of curiosity, when you override website fonts, what typeface do you use?

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    Imogen Levy

    May 18, 2016 9:53 am

    Great article! As the digital manager at Alzheimer’s Society I wonder if you would come and talk to my team about this project, we have just kicked off a big re-design piece here and i’d love to hear more.

    thanks

    Imogen

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    Thanks for this article, besides being full of great practical suggestions it really shows a different way of doing website design that we all can learn from, where users are consulted and part of the process from the beginning. I think a lot of the accessibility principles you discovered with the users could be applied more widely — for those with other disabilities, for older populations, for those less computer literate in general. Well done!

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    Penelope Singer

    May 18, 2016 5:18 pm

    Thanks for addressing a problem many people don’t realize exists. My father has dementia and when the computer got too difficult to use, he was still able to use his iPad and iPhone. It made such a difference in his perception of independence.

    One thing that I’d add is that using fewer pronouns in text is also helpful. A person with dementia often gets confused when you refer to things as they, them, it, he, she, especially the further away you get from the noun they refer to. I used this strategy when talking to my father and saw immediate results in his engagement. It’s especially important in text; there’s no way to identify when you’re losing their attention and course correct.

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    Great article. Now how do you solve the problem of the “clutter” that operating systems like Windows 8 and ad-laden web pages cause? A formerly computer-savvy friend living with dementia can no longer use his computer or tablet because of the continual intrusion of pop-ups, click-bait. Windows 8 – out of the box – was impossible for him to use, even though he knew he wanted to “use the internet”. Having websites designed with the principles you advocate is important — but if the user can’t even get to them….

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      Use an adblocker? Something that doesnt use intrusive configuration pages, instead just gets its job well done? Or if that’s not an option, use something like Privoxy or Proximodo (apparently a fork of the all-famous Proxomitron; which I’ve actually been using before the rise of ABP + Co).

      cu, w0lf.

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    beth franssen

    May 19, 2016 6:52 pm

    Today, May 19th is Global Accessibility Awareness Day! Please share with your colleagues to bring more awareness. So glad to see this caring project exists. I’ve experienced my own family going through Alzheimer’s and dementia, and there is much to be improved with the technology so that our loved ones can retain their independence as long as possible. The tablet definitely has more longevity and possibilities to be an assistive device using all it’s “senses”: sound, camera, pressure touch, and peripherals.

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    Mark Notess

    May 20, 2016 6:40 pm

    Great issue to address! In fact you will help many older users without dementia by following the advice in the article. However, I would like to point out that one of the biggest hurdles isn’t really addressed: inconsistency. By this I mean inconsistency both across and within websites. Let me explain.

    Think about the kinds of websites seniors need to access, say banking sites and doctor’s office portals. These are wildly inconsistent across sites. I have the pleasure of needing to see multiple doctors on a regular basis, all of whom use portals to communicate with me. They are differ. They have some similar functionality, but there isn’t much transfer of training across the different portals. The distinct medical practices have chosen different vendors. The same is true with banks.

    But even when I’ve stayed with the same bank for some length of time, the bank may decide to switch to a different online banking software vendor. Or the same vendor may have some eager, hip designers who want to give the banking site a new, fresh look. Oops! Now I can’t find anything anymore.

    One challenge of aging is increased difficulty in encoding things into procedural memory. But when the way to accomplish something keeps changing, or when they same essential task (such as registering a login and password or providing billing information) is so different across sites, opportunities for confusion, frustration, and despair abound.

    A few years back I co-authored an article about online learning opportunities for seniors, which addressed some of these same issues–it provides a framework for classifying the problems which may be of interest.

    At the end of the day, the best solution may be a browser plugin or a virtual platform that websites design for in addition to designing for desktop and mobile platforms. Such a platform could use semantic markup to indicate standardized interaction patterns and then present them consistently, across applications and across time. It beats needing legislation to address the issue, but I imagine that could happen to.

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    When I started reading this article, I soon thought that this was about me! I do not have dimentia or suffer from some other disability or difficulty (other than being 61 years of age, stubborn and thinking that I still can do anything). The key lessons listed in the article will help anyone that visits a website or use soms piece of software. Thank you for refreshing my memory about what to do to create usable stuff!

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    Fantastic article shows how we must tailor WCAG AAA to suit audience needs

    May 30, 2016 8:21 am

    Very easy to follow and with helpful examples.

    Most of it is WCAG 2.0 level AA success criteria that should be enforced on all digital assets already. Others are AAA criteria cherry-picked for relevance, such as colour contrast, content-independent link text etc.

    However what’s great is it’s conciseness and relevance. Accessibility gatekeepers, note how this is done when assessing your own audience needs

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    Gerry Neustatl

    May 30, 2016 8:34 am

    Very easy to follow and with helpful examples.

    Most of it is WCAG 2.0 level AA success criteria that should be enforced on all digital assets already. Others are AAA criteria cherry-picked for relevance, such as colour contrast, content-independent link text etc.

    However what’s great is it’s conciseness and relevance, and that it exemplifies the need to tailor WCAG to suit audience need.

    Accessibility gatekeepers, note how this is done when assessing your own audience needs

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