Development of Accessible Interventions for Older Adults With Low Vision

PURPOSE: Approximately 246 million individuals worldwide have low vision (World Health Organization, 2014). Older adults with moderate visual impairment are four times more likely to have significant limitations in occupational performance, and those with severe impairment are 17 times more likely to experience decreased participation (O’Connor, Lamoureux, & Keeffe, 2008; Warren & Barstow, 2011). Many occupational therapy interventions rely on an individual’s ability to view demonstrations or read handouts. Persons with low vision have difficulty seeing features within the environment and often have a limited ability to read, even with magnification (Warren & Barstow, 2011). There are currently no studies addressing best presentation of intervention materials for persons with low vision. The purpose of this study was to determine how best to prepare intervention materials that will be accessible to older adults with low vision. The research question was, What are the perspectives and suggestions of older adults with low vision for increasing the accessibility of intervention materials?

DESIGN: We selected a phenomenological qualitative design in order to generate participants’ detailed descriptions needed to understand a population’s experience of similar phenomena: the best presentation of intervention materials. We used purposeful sampling to obtain participants meeting the following inclusion criteria: age 65 or older, diagnosis of age-related disease or condition causing low vision, visual impairment that interferes with reading ability, low risk for cognitive impairment, and absence of significant risk for depression.

METHOD: We used semistructured interviews carried out within participants’ homes. Interviews were audio recorded and transcribed verbatim. Four researchers performed open coding on the scripts to develop and organize categories based on the thematic properties of the interview data. Methods to increase trustworthiness included having an interview script developed based on a literature review and reviewed by a low vision expert, incorporating member checking, and having multiple coders to allow for comparison of resulting interview themes.

RESULTS: Ten participants with low vision (six women, four men) ages 65–93 yr completed interviews. Participants reported the following themes: factors that increase readability, barriers to intervention access, and ideal presentation of interventions. The four factors that increase readability included font size, contrast, text organization, and font style (examples provided for each factor). Barriers to intervention access consisted of lack of transportation to attend intervention sessions, fear of navigating unknown locations, and general preference for staying within the home. To provide accessible interventions, participants stated that all written materials must be large, contain strong contrast, be well organized, and use sans serif font. Participants also discussed the importance of having multiple methods of education delivery (e.g., written and audio components).

CONCLUSION: Interventions should include the suggestions for increasing readability, including increased font size, contrast, organization, and sans serif font. Practitioners should be aware that individuals with low vision may have difficulty traveling to intervention locations and may be fearful of navigating new environments. Also, having more than one presentation medium will help more individuals access intervention content. We have used this information to adapt a falls prevention intervention, the SAFE Health Behavior and Exercise Intervention. We are currently receiving qualitative and quantitative feedback from older adults with low vision and therapists who work regularly with individuals with low vision regarding the accessibility of the adapted intervention.

References

O’Connor, P. M., Lamoureux, E. L., & Keeffe, J. E. (2008). Predicting the need for low vision rehabilitation services. British Journal of Ophthalmology, 92, 252–255. https://doi.org/10.1136/bjo.2007.125955

Warren, M., & Barstow, E. A. (Eds.). (2011). Occupational therapy interventions for adults with low vision. Bethesda, MD: AOTA Press.

World Health Organization. (2014, August). Visual impairment and blindness. Retrieved from http://www.who.int/mediacentre/factsheets/fs282/en/