XXVI.2 March - April 2019
Page: 44
Digital Citation

Disability interaction (DIX): A manifesto

Catherine Holloway

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Disability has often spurred designers to create novel technologies that have later become universal; for example, both the typewriter and the commercial email client originated from a need to communicate by blind and deaf people. The design constraints imposed by disability have pushed ingenuity to thrive within the design process. Recent technological advances in artificial intelligence (AI), the Internet of Things, and pervasive computing provide great scope for designers and researchers to explore this symbiosis when considering future innovations for disability, as well as for society at large. Here, we propose a new agenda for harnessing such opportunities; we call it disability interaction (DIX). DIX views disability as a source of innovation, one that can push the boundaries of the possible.


Increasingly, mainstream products and services that create content, and allow for its absorption, are becoming inclusive. This cultural shift can be seen in the accessibility options offered by Microsoft (e.g., prompting for alt text captioning), Google (e.g., Chrome's built-in ChromeVox screen reader), and Apple (e.g., LiveListen, which turns the iPhone or iPad into a remote microphone that sends sound to a paired, compatible hearing aid). Simultaneously, new use cases addressing challenges faced by disabled people are driving technological developments. Wheelchairs are becoming part of the Internet of Things (see Figure 1). Microsoft has used artificial intelligence to create SeeingAI, a visual assistant for visually impaired people. There is a changing mindset.

ins02.gif Figure 1. ARCC, an example DIX project (www.arccs.org) that turns a wheelchair into a part of the Internet of Things to automate accessibility mapping of cities.

back to top  Insights


This change in mindset, attitude, and policy is also being helped by major world events such as the London 2012 Olympic and Paralympic Games. These were an inflection point, changing the perception of disability in the U.K. and arguably throughout the world. They were the most accessible Games ever, and the Paralympics was sold out for the first time in history. This was achieved by a combination of mainstreaming and mission setting. Accessibility and inclusion were not "nice to haves," but rather essential, built into contracting and delivery targets. The success of the Games was also enabled by the co-design of programs, policies, and places with local and disabled people. This approach is central to our vision of HCI for disability innovation: exploring what happens when diverse communities of people are empowered to creatively shape and develop new mechanisms to achieve accessibility and inclusion themselves.

Assistive technology is also being developed in new and exciting ways. The maker community is playing an interesting role within this space. An early example is the Enable Hand project (http://enablingthefuture.org/), which allows people to create their own prosthetic hand. The initial idea was given away for free, repurposed, adapted, enhanced, and ultimately made locally using 3D printing. This bottom-up approach to innovation is sparking a generation of people to design their own solutions and to share these to allow others to further evolve their designs. Digital manufacturing combined with advances in the Internet of Things, robotics, virtual and augmented reality, and low-power sensing are each opening up new and creative opportunities to address inclusion.

While the Web has democratized how content is created and shared, it also means anyone can create a website and, by the same token, can create an inaccessible website.

The time is ripe for HCI to lead the way in making the world truly accessible and inclusive. To do this there is a need to move beyond discipline-based inquiry, and even transdisciplinary investigation, to one in which disciplines no longer provide the framing but are replaced by issue-based design, drawing on specific disciplinary methods as and when required [1]. This new undiscipline is disability interaction (DIX).

Here, we first set out the argument for DIX with a critique of the current interactions between technology and disabled people; then we start to explore what is possible through designing disruptive technologies for inclusion.

back to top  Interactions, Accessibility, and Disability

Creative solutions that allow disabled people to use computers, and technology more broadly, are usually captured under the term accessibility. They can be categorized into: 1) assistive technology (AT), targeted at a specific person or a subset of people, and 2) inclusive (universal) design approaches, which incorporate accessible design features into a mainstream product or service. A classic example of the former is screen readers, which make content available to blind and partially sighted people. Such technology has been widely praised since the 1990s but until very recently was a form of AT that required specialized software. Now it is a mainstream offering of inclusively designed products. The universality of the Internet has had the most widespread impact: enabling easy information access to disabled people. However, while the Web has democratized how content is created and shared, it also means anyone can create a website and, by the same token, can create an inaccessible website. Both the screen reader and the Internet depend on the creation of accessible content. To ensure website accessibility, developers need to be aware of and implement accessibility standards (e.g., WAI-ARIA). However, this rarely occurs, and most websites continue to breach basic accessibility standards.

Globally, just 10 percent of the people who need AT have access to it, representing "one of the most pressing problems facing the global health sector" [2]. So how do we make technology accessible to all such that it is not the exception but the norm?

First, we need to overcome the stigma associated with using an assistive product by designing more inclusively. Stigma contributes to the generally agreed upon figure that a third of all AT is abandoned by users [3]. Stigma in many cases is fueled by ignorance of what disability is and the ways in which AT can help; therefore, an essential part of reducing stigma is the mainstreaming of disability. Stigma is captured within the World Health Organization's International Classification of Functioning (ICF) as a deterministic factor in preventing participation. The ICF is a bio-psycho-social model of disability that captures the dynamic nature of both functioning and disability. It offers a way of working around the previously dichotomous viewpoints of the medical and social models of disability. Within this framework, disability arises when there is a negative interaction between an individual's capabilities (which arises from their health condition) and the contextual factors at play when undertaking an activity (e.g., environmental and personal factors) [4]. The impairment just means a person has a different spectrum of capabilities than has been catered for in the design process. AT, designed specifically to overcome an impairment or a lack of a function, can by its very nature create unexpected forms of social exclusion when it is designed for disability rather than for people [5]. We propose a new lens, viewing AT as an extension of the mind and body as defined by Andy Clark and David Chalmers [6], where the technology creates an external coupling with the user and becomes a constant in their life. This reframing allows for the new paradigm of DIX to emerge: creating technologies to extend people's capabilities, rather than specifically designing for impairment.

Second, we need to overcome social exclusion. Within the context of the ICF, participation in activities can be restricted by a range of medical, environmental, personal, and social factors. In the Global South there is a critical mix of these factors at play, leading to an established and strong link between disability and poverty [7]. However, it can also be seen in a lack of interactions within the Global North. For example, disabled people are generally less likely to be confident in their use of the Internet and less likely to own a laptop or desktop, and are more likely to say they never go online compared with their non-disabled peers (23 percent versus 8 percent) [8].

Third, we need to find ways of including disabled people in the design of emerging smart technologies. One example of such inclusion is shown in Figure 2. Globally, most people now live in cities, and increasingly these are becoming "smart." Such movements offer a huge opportunity to ensure that the systems we embed into cities are accessible from the start. For example, the open standard for developing audio navigation applications (Wayfindr; https://www.wayfindr.net) will allow future designers of indoor navigation systems to make their technology readily accessible to blind and partially sighted people. Additionally, it will aid people with a temporary impairment.

ins04.gif Figure 2. An example DIX Project: Brave Boy Billy, an augmented-reality art piece that tells the stories of young wheelchair users, by artist Jason Wilsher-Mills.

These strands of research have until now been based in separate disciplines, with researchers working in multi-, cross-, inter-, and transdisciplinary teams to attempt to tackle the problems. As the world becomes increasingly digital, a new framing is required where HCI sheds the shackles of strict disciplinary practices to create a new undiscipline: disability interaction (DIX).

back to top  The Time is Now

Some have proposed that a combination of basic and applied research can help reduce the barriers to technology or innovation commercialization [9]. To drive change, the choice of problem is critical: It must be actionable and must address civic, business, and global priorities [9]. DIX works on exactly such challenges, which are set within a broader global Sustainable Development Goals agenda to ensure no one is left behind. Part of our proposed new approach will require the reframing of what it means to be disabled and, by the same token, what it means to be inclusive, moving beyond the common-language and classification framework given by the ICF to the development of inclusive technologies that blur the boundaries between disability and additional ability, and across functioning domains.

To begin, DIX will start by building a deeper understanding of actual user needs in relation to what new technology opportunities there are to address them. The creation of disability innovations will entail personalization and the remixing of designs along the philosophy of one size fits one rather than one size fits all. DIX will grow as the technology for digital fabrications advances and the costs decrease.

back to top  DIX Principles

Disability innovation is more than simply the production of a product, a service, or a policy. DIX will enable the creativity of diversity to inspire a global movement. Drawing from the literature and—crucially—practice in the fields of HCI, participatory design, and tech4good, we propose the following initial principles:

  • Openness to radically different interactions. DIX will utilize Dan Saffer's four types of interaction design practice [10]—user-centered design, activity-centered design, systems design, genius design—to co-create completely new ways of interacting with technology.
  • Acknowledgment that disability inclusion is a wicked problem. DIX will acknowledge that the outputs of DIX can hinder and help the cause of disability inclusion, and that it is possible to do both. Therefore, wherever possible it will seek to fully understand the full context within which technology is being designed and will continually seek to define the value this is adding to people and society (see "Value use and usefulness" below).
  • Co-created solutions. DIX will work with disabled people and disabled people's organizations to define the problem, create the solution, and form a community of practice that evolves the solution.
  • Value use and usefulness. DIX will focus on designing things that get to and are used by disabled people. Currently technology is often inaccessible due to a lack of demand, not need [2]. To enable demand to grow, the value to society of the thing (e.g., increased well-being, access to livelihoods and education) must be captured to more broadly create sustainable models of disability innovation.
  • Open and scalable. DIX will harness the power of ICT and the maker movement as it moves toward a distributed design-and-manufacture model [11] of production to ensure that it reaches as many disabled people as possible.

back to top  The Benefits of DIX

The benefits of DIX will be enjoyed by everyone. Technological advances driven by DIX investigations can open up new areas of research and innovation; DIX can provide a methodology that develops basic and applied research in tandem. DIX will co-create the problems, define problems for communities to galvanize around, and demonstrate new economic models of valuing the development of technology. In short, DIX will be better for inclusion, better for innovation, and better for societies.

back to top  A Research Agenda

Pressing questions we will begin with are: How do we design with disabled people who are hidden from society? How do we create AT that has a positive impact on a person's psychological as well as physical well-being? How do we use technology to help overcome stigma and discrimination experienced by disabled people? How can we create technologies that are usable in low-resource settings? How can we generate data that can inform policy? How do we democratize access to technology that assists disabled people?

Ultimately, our key line of inquiry is: How do we develop design practices that result in products and services that support the inclusion of disabled people in all aspects of life?

Ultimately, our key line of inquiry is: How do we develop design practices that result in products and services that support the inclusion of disabled people in all aspects of life?

back to top  An Action Plan

Below is a preliminary roadmap of a six-pronged attack:

  • First, learn from what has been done. Disability innovations may not always be global, but they are happening in numerous pockets in the world. We will bring together disability innovators globally as well as the larger companies who are developing new inclusive platforms, consolidate their knowledge, and develop a common framework of DIX. We will map barriers and enablers to successful technology diffusion. Furthermore, we will develop an overarching hierarchy of DIX that will show the forms of interactions, the barriers and enablers to technology adoption, and, critically, who in the world has access to which products and services. The aim is to fully understand how to unlock successful technology diffusion for products and services to people globally across a range of income levels.
  • Second, create a new body of knowledge with disabled people through the exchange of ideas around domain-specific knowledge relevant to DIX. From digital health we can learn about the barriers to personalized medicine; from neuroscience we can learn about the adaptations of the brain to impairment; from international development we can learn about the challenges of deploying technology in resource-poor settings. We can also learn from medical professionals who understand particular functional losses such as hearing, sight, and motor function. Equally, we can learn from engineers about new technologies that will allow for new forms of interaction and from the maker movement on how to grow communities of practice.
  • Third, study the problem through in-the-wild studies testing co-created solutions with local communities. We need to develop new platforms for novel empowering interfaces and interactions, and use sensing technologies that are readily available, or easily created, to capture user experiences in a range of different contexts. The resulting new knowledge will be used to build innovative models of DIX, mapping as we learn the disruptive uses of technology.
  • Fourth, develop mission statements from the collective user experiences for the global community to solve. We will create an open source community of researchers and innovators to co-develop research and design protocols with disabled people, building on human-centered interaction design protocols. These will detail empirical methods for measuring the usefulness and usability of new DIXs and methods for scaling beyond the initial context, where appropriate. This user-centered, collective-commons approach to research will necessitate the adaptation of current methods and might require the development of whole new methods.
  • Fifth, co-create with disabled people curricula for DIX, which can be used globally to train people in how to become creators of new DIXs. We plan to create a global community of people who can contribute to the development of the curriculum for DIX, which could be integrated into the research and development cycle, providing a continually updating loop of knowledge exchange between our theoretical understanding and empirical findings. This will be led by disabled people.
  • Sixth, develop new theoretical models of DIX that build on the pre-DIX disciplines of accessibility, inclusive design, and assistive technology, enhanced by the empirical and theoretical advances in DIX. The resulting models will drive further research questions and insights, evolving the research manifesto put forward here.

back to top  An Invitation

DIX puts disability front and center in the design process, and in so doing aims to create accessible, creative new HCI solutions that will be better for everyone, including poor communities, which disabled people are more likely to be part of. DIX design presents significant challenges and will require a global network of researchers, users, and collaborators to succeed in reducing the inequalities faced by the world's billion disabled people. If you would like to join this movement, which is determined to achieve breakthrough technologies that will ensure no one is left behind, you are warmly invited to join the community: www.DisabilityInnovation.com/Research/DIX/

back to top  Acknowledgments

I am indebted to Yvonne Rogers, Victoria Austin, Nadia Berthouze, Aeesha Singh, Giulia Barbareschi, and the editors for their constructive criticism and thoughtfulness to help improve the ideas presented here.

back to top  References

1. Bremner, C. and Rodgers, P. Design without discipline. Design Issues 29, 3 (2013), 4–13; https://doi.org/10.1162/DESI_a_00217

2. Holloway, C., Austin, V., Barbareschi, G., and Ramos Barajas, F. et al. Scoping research report on assistive technology: On the road for universal assistive technology coverage. Prepared by the GDI Hub & partners for the UK Department for International Development; https://bit.ly/2FZXmH8

3. Phillips, B. and Zhao, H. Predictors of assistive technology abandonment. Assistive Technology 5, 1 (1993), 36–45; https://doi.org/10.1080/10400435.1993.10132205

4. WHO | World report on disability; https://www.who.int/disabilities/world_report/2011/report/en/

5. Foley, A. and Ferri, B.A. Technology for people, not disabilities: Ensuring access and inclusion. Journal of Research in Special Educational Needs 12, 4 (2012), 192–200; https://doi.org/10.1111/j.1471-3802.2011.01230.x

6. Clark, A. and Chalmers, D. The extended mind. Analysis 58, 1 (1998), 7–19.

7. Banks, L.M., Kuper, H., and Polack, S. Poverty and disability in low- and middle-income countries: A systematic review. PLOS ONE 12, 12 (2017), e0189996; https://doi.org/10.1371/journal.pone.0189996

8. Anderson, M. and Perrin, A. Disabled americans are less likely to use technology. Pew Research Center. Apr. 7, 2017; http://www.pewresearch.org/fact-tank/2017/04/07/disabled-americans-are-less-likely-to-use-technology/

9. Shneiderman, B. The New ABCs of Research: Achieving Breakthrough Collaborations. Oxford Univ. Press, 2016.

10. Saffer, D. Designing for Interaction. New Riders Berkeley, 2010.

11. Diez, T. Fab City: The Mass Distribution of (almost) Everything. Institute for Advanced Architechture of Catalonia, 2018; https://www.peecho.com/check-out/154028456915119538/457294/fab-city-the-mass-distribution-of-almost-everything

back to top  Author

Catherine (Cathy) Holloway is an associate professor at UCLIC and a cofounder and academic director of the Global Disability Innovation Hub (www.DisabilityInnovation.com). Her research focuses on the design of accessible and assistive technology, using IoT technology and sensing to measure and map accessibility. She is the research and innovation lead for the AT2030 program (https://www.disabilityinnovation.com/at-2030). cholloway@ucl.ac.uk

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The Digital Library is published by the Association for Computing Machinery. Copyright © 2019 ACM, Inc.

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