INTRODUCTION

Braille is a tactile phonetic alphabet system which enables people who are blind or visually impaired to read through touch.[1] Braille is crucial for social and economic opportunity and has been linked to higher rates of employment, education, financial self-sufficiency, and self-esteem.[2-5] The World Health Organization estimates that 180 million people are blind or visually impaired worldwide, 90 percent of whom live in developing countries. [6] Braille literacy is decreasing, and the American Foundation for the Blind has declared a Braille literacy crisis.[7] In 2009, they estimated that only 10 percent of children who are blind or visually impaired were learning to read and write due to the misconception that Braille is isolating or stigmatizing, a historical emphasis on print instruction, and a lack of qualified teachers.[7]

One area of the world particularly impacted by Braille illiteracy is the Philippines. In the Philippines, up to four percent of people are blind or visually impaired, compared to about one percent of people in Canada.[8-9] In 2016, Digital Learning for Development and All Children Reading released a “Grand Challenge for Development” which challenged researchers to address the need for assistive technologies to help children with sensory disabilities learn to read in the Philippines.[10] The slate and stylus method of Braille production is commonly used in the Philippines: Braille is written mirrored from right to left by punching holes into cardstock.[11] Learning to write with a slate and stylus can be challenging because students must learn mirror images of the alphabet, and feedback is delayed until the paper is removed from the slate.[12] However, this method is common in developing countries due to its cost. A slate and stylus is available for approximately $15 CAD, whereas other technologies such as Braillers or Braille Notetakers typically cost $1000 - $5000 CAD.[13-15]

A previous study by Lopez aimed to identify the barriers that children in the Philippines who are visually impaired face when using existing assistive technologies for learning to read. Lopez found that accessibility, portability, durability, and usability were key design criteria that directly related to user needs.[16] We hypothesized that the design criteria captured by Lopez did not entirely encompass all criteria that could lead to the best device outcomes. The purpose of this research was to develop a comprehensive set of ideal design criteria for a device for Braille literacy education in the Philippines, with the intention of implementing these criteria in future design work.

METHODS

Design criteria were selected from a scoping review, systematic review [17], questionnaire [16], and semi-structured interview with a community partner. The scoping review encompassed evidence-based practices for educational strategies in Braille literacy education, a cross section of market technologies for Braille literacy education, and studies developing and evaluating novel devices for Braille literacy education in developing countries. The systematic review investigated the effectiveness of technologies for Braille literacy education for children and youth; followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [18]; and assessed study characteristics, participant characteristics, methodological quality, and technology characteristics including strengths and weaknesses of the technologies. The questionnaire investigated the needs of potential users in the Philippines. Participants were invited to complete the questionnaire if they lived in the Philippines and: (i) were below the age of 18, living with visual impairment, and learning how to read; (ii) any age, living with visual impairment, and had already learned how to read; or (iii) teaching reading to persons with visual impairment (e.g. teachers, parents of children with visual impairment). The community partner was a special education teacher who worked with children who were blind or visually impaired and gave advice on the demographic of students who are blind or visually impaired in the Philippines, and the setting where a device would be used.

Evidence of user-needs and effective educational strategies were collected from these sources and combined to create a comprehensive list of design criteria.

RESULTS

The scoping review considered 16 sources detailing evidence-based practices for Braille literacy education, five examples of market technologies, and two studies developing and evaluating novel devices for Braille literacy education in developing countries. The systematic review considered nine articles that met the systematic review inclusion criteria, and 42 participants from the Philippines completed the user needs assessment questionnaire. The design criteria drawn from each of these sources and the interview with the community partner were combined and summarized in Table 1.

The device should promote transferable Braille literacy skills including writing with a slate and stylus for children with or without a variety of disabilities including but not limited to autism, learning disabilities, motor impairments, any type of vision impairment ranging from completely blind to low vision, and children as young as age five years old. The device should be able to be used daily to aid in learning when teachers cannot give 1:1 attention due to large class sizes, provide real time auditory and tactile feedback, and function in either English or Tagalog (the languages which are taught in the Filipino curriculum). The device must be accessible to the user considering physical and financial accessibility, as well as availability in low-resource areas. The device should be durable and reliable, maintainable in a low-resource setting, and usable in multiple ways such that it maintains some function if a single component fails. It should be safe, easily and independently operable, and enable co-play and cooperative learning. To entice students to use the device, it should be engaging, motivational, and portable.

DISCUSSION

There is little research examining the effectiveness of technologies for Braille literacy education using a slate and stylus. Of the nine studies included in the systematic review, only two detailed technologies for slate and stylus education, and each study detailed a different iteration of the same concept.[12,20] Although this represents a small body of evidence, these technology examples were shown to be effective. Since there is no evidence that technology has an adverse effect on the development of literacy through Braille, it is expected that the design criteria presented are at least neutral to literacy outcome development if not facilitators of positive literacy outcomes.[21] Reading instruction should not be based on a single tactic or principle therefore, as many design criteria as possible should be incorporated.[22] As it may be challenging to meet all of these criteria concurrently, criteria that should be prioritized to ensure device functionality include accessible, easily and independently operable, reduce the challenges of learning to write with a slate and stylus, and transferable learning to reading and writing, as demonstrated by Kalra et al.[12] Additionally, special attention should be payed to ensure that a device provides tactile feedback as people who are blind or visually impaired are often forced to rely on auditory feedback when Braille is unavailable, despite its disadvantages for comprehension and mind wandering.[23] Furthermore, financial accessibility must be prioritized. Many technologies for Braille literacy education cost over $1,000 CAD.[24-25] This is well outside of feasible cost for developing countries considering that the average family income in the Philippines is 264,000 PHP, or about 6,600 CAD per year.[26]

Although the design criteria were drawn from a variety of diverse sources, they are subject to some limitations. One community partner was consulted to understand the demographic of students who are blind or visually impaired and the learning environment in the Philippines. However, these are likely to vary within and among schools. Additionally, due to the researchers and participants being in different countries, only participants with internet access were able to participate in the questionnaire. This may have reduced the voice of users living in rural areas, or of lower economic status. Alternative methods of data collection that do not require the use of internet questionnaires should be explored to include a more diverse set of participants. Furthermore, to expand the reach of the design criteria, and reduce potential production costs through a relationship of cost and demand, additional countries should be included through the questionnaire and community partnerships.

CONCLUSIONS

There is a need for a device that promotes transferable Braille literacy skills, including writing with a slate and stylus for children in the Philippines. To be effective, such a device must be accessible to a diverse subset of students, easily and independently operable, safe, durable / reliable, engaging, motivational, portable, enable co-play and cooperative learning among students, and provide real time auditory and tactile feedback.