BACKGROUND

Assistive technologies (ATs) can be critical for maintaining and improving the functional abilities of individuals with disabilities. Cook and Hussey define ATs as “devices, services, strategies, and practices that are conceived and applied to ameliorate the problems faced by individuals who have disabilities” (1), and they often are essential for facilitating user independence and safety at home, within work environments, and throughout the community. Many consumers looking to purchase technologies for their specific needs find it difficult or impossible to make informed decisions of the best technologies available, often due to a lack of available information that is useful in their selection process. Specifically, individuals need to evaluate factors such as the accessibility, quality, usability, and reliability of products, which may be difficult without considering input from previous or current users of the technology (2). Afterall, it is critical to consider “the effects of assistive technology on the lives of the people who use it” (3).

Professionals making recommendations for individuals with disabilities also may find it difficult to make informed recommendations for clients without considering the viewpoints of current or past users of the technologies. Although numerous types of ATs are used by people with disabilities, currently there is no comprehensive method for tracking how well different types of equipment work for people with varying abilities. While manufacturer marketing information for products are usually readily available, this information can be biased and may be irrelevant when evaluating important design features for individuals with disabilities. Furthermore, manufacturers are not likely to point out limitations or negative aspects of their products, which is often the critical information needed for recommending or selecting appropriate and useful devices. This critical information may only be available from real users who have current or past experience with a given technology.

Currently there is a strong need for a system to gather the data needed for informing the choices of consumers and clinical professionals when recommending and purchasing AT equipment to enhance the quality of life and functional abilities of individuals with disabilities. Because of the vast array of existing assistive technologies that could be included in this database, as well as the limited resources available for this one-year project, the first stage of development for this prototype software has focused on different types of bathroom safety assistive technologies. This category was selected because these types of ATs are frequently recommended and provided by service professionals, but they are also obtained without professional consultation on the basis of friendly recommendations. It is anticipated that due to the importance of collecting and reporting consumer feedback, as well as the potential applications of the information collected by Got-it?, that a secondary phase of development will be used to expand the product areas covered within the database.

PROJECT OVERVIEW

The “Got-it?” project has designed and developed a prototype web-based data collection and reporting system in order to gather and provide outcome data in the form of consumer feedback for different ATs. The site is not intended to determine if consumers like or dislike products or services, however the questions and information presented are geared towards reporting on the performance and effectiveness of ATs in facilitating safety and independence for individuals with disabilities. The site is especially useful for helping individuals with disabilities interested in purchasing and using similar products, as well as for professionals attempting to recommend useful products for their clients.

The Got-it? project gathers and reports information for people with disabilities and their friends and caregivers, OTs, PTs and other healthcare practitioners, AT dealers and vendors, and evaluation and equipment centers. The website allows visitors to learn more about how well specific ATs work or do not work, from the perspective of the people with disabilities who actually use the different technologies. The Got-it? website includes mechanisms for users to report on both products and services, for example a transfer bench and the training materials that are offered with it.

METHODOLOGY

The Got-it? project has gone through several phases of research and development in order to produce a reliable and dependable system for gathering and reporting consumer based feedback on different technologies.

Evaluation of Current Consumer Feedback Websites for Products

Current consumer rating websites were evaluated and compared in order to develop and improve concepts for the Got-it? project. Sites were reviewed to determine the types of products being evaluated, types of consumer groups targeted for providing feedback, and strategies for collecting and reporting information about AT and other products and services. Some of the sites reviewed include: http://www.usatechguide.org/, http://abledata.com/, http://www.dynamic-living.com/index/, http://www.amazon.com/, http://www.assistivetech.com/corporate/home.aspx, http://www.hotels.com/, http://www.wiredonwheels.org/, http://www.scipilot.com/index.php, http://www.wheelchairjunkie.com/, and http://www.ableplay.org.

Reviewing the aforementioned sites established the fact that there is a paucity of consumer feedback information about ATs available on the web, although it was realized that the information available is very limited in terms of the type of equipment (i.e., mainly mobility AT), types of impairments (i.e., mainly SCI), and quality of information (i.e., mainly subjective narrative content). However, the existence of these sites yielded evidence that there is a need for this type of information, while the numbers of subscribers providing feedback on these sites is also impressive. Abledata includes an exhaustive list of ATs with the opportunity to contribute to a Consumer Forum where a list devices are presented with narrative responses to specific questions. The Spinal Cord Injury Peer Information Library on Technology (SCI PILOT) website documents consumer experiences with acquiring and utilizing all types of AT through qualitative “Product Reviews”. Reviewers can provide narrative reports of specific reasons why products work or do not work for them. Reviewers also describe themselves and the situations they used products in so that readers can judge how relevant an opinion might be for their own use. Wheelchair Junkie facilitates a bulletin board for users to provide narrative information on products they like and do not like. It is interesting that Wheelchair Junkie currently has 4,752 registered users, indicating a large participating audience for the topic of wheelchairs. USA-Tech Guide provides consumer reviews for wheelchairs, cushions, standers and scooters, including summative data on durability, ease of use, meeting expectations, and an overall product rating in addition to narrative consumer feedback. Interestingly, it collects and displays this feedback data by “end-user”, “caregiver”, and “clinician” feedback categories.

Development of Rating Content and Data Collection and Reporting Website

The Got-it? project is intended to greatly expand the types of devices that are reported on as well as the quality of information collected and displayed. Security and privacy were of utmost concern when designing the site so as to minimize the barriers to participating and protecting the information of the raters who choose to provide information on the site. Industry technology standards were used to protect the data in conformance with HIPAA and IRB regulations (e.g., using firewalls, running the database server separate from the web server, requiring strong passwords, and making regular backups of the data). Low-tech strategies were also implemented (e.g., physically securing the server and minimizing the collection of private information in case a breach of security were to occur). Further, when consumers create an account for posting reviews, a basic challenge/verification system is used to minimize the creation of accounts for the purpose of posting unrelated information or providing concocted information about products. This ensures that the database contains valid and representative data.

In order to determine the appropriate content to collect and report, a literature review was conducted to develop the questions for rater demographics and disabilities, AT descriptions, AT acquisition, AT use, and AT ratings. Wherever possible, live branching was used in the question set to increase question efficiency. Although specific types of bathroom safety products were targeted in this first stage of development, careful attention was placed on developing questions, collecting information, and displaying content that will be relevant for other classes of ATs in case of future expansion of the Got-it? website. Wherever possible, question responses were designed to be answered using a standardized rating scheme with anchors of -3 to +3 with 0 as the center point (e.g., poor, well below average, slightly below average, average, slightly above average, well above average, excellent). This allows raters to indicate both positive and negative feedback for a device. Free response questions were also included throughout the survey, where appropriate.

Accessibility and Usability Testing of the Interface

The Got-it? site was designed to be user friendly (e.g., easy to search and organize content in a customizable manner, simple but appealing layout), easily accessible (e.g., for users who are blind, searchable through common search engines), and easy to use (e.g., on a 3rd grade reading level, optimal organization of data). Several rounds of testing are being completed to evaluate the reliability and appropriateness of the question set developed as well as the accessibility and usability of the interface. An IRB approved protocol is being conducted with both subjects with and without disabilities in order to enhance the site and improve the evaluation questions, reporting mechanisms, website layout, and overall accessibility. Web Content Accessibility Guidelines (WCAG) 2.0 are also being considered to enhance the accessibility of the site (4).

RESULTS

The Got-it? website is hosted within the web domain of the R2D2 Center at the University of Wisconsin at Milwaukee, which can be accessed at: https://got-it.r2d2.uwm.edu (see Figure 1). A database of ratings for the following classes of AT are provided: bath lifts, shower chairs, transfer benches, anti-slip products, raised toilet seats, commodes, water safety, lighting, and grab bars. The structure of the site includes: a welcome page, a mechanism for creating a new user account and recalling a user name or password, device rating pages to input information about specific technologies, product reviewing pages to view information reported for specific technologies, a frequently asked questions section, and links to other pertinent information (e.g., project overview, disclaimers).

DISCUSSION

As discussed, there is no existing system to inclusively collect and report consumer feedback about AT. The development of the Got-it? site is intended to address this void and through collecting and summarizing data from consumers with disabilities who use specific ATs to help elevate the voice of consumers in the provision of AT devices, services, and outcomes. Additionally, the innovative data collection methods used here enhance the meaning and usability of summative results on products to serve as a model for other AT outcomes research. In addition to a future proposal for funding the expansion of this prototype system and comparative analysis of the data, the development of a business model is being explored to ensure the viability of this consumer feedback system beyond the period of this project.