November 10, 2009

1. An Interactive Computerized Sign Language Health Survey for Deaf Adults: Interface Design and Functionality Elouise Oyzon1, M.F.A., Vincent Samar2, Ph.D., Steven Barnett3, M.D., Deirdre Schlehofer3, Ed.D., Elizabeth Finigan4, M.D., Peter Lalley2, Ph.D., Erika Sutter3, M.P.H. NCDHR is supported by Cooperative Agreement Number U48 DP000031 from CDC. The contents of this poster are solely the responsibility of the authors and do not necessarily represent the official views of the CDC. Steven Barnett is supported by grant K08 HS15700 from the Agency for Healthcare Research and Quality. Thank you to the NCDHR Research Committee, the Deaf Health Community Committee, Mike Delaney, and the ITX corporation for their contributions to the interface development. For more information, go to http://www.urmc.rochester.edu/NCDHR 1Rochester Institute of Technology 2National Technical Institute for the Deaf 3University of Rochester 4Veteran’s Health Care Administration Efficacy of the Interface Design Purpose and Target Audience Usability Test Highlights Little is known about the health of Deaf adults since standard telephone health surveys are inaccessible to Deaf people. Deaf people are a diverse cultural minority group in America with diverse language skills, which include skills in American Sign Language (ASL) and English based sign language. Therefore, Deaf and hearing researchers from the National Center for Deaf Health Research and Deaf community members designed a user friendly, multimedia interface to deliver the first computerized sign language health survey to the Deaf community. Initial performance data from the first administration of the Deaf Health Survey suggest that the interface is accessible to a broad segment of the Deaf community and that respondents take advantage of the flexible usability features and culturally relevant personal options that it provides. This interface can also deliver health survey video and print content to other cultural and linguistic communities or to low literacy populations in appropriate spoken languages. • In an early prototype design, the signer window and attendant English text would appear simultaneously. Surprisingly, regardless of communication preference, users would read the English text first despite the competing video’s more dynamic screen. Some users would answer the questions and ignore the sign language completely. There was concern that some users were relying on text despite reduced comprehension. Therefore, the interface was changed to delay display of the English text until the signed version was done. • The early prototype design used a button to select each answer and a separate button next to that button to replay the video. Half the users assumed that selecting the play button would select the answer while touching the answer box would display the video. In the next iteration we reversed the functionality and, again, half the users chose the opposite buttons to select the answer or replay the video. The final interface used a single button to select each answer and automatically replay the video, avoiding the confusion and ensuring immediate video feedback of answer choice. Interface Design Features Respondents’ Field Performance • Accommodate Diverse Language Skills • On-Demand Choice of ASL or Signed English • Optional English Captions • Automatic appearance of the English Text of the Survey Item and Answer • Accommodate Respondents’ Interpersonal Preferences • On-Demand Choice of Signer’s Physical Characteristics (gender, age, race/ethnicity) • Accommodate Vision Limitations and Viewing Comfort • On-Demand Control of Size of Signer Video, Size of Text, Color Contrast of Signer Background • Facilitate Respondent Comprehension • Optional Dictionary of Signed Medical Terms • Sensitive-Item Explanatory Messages/Warnings (e.g., drink equivalents, interpersonal violence queries, etc.) • Efficient and Relevant Item Presentation • Automatic Branching to Different Items and Health Themes Based on Respondent-Supplied Information such as Gender, Age, and Health Behaviors (e.g., only women receive women’s health questions) • Graphically Animated Interface Instructions in ASL, English-Based Signing, and Text • Full Touch Screen Survey Access • Automatic Replay of Signer video upon touch of Item Question and Answer buttons • Optional Return to the Previous Item • Dynamic Formatting of Items with Various Text Length, Answer Set Sizes, and Answer Types (e.g., multiple choice, yes/no, write in, multiple answer selection) • Respondents exercised personal choice of signer language, gender, and race/ethnicity. • Each signer was chosen by 7% - 28% of respondents • 74% chose ASL Signer; 26% chose English signer • 11% changed signer language during survey • Women respondents more often preferred women signers (59%) • Men Respondents had similar preference for men (53%) and women (47%) signers • Respondent’s race/ethnicity (Fig. 1), age (Fig. 2), and best language (Figs. 3 & 4) affected performance and signer choice. Future Interface Refinements • Users were presented with myriad options to tailor the experience to their comfort. Future interface refinements will be informed by further usability and field data that address questions like: • What preferences do respondents display for text size, video size, and signer background color? • Were users provided too many options? • What options did the majority of users utilize? • Are any design features unnecessary? • Do text size, video size, and signer background color relate to personal traits (e.g., age, gender, vision skills)? • Do respondents use the dictionary, and on what items? • Could the survey be deployed via the web, rather than through dedicated touch screen interfaces? And what controls and constraints would that require? Fig 4. Respondents with different best languages tend to select signers whose language is consistent with those languages Fig 1. Respondents from different race/ethnicity groups show different preference rates for signer race/ethnicity Fig. 2. Older respondents can successfully complete the survey, although they require progressively more time. Fig 3. Respondents whose best language includes ASL/Sign had longer survey completion times, suggesting more reliance on ASL or Signed English than respondents whose best language is English only November 10, 2009