Back in July 2019, Stephanie Wilson and Abi Roper from City, University of London ran a workshop at Aviva Digital Garage to share their knowledge of creating digital experiences for users with a communication impairment called aphasia. Their in-depth knowledge about designing technologies for people with aphasia comes from an interdisciplinary approach across their respective fields: human-computer interaction design and speech and language therapy.
At the workshop, Stephanie and Abi were joined by colleagues Timothy Neate and Charlotte Pearce-Slade; and four panel guests who have varying severities and expressions of aphasia: Colin (and his support worker, Sian), Ben, Lynn and Ian.
This article is a reflection on the experience of participating in an aphasia design workshop, from the perspective of a visual designer, a user experience designer and a researcher from Aviva’s Digital Garage design team.
What is aphasia
Aphasia is a communication impairment which is often the result of a stroke. Roughly 1 in 3 people who survive a stroke will acquire aphasia, and current numbers suggest there are more than 350,000 people in the UK living with the condition. Many people will not have heard of aphasia, yet there are more people living with aphasia than both Parkinson’s disease and multiple sclerosis (MS). Aphasia can affect all aspects of language, whether that is reading, writing, speaking or comprehension; however, it does not affect intelligence. People with aphasia often have other impairments they have acquired from having a stroke or other traumatic brain injury, such as vision- or motor-related impairments, which can make this group of people particularly challenging to design for.
About the workshop
During the workshop, Stephanie and Abi took the Aviva team through the research they’ve been conducting at the university. This included the EVA Park project – a virtual world co-designed by people with aphasia to be a safe space to practice speech, the INCA project – which is interested in empowering people with aphasia to create and curate digital content, and design guidelines and principles that have been established as a result of these research projects.
Following this, the panel members shared their experiences of using digital technologies, their likes and dislikes of different apps, websites and devices. They also answered questions from the Aviva team; questions such as their reading preferences and uses of financial services products.
Stephanie and Abi presented considerations for producing digital technologies for people who have aphasia, and gave us top tips on how to adapt standard usability testing protocols for people with a communication impairment.
For the majority of the session, the design team had a chance to work collaboratively in groups with a panel member, to discuss the effectiveness of designs from a travel insurance website, and to conduct an adapted usability study.
To end the workshop, Abi and Ian (who was an aphasia consultant in the INCA project), presented a paper they co-wrote and presented at the ASSETS conference on the topic of participating in a usability study from the perspective of a participant with aphasia.
Reflections from the design team
Members of the design team have written a reflection of their experience participating in the workshop with people who have aphasia.
Zara Nowell, UX Designer
Prior to the workshop, I was completely unaware of aphasia and what the condition entailed. I had attended accessibility events that focused on visual impairments, motor impairments and dyslexia, but aphasia had not been included in these discussions.
It was interesting to learn about an impairment that I had no knowledge of and to consider how we can better design for people living with this condition. In my role as a UX Designer for an insurance company, I already enjoy finding ways to improve the communication of our seemingly complex products. So, for me, designing for aphasia is just another interesting opportunity to make our products easier to understand and use. If we can ensure our products are easy to use for people with aphasia, then all our users will benefit from our simpler products and experiences.
One of the most powerful parts of the event was hearing directly from a panel of individuals who have aphasia. It was from listening to them that I started to build a better picture of what it was like to live with the condition. We learnt how background noise can impact communication, the emotional toll of the condition and what types of interactions are better or worse for this group.
Towards the end of the event we also got the opportunity to sit alongside the panel members who have aphasia and observe how they interacted with a website. This experience was invaluable for identifying ways in which an experience can perform well or badly for people living with this condition.
This event has given me an understanding of how we can design better for people who have a condition that affects so many people in the UK and a good prompt to include someone from this demographic when we test our product experiences. Thank you to the City, University of London team and the panel of aphasia advisors for explaining the condition in such depth.
Anna Forsythe, Visual Designer
As a visual designer this workshop really emphasised the importance of accessibility and good design principles. While watching Lynn navigate a travel insurance website, I could see that hierarchy, typography and layout had a big impact on the way she experienced and moved around the site. Complex layouts with a lot of text slowed her down the most and she occasionally had to re-read sections before she felt confident enough to continue. For me this reinforced the need for more concise content and clear page layouts, and that where relevant, it is beneficial to use imagery to communicate rather than relying on written words alone.
Witnessing accessibility barriers first-hand helped me understand the problems that digital products can cause for people living with aphasia. The challenges presented by the website would’ve been similar for people with other cognitive or communicative impairments and demonstrated that by designing for more extreme user needs, we can create an experience that is better for everyone.
It also highlighted the value of running user testing sessions with people of various cognitive and communicative abilities. Going forward I will continue to push for simplified content and aim to implement all that I’ve learnt to make our designs accessible to as many people as possible.
Alexander Darlington, UX Researcher
Working in such a busy environment, I seldom have the opportunity to stop, look, listen, and consider things that aren’t directly related to the project or piece of work I’m contributing to. However, as a researcher, I cherish the time to learn from others. The aphasia event provided a safe space to explore how the design choices for products and services may result in particular groups of people being excluded from using them.
Before attending the workshop, I had a basic knowledge of what aphasia was, but little to no understanding of its implications in a design context.
In previous roles, accessibility was perceived as a specialist field by the organisation and that, ironically, resulted in exclusion and less collaboration from people like myself who had alternative competencies. So in some ways, I felt like I was exploring something new to me.
Having people with aphasia present, acting as consultants, was incredibly humbling, especially when they shared their experiences with the room. However, it was just as valuable to hear them interact with each other. They were familiar with each other, and there was joy in the room as they teased and made jokes. It was this sense of play that made me, and everyone else feel comfortable to be part of the workshop.
Rather candidly, and very matter of fact, the consultants shared what it is like to be excluded from everyday tasks we might take for granted. It was during this that I was involved in some valuable discussions, particularly as a researcher, on considerations when conducting research with people with aphasia. The most stand-out was how communication should be considered — this seemed central, what with the nature of aphasia being a communication impairment. We learnt about how communication should be considered: how the researcher communicates tasks and asks questions to the participant; as well as how the participant may be able to communicate back their answers and experiences.
Overall I found the session really stimulating, however, at times I felt somewhat uneasy as the challenges they faced were not small but seemingly no more of a challenge than anything else a design team might face in any tech business. This was the most powerful of feelings I took away from the event; the ability to make such a significant change for someone else by designing to be inclusive.
Learning about how Stephanie and Abi conduct their work by including people with aphasia at every stage in their research and product development cycle; including co-authoring papers, and participation in workshops – we learnt what it truly means to have an inclusive research and design practice.
Since the aphasia workshop, and other accessibility-related events, there have been some meaningful improvements to Aviva’s inclusive design practice. Importantly, more people, and people in different roles and seniorities are aware of the condition. As a result, there are more discussions and considerations for accessibility requirements at various stages in the design process. Designers have specific use cases and user groups to dissuade teams from using large blocks of legalese texts. Significantly, one team have made their email templates compliant to accessibility standards, and have implemented accessibility checks in their review process. Indeed, there may be others.
Thank you to Stephanie Wilson, Abi Roper, Timothy Neate, and Charlotte Pearce-Slade for coming to Aviva and running the workshop for us. Special thank you to the aphasia panel members: Ian, Ben, Lynn, and Colin, for sharing their stories and collaborating with us in activities for what was a very insightful afternoon.
- Dos and Don’ts of Designing for Aphasia Accessibility Poster
- The INCA Project – Inclusive Digital Content for People with Aphasia
- Usability Testing – An Aphasia Perspective − Paper co-written by Abi and Ian
- Stroke Association Information Communication Guidelines
- Centre for Human-Computer Interaction Design – City, University of London
- Centre for Language and Communication Science Research – City, University of London