Definitions
Universal design has been described as a design method to achieve the inclusion of as many people as possible throughout their life. The defines inclusive design as ‘The design of mainstream products and/or services that are accessible to, and usable by, as many people as reasonably possible without the need for special adaptation or specialized design’. ‘Design for all’ and ‘Universal design’ both have the same meaning. These approaches aim to build environments and websites or products that are accessible to all regardless of age, sex, capacities or cultural background. On the other hand, inclusive design acknowledges the commercial restrictions linked to fulfilling the requirements of an intended audience ( ). Inclusive design suggests that it is not always possible to design a single product that addresses the needs of the entire population. However, it is recognized that what makes a product essential for some particular users will often make it more accessible and easier to use for everyone else ( ). As a simple example, consider a ramp which leads to a shopping centre. It might be designed for wheelchair users, but will also help people pushing prams, those with shopping trolleys, and cyclists wheeling their bike.
Inclusive design involves developing a family of products which between them cover the majority of the population, with each product targeted to specific users. This design process should involve much more than just adding a Braille label.
The University of Cambridge have developed guidelines to assist product designers ( http://www.inclusivedesigntoolkit.com/ ). The Royal National Institute of Blind People (RNIB) have a ‘Tried and Tested’ certification for some products whose accessibility and usability has been checked by a panel of visually impaired users.
There are a few principles that comprise universal design ( ):
Equitable use—The design is usable and saleable to individuals with different characteristics and income.
Flexibility in use—The design is aimed to accommodate a wide range of people with diverse abilities and preferences.
Simple and intuitive use—The use of the design is easy to understand, independently of the individual’s experience, knowledge or language skills.
Perception information—The information provided by the design is sufficient so the individual can use it effectively, independently of their environment and their sensory abilities. In the case of vision, the advice given to designers is based on the size, colour and contrast of visual stimuli.
Tolerance for error—The design reduces adverse consequences from accidental or unintended actions.
Low physical effort—The design is used with minimal fatigue and in a competent and comfortable manner.
Size and space for approach and use—The size and space to use the design need to adapt to the individual’s characteristics and circumstances (e.g. body size, posture, mobility).
A good example of the need for universal design is in health testing. For example, current pregnancy tests are not usable by blind women, which means that very private results have to be shared with others. The RNIB has therefore developed a prototype for a more suitable design, in the hope that it will be taken up by a commercial supplier. Another example is COVID-19 self-testing (i.e. lateral flow tests), which is not possible without sighted assistance.
Equality legislation (the Equality Act 2010 ) already requires websites to be accessible, but this is often not the case for users of screen readers or screen magnification software. The Web Content Accessibility Guidelines (WCAG) ( https://www.w3.org/TR/WCAG21/ ) provide guidance to web designers to ensure that their content is universally accessible. Good design ensures that webpages can be accessed by all users, including those using screen readers, magnification or Braille displays.
Basic requirements for visually impaired users are to optimise text size and contrast, preferably in a way which can be selected by users. Good contrast is important, particularly for forms, tick boxes and edit fields.
More specific requirements must be met for users who access the website using screen-reader software. A logical heading structure is vital so that the user can establish a clear understanding of the overall page layout. Speech users also need to be given (audio) feedback on any actions they have executed, for example, when selecting an option or placing an item in a basket. Images and icons should come with their own short accurate spoken description (‘alt text’). Decorative rather than informative images can have alt text set so that it will be ignored by the screen reader. Any video content should have audio-description, and transcripts should be available for video and audio content, with clear information added about nonverbal content.
‘The Public Sector Bodies (Websites and Mobile Applications) (No.2) Accessibility Regulations 2018’ came into force in 2019, with the aim of ensuring that public sector websites and mobile apps are accessible to all users, especially those with disabilities.
New public sector websites must meet these accessibility standards and publish a statement to that effect.
Recommendations for Good Practice in the Built Environment
The possibilities for improving visibility of objects or for modifying their indoor environment can be suggested and demonstrated to the patient, to be adopted as the opportunity arises: they will obviously not have their whole house reequipped and redecorated immediately, but the next time they choose wallpaper may think of choosing a pale colour to reflect light and to contrast with the carpet, for example. Occasionally, however, it is possible to make major recommendations for a complete environment, taking into account all possible factors which could make the environment more appropriate. Many care homes for older people will have a substantial proportion of their residents experiencing visual problems, and many mainstream schools will have a small number of visually impaired pupils: in either case, a low vision practitioner may be asked for advice or recommendations. These factors should also be considered when designing healthcare facilities, including optometric practices.
General Layout
Rooms should be regular rectangular shapes of moderate size, with all surfaces matt so there is no specular reflection to create a glare source. In general, the decor should be light to give ample diffuse reflection of light, with contrasting (darker) floors and doors/doorframes. The difference in reflectance between pale and dark walls is considerable, and it is desirable to use pale decor because much of the light falling on surfaces in the environment is reflected. It is not good, however, to create large featureless white spaces: we align ourselves in our environment with reference to corners, horizons and edges, and a large area without such features is difficult to orientate in. Such orienting features can be added by using a contrasting frieze at the top of the wall, with a contrasting dado rail and dado ( Fig. 16.1 ). The floor covering may be coloured differently to ‘divide’ the floor space into sections, or a route across it may be defined by contrasting surface colour or texture. It is essential that this path is free of obstructions such as chairs or tables (especially those which are low and have sharp corners).
The location of reception desks, stairs and lifts should be obvious. They should not be hidden around corners, and if the visitor is required to approach an enquiry window, the floor in front of that should be a different colour to mark its location. If there is a clear glass screen at the reception window, this should not be located so that the visitor could bump their head into it. There should be a direction-finding guide in a public building—this may be a tactile or auditory map, or a telephone line to an information service, or to summon a sighted guide.
All corridors should be the same constant width, and travel in straight lines. All changes in the direction of corridors should be right-angled to maintain orientation. It is not desirable to have a zig-zag in the middle of the corridor: if it cannot travel in a straight line then a gentle curve is more acceptable. A contrasting band painted on the wall can provide orientation, and it will have breaks in it to indicate the location of doorways. The same contour could be provided by a contrasting-coloured handrail if one was required. Tactile markings on the handrail can be used to give information: at the break for a doorway, one raised dot could indicate a classroom door, two raised dots a lift door, for example. Different colours can be used for doors or walls on different floors: for example, every door on the ground floor might be red and every door on the first floor blue.
The choice of floor covering can allow use to be made of the sounds produced by footsteps or a tapping cane, to aid in orientation. The usefulness of this will be lessened if there is a lot of background noise to mask it (e.g. the sound of an escalator or machinery), and too much echo (such as in a swimming pool) makes it impossible to tell where sounds are originating. The change in texture of flooring or paving (which might, for example, be grooved or studded near a doorway) can be used to give information about an approaching hazard, or indicate a route through the area. If a building is carpeted throughout, there is no possibility of using sound clues to location, and there is no possibility of using a change in texture as a signal. It is essential to have a matt (to avoid specular reflection), nonslip floor surface with no loose coverings (such as rugs or mats).
There should be no change in floor level within a room or corridor. If one is unavoidable, warning should be given of its presence by a change in the colour or texture of the floor covering, and on a corridor the handrail or contrasting wall band should begin to slope before the step is reached. Conversely, it can be undesirable to have a change in colour or texture just for aesthetic reasons if there is NOT a difference between adjacent areas: the visually impaired person will usually think that there is a step at this point. It is better that all changes in level should be at a doorway.
Obstacles and Obstructions
Very narrow corridors and passages should be avoided because collision with wall-furniture or other people is more likely. All circulation routes should be free of obstacles: if these cannot be avoided, they should be of contrasting colour, or with rounded edges so they do not constitute a hazard. If possible, they should be extended down to ground level so that there is a greater chance of the lower part being touched with the cane or foot before the patient’s body contacts them. The long-cane user cannot detect an obstacle above 0.7 m from the floor with their cane, so it will only be located when they bump into it.
It should be possible to walk down a passage close to the wall without encountering free-standing columns or pillars. This is important if the patient uses the technique of ‘trailing’ their hand along the wall to locate landmarks—for example, to count down the number of doorways when given an instruction such as ‘it’s the fourth door on the right’. Protruding display cupboards or stands should be avoided, or at least extend to ground level so that the user of a long-cane would detect them. Coat-hooks, litter bins and fire-extinguishers may be unavoidable but could be recessed into the wall: a protrusion greater than 10 cm is not acceptable ( Fig. 16.2 ). An upper height clearance of 2.2 m from ground level should apply to awnings, signs, ladders and light fittings. Light fittings are often best recessed into the wall or ceiling, as this should also avoid a potential glare source. Shelves or cupboards should be continuous from wall to wall, so that it is not possible to walk into the edge. Windowsills, balustrades and guard-rails should not be lower than waist high. All heating appliances which constitute a fire risk should be guarded.
