Developing accessible interfaces for collecting patient-reported outcomes

Many individuals with chronic conditions have disabilities that limit their participation in activities. Users with disabilities face challenges when using computer systems if those systems are not developed to be universally accessible. Computer systems may be inaccessible to people with disabilities if they provide only one way for users to gain access to, or manipulate information, particularly if the ability to use the technology depends primarily on user vision or hearing. For example, people who have visual impairments cannot read instructions presented only in a visual format; people who are deaf cannot understand content that is only presented aurally; people who are color-blind cannot discriminate between color-coded options; people who have limited use of their hands or arms cannot use a mouse. Web-based or other computer interfaces with inconsistent layout, difficult to recognize graphics, and inaccessible language are problematic for all users, but present significant barriers for people with some kinds of learning and other cognitive disabilities.

Accessible computer systems must be compatible with the assistive technology used by individuals with disabilities such as screen readers or screen magnification. In addition, accessibility features may be built-in such as the option for auditory feedback from the information system, or a high contrast option in computer operating software. Or the information may be available on demand, like closed captioning or audio description for video. Accessible web-based information systems or interfaces are those that provide a text equivalent (typically a description) for all non-text elements, such as audio, video, graphics, animation, graphical buttons, and image maps. They also include clear and consistent navigation and adhere to web content accessibility guidelines, like those published by the World Wide Web Consortium's Web Accessibility Initiative (WAI) or Section 508. Websites designed in this way allow those who cannot see the screen to access the information using assistive technology such as screen readers used by some people with vision impairments.

The goal of this project is to test the accessibility of an online assessment system that is being developed by an NIH funded national initiative to evaluate patient reported outcomes. The system, titled the Patient Reported Outcomes Measurement Information System (PROMIS), is a form of computer adaptive testing (CAT). It will be used to measure common symptoms such as pain and fatigue in individuals with chronic conditions such as multiple sclerosis, arthritis, spinal cord injury, etc. In CAT, sophisticated probability estimates (derived through Item Response Theory) allow the system to target the questions asked of the user. The questions a user receives are based on the answers given to previous questions.