Understanding the interaction strategies of blind health IT users: a qualitative study

Blind and visually impaired (BVI) individuals face significant accessibility and usability problems while interacting with web and mobile applications. Current approaches to resolve those problems are overly techno-centric and ignore the role of BVI users in determining the success or failure of an interaction. Using the “Theory of Affordances” as a theoretical lens, this research includes the users in the equation. This research argues that the interaction strategies of BVI users play a vital role in determining the success or failure of their web and mobile interactions. Extant Information Systems literature lacks a comprehensive understanding of the BVI users’ interaction strategies. Therefore, the purpose of this research was to produce a comprehensive understanding of the BVI web and mobile users’ interaction strategies, respective accessibility, and usability problems, and use that knowledge to resolve the identified problems. This research is situated in the context of BVI users’ personal health information management using web and mobile applications. The research adopts a novel semiethnographic, conversation-style qualitative data collection methodology. The research design is an observation study with BVI web and mobile users. The research produces the comprehensive understanding of the web and mobile interaction strategies of BVI participants, and the respective accessibility and usability problems. The identified Web interaction strategies are: *Use of screen-reader specific navigation functions, *Use of links list, *Use the up and down arrow keys, *Use the “table layer”, *Using arrow keys, *Use of the tab key, *Use of the screen-find function, *Hit the enter key, *Hit the spacebar, *Tab and shift + tab in succession, *Up and down arrow keys in succession, *Use screen-reader function such as insert + tab in JAWS, *Re-doing the component-level operation, *Restarting the browser and re-doing the entire task-flow, *Trial and error, The identified mobile interaction strategies are: *Sequential scanning, *Gambling scanning, *Direct-touch scanning, *Read character-by-character, *Read word-by-word, *Read line-by-line, *Skim through headings, *Flick left and flick right in succession, *Flick left and flick right in succession, *Use of handwriting, *Use of braille screen input, *Use of direct-touch typing, *Use the dictation feature, *Use of an external keyboard, *Use of standard typing, *Use of touch typing, *Re-doing the component-level operation, *Moving one step back and re-tracing the path, *Restarting the application and re-doing the entire task-flow, *Trial and error. The web interaction strategies are very similar to the mobile interaction strategies. The participants often develop multiple strategies to achieve their objectives and then choose to execute one or more of the strategies considering various contextual factors. The strategies can be broadly classified as exploration or exploitation. The strategies in the exploration category intend to gather the information about the interface. The strategies in the exploitation category intend to use the properties of the interface without exploring the interface. This research makes the following contributions: *Defines the construct “interaction strategy” as a coordinated sequence of user interactions with online resources that is intended to achieve an interaction goal. It allows us to study the entire interaction as a single unit. *Develops a semi-ethnographic, conversation-style qualitative data-collection methodology to study human technology interactions. It implements the methodology to study the BVI users’ web and mobile interactions using a screen-reader. * Develops the theoretical analysis methodology to identify the areas of improvement in human technology interactions. *Generates the design and interaction principles to resolve the identified accessibility and usability problems