Designing an accessible indoor navigation application Guidelines of how to apply universal design when designing an indoor navigation application to help users with wayfinding Master’s thesis in Interaction Design and Technology LINNEA PALMGREN SÖDERSTRÖM MOLLY ZELMERLÖW SIGANDER Department of Computer Science and Engineering CHALMERS UNIVERSITY OF TECHNOLOGY UNIVERSITY OF GOTHENBURG Gothenburg, Sweden 2021 Master’s thesis 2021 Designing an accessible indoor navigation application Guidelines of how to apply universal design when designing an indoor navigation application to help users with wayfinding LINNEA PALMGREN SÖDERSTRÖM MOLLY ZELMERLÖW SIGANDER Department of Computer Science and Engineering Chalmers University of Technology University of Gothenburg Gothenburg, Sweden 2021 Designing an accessible indoor navigation application Guidelines of how to apply universal design when designing an indoor navigation application to help users with wayfinding LINNEA PALMGREN SÖDERSTRÖM MOLLY ZELMERLÖW SIGANDER © LINNEA PALMGREN SÖDERSTRÖM & MOLLY ZELMERLÖW SIGANDER, 2021. Supervisor: Thommy Eriksson, Division of Interaction Design, Department of Com- puter Science and Engineering Advisor: Håkan Wilken, Locum AB Examiner: Staffan Björk, Division of Interaction Design, Department of Computer Science and Engineering Master’s Thesis 2021 Department of Computer Science and Engineering Chalmers University of Technology and University of Gothenburg SE-412 96 Gothenburg Telephone +46 31 772 1000 Cover: Illustration of a person using a wayfinding application standing outside the main entrance of a hospital. Typeset in LATEX Gothenburg, Sweden 2021 iv Designing an accessible indoor navigation application Guidelines of how to apply universal design when designing an indoor navigation application to help users with wayfinding LINNEA PALMGREN SÖDERSTRÖM MOLLY ZELMERLÖW SIGANDER Department of Computer Science and Engineering Chalmers University of Technology and University of Gothenburg Abstract Navigating within large buildings, such as a hospital, can be stressful and time- consuming, leading to a bad user experience, causing anxiety and frustration due to missed appointments. Therefore, applications for indoor navigation have recently been catching attention. In the designing of a wayfinding system for a hospital envi- ronment it is important that the application is easy to use, effective, accessible, and intuitive as the ambition is to simplify the wayfinding to allow the user to access information and help individual navigation. This thesis explores how to develop an accessible design supporting wayfinding within a complex environment, such as a hospital. With the purpose to investigate how an indoor wayfinding application can be designed to be accessible, with all users in mind, with the aim to fill the gap of the existing research regarding this subject. To attempt this, a pre-study was conducted to research previous literature within the subject of accessible and universal design, and by designing and testing an in- door navigation application for Danderyds hospital with users, with and without disabilities. Through an iterative design process, the application explored key fac- tors and solutions to support for indoor navigation. The conducted usability testings involved both remote asynchronous and synchronous usability testing online, and synchronous usability testing on smartphones. The outcome of this thesis resulted in nine guidelines of how to design for an indoor navigation application with a universal design approach. Keywords: accessibility, universal design, inclusive design, indoor navigation, graphical user interface, complex environments, interaction design, usability test, prototyping. v Acknowledgements We would like to give a big thank you to our supervisor Thommy Eriksson, for your guidance and dedication in the work process of this thesis, and throughout our study time at Chalmers University. We want to give our gratitude to Håkan Wilken, Helena Mansell and Lovisa Widén at Locum AB for including us in their project and providing us with resources, a problem statement and scope to perform this thesis. Also, to Navid Nosrati, Kaija Alaraudanjoki and Jasmina Lindgren at Axel Health for involving us in their team with great collaboration during the project. Further, we would like to thank Locums samverkansråd, for the participation in the focus group and providing us with important insights. Additionally, to our peers at interaction design for supporting us when in doubt. And lastly, to our friends, family and loved ones, for your support and patience not only for this thesis project but throughout our five years of study. Without you this would not have been possible! Linnea Palmgren Söderström & Molly Zelmerlöw Sigander, Gothenburg, May 2021 vii Contents List of Figures xiii List of Tables xvii 1 Introduction 1 1.1 Project background . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Research Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.2.1 Research Question . . . . . . . . . . . . . . . . . . . . . . . . 3 1.3 Constraints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.4 Ethical issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.5 Stakeholders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2 Theory & Background 7 2.1 Digital Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 2.1.1 Designing for mobile interface . . . . . . . . . . . . . . . . . . 8 2.1.2 Design principles . . . . . . . . . . . . . . . . . . . . . . . . . 8 2.1.2.1 Human interface guidelines . . . . . . . . . . . . . . 9 2.1.2.2 Material Design . . . . . . . . . . . . . . . . . . . . . 10 2.2 Universal design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2.2.1 Universal design - accessible, usable and inclusive . . . . . . . 11 2.2.2 Conceptual framework for universal design . . . . . . . . . . . 11 2.3 Disabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.4 Designing for disabilities . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.4.1 Dyslexia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2.4.2 Visual impairments . . . . . . . . . . . . . . . . . . . . . . . . 14 2.4.3 Elderly people . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.4.4 Cognitive disabilities . . . . . . . . . . . . . . . . . . . . . . . 16 2.4.5 Designing for children . . . . . . . . . . . . . . . . . . . . . . 19 2.5 Designing with icons . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.5.1 Pictogram design . . . . . . . . . . . . . . . . . . . . . . . . . 20 2.5.2 Pictogram on signage . . . . . . . . . . . . . . . . . . . . . . 20 3 Related Work 21 3.1 Wayfinding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 3.2 Wayfinding in hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . 22 3.3 Wayfinding and indoor maps . . . . . . . . . . . . . . . . . . . . . . . 23 3.3.1 Positioning for indoor navigation . . . . . . . . . . . . . . . . 23 ix Contents 3.4 Previous wayfinding systems in complex environments . . . . . . . . . 24 3.4.1 Existing indoor navigation applications . . . . . . . . . . . . . 27 4 Methodology 29 4.1 Design thinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 4.2 The design process . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 4.3 Discover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 4.4 Define . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 4.5 Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 4.6 Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 5 Planning 41 5.1 Discover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 5.2 Define . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 5.3 Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 5.4 Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 6 Execution & Process 43 6.1 Design process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 6.1.1 Discover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 6.1.2 Define . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 6.1.3 Development . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 6.1.4 Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 6.2 Pre-study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 6.2.1 Discover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 6.2.1.1 Literature Review . . . . . . . . . . . . . . . . . . . 46 6.2.1.2 Interviews . . . . . . . . . . . . . . . . . . . . . . . . 47 6.2.1.3 Focus Group . . . . . . . . . . . . . . . . . . . . . . 48 6.2.1.4 Brainstorm . . . . . . . . . . . . . . . . . . . . . . . 48 6.2.1.5 Exploratory Research . . . . . . . . . . . . . . . . . 49 6.2.2 Define . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 6.2.2.1 Affinity Diagram . . . . . . . . . . . . . . . . . . . . 50 6.2.2.2 The Golden Path . . . . . . . . . . . . . . . . . . . . 51 6.2.2.3 Extreme Characters . . . . . . . . . . . . . . . . . . 53 6.2.2.4 Journey Mapping . . . . . . . . . . . . . . . . . . . . 53 6.2.2.5 Benchmarking . . . . . . . . . . . . . . . . . . . . . 57 6.2.2.6 Design Decisions . . . . . . . . . . . . . . . . . . . . 57 6.3 Iteration One . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 6.3.1 Development . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 6.3.2 Designing a new interface . . . . . . . . . . . . . . . . . . . . 64 6.4 Iteration Two . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 6.4.1 Development . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 6.4.1.1 Design Decisions . . . . . . . . . . . . . . . . . . . . 66 6.4.1.2 RITE . . . . . . . . . . . . . . . . . . . . . . . . . . 75 6.4.2 Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 6.4.2.1 Heuristic Evaluation . . . . . . . . . . . . . . . . . . 76 6.4.2.2 Remote asynchronous usability testing in Maze . . . 76 x Contents 6.4.2.3 Thematic analysis of Maze usability testing 1 . . . . 78 6.5 Iteration Three . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 6.5.1 Development . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 6.5.2 Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 6.5.2.1 Synchronous usability testing on smartphone . . . . 83 6.5.2.2 Remote synchronous usability testing with cognitive walkthrough . . . . . . . . . . . . . . . . . . . . . . . 84 6.5.2.3 Thematic analysis of usability testings . . . . . . . . 84 6.6 Iteration Four . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 6.6.1 Development . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 7 Results 93 7.1 Final Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 7.1.1 Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 7.1.1.1 Final interface of the Easy Wayfinding design . . . . 93 7.1.2 Remote asynchronous usability testing in Maze test 2 . . . . . 99 7.1.3 Thematic analysis of Maze usability testing 2 . . . . . . . . . 99 7.2 Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 8 Discussion 105 8.1 Background and theory . . . . . . . . . . . . . . . . . . . . . . . . . . 105 8.2 Execution & Process . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 8.2.1 Implementing the Easy Wayfinding design . . . . . . . . . . . 106 8.2.2 Usability testing . . . . . . . . . . . . . . . . . . . . . . . . . 106 8.2.3 Technical limitations . . . . . . . . . . . . . . . . . . . . . . . 108 8.3 Further improvements and research . . . . . . . . . . . . . . . . . . . 109 8.3.1 Usability testing in field . . . . . . . . . . . . . . . . . . . . . 109 8.3.2 Live position . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 8.3.3 Help tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 8.3.4 Including additional disabilities . . . . . . . . . . . . . . . . . 110 9 Conclusion 111 Bibliography 115 A Maps created of each floor of the hospital with their routes I B Findings from the brainstorming supported by literature V C Patient mapping of personal data XI D Construction of the two usability tests in Maze XIII E Findings from the thematic analysis of Maze test one XV F Findings from usability tests in iteration three XVII G Findings from the thematic analysis of Maze test two XXI xi Contents xii List of Figures 2.1 Universal Design of Instruction (UDI) framework (Burgstahler, 2020). 11 2.2 Universal Design of Instruction (UDI) framework (Burgstahler, 2020). 12 2.3 Universal Design of Instruction (UDI) framework (Burgstahler, 2020). 13 4.1 The double diamond of design (Sharp et al., 2019). . . . . . . . . . . 30 4.2 Correlation between heuristics and interaction design patterns (Botella et al., 2011). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 6.1 The design process executed for this project. . . . . . . . . . . . . . . 43 6.2 The Golden Path illustrating the general and ideal interaction with the application. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 6.3 The Golden Path illustrating the route to the emergency room. . . . 52 6.4 The Golden Path illustrating the route to the X-ray. . . . . . . . . . . 52 6.5 The Golden Path illustrating the route to the orthopedic. . . . . . . . 53 6.6 Journey mapping illustrating navigation to the orthopedic. . . . . . 55 6.7 Journey mapping illustrating navigation to the emergency room. . . . 55 6.8 Journey mapping illustrating navigation to the x-ray. . . . . . . . . . 56 6.9 Images of the start page of the MID design. The original MID design to the left, and the changes made of the design to the right. . . . . . 61 6.10 Images of the navigation descriptions in text. The original MID de- sign to the left, and the changes made of the design to the right. . . . 62 6.11 Images of the navigation in map view. The original MID design to the left, and the changes made of the design to the right. . . . . . . . 63 6.12 Images of the information of a POI. The original MID design to the left, and the changes made of the design to the right. . . . . . . . . . 64 6.13 An illustrated model of the parallel processes for the two prototypes. 65 6.14 Descriptions of functions and buttons in the route overview. . . . . . 66 6.15 Descriptions of functions and buttons in the map view. . . . . . . . . 67 6.16 Descriptions of functions and buttons in the list view. . . . . . . . . . 67 6.17 The design providing feedback of arrival. . . . . . . . . . . . . . . . . 69 6.18 The flow when interacting with the end button. . . . . . . . . . . . . 71 6.19 Image of spacing, margins, font size and paddings in the interface. . . 71 6.20 The left image shows the search field before putting in a search word, and to the right a search has been made and a list shows auto- complete suggestions. . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 6.21 An image showing the icons of the POI:s on the map. . . . . . . . . . 73 6.22 Textual step by step directions provided in the map view. . . . . . . . 74 xiii List of Figures 6.23 Start navigation buttons with different icons. . . . . . . . . . . . . . . 75 6.24 First version of the toggle button for map view or list view. . . . . . . 76 6.25 Second and final version of the toggle button for map view or list view. 76 6.26 Image showing the old interface (left) and the new interface (right) with changes made to a less saturated map, removed text of icons. . . 80 6.27 Image showing the old interface (left) and the new interface (right) with changes of navigation line and the position icon. . . . . . . . . . 80 6.28 Image showing the old interface (left) and the new interface (right) with the added close button on the information about a POI. . . . . . 81 6.29 Image showing the old interface (left) and the new interface (right) with the position icon, and text when changing floors. . . . . . . . . . 82 6.30 The image to the left is the interface with the old color scheme, and to the right is the interface with the new color scheme. . . . . . . . . 86 6.31 The image to the left is showing the old interface with complementary text to the icons, and to the right changes are made only providing complementary text to the target points and departments. . . . . . . 87 6.32 The image to the left shows the filter switch that was added next to the switch to avoid stairs. The image to the right shows both filter switches that were added in the overlay that appears when interacting with the “end” button. . . . . . . . . . . . . . . . . . . . . . . . . . . 88 6.33 The left image shows the old floor selector, and to the right is the new appearance of the floor selector. . . . . . . . . . . . . . . . . . . 89 6.34 The image to the left is showing the old design of the textual descrip- tions, and to the right is the new design presented with its changes. . 90 6.35 Image showing the old interface (left) and the new interface (right) of when arriving at the destination. . . . . . . . . . . . . . . . . . . . 91 7.1 First screen when opening the application with a preset destination, presented with a map overview on the left & a list view on the right. 94 7.2 An example of the map view (to the left) and on the list view (to the right) when the user has started the navigation. . . . . . . . . . . . . 94 7.3 An example of the map view (to the left) and on the list view (to the right) of the indoor navigation when the user is approaching the elevator. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 7.4 An example of the map view (to the left) and on the list view (to the right) of the indoor navigation when the user is leaving the elevator. . 95 7.5 An example of the map view (to the left) and on the list view (to the right) of when the user arrives at their destination. . . . . . . . . . . 96 7.6 The interface without any navigation set before the user has shared their location. The outside view (left)and inside view (right) of the hospital. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 7.7 The interface without any navigation set after the user has shared their location. The outside view (left)and inside view (right) of the hospital. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 xiv List of Figures 7.8 The interface of setting up a navigation. To the left are the categories and to the right the listed options within the category “departments” presented. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 7.9 The interface when making a new search. It is possible to search by choosing from the categories in the list (to the left) or by typing (to the right). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 7.10 A new search within the hospital between two different departments. To the left is the map overview and to the left is the list view of the route. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 xv List of Figures xvi List of Tables 2.1 Example of design principles (Interaction Design Foundation, n.d.-a). 9 2.2 Factors to support for dyslectic users. . . . . . . . . . . . . . . . . . . 14 2.3 Factors to support for elderly users. . . . . . . . . . . . . . . . . . . . 16 2.4 Factors to support for users with cognitive disabilities. . . . . . . . . 18 6.1 Design principles that were examined during usability testings. . . . . 45 6.2 The executed methods performed in the design process. . . . . . . . . 46 6.3 Applied design principle in the design for an accessible/universal design. 59 xvii List of Tables xviii 1 Introduction The growth of digital technology creates new opportunities of how to interact with the physical environment. As digital devices such as smartphones, tablets and oth- ers have become more popular it has helped to improve how people interact and exchange information (De Lima Salgado & Freire, 2014). Mobile applications can serve as a bridge between the digital and physical world, to help optimize the real-life experience. Applications for indoor navigation have recently been catching attention (Diakité & Zlatanova, 2018), optimizing the real-life experience with the possibility to individually navigate within buildings. Navigating within a large building, such as a hospital, can be stressful and time-consuming (Marshall, 2017) leading to a bad user experience, causing anxiety and frustration due to missed appointments or stress (Hughes, Pinchin, Brown & Shaw, 2015). Therefore, in the designing of a wayfinding system for a hospital environments it is important that the application is easy to use, effective, accessible, and intuitive as the ambition is to simplify the wayfinding to allow the user to access information and help to individual navigation (Harper, Duke, Crosser, Avera & Jefferies, 2020). To design a seamless user interaction for indoor wayfinding systems that is invari- able regarding who the user is and that will not cause stress, anxiety or frustration, is a challenge. To be able to individually navigate within a new building it is of im- portance that the indoor navigation application involves a graphical interface that supports an enjoyable user experience without any barriers, despite language, age or disability. Universal design is an approach in design that incorporates products or systems, as extensively as possible, that can be used by everyone (Lenker, Nasar- wanji, Paquet & Feathers, 2009), regardless of age or ability, and without any need for adaptation (Silva, 2011). To make an application that is designed for everyone also makes it accessible for everyone (O’Briant, 1999). 1.1 Project background This master thesis is in collaboration with Locum AB, a Stockholm based com- pany that manages, builds and develops healthcare properties for Region Stock- holm. Locum strives to provide an attractive and sustainable healthcare environ- ment through commitment and innovation and has begun to explore the possibilities of developing an application to help visitors navigate within the hospital environ- ment, as well as their way to the hospital. Locum has observed that hospital visitors struggle with navigating within the hospital to find the right department or destina- 1 1. Introduction tion. Therefore, Locum intends with a pilot project to investigate the possibilities to help visitors to easier find their way and navigate to their booked appointments at the hospital, with the use of a wayfinding application. This project is named “Lätt att hitta rätt” and the application that will be developed in this thesis will therefore be referred to as “Easy Wayfinding”. To help with the present project Locum has hired Axel Health, a company that specializes in developing human technology for healthcare and provides tools for managing patient flows, to support the develop- ment of the application. This thesis project will help and assist Locum and Axel Health with the user experience design by investigating, discovering, designing, and testing an application for indoor navigation and wayfinding within the hospital en- vironment, between buildings and outdoor transportation. To develop an indoor navigation application that will be functional and usable at Danderyds hospital, Axel Health decided to use the system provided by MapsIndoors as the foundation for the maps and the navigation system. Since MapsIndoors pro- vides a solution that can be integrated with the hospital’s floor plan, and provide a seamless transition to Google Maps outdoors (MapsPeople, n.d.) it was chosen by Axel Health as a proper fit for this project. Further, an additional prototype called Easy Wayfinding will be designed by us, the researchers, that will serve as a future option for the applications interface where the approach is to design an universal interface that is accessible for all users. The ambition is to combine user research for both the MapsIndoors design and the new interface of the Easy Wayfinding pro- totype to investigate the best solution for a universal design for indoor navigation in hospital environments. This will be done by evaluating the interface of MapsIndoors and designing for a future implementation of the interface of the Easy Wayfinding design. The planned result of the application for this project will be either a native application or a web based solution for a mobile device that provides navigation guidance based on a preset starting point from the user’s position to their booked appointment at the hospital. This is planned to be done by either the user opening the application with help of a QR code, provided in the invitation for the booked appointment at the hospital or through a link sent in a text message to the patient. The purpose of this project is to design an application with a universal design approach that is accessible for all users, regardless of disability, age or language. As Marshall (2017) states, it has been discovered that healthcare facilities often are in- timidating and overwhelming and that directional signage is insufficient for visitors in order to find their destination. Signage generally includes unfamiliar terminology which makes it ineffective and causes confusion. For a wayfinder to get lost when navigating within a hospital is often caused by a poor design, and not the person. Therefore, it is important that, when in the process of designing a wayfinding sys- tem for hospitals, focus should be on the impact of the users on one hand, and the hospital on the other. When a user can navigate and understand the environment it provides a feeling of natural movement due to the good design. With a poor design, it can be costly for the hospital due to lost staff time and also patients leav- ing as a result of bad user experience (Morag & Pintelon, 2021). Therefore, this project strives to design a graphical interface for an indoor wayfinding application 2 1. Introduction for a hospital environment, with an interaction based on universal design and us- ability testing, that hopefully will create a pleasant user experience for all users. The purpose is to investigate and examine what design solutions are important and what functionalities should be implemented in the design to make it as accessible as possible. 1.2 Research Problem As the digital wayfinding system increases, there are still issues yet to be addressed, such as the system’s ability to support people with disabilities (Marshall, 2017; Morag & Pintelon, 2021). Previous research exists on universal design, of how prod- ucts should be designed to suit everyone regardless of disability or not (Singh & Tandon, 2018), and further research examines wayfinding for specific types of users with different disabilities (Huang, 2018). However, there is a gap in the research of how to combine these and design a wayfinding system that supports all users. The use of a universal design approach helps to develop products that are benefi- cial for everyone in a society, and facilitates the use for all users, and not only for individuals with disabilities. There are some well known applications for outside navigation, which has had a major impact on wayfinding. However, outside naviga- tion profoundly differs from indoor navigation, as for example, an indoor navigation must operate navigation of different floors and efficiently communicate this to the user. This project aims to investigate how an indoor wayfinding application can be developed to be as accessible as possible, with all users in mind, with the purpose to fill the gap in the existing research, and develop an application that can help visitors navigate when arriving at a new location where assistance and guidance are needed. For this project the application will be developed for Danderyds hospital in Stockholm. 1.2.1 Research Question The objective for this project is to gather information on how people with different types of disabilities handle digital applications and their specific needs, requirements and desires, to compile these to create and design an accessible product for indoor wayfinding. This will be investigated with the research question stated below: What design solutions are important to consider when designing a universal ac- cessible application for indoor wayfinding? 1.3 Constraints Since this master thesis was collaborating with a pilot project that was developing a prototype of a wayfinding application there were some existing and possible con- straints within the project. Something that needed to be addressed quite early in the process was trying to include a broad variety of disabilities as possible, and to balance several aspects regarding availability, and to have them working together 3 1. Introduction in one application. It could be argued that separate applications supporting spe- cific types of disabilities would offer the best solutions in order to support the users needs. However, for this project only one application was developed, with the aim to support as many types of disabilities as possible. To succeed in this, a lot of focus was addressed on performing user tests and continuously having dialogues with a focus group and including them throughout the design process. Thus, it was not possible to implement all desires and requests provided by the users of the project, and some features had to be disregarded. However, all desires and findings of this project will be considered for future improvements of the application, which was clearly communicated to all participants involved in the project. Another limitation regarding the scope of this project that had to be addressed was the area of navigation. This project was limited in the number of functions to implement in order to test different features and settings on a small scale, to then develop it further when a working prototype was created. The aim for the final product beyond this project was for the application to provide visitors with wayfinding guidance within and between buildings, as well as navigational guidance to the hospital. However, the scope of the application created for this project was much smaller, and was limited to three pre-selected routes at Danderyds Hospital. Furthermore, an additional limitation for the pilot project was trying to develop a digital solution for indoor wayfinding, as positioning is an important part of nav- igational applications, but the problem arises where GPS signals can not be used inside a building as it can not provide a sufficiently accurate positioning. This is a rather new area of research that does not have a conventional solution and there are many different ways with various technologies to provide for indoor positioning. However, all solutions require a network involving digital devices to be installed in the physical environment within the buildings, where these devices support differ- ent methods to calculate the position of the user. To do this, these devices require access to data provided by the operational system of the device running the applica- tion, and therefore, an installed application must be used and not a web application since this does not allow access to the required data. Another concern about the application providing for positioning was the budget of this project. An accurate positioning requires these devices to be installed in the environment which is expen- sive and could therefore result in the solution providing for positioning becomes too costly to implement in the pilot project. 1.4 Ethical issues This project does not approach all different disabilities as it was not possible to investigate or involve all different types for this project. The specific traits for the target disabilities for this project was based on literature about the disabilities along with feedback from the user testings. However, results based on this study claims to create guidelines to support universal design, even if users in this study only refer to a small part of all types of disabilities. This project has made a generalization of these disabilities with awareness that it does not reflect or regard everyone living 4 1. Introduction with these specific disabilities, and that disabilities can vary between individuals and therefore be experienced differently. Designing a digital application for wayfinding to be used during navigation requires the user to have a portable device to run the application on. To use this product as intended, the user also needs to carry out some steps such as opening the applica- tion provided in a link assigned by a text message and approving location sharing, which requires technical knowledge. Elderly people or users with cognitive disabili- ties might not know how to perform theses tasks in order to access the navigational descriptions and therefore can not use the application. Also, there are people in the society who do not use a smartphone at all, where this application will exclude these people from the design completely. During the time of this thesis with the ongoing COVID-19 pandemic almost all interviews and user tests were done remotely and therefore there was no risk of in- fection that could be caused by this project. A few usability tests were conducted in a synchronous setting, but these were performed with near friends and family and during controlled circumstances, with no risk of spreading the virus. Therefore, this project did not violate restrictions and regulations due to the Coronavirus. During usability testing screen and audio recordings were collected where all data is anonymous, and no personal data was recorded. In the analysis it was not possible to deduce any information to a specific participant. Only us, the researchers for this project, have had access to the data. When the project is completed, and the thesis is approved, all data will be deleted. This will be at the latest in December 2021. 1.5 Stakeholders Locum AB – One of the main stakeholders for this master thesis was Locum, which is a company that manages, builds and develops healthcare properties for the Stockholm Region. This thesis was a part of the project “Lätt att hitta rätt”, with the aim to create an application for wayfinding within hospital environments. Our expertise of user experience design was requested to help evaluate the application, understand the end users requirements and to help design a user interface that was accessible to all users. Chalmers University of Technology – The other main stakeholder was Chalmers University of Technology where the students conduct this research. They conduct research and provide education in technology and natural science, and promote knowledge and technical solutions for a sustainable world. 5 1. Introduction Axel Health – Locum performed this project in collaboration with Axel health, a company that specifies on developing human technology for healthcare. Axel Health was hired to manage this project and develop the application led by Locum. Healthcare properties – Locum manages several healthcare properties in the Stockholm Region and provides their service to some of Sweden’s biggest hospitals; Danderyd Hospital, Södersjukhuset, Karolinska university hospital, etcetera. In this specific project the application was developed and designed for Danderyd Hospital. End users – The main target group and the end users for this project were hospital visitors and patients. Everyone is a potential hospital user and therefore, the aim was to design the application based on universal design. Linnea Palmgren Söderström & Molly Zelmerlöw Sigander – The two in- teraction design students at Chalmers University conducting this master’s thesis. The purpose with this thesis was to contribute to research within the field of inter- action design by gaining knowledge of universal design and using this in designing a high-fidelity application for navigation. 6 2 Theory & Background In this chapter the theoretical background for this project will be covered, such as frameworks, and relevant concepts. Included in this chapter is digital design, universal design and designing for disabilities. The material presented in this chapter will be the foundation for the work in the design process. 2.1 Digital Design Cooper, Reimann, Cronin and Noessel (2014) state that digital products should be designed in order for users to use them and easily achieve their goals, to be efficient, satisfied and happy. Approaching a human-oriented design means designing with the user in focus. This involves understanding the user’s needs, motivations, desires and context. To achieve a good design, the designer also needs to understand the business, technology, requirements and constraints. This knowledge should be used as a foundation for the design in the development of a product in order to create products whose behavior, form, and content are useful, usable, and desirable, as well as technically feasible and economically viable. To make the user experience seamless and comfortable, consistency and coherence should be used in the design along with using standard solutions that allow for the opportunity for the user to quickly learn the interface reducing the risk of errors (Cooper et al., 2014). Web Content Accessibility Guidelines (WCAG) have developed internationally es- tablished recommendations and guidelines for accessible content on the web, for de- signers and developers to follow when designing websites and applications to be as accessible and useful as possible to include people with different disabilities (DIGG, 2018). There are three levels that WCAG are divided into; A, AA, and AAA. The level A criteria, the lowest level of ambition, must be met for all websites in order not to exclude any user. The next level, level AA is the base level that needs to be met by websites and mobile applications within the EU. When referring to level AA, both criteria at level A and at level AA are included. Level AAA is the highest level of ambition. By using these guidelines, a website becomes more accessible and increases the opportunity for everyone to participate in society on equal terms. 7 2. Theory & Background 2.1.1 Designing for mobile interface Mobile applications usually have basic UI elements and layout patterns such as lists, grids, bars and drawers. Grids for example, are used to organize content and func- tions into regular rows and columns to give an aesthetic and pleasing appearance. For navigation in a mobile interface, menu bars are the most commonly used mech- anism. They are placed at the button or at the top of the interface as narrowed horisontal regions consisting of tab-like or button-like control labeled in text or icons (Cooper et al., 2014). Cooper et al. (2014) propose different options on how to in- tegrate a menu on a small screen such as drawers, or hamburger menu as it also is called. Further, the authors claim that the most important activity on mobile appli- cations is searching. However, the challenge for searching within a mobile interface is to allow sufficient expression of search terms that requires a minimum of data entry for the user. Some examples to solve this problem is by having voice search allowing the user to search by audio input. Other suggestions that decrease the keyboard time for the user are auto-complete that provides the user with a list of popular options matching the user’s input as they are writing and tap-ahead that allow the user to select from the auto-complete option and use that as a search. Auto-suggest is a further improvement that allows for misspellings, and provides correctly spelled options and synonyms. Building on auto-suggest, to suggest options within a cat- egory, categorized suggestions can be provided. Moreover, a search function should remember the user’s past searches and allow for recent/frequent searches. Filtering and sorting can also be used and due to the limited screen size on mobile interfaces, sorting and filtering are often merged and have a similar function. Cooper et al. (2014) write that as the interaction on a mobile is multi-touch, it requires the onscreen objects to be big enough and easy to activate with the fin- gers without accidentally triggering another interaction. Cooper et al. (2014) claim that multi-touch gestures are the heart of the mobile experience but the number of core gestures is small and the users usually do not need a large amount of different gestures to be satisfied, it is just important that the gestures are simple, intuitive, and easy to learn and discover. Some of the most frequently used gestures are tap to select, activate or toggle, tap-and-hold for contextual pop-up menus, drag to scroll, drag to move, drag to control knobs, switches and sliders, swipe up/down for scrolling, swipe left or right for horizontal scroll or open drawers, pinch in/out to shrink or zoom, rotate by twisting the thumb and forefinger and multi finger swipes to switch between screens (Cooper et al., 2014). 2.1.2 Design principles Design principles are principles used as guidance for designers to be able to create designs that are pleasurable and user friendly (Interaction Design Foundation, n.d.- a). Design principles are generalizable guidelines that intend to guide designers to think about different aspects of their design (Sharp, Rogers & Preece, 2019). The Interaction Design Foundation (n.d.-a) writes that the principles represent gathered wisdom of researchers and practitioners in design and related fields, and Sharp et al., (2019) refer to design principles as derived knowledge, experience and common sense. 8 2. Theory & Background The principles are applicable rules, laws, guidelines, biases and design considerations that a designer should apply by selecting and organizing features and elements in the design (Interaction Design Foundation, n.d.-a). With the use of principles a designer can predict how a user is expected to behave while interacting with the design. The principles improve the usability by reducing the cognitive load and decision making time during the user experience, and it increases the appeal of the design. For designers it helps to make effective design decisions in a project. To be able to use and apply the principles it is important to understand the user’s problems and how the user will understand the design solutions. Therefore, the principles should be adapted to each case and design based on the situation to build a solid user experience (Interaction Design Foundation, n.d.-a). However, design principles should only act as guidelines or triggers for a designer to ensure a feature is provided in the interface, but the principles should not tell the designer of how to design a certain element (Sharp et al., 2019). Examples of design principles can be found in Table 2.1. Table 2.1: Example of design principles (Interaction Design Foundation, n.d.-a). Design principle Balance Equal weight of objects Repetition Leads to the eye following elements and are used to attract the user to a part of the de- sign Contrast Can be used subtly in a design and can also be used to draw attention to an object Proximity According to the Gestalt psychology ele- ments that are near each other are being per- ceived as one group Hierarchy Elements arranged in order of importance Emphasis A strategy to draw the user’s attention to a specific element in the design that distinctly stands out from the rest of the elements 2.1.2.1 Human interface guidelines Apple has developed the Human Interface Guidelines (Apple Developer, 2020) to guide designers to create more compelling, intuitive and beautiful experiences re- sulting in better designed applications. It offers designers and developers a compre- hensive perspective of the key user interface elements and how to best implement 9 2. Theory & Background the features in the design. Apple Developer (2020) has developed guidelines for each of their platforms of macOS, iOS, watchOS and tvOS and each has multiple sections that regard fields like application architecture, interaction, views, control and system capabilities. 2.1.2.2 Material Design One adaptable system of design guidelines, components and tools is Material Design (n.d.). It is a design system created by Google to help designers and developers build digital experience for Android, iOS, Flutter and the web. The principles are inspired by the physical word material and used to be able to create hierarchy, meaning and immerse the user experience. The principles are guided by print design methods such as typography, grids, space, scale, color and imagery (Material Design, n.d.). 2.2 Universal design Universal design, or design for all (Stephanidis, Akoumianakis & Savidis, 2001), refers to the design of systems, products and services that are usable, accessible and functional without need for any adaptation to the greatest extent possible, regard- less of age or ability (Silva, 2011). The motivation for universal design comes from exclusionary design, occurring when a design is directed for the “fully able people” (Singh & Tandon, 2018), which does not provide the needs for the biggest range of people (Stephanidis et al., 2001). As universal design targets a broader perspective it has a positive effect on the society as a whole, since it is designed for everyone, not only the “average” person or a person with a disability. Since it meets the needs of people with different abilities, it is still accessible for the “average” per- son and is therefore beneficial and offers better conditions for everyone (Silva, 2011). The Center for Universal Design developed a research project to establish guide- lines for universal design, and developed 7 principles of Universal design; equitable use, flexibility in use, simple and intuitive use, perceptible information, tolerance for error, low physical effort, and size and space for approach and use (Preiser & Ostroff, 2001). The purpose of the principles is to guide the design process, allow for systematic evaluation of design and to educate both designers and consumers about more usable design solutions. The principles still serve as important and useful guidelines while designing, however, they only offer a starting point for the universal design process, and to select the most appropriate design solution requires understanding and negotiation among accessibility and usability. This demands for a user’s input in the design process to help evaluate the design during the develop- ment phase, to ensure that the needs of the full diversity of users have been met. The main purpose of the principles is to guide others in their process of designing inclusive design, and has proven to be useful all over the world (Preiser & Ostroff, 2001). 10 2. Theory & Background 2.2.1 Universal design - accessible, usable and inclusive Accessible, usable and inclusive design are terms commonly associated with univer- sal design. The terms have the same approach to design products that are suitable for everyone, however they slightly differ (DO-IT, 2019), and can vary across the design space (McAdams & Kostovich, 2011). Accessible design refers to designing specific for people with disabilities, such as adding a ramp to every entry of a build- ing. Adaptable design is further an approach where the design modifies to be easier to use (McAdams & Kostovich, 2011).Usable design indicates the usability of a prod- uct, the ease, satisfaction and efficiency of using it. However, usable design does not invariably consider individuals with disabilities, which can lead to products that perform well in usability tests but are not accessible for everyone (DO-IT, 2019). Universal design is the broadest concept but cannot be seen as a substitute for ac- cessible design, since the goal with universal design extends further than eliminating discrimination for people with disabilities. The purpose with universal design is to be beneficial for everyone (Steinfeld & Maisel, 2012). Inclusive design can be seen as equivalent to universal design as universal design is design that can be coequally used by people of any ability with no discrimination against users based on their abilities (McAdams & Kostovich, 2011). Burgstahler (2020) presents a framework to illustrate the relationship of these terms (Figure 2.1). Figure 2.1: Universal Design of Instruction (UDI) framework (Burgstahler, 2020). 2.2.2 Conceptual framework for universal design Singh and Tandon (2018) introduced a framework that identifies four key elements of universal design that are important to make a product more accessible; functionality, usability, performance and product attachment. Singh and Tandon (2018) claim that for designers to understand all user’s needs and aspirations, people are divided into three user groups that are important to understand and develop universal products that will work best for people with and without disabilities. To achieve true universal products, the designers need to classify the users in a hierarchical manner, to identify their needs based on some priorities. The first group of their pyramid is Fully Able People (FAP), that are people that will have no difficulties while using the product 11 2. Theory & Background (Figure 2.2). The second group of people is people who have some special needs or temporary disability, and is called Specially Abled People (SAP). The last group is the Differently Abled People (DAP), that consist of people with severe permanent physical or mental disability. Figure 2.2: Universal Design of Instruction (UDI) framework (Burgstahler, 2020). Singh and Tandon (2018) write that to identify the key elements of universal design involves three stages; identify words that represent product attributes in a value database, clean and filter the database and lastly identify a few important elements that are responsible for the issues related to the design of a universal design product. Singh and Tandon (2018) identified four elements: 1. Functionality: The quality of being suited to serve a purpose well 2. Usability: Ease of use and learnability of human-made objects 3. Performance: The action or process of performing a task or function 4. Product attachment: Procut attachment is the emotional bond consumer ex- perience with a product Further, Singh and Tandon (2018) claim that if all these four elements are being satisfied in a design, the possibility of the product to be accepted as a universal product will significantly improve. Based on this, the authors designed a conceptual framework model (Figure 2.3), that describes the effect of the four elements of universal design. According to their study functionality, usability, performance, and product attachment are important contributors to universal design (Singh & Tandon, 2018). 12 2. Theory & Background Figure 2.3: Universal Design of Instruction (UDI) framework (Burgstahler, 2020). 2.3 Disabilities A disability applies to individuals with a long-term physical, mental, intellectual or sensory impairment that might hinder an individual’s full and effective participa- tion in society when interacting with different attentional or environmental barri- ers (United Nations, n.d.). This refers to people with perceptual disabilities, such as hearing and visual impairments, motor disabilities, such as limited or no use of hands, arms, legs, mouth and cognitive/intellectual disabilities, such as lifelong impairments as down syndrome or autism or impairments that develop over time such as dementia or Alzheimer’s disease or event-based impairment such as aphasia (Lazar, Feng & Hochhesiser, 2010). Lazar et al. (2010) write about the impor- tance of involving users with disabilities in research to avoid researchers making assumptions based on stereotypes. 2.4 Designing for disabilities To avoid exclusionary design (Singh & Tandon, 2018), and to approach universal design that will make the use of digital devices similar for everyone there is a need to understand all the various users and their needs. It is important to have a diverse awareness of different disabilities and the critical features that are important to be able to interact with an interface. Therefore, in this section focus has been to under- stand the needs of people with dyslexia, visual impairments, cognitive disabilities, elderly people and children. These disabilities were chosen to cover a wide variety of different disabilities to include a diversity of people in the research for this project. 13 2. Theory & Background 2.4.1 Dyslexia Dyslexia is a cognitive learning disorder regarding reading, spelling and written language but can also affect number work (Vangeli & Stage, 2018). It can take different forms and can manage differently depending on which age a person is diag- nosed (Habib & Giraud, 2013). Habib and Giraud (2013) state that dyslexia affects the acquisition and development of written language, and a person with dyslexia has a poorer reading performance with a greater deviation compared to others of the same age. A person with this learning disability cannot write or read, understand and interpret texts in the same way as a person without dyslexia can and therefore, dyslectics often experience difficulties in their daily life (Habib & Giraud, 2013). Vangeli and Stage (2018) have in their research found common dimensions and elements among interaction design parameters which support and improve users in their reading skills. Technology is a helpful tool that can contribute to the im- provement of dyslectics’ cognitive skills. In their study of interaction design and dyslexia, the focus was on functionality and user interface, leading them to estab- lish some guidelines and parameters focusing on helping dyslectics to improve their reading skills. The three factors that facilitate dyslectics to improve their reading performance are: font size, colors and layouts (Table 2.2). Table 2.2: Factors to support for dyslectic users. Font Color Layout Size 12-14 Avoiding bright colors Simple and clear Sans Serif fonts Light grey as font color, or have a light contrast between background and fonts’ colors Large letter spacing Text should be enriched with pictures and audio elements Have clear differences among text and back- ground Lines of 60 to 70 charac- ters Line spacing: 1.3, 1.4, 1.5, 1.5–2 Narrow columns should be avoided 2.4.2 Visual impairments People who are visually impaired use touchscreen devices differently than fully sighted users do. Fleizach and Seymour (2013) claim that digital products are increasing and touchscreen interfaces are becoming more common. Huang (2018) has explored factors of accessibility of touchscreen interfaces for people who are visually impaired. Touchscreen has become a standard feature of smart mobile de- 14 2. Theory & Background vices and provides an easy-to-use interface and smart devices can provide different assisting tools supporting people with disabilities. Smartphones are equipped with many accessibility functions such as VoiceOver, text-to-speech functions, inverted screen color and larger font size, which enables visually impaired users to use these devices. However, these functions are only basic and insufficient where visually im- paired users still face difficulties using touchscreen interfaces. This is mainly due to the fact that a touchscreen does not offer any tactile feedback (Huang, 2018). Furthermore, Huang (2018) describes a smartphone wayfinding system for visually impaired people. This system used auditory and tactile feedback to compensate for the visual information on the screen, and the result showed that visually impaired and blind users effectively could use the application without assistance. Huang (2018) outlines several functions that can improve accessibility on mobile devices for people with visual and motor disabilities, such as screen readers, voice input, large buttons, screen magnification and high-contrast screens. Including a bold bor- der around an object to induce that it has been pressed which would enable for visually impaired users to locate and track clues on the screen. Sound feedback or auditory clues, that describes the current object that has been touched enhances the input. Also, the interface should provide tactile and vibration corresponding to the signals. Voice control functions such as Siri (iOS) and Google Now (Android) are included in smartphones and can assist users to operate and control their phones through their voice. Also, touchscreen interfaces include lots of ‘multipoint gestures’ to operate different functions, for example zoom in and out with the pinch gesture. However, these systems are provided with an assisting tool so that the same function can be performed with one finger as well. Huang (2018) states that the content in an interface should be read aloud using voice control when users touch the screen interacting with text or objects in the interface. Furthermore, even non-textual ob- jects should have auditory information and ‘speak out’. It is also of importance that when an interaction with the interface has been made, the interface should announce the action. Lastly, contrast of the interface should be high because it makes text and objects easier to perceive for visually impaired users, and a function to invert the colors on the screen can be used to achieve high contrast. 2.4.3 Elderly people Mobile phones are an essential gadget in ederly people’s life, and have become a great necessity for them (Al-Razgan, Al-Khalifa, Al-Shahrani & AlAjmi, 2012). However, the graphical interface of the mobile phone has become more complicated (Al-Razgan et al., 2012), and with a growing elderly population, the technological innovations need to support the growing population in their need of help to manage their everyday life (Endter, 2016). To design for eldery people is a challenge as age- ing is a life-long process that differs between individuals (Endter, 2016). However, with a growing age the physical health and cognition is declining, elderly people can suffer from gradual deterioration in their hearing, visual and cognitive abilities (Sugam & Wong, 2019). For devices to have an age-friendly design it should be adaptive, usabel, affordable, 15 2. Theory & Background discreet and intuitive, and also allow elderly to be independent in their numerous areas in their life, especially regarding health, house, mobility, security and com- munication (Endter, 2016). To design for elderly the graphical interface needs to require minimal physical, visual or cognitive operational stress (Sugam & Wong, 2019). Further, Al-Razgan et al. (2012) present a set of guidelines and design rec- ommendations for touch based mobile phones interfaces that are targeted towards elderly people (Table 2.3). Table 2.3: Factors to support for elderly users. Functionality Look and feel Interaction Functionality of the same type should be grouped together Three- dimensional appearance button for touch-screens Easy to zoom in and out and pinching Main navigation placed identically on all the “pages” Separate keypads for numbers and letters Tapping with audio con- firmation Critical functions should never disappear Good spacing between buttons Tap action and not drag and drop Important functions placed at the top of the screen to avoid mistake touches Larger font for text and labeled icons The interface needs to clearly express where the user is, and which “task” is active Buttons for specific ac- tions, e.g. a single but- ton to return to the home state The most important fea- ture available directly via a labeled button and not via menu navigation Avoid slide-out keyboard Naming programs and commands Not to have too many or too few features 2.4.4 Cognitive disabilities A cognitive challenge or disability can take different forms and vary within individ- uals. Cognitive disabilities are generally considered to include learning disabilities, autism, traumatic brain injury, aphasia, attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), alzheimet’s disease etc (Friedman & Bryen, 2007). Some cognitive capabilities will never change, some might change over time 16 2. Theory & Background if an individual has had a concussion or a stroke and some people might experi- ence gradual degradation in mental capabilities over time (Bessa, 2012). Many of these disabilities include deficits in memory, perception, problem-solving, conceptu- alization and attention. This creates innumerous accessibility barriers in use of web applications and individuals with cognitive disability can experience difficulty using the web due to limited reading comprehension, complexity, slower learning, limited fine motor control, reduced spatial perception, lowered visual acuity, less hand/eye coordination, finger dexterity and lowered information overload thresholds. Prob- lems can occur when a user have to control the mouse, click and locating on small items, read the text, navigate the screen, distinguish foreground images and text from background material or have to choose between many different options as it can be hard to recognize the most appropriate choice (Friedman & Bryen, 2007). Friedman and Bryen (2007) conducted 22 web design recommendations that fo- cused on addressing cognitive disabilities, cognitive impairments, learning disabili- ties, dyslexia, aphasia and intellectual disabilities. The recommendations as follows regard these addressed disabilities shown in Table 2.4. 17 2. Theory & Background Table 2.4: Factors to support for users with cognitive disabilities. Cognitive disabilities Use pictures, icons and symbols along with text Use clear and simple text Consistent navigation and design on every page Use headings, titles and prompts Support screen readers. Use alternate text tags Use larger fonts, fonts in minimum 12pt or 14pt Uncluttered, simple screen layout Maintain white space: Use wide margins Website customizable, control of: type size, placement of navigation (right, left side) contrast, large print, sound Use exit, home, help, next page buttons on every page Use with sans serif fonts, such as Arial, Verdana, Helvetica, Tahoma Navigation buttons should be clear, large, and consistent Use numbered lists rather than bullets Support font enlargement for Web browsers Use color for contrast Check reading level with automated tools Don’t right justify text; use ragged edge right hand margins Use lower case, no all in caps Provide voice captions (audio files) for text Provide audio/voice-overs where the words are read aloud Use navigation methods, i.e. ‘undo’ or ‘back button’ to help users recover when lost Give feedback on a user’s actions (e.g. confirm correct choices, alert users to errors or possible errors) 18 2. Theory & Background 2.4.5 Designing for children Adults and children have different information-seeking behaviours as children are more effective, efficient and provide more quality in their searches and web naviga- tion than adults. Children like to play games and lack reading fluency, and they are curious. Therefore, the conventional interfaces that are rigid, text-based and task-oriented are inconvenient for children in their information-seeking. This means that information-searching interfaces that are designed for adults might not be as effective for children. As children have limited information seeking capabilities they need an interface that helps them with their information searching barriers. One way to do this is to have icons in the interface that are simple with a clear meaning (Wu, Tang & Tsai, 2014). Kamaruzaman, Rani, Nor and Azahari (2016) designed a touchscreen mobile ap- plication to assist the teaching and learning of numeracy and basic calculation for children with autism. The authors mention the importance of using both pictures and words next to each other where the pictures should be big and easy to under- stand, there should be short sentences and if difficult words are used they should be explained. Additional recommendations that the authors describe are to keep sentences together in one page to not fill it with too much information, illustrations should be in sharp focus, never to use inverted printing and never use roman nu- merals. Shneiderman (2004) writes that children expect to have fun while they are using technology and that children often link the idea of fun to challenges, social interac- tion and control over their world. He recommends designers to address three goals that contribute to make the interface fun, which are providing the right functions so that users can accomplish their goals, offer usability plus reliability to prevent frustration from undermining the fun and engage users with fun-features. To reach the second goal he lists eight golden rules for designing a user interface; strive for consistency, cater to universal usability, offer informative feedback, design dialogs to yield closure, prevent errors, permit easy reversal of actions, support internal locus of control and reduce short-term memory load. 2.5 Designing with icons Huang, Shieh and Chi (2002) describe that icons are commonly being used as a communication tool in an interface, since icons can be easy to recognize, remember, and have more universal recognition than text as icons interfaces confront fewer obstacles than language, and offer a perception of affordance. However, there are two common problems regarding icon designs. One of them is that icons often have language barriers that do not guarantee an instant comprehension within or across cultures. The other problem refers to the fact that people cannot quickly locate the icons they need. Previous studies indicate that factors that affect the quality of the icon are that they need to be identifiable, meaningful, concise, associable, and memorable (Huang et al., 2002). 19 2. Theory & Background 2.5.1 Pictogram design Pictograms are symbol-based icons that represent an object or concept through a simplified illustration. Pictograms are specific for being an image-like graphic sym- bol that is illustrated in white on a black background and every symbol stands for a word or a concept. These are used to communicate at a simple linguistic level, to be an alternative to the written language and can serve as a support for time, structure, memory and location. Pictograms can also be used as signage in public environments, and since they are clear and quick to read, it can provide a better understanding of written signs (Specialpedagogiska skolmyndigheten, 2020). Pictogram is a quick reading visual language that is designed for people with diffi- culties in reading, and has been shown to improve communication for many disabled people. Each Pictogram image has a universal meaning that makes it work in sev- eral similar contexts which provide the user with abstract thinking and give each Pictogram image a general meaning (Specialpedagogiska skolmyndigheten, 2010). Lidén (1999) suggests that Pictograms should be low iconic images, which are a combination of very simple silhouettes and pictures with some reproduction of de- tails, structures and simple perspectives. They should be designed with the highest contrast possible, such as white silhouette figures with black background to help to perceive the images quickly (Lidén, 1999). 2.5.2 Pictogram on signage Siti and Swasty (2017) write that the importance of signage is not only to steer the place or location but also to inform visitors about rules that exist inside or outside of a building. Having a presence of pictograms makes an easier identification and understanding of the scheme and can communicate information to visitors briefly and effectively. Many pictograms may be used in different domains without problems concerning the graphic representation and meaning of them, such as men/women toilets, lift, escalator, stairs, parking area, which is usually understood by everyone, as it has a simple graphic drawing using a very familiar representation. Symbols can overcome a language barrier and can therefore be useful on signage in public facilities where visitors might come from different cultures or speak different languages, as in hospitals, hotels or airports. Some symbols can be understood all over the world, such as arrows, and the most common one used in signage is a map. A map can be necessary when communicating the position of places and spaces, as it is a visual replacement for complex direction and is often additional information content for signage (Siti & Swastys, 2017). Further, pictogram is an informative signage element that is important to clarify information that does not require reading the text and are useful in signage for three reasons: to save space of sign, that the meaning of a symbol can overcome the language barrier, and it can help communicate more clearly than words. Pictograms communicate visually rather than verbally, and to convey good communication without words it is needed to have a good representation because a graphic and visual language is above the written language. Therefore, pictograms on signage should be standardized and informative (Siti & Swasty, 2017). 20 3 Related Work This chapter will describe some of the previous work related to this field of research. The topics of this chapter concerns the meaning of wayfinding, wayfinding in indoor and hospital environments, and previous and existing wayfinding systems for indoor navigation. Further, the chapter touches upon the challenge of live positioning for indoor navigation. 3.1 Wayfinding The process of determining where to go, how to best navigate and understand one’s location in an unknown environment, is called wayfinding. Wayfinding facilitates navigation in large complex buildings and environments, such as hospitals (Harper, Duke, Crosser, Avera & Jefferies, 2020). It has been shown that it is commonly difficult to navigate at places like hospitals, and that poor signage and architectural planning makes it inefficient to navigate (Smolenaers, Chestney, Walsh, Mathieson, Thompson, Gurkan & Marshall, 2019). Traditional wayfinding systems are often based on static signage, such as text signs, arrows, color and numeric coding. How- ever, it can cause confusion for the wayfinder when an excessive number of signs are presented and can lead to information overload. Therefore, hospital environments are usually too complex to explain with signs (Morag & Pintelon, 2021). Smolenaers et al. (2019) explain existing wayfinding strategies and present some potential solutions to the problem of wayfinding in complex environments. Signage is the most obvious method of wayfinding in public spaces, but unfortunately it often involves complexity and difficulty. Morag and Pintelon (2021) claim that signs do not convey cues that are simple enough and it does not provide natural movements. Smolenaers et al. (2019) write that a solution could be to use icons and symbols in order to make the signage more effective and universal, maps are another common method to use for indoor navigation. However, many hospital maps lack accessi- bility where it uses exaggerated acronyms, nomenclature, lack of details, and are out of date. Signage and maps could also differ in their designs, which can make it inconsistent and confusing for the users. Additionally, visual landmarks and motifs can be built in the environment and work as a help for orientation and navigation within a space. Some hospitals make use of a concierge system to offer help with wayfinding where visitors can seek wayfinding assistance either by getting directions to their destination, or by getting help by a concierge accompanying them to their destinations (Smolenaers et al., 2019). 21 3. Related Work Traditional wayfinding using environmental cues and signs, has advanced by the use of technology such as interactive displays, kiosks and mobile applications. The purpose with using an application is to simplify the wayfinding as it allows the user to access the essential information about their whereabouts and helps them navigate individually in the complex environment (Harper et al., 2020). Morag and Pintelon (2021) describe digital wayfinding to be beneficial for the user since it helps them find the simplest route to their destination or the possibility to adjust the displayed information to fit their needs and preferences. Therefore, in the designing of such wayfinding applications it is of importance that the application is easy to use, effec- tive, accessible, and intuitive (Harper et al., 2020). According to Marshall (2017), there are many advantages and possibilities with a wayfinding application. However, it cannot constitute as the sole source of wayfinding in healthcare facilities. There is a risk that wayfinding technology would be highly favored by younger visitors and patients, but might not be utilized or even understood by the older adult popula- tion. Additionally, a population of users with various types of disabilities such as blindness, hearing loss, or cognitive impairments, may be excluded from using the application because their needs have not been taken into account. Even language barriers and cultural barriers may exist (Marshall, 2017). 3.2 Wayfinding in hospitals Hughes et al. (2015) argue that many people, both visitors and staff, experience issues navigating in hospitals and that there were concerns about not arriving at appointments in time, and having to plan for the total travel time to the destina- tion. Other barriers that affected navigation involved security and limitations to access where some sites might be isolated or closed, which can prevent both staff and visitors taking the optimal route. Barriers to navigation is also about cognitive limitations and the mental state of the person in need of navigation. Stress, sickness, confidence and mobility can have a large impact on their attempt to navigate and people having different needs require help in various ways (Hughes et al., 2015). Hughes et al. (2015) have listed different types of navigation aids that involve the interaction between the hospital and its users, where the first interaction often involves textual information. Verbal directions is another navigation aid often used to seek guidance and was also found to be the most popular form of navigation aid in their study. Other examples of navigation aids mentioned are different types of maps, labeling systems, physical landmarks and external information such as GPS applications and websites. Further, it was found that participants valued clear, con- sistent and comprehensible information that were delivered verbally, through signage or with the use of colour. 22 3. Related Work 3.3 Wayfinding and indoor maps Indoor navigation is not as developed as outdoor navigation, but in recent years it has gained much more attention (Diakité & Zlatanova, 2018). Indoor maps differ from outside maps where there are pavement and roads to help organize the naviga- tion. Diakité and Zlatanova (2018) describe the importance of having a non-trivial navigation system to support guidance and possible evacuations from a building. The authors present a framework that considers the complexity of an indoor en- vironment and provides a spatial partitioning scheme. It mainly presents three different types of objects that can be found in different buildings and indoor envi- ronments, which should determine the map’s planned route. These objects will be distinguished on the basis of their mobility, where static, semi-mobile and mobile objects can occur. What kind of object it is depends on their ability to indepen- dently change their position. This classification of objects can facilitate the design and production of an indoor map. Another study performed by Ponchillia, Song-Jae, Kim and Harding (2020), investi- gated the needs and preferences of users who are visually impaired. The participants in the study stated that the most important type of indoor information was points of interest, e.g., elevators, bathrooms, cafeterias. Further, the most important feature of an application was the ability to know one’s location at any time. When it came to finding the best output mode, verbal output and vibrational cues were the most suitable. The result from the study showed that airports and bus or rail transit facilities were buildings where it was most important to have navigation systems, and sports arenas and airports were buildings where it was generally most difficult to navigate. 3.3.1 Positioning for indoor navigation The field of indoor navigation, and more specifically indoor positioning, is a fairly new subject and has not yet achieved the same success as outdoor positioning. In- door positioning systems (IPS) are used in different ways to locate objects in an environment where GPS and other satellite technologies lack precision and can not be used indoors because of disturbed reception of signals (Santosh, Kwon, Shin, Hwang & Pyun, 2016). Locating an object with GPS signals requires undisturbed reception of signals from at least four satellites, and therefore other technology to facilitate indoor positioning is needed (Santosh et al., 2016). Bluetooth Low Energy (BLE) beaconing technology, trilateration, triangulation, and geomagnetic field fin- gerprinting are some options that can be used for indoor positioning (MazeMap, 2021; Bekkelien, 2012). A BLE beacon is a small wireless transmitter that sends signals to other devices nearby (WordStream, 2020), where these signals can be picked up by a compatible application or operating system to determine its physical location (Wang, Yang, Zhang & Zhang, 2015). Wang et al. (2015) describe this technique having high potential when it comes to indoor positioning as it has both low energy consump- 23 3. Related Work tion and low cost and can cover up to 100 square meters depending on the signal power. By using BLE beacons it is possible to set up a network inside a building to support indoor positioning by detecting objects within its range that are receiving the signals and with an algorithm calculating its physical location. However, these transmitters need to be installed in the physical environment to communicate to other devices, such as a smartphone, to send and receive signals form. 3.4 Previous wayfinding systems in complex en- vironments Morag, Heylighen and Pintelon (2016) argue that wayfinding with poor design might cause the user stress, anxiety and can also be costly due to lost time. While wayfind- ing with good design can reduce stress and give people a sense of control and empow- erment. When it comes to large complex buildings such as hospitals, that might be growing and expanding, a need for a good wayfinding system becomes more critical and acute. To design a good wayfinding system Morag et al. (2016) claim that the system should communicate to the broadest target group possible, hence taking into account the different sensory, physical, language, intellectual needs, and social and cultural backgrounds that people might have. In the study of Morag et al. (2016) it was found that a diversity of hospital user’s face difficulties at the entrance, and that directional signs were difficult to understand if the icons and symbols were color coded with different colors. Several participants also reported that they did not receive enough satisfying feedback when they had arrived at their final desti- nation and therefore needed to ask to be sure. All participants managed to reach one destination but when they needed to reach several destinations in a sequence, it was even more complicated and time-consuming to understand the colored signs and symbols (Morag et al., 2016). Harper et al. (2020) examined what aid is the most efficient for wayfinding systems in complex environments and discovered usability issues that impact the effective- ness of a mobile wayfinding application used by large complex hospitals providing information recommendation used to enhance the user’s navigation. The research conducted by Harper et al. (2020) examined the usability of an interactive wayfind- ing on a touchscreen kiosk and of an interactive wayfinding mobile application. The results indicate that the mobile application solved the problem of cognitive load as the participants were able to bring the instructions with them. Another problem dis- covered in the kiosk but solved in the mobile application was an accessibility issue of being able to reach and use the kiosk from a wheelchair. The mobile application pro- vides a more accessible option for everyone, including people with disabilities, since it is possible to be used remotely and therefore presents the possibility to bring the instructions. Further, the information provided by the application complemented other wayfinding aids used in the physical environment, such as landmarks, signage and color. Therefore it is beneficial if the application and the environment match as it is more efficient for wayfinders to be able to identify their position using cues in the surroundings. The mobile application solved several problems that existed 24 3. Related Work with the kiosk, however it did not include a universal search feature, providing in- structions on how to access help from a human, or provide location-based navigation. Harper et al. (2020) describe three recommendations designing for mobile applica- tions to be used in a hospital. The first recommendation is that the system should provide a search function that will allow the participants to search for a diversity of data, where it is of importance that the search function is easy to discover and that it will be easy to use. The other recommendation is an option to locate a help desk. If participants did not feel that they got the assistant they needed from the system, they would ask a staff member to help. Even if the system aims to work without any need for external help, it is beneficial to provide that option which would increase the effectiveness of the system. The third recommendation is that the system should provide a map for visual aid with appropriate orientation. The system should therefore be designed to provide a list of instructions for navigation with symbols, buttons and icons matching the environment. Morag et al. (2016) discuss the development of different technologies that can assist people in their wayfinding since it is complex to navigate in hospitals even with the use of signage, spatial cues such as arrows, numeric encoding, color coding, guid- ance from staff, etc. The implementation of customized and adaptive technologies produces a personal wayfinding guidance that is tailored to meet the users personal needs. They mention examples of a system having arrows presented on the floor to direct a person or have dynamic displays along the route to present relevant infor- mation based on the people’s specific needs, such as large fonts for visually impaired users, or English for them who do not speak the local language (Morag et al., 2016). Morag and Pintelon (2021) carried out an interview study in twenty hospitals to evaluate digital wayfinding systems, to find the challenges and the benefits associ- ated with these systems and to help understand why these systems are widely used in commercial environments but not as common in hospital environments. Despite the benefits that digital wayfinding systems offer for the hospital wayfinders the actual presence of them in hospitals are low even if the system offers a considerable potential to assist elderly or people with disabilities. As these digital wayfinding systems increase there are important issues that have not yet been shown in the literature about this subject. This includes user responsiveness in operating the sys- tems, which particularly applies to elderly people, an evaluation of the benefits that a system would provide for hospitals, and the system’s ability to support people with disabilities. When wayfinders navigate inside a complex environment such as hospi- tals, individuals usually use the information of an available wayfinding system with information provided in the buildings architecture, landmarks, and interior design. Therefore, when the hospital grows and changes it becomes even more complex as a wayfinder to navigate having to adapt to new routes. This is especially challenging for the growing number of elderly people who usually visit hospitals more often than the young population (Morag & Pintelon, 2021). The result from Morag and Pintelon (2021) study indicates a consensus that digi- 25 3. Related Work tal wayfinding systems bring a significant value both for the hospital and its users and believe it will become more common with these systems at hospitals in the future. First the authors apply to the individual trust in the technology. If some information does not provide the users’ needs, they will want to speak to someone and this worry will increase if there is any communication lost or delay in receiving information, especially for elderly and people with impairments. Further, the au- thors refer to the reduced task complexity and the overall user stress and anxiety as the systems simplify the wayfinding complexity, users can more easily navigate from one department to another, and it also makes the movement between floors easier. As the users are able to see the duration to their destination it also reduces the stress level. Further, the authors refer to the parallel or substitute use of static and digital systems. Elderly users are especially familiar with the signage system and might prefer using it, therefore there should be an overlap between the systems. The signage system should also back-up the new digital system based on the reli- ability issues users might have. Lastly, regarding the individual user’s perspective, the system supports people with diverse needs and abilities. For example, people with reduced movement could find the shortest route and the people with vision impairment could adapt the information in the system based on their needs (Morag & Pintelon, 2021). Outdoor wayfinding applications of different kinds are common to use on smart- phones, but limitations with electronics and the ability to accurately position loca- tion and tracking of movement is a reason why indoor navigation is not as widespread. Indoor maps must also be adapted in such a way that they are suitable for use in a navigation application (Smolenaers et al., 2019). Smolenaers et al. (2019) de- scribe three phases of where a navigation application has been developed, tested and evaluated. During user testing some confusions were discovered regarding the map. Some users found it confusing when the map and symbols rotated on the map, and the level of detail was agreed to be too complex. Further, some problems with the tracking of the user in outdoor areas between buildings and parking areas were discovered. A suggestion to solve this was to add color to the application to distinguish inside rooms from outdoor areas. The evaluation and usertesting led to some additional improvements such as icons to mark points of interests on the map. Additionally, to improve the design of the map, the path was highlighted in blue in front of the user with a blue arrow pointing in the right direction, where the path then changed to white behind the user to convey a clear difference between forward and backward on the path. Another feature that was added was “favourites” and “recent destinations” so that users could easily save and find previous locations. To facilitate for the user to pre-program their destination a QR code is included in the clinic appointment letters that can be scanned within the application. A devel- opment of this feature could also include guidance to the hospital from the user’s home. Lastly, Smolenaers et al. (2019) describe some improvements for future de- velopment of the application which involve accessibility features for users who are visually impaired, but also support of additional languages. 26 3. Related Work 3.4.1 Existing indoor navigation applications A study conducted by Marshall (2017) explored the possibility to assist visitors with smart phone navigation. The purpose of this study was to develop a wayfinding smartphone application, Navihealth, for a large healthcare facility to help visitors navigate in the buildings, which would decrease visitor stress and improve over- all patient satisfaction. NaviHelath gives real-time navigation with step-by-step instructions and offers navigation for indoor facilities, between multiple buildings, through parking areas but also to locate the hospital itself (Marshall, 2017). An advantage of the application was that it could be updated and suggest alternative routes, if any part of the building would be closed or if an elevator would be bro- ken, compared to signage in hospitals. Apart from patient satisfaction and reduced stress, the application could also entail improved staff workflow due to a reduction of staff having to provide directions to visitors or patients. Marshall (2017) also describes some weaknesses of the application where the absence of owning a smart- phone or not using navigational services, which makes the application less accessible. The result of the study showed that participants expressed a strong interest in the application and that it would likely have a positive impact on helping visitors and staff (Marshall, 2017). Norwegian University of Science and Technology together with Wireless Trondheim developed the application MazeMap, a wayfinding application for indoor and out- door navigation (Biczok, Diez Martinez, Jelle Krogstie, 2014). The application allows the user to navigate with an accuracy of 5-10 meters, see buildings on the map, locate one’s position within a building and search for rooms and other objects such as toilets and parking lots. The users are also being presented with step-by-step directions of where the user is and where they are going. The aim with MazeMap is to help the user to navigate with the use of smartphones, tables and laptops. The MapsIndoor navigation system was developed in 2014 by Mapspeople and was first designed for indoor navigation for the University of Copenhagen (MapsPeople, n.d.). MapsIndoor is designed to make wayfinding in indoor complex areas easier as the platform is built on Google Maps, which is supposed to create a smooth transition between indoor and outdoor navigation. The purpose is to have the op- portunity for users to navigate from one’s home to a specific point of interest (POI) inside a building. The system can be integrated into mobile applications, kiosks and websites which provide the users with a digital navigation tool to help them navi- gate within a large indoor facility with only the usage of a smartphone. Since GPS doesn’t work inside buildings, MapsIndoors native application can be integrated to either Blutethoos beacons, WiFI positioning, positioning via magnetic fields or via lighting. Indoor spaces can occasionally change, and with an Indoor Navigation Content Management System allows developers to add, edit and delete points of interest. With the system it is possible to see the users exact location (MapsPeople, n.d.) 27 3. Related Work 28 4 Methodology This chapter will explain various kinds of research methodologies that can be applied during the research and design process. All methods contribute to different solutions and are being used for different purposes depending on the design being developed. Therefore, this section will describe the aim of each method and how they are applied in practice, and not the actual application of the method for this project. A detailed description of the chosen methods applied during this project will follow in chapter 6. Execution and Process. 4.1 Design thinking Booth, Colomb, Williams, Bizup and FitzGerald (2016) write about the importance of asking why the performed research is important. The aim with the research ques- tion“to find design solutions that are important when designing a universal accessible application for indoor navigation in a hospital environment” is to investigate how to design a product that can be useful for everyone. The objective with this project is to find guidelines of what to consider when designing an accessible application for indoor navigation for future designers and developers to pursue, to be able to create designs that everyone can use. Booth et al. (2016) further mention the importance of having a plan when a re- search question is set. A plan to test the gathered data for the research question and perform research. In order to do so, the ambition with this project is to per- form user research to gather insights and needs from people with various disabilities of what is important for them along with support from literature about design for disabilities, as the primary sources for this project. Further, the secondary source will be peer-reviewed literature of existing, tested and planned navigation systems for indoor hospital environments. The intention with this project is to make claims and arguments of how to design an accessible application for an indoor navigation system for hospital environments based on acknowledgement and responses from user research, literature and usability testing (Booth et al., 2016). Graver (2012) writes that over the last year it has become more common to perform research through design (RTD), and mentions that there have been opinions about it lacking clear expectations and standards of what is good design research. However, Graver (2012) reasons that standards might be too restrictive and that RTD should be exploring, speculating, particularising and diversifying rather than being scien- 29 4. Methodology tific. The methodology plan for this project was to perform research through design, by the designing of an indoor navigation application, to envision design solutions that are important when designing a universal accessible application for indoor nav- igation in a hospital environment. This was planned to be done by first gathering insights and opinions based on literature and conducting user tests, to then analyse the result and use it as a foundation in the iterations of the designing of the interface to lastly perform iterative usability testings to evaluate and test the product. The aim with the project was exploring, speculating and finding new insights of how to behave when designing an accessible indoor navigation application for hospital environments. 4.2 The design process Hartson and Pyla (2012) write that building usability into a system requires an interaction design process to help guide the designers with a structure to deal with the complexities in a project. The guidance from a design process ensures that important phases in a development of a product will be present. The double diamond design process (Design Council, 2021) will be used as the foundation for the design process for this project. The process is divided into two diamonds with four phases; discover, define, develop, and deliver, as presented in Figure 4.1. Figure 4.1: The double diamond of design (Sharp et al., 2019). 4.3 Discover The first phase of the diamond, the discover phase, is to help understand the prob- lem and the users to be able to design based on gathered insights and findings, 30 4. Methodology rather than assume what the problem is or what the users needs are. This phase includes doing research of the problem and involves users that are affected by the problem (Design Council, 2021). Literature review A literature review establishes the context of the study and gains insights for the researchers about the subject, to help understand gaps in the field, unresolved issues and new perspectives (Turner, 2018). Focus group Focus groups are interviews held in group sessions and are beneficial since they al- low for perspectives that might not have been raised without a group. The method captures shared experience and enables individuals to put forward their opinions and insights. The sessions should be guided by facilitators but allow for flexibility to let the discussion steer and follow unanticipated problems and issues that are being mentioned (Sharp et al., 2019). Brainstorm Brainstorming (BS) is a technique that can be used to reach solutions to practical problems and fosters group creativity where ideas and thoughts are shared among members spontaneously (Al-Samarraie & Hurmuzan, 2018), but it is beneficial if BS sessions are planned for in advance (Bonnardel & Didier, 2020). Positive feedback is important to increase a group’s creativity (Lu, Qiao & Hao, 2019) and there are several ways to reduce performance anxiety or stress by tackling the problem from different perspectives, such as having a BS session to consider the worst possible idea (Interaction Design Foundation, n.d.-c). Al-Samarraie and Hurmuzan (2018) write about three different brainstorming tech- niques, where the performance of these techniques is highly dependent on the con- text. In verbal/traditional brainstorming (TBS) group members actively participate in a dialogue and verbally share their ideas one at a time. This helps group mem- bers to combine ideas, however, it can be discussed that individuals working alone produce more ideas, and therefore nominal brainstorming (NBS) promotes group members to generate ideas individually and no communication with other group members takes place. Electronic brainstorming (EBS) facilitates simultaneously idea generation with the use of online resources. The discussion process can be sup- ported by chat, e-mail or other resources to enhance a group discussion. Kunz et al. (2014) write that challenges can occur when sighted and blind peo- ple collaborate as it can be difficult to overcome the different ways of perception and expression. A BS session mixed with both sighted and blind people could lead blind people into an unintended and unconscious exclusion. Screen readers and Braille can be used to access the same digital information for a sighted and for a blind person. However, accessing and processing the information will be differ- ent since visual channels allow for fast and parallel perception of information while Braille or audio is not comparable to a serial perception. Therefore, blind people 31 4. Methodology will need more time to process the content of the information. Non-verbally com- munication such as gestures, postures, facial expression provide a large amount of information that is only processed visually. These non-verbal expressions are also used when conducting a BS session for coordinating the discussions and turn taking. To engage blind people for these coordinations is by verbalizing it which evokes new problems as non-verbal communication is parallel and unconscious and thus have to be made conscious to be ab