The Design and Prototyping of an App to Teach Adults with Intellectual and Developmental Disabilities to Empower Them Against Abuse
Krishna Venkatasubramanian, Tina-Marie Ranalli, Jack Lanoie, Alexander Sinapi, Andrew Laraw Lama, Jeanine Skorinko, Mariah Freark, Nancy Alterio · 2023 · ACM Transactions on Accessible Computing · doi:10.1145/3569585
Summary
This paper presents the design and prototyping of "Recognize," a mobile app that empowers adults with intellectual and developmental disabilities (I/DD) to independently learn about abuse. The work addresses a critical problem: people with I/DD are sexually assaulted seven times more often than people without disabilities, yet abuse is severely underreported because many individuals with I/DD are unaware of what constitutes abuse or how to report it. The researchers conducted an auto-ethnographic co-design process with self-advocates from the I/DD community, specifically partnering with Massachusetts Advocates Standing Strong (MASS)—a self-advocacy organization where the board of directors comprises entirely people with I/DD. The co-design team included three individuals with I/DD who have each led over 100 abuse-prevention trainings and are themselves abuse survivors. This positioned people with I/DD as experts rather than subjects. The app content derives from the "Awareness and Action" (A&A) training, a three-hour in-person workshop taught primarily by individuals with I/DD that covers five types of abuse: physical, sexual, verbal, financial, and neglect. The co-design process produced six design concepts across two categories: learning design concepts (static slides, video, skill activities, quizzes) and engagement design concepts (grounding activities for self-regulation, emoji-based rewards for motivation). Three initial prototype variants were created and evaluated with six instructor-participants who teach abuse prevention. Based on their feedback, a consolidated prototype combining all approaches was developed and tested with 11 participants with I/DD representing eventual users.
Key findings
The consolidated user study revealed several important findings about designing sensitive educational content for people with I/DD: Images were highly valued for learning. Most participants (9/11) found the static learning content with images helpful, noting that pictures helped them understand abuse more clearly than text alone. However, about a quarter of participants appeared not to read the accompanying text, suggesting narration with captions is essential for accessibility. Video content was considered useful despite its triggering potential. Almost all participants (10/11) liked the video learning content because it showed realistic scenarios. However, participants requested three improvements: more context about characters and situations, narrative closure showing the outcome (was abuse reported? was the perpetrator held accountable?), and pre-video clarification that the scenes are fictional. Engagement mechanisms were effective. The emoji-based reward system was almost universally liked (10/11 participants), with some preferring the term "prizes" over "emojis." Grounding activities (breathing exercises, music-making) were appreciated for self-regulation, though participants requested more variety including physical activities like walking or yoga. Skill-learning activities had mixed results. The private body parts identification activity made some participants uncomfortable, and the money-counting activity was inaccessible to those with limited literacy. The researchers concluded skill activities should focus on distinguishing abuse from non-abuse generally, rather than categorizing specific abuse types. An unexpected finding was that participants saw the app as a tool for indirect reporting—helping individuals with communication difficulties show what happened to a mandated reporter who could then file a formal report.
Relevance
This research provides a model for designing technology that addresses sensitive topics for people with I/DD. The co-design approach—partnering with self-advocates who have lived experience as both abuse survivors and trainers—demonstrates how to position people with disabilities as experts rather than passive research subjects. For practitioners developing e-learning content for people with I/DD, the study offers concrete design recommendations: (1) present content visually using images with text, plus narration and captions; (2) use videos to demonstrate real scenarios but include context, narrative closure, and pre-video warnings; (3) incorporate grounding activities with both digital and offline options; (4) use non-punitive reward mechanisms; (5) keep language simple, direct, and conversational—avoid euphemisms and academic terminology. The finding about indirect reporting has implications for abuse reporting systems. People with I/DD may be able to use visual apps to communicate what happened to them even if they cannot verbalize it, enabling mandated reporters to file appropriate reports. This suggests accessibility features in reporting tools could significantly improve abuse documentation. Limitations include that the study was conducted over Zoom due to COVID-19, which created technical barriers. The participants had mild-to-moderate I/DD and considerable digital skills; the app may need further adaptation for people with more significant disabilities. Additionally, the sensitive private body parts activity caused discomfort for some participants, highlighting the need to carefully consider how such content is presented.
Tags: intellectual disability · developmental disability · abuse prevention · self-advocacy · co-design · mobile app · e-learning · empowerment