Dismantling perceptions of priority and the hierarchy of importance of AT?

by David Banes.

It is not a new issue, but it is worth regularly revisiting. I recently sat in two meetings where one or more people suggested that when planning the provision of AT, we needed to focus on the most important items first. In their minds, these were very traditional AT, mobility aids, spectacles, hearing aids, prosthetics, and self-care aids. Other technologies were relegated as “nice to have” but in some way peripheral. This thinking has continued to permeate the provision of assistive technology. The GARI research into funding of mobile phones and the DATEurope landscape study of the financing for Digital AT highlighted significant barriers to access to devices that pervade daily lives throughout the population.

Around 2017-2019, I had the privilege of working on projects to explore how we could build education provision for refugees as they fled towards host countries. Whilst in Jordan and over lunch, those who had escaped the war chatted about the things they had chosen to take with them. Educational certificates were regularly mentioned, but the one thing they all had in common was to make sure they had grabbed their mobile phone and chargers. Many took their phone out of their pockets or lanyards strung from their necks. Each phone was battered and bruised, sometimes held together with tape. However, everyone spoke of how critical the device was as families dispersed in different directions with little planning or coordination.     

I have often thought that if a phone was so important to this group, why do so many professionals, notably in health and education, seem unable to grasp and appreciate the value? Mobile technology is pervasive and has become an integrated part of our everyday lives. Many of us reflect on this when travelling or interacting with new people and ask, “How did I do this before?” Why are dismissive attitudes towards the importance of this technology as an enabler for people with a disability still expressed?

In our review of the history of phones as enabling technologies Banes, Lobnig and Milligan 2024), we charted the development process of accessibility features and functions on mobile phones. In many cases, this has been incremental, building enhancements upon enhancements, year after year, with some major disruptions, such as the introduction of smartphones. The technology has evolved rapidly, making it difficult for some professionals to see the opportunity for access that the devices offer. 

A rapid review of the WHO Priority Assistive Products List suggests that almost 50% of the desired assistive features and functions can be replicated on a mobile phone, and many other benefits could be offered beyond the 50 within the PAPL. However, unlike traditional forms of AT, using a mobile phone is not overtly or directly linked to a single impairment or barrier. 

Too often, it feels as if perceptions of the importance of an AT are based not on removing barriers but on the extent to which it mitigates impairment. Whilst we value a social model in theory – a medical model seems to emerge when we begin to think about what is most “important”. Mobility aids address physical disabilities; hearing aids address hearing loss, whilst the availability of Braille format books addresses print impairments.  

Most people with disabilities value technology based on how much it reduces or removes barriers. Hence, we need to begin to prioritise the provision of technology based on the extent to which it addresses obstacles we encounter. If a tablet computer with an AAC app is the basis of communication, it becomes essential; it is vital if a phone allows access to information in education or employment. If a smart speaker enables a person to live independently in their own home, it becomes essential. What others do with these technologies, whether for fun or entertainment, does not matter. For any user, access is denied if we don’t value the technology. 

Almost anyone working in the field of Digital AT would recognise this as being true. But, whilst greater evidence of consumer technology’s impact as an enabler is still needed, we learned much from 18 months of the pandemic, lockdowns and sudden experience of new challenges. finding that we faced a lonely, powerless life without access to technology. For those with disabilities, continuing to face similar barriers, trivialising the value of access to consumer technology is to trivialise their experience and need.