Exploring the Usability of Gaze-based Mobile Communication in Ghana

The first Global Report on Assistive Technology (AT) [47] found that 2.5 billion people need AT today, a figure likely to rise to 3.5 billion by 2050, yet in some countries, access is as low as 3% for those who need it. Therefore, many people are still without access to the AT they need to carry out activities of daily life, and this is especially true for the 28-49% of people globally with communication disabilities [30]. In the last decade, digital devices, and especially smartphones with accessible applications, have become increasingly important as AT for the billion of disabled people worldwide, as they offer a variety of tools that enable people to address access barriers experienced in daily life [7, 8, 51, 52, 60, 61]. In contrast to often more costly and less available dedicated assistive devices such as Braille readers or digital communication boards, low-cost Android smartphones are available in most of the Global South through a variety of different providers [49, 70]. However, to date studies looking at the use and impact of smartphone applications to support the needs of people with communication difficulties in the Global South are still relatively scarce [6, 18, 42].

Impaired speech makes communication challenging and is compounded by stigma, which can isolate or marginalise people [19, 71]. Often, people who have impaired speech will be understood by and communicate with and through trusted individuals, limiting their speech to others due to the risk of ‘failing’ to communicate within a social exchange, leading to a feeling of inferiority and reduced participation in the moment and cumulatively over time [16]. These issues can also be more pronounced in Ghana and other countries in the Global South where disability stigma and other systemic failures contribute to lack of access to support and subsequent further marginalization [27, 73, 74].

In Ghana, people with communication challenges could benefit from gaze-based Augmented and Assistive Communication devices (AACs), widely used in countries with greater resources. However, there is limited evidence about the potential of such devices by people with communication disabilities in the Global South. Our study sought to evaluate the usability, identifying barriers and facilitators of adoption of a freely available Android-based eye-gaze AAC application called Look to Speak. The study included training of 10 local speech and language therapists and 15 people with communication difficulties. Our findings highlight how, despite some initial successes and the positive opinions of clients, caregivers and speech and language therapists the Look to Speak application largely failed to deliver substantial communication benefits to individual users. This was due to a combination of factors including the high cognitive load, design flaws of the application - such as the lack of optimization of the selection process depending on the chosen interaction mode, and lack of wheelchairs with adequate postural support, which are necessary for users to be able to successfully utilise the application. We contribute insights surrounding the mismatch between expectations and reality of gaze-base AACs, and considerations about the broader ecosystem required to support adoption and impact of such technologies in Ghana.