Vulnerable User Group Research Articles

Challenges and barriers for gender-inclusive public transport policies and practice in Delhi, India

The importance of gender mainstreaming in transport services has been brought to focus by leading organisations such as the World Bank and Asian Development Bank. Commonly, women in South and Southeast Asian countries struggle with a public transport system that is not designed for them. National policy makers from these countries typically pick and choose when to follow international guidelines. The present study explores the challenges and barriers for implementation of international guidelines and standards on gender when designing inclusive public transport systems. Semi-structured interviews were undertaken with leading national policymakers and transport practitioners to gain an in-depth understanding of current practices in Delhi, India. Discussions with policymakers revealed a significant lack of willingness to consider women as a distinct user group, largely due to a male-dominated sector. Women, when rarely considered, are often categorized within the vulnerable user group. This makes any gender-specific travel requirements absent from policies and guidelines for transport practitioners to implement. Without any adequate gender-inclusive policies and government guidelines, practitioners are hamstringed into designing and implementing services which negates women’s travel needs. Interviews with transport practitioners also revealed major barriers to include funding constraints and poor national data resources. The study concludes with critical gaps in the pipeline from international to national to transport practitioners which prevents gender-specific travel needs from being met for women riding public transport.

The artificial intelligence divide: Who is the most vulnerable?

This study investigates users’ artificial intelligence (AI)-related competencies (i.e., AI knowledge, skills, and attitudes) and identifies the vulnerable user groups in the AI-shaped online news and entertainment environment. We surveyed 1088 Dutch citizens over the age of 16 years and identified five user groups through the latent class analysis: the average users, the expert advocates, the expert skeptics, the unskilled skeptics, and the neutral unskilled. The most vulnerable groups with the lowest levels of AI knowledge and AI skills (i.e., unskilled skeptics and neutral unskilled) were mostly older, with lower levels of education and privacy protection skills, than the average users. Overall, the results of this study resonate with the existing findings on the digital divide and provide evidence for an emerging AI divide among users. Finally, the societal implication of this study is discussed, such as the need for education programs and applications of the explainable AI.

МОДЕЛЬ АРХИТЕКТУРНО-ПРОСТРАНСТВЕННЫХ ПРИНЦИПОВ ДЛЯ ОБЕСПЕЧЕНИЯ АДАПТАЦИИ ЛЮДЕЙ С АУТИЗМОМ

Current architectural environment mostly accounts for the interests of its neurotypical users, which do not correspond with the needs of people with neurodiversity. The relevance of using certain architectural solutions for autistic people is based on their sensitivity to external stimuli, as well as statistics with increased rates of autism diagnoses. After analyzing theoretical works of foreign researchers and architects, and taking into account modern architectural solutions for people with autism spectrum disorder, we developed a model of architectural and spatial guidelines. It was based on five types of interaction between the autistic person and space: sense of self in personal space; sense of self in public space; perception of space around self; sensory sense of space; and sensory overload. The model considers the relationship between the person and the space, and prioritizes approaches to autism-friendly design such as differentiation, zoning, gradation, linking the external and internal environment, and specific architectural solutions. This design approach will adapt autistic people to interact with the environment in future, and may have a positive impact on the other user groups through "the curb-cut effect" (a phenomenon when solutions aimed at transforming the living conditions of a specific vulnerable user group help society as a whole). The model can be applied as a guide in architectural design and can also be used for future theoretical research.

Remote Inclusion of Vulnerable Users in mHealth Intervention Design: Retrospective Case Analysis.

Mobile health (mHealth) interventions that promote healthy behaviors or mindsets are a promising avenue to reach vulnerable or at-risk groups. In designing such mHealth interventions, authentic representation of intended participants is essential. The COVID-19 pandemic served as a catalyst for innovation in remote user-centered research methods. The capability of such research methods to effectively engage with vulnerable participants requires inquiry into practice to determine the suitability and appropriateness of these methods. In this study, we aimed to explore opportunities and considerations that emerged from involving vulnerable user groups remotely when designing mHealth interventions. Implications and recommendations are presented for researchers and practitioners conducting remote user-centered research with vulnerable populations. Remote user-centered research practices from 2 projects involving vulnerable populations in Norway and Australia were examined retrospectively using visual mapping and a reflection-on-action approach. The projects engaged low-income and unemployed groups during the COVID-19 pandemic in user-based evaluation and testing of interactive, web-based mHealth interventions. Opportunities and considerations were identified as (1) reduced barriers to research inclusion; (2) digital literacy transition; (3) contextualized insights: a window into people's lives; (4) seamless enactment of roles; and (5) increased flexibility for researchers and participants. Our findings support the capability and suitability of remote user methods to engage with users from vulnerable groups. Remote methods facilitate recruitment, ease the burden of research participation, level out power imbalances, and provide a rich and relevant environment for user-centered evaluation of mHealth interventions. There is a potential for a much more agile research practice. Future research should consider the privacy impacts of increased access to participants' environment via webcams and screen share and how technology mediates participants' action in terms of privacy. The development of support procedures and tools for remote testing of mHealth apps with user participants will be crucial to capitalize on efficiency gains and better protect participants' privacy.

Commercial mHealth Apps and the Providers’ Responsibility for Hope

In this paper, we ask whether the providers of commercial mHealth apps for self-tracking create inflated or false hopes for vulnerable user groups and whether they should be held responsible for this. This question is relevant because hopes created by the providers determine the modalities of the apps’ use. Due to the created hopes, users who may be vulnerable to certain design features of the app can experience bad outcomes in various dimensions of their well-being. This adds to structural injustices sustaining or exacerbating the vulnerable position of such user groups. We define structural injustices as systemic disadvantages for certain social groups that may be sustained or exacerbated by unfair power relations. Inflated hopes can also exclude digitally disadvantaged users. Thus, the hopes created by the providers of commercial mHealth apps for self-tracking press the question of whether the deployment and use of mHealth apps meet the requirements for qualifying as a just public health endeavor.

Exploring crowdsourced self-care techniques: A study on Parkinson’s disease

Living with Parkinson’s Disease introduces a range of significant challenges into one’s daily life. While medical interventions exist to overcome some of these challenges, patient self-care techniques often form an essential complement to the treatments recommended by medical doctors. Knowledge on these self-care techniques often originates from those living with Parkinson’s themselves or their close caregivers, as they have the knowledge and experience required to assess self-care techniques. This so-called ‘patient knowledge’ is usually exchanged in peer meetings or discussion forums. Although vital to the Parkinson’s Disease community, this information is often difficult to access due to its unstructured format and the difficulty of navigating through online forums. We present an online tool that allows for contributing, assessing, and finally discovering Parkinson’s Disease self-care techniques. The custom discovery tool was populated with self-care knowledge by over 300 people with Parkinson’s and dozens of their carers, spanning areas such as daily well-being and using assistive equipment. Then, we invited patients to explore the discover features in a smaller scale trial. While well-received, our deployment highlighted several challenges that we further discuss in this paper. Overall, our study contributes to crowdsourced digital health solutions and provides both design and research implications to this challenging domain with a vulnerable user group.

Target-group specific requirements for inclusive automated mobility

Automated mobility services have the potential to improve the mobility of vulnerable user groups, but run the risk of excluding them if their needs are not considered. The specific requirements of vulnerable user groups for automated mobility services have been underrepresented in the development process of these services so far. Through quantitative and qualitative research, the CATAPULT project analysed user needs and requirements of children, senior citizens and people with impairments. Initial results suggest not only focusing on the vehicle itself, but considering all aspects of a journey to ensure the inclusivity and accessibility of automated mobility services, is crucial. Safety, responsibility, information provision and accessible design are important issues for our target groups. A Serious Game was designed to facilitate the dialogue between mobility providers and user groups.

Assessment of inequity in bicyclist crashes using bivariate Bayesian copulas

Introduction: Physical activity associated with active transport modes such as bicycling has major health benefits and can help to reduce health concerns related to sedentary lifestyles, such as cardiovascular disease, Type II diabetes, and obesity, as well as risks of colon and breast cancer, high blood pressure, lipid disorders, osteoporosis, depression, and anxiety. However, as a vulnerable user group, bicyclists experience negative health impacts of transportation policies and infrastructure, such as traffic crashes and exposure to air and noise pollution that is disproportionately distributed within low-income and underserved areas. Method: This study used aggregated (block-group) bicyclist crash data from Harris County, Texas, to analyze how various equity measures are associated with both fatal and injury (FI) and no injury (property damage only) bicyclist crashes that occurred from 2010 to 2017. We used Bayesian bivariate copula-based random effects regression analysis to evaluate these associations. In contrast to more traditional univariate analysis, this novel methodology can consider the effects of factors of interest across different severity levels or crash types to fully understand their effects and how they may differ across categories. Results: The analysis results indicate that the bicyclist exposure, vehicle exposure, population demographics, population density, the percentage of African-Americans, and households below the poverty level are associated with both FI and PDO bicyclist crashes. Conclusions: Although more location and context-specific analyses are required, this study's overall results once again conform with the findings and assumptions in bicycling safety literature that the low-income and racially diverse communities are prone to experience more bicyclist crashes. Practical Applications: The findings of this study may have implications for future transportation and planning policies. These findings can be used to guide the policies and strategies targeting the elimination of inequity in transportation-related health concerns.

Applying deep learning techniques for the prediction of pedestrian behaviour on crossings with countdown signal timers.

The improvement of road safety is considered as a top priority on the agendas of governments and transport policy making stakeholders worldwide, with the ‘Vision zero’ target being the pinnacle of the European Commission’s road safety strategy. Increased attention has been given to pedestrians, since crashes involving this vulnerable user group, have a higher mortality rate. As a result, research focusing on the behaviour of pedestrians and on the application of Intelligent Transport Systems that will assist pedestrians, is of increased importance. This paper attempts to predict pedestrian behaviour on crossings with a Countdown Signal Timer (CST), through the application of two machine learning algorithms. In the frame of the case study presented, an intersection in the Kalamaria city of Thessaloniki, Greece, where countdown signal timers have been installed on the pedestrian traffic lights, is analysed. For the needs of the analysis two models were implemented, a Deep Neural Network (DNN) and a Logistic Regression model. Results of both models indicated a satisfactory performance. In detail, the DNN model managed to estimate the pedestrians’ crossing speed with a Mean Squared Error value of 0.0647 (km/h)2, while the Logistic Regression model, which classified pedestrians based on their behaviour, achieved an accuracy of 97%. The accurate determination of pedestrians’ crossing behaviour could not only underline the influence of countdown signal timers, but also highlight appropriate countermeasures that can make infrastructure safer for this user group. Findings of this research can prove beneficial for researchers, infrastructure operators and policy makers alike, in their effort to improve the safety level of pedestrians.

The impact of the 2016 Psychoactive Substances Act on synthetic cannabinoid use within the homeless population: Markets, content and user harms.

On 26 May 2016, the UK introduced the Psychoactive Substances Act. The Act made it an offence to produce, supply, or offer to supply, any psychoactive substance likely to be used for its psychoactive effects. While a Home Office review of the Act in 2018 proclaimed that the Act had been successful in achieving its main goal of preventing the open sale of psychoactive substances, significantly, the review acknowledged that high levels of synthetic cannabinoid use remain amongst vulnerable user groups, in particular the homeless population. The research adopted an innovative interdisciplinary approach drawing on sociology and chemistry. The sociological element involved 82 face-to-face qualitative semi-structured interviews with 37 homeless synthetic cannabinoid users, 45 stakeholders, and over 100h of fieldwork observations. The chemical analysis element involved the testing (using Gas Chromatography-Mass Spectrometry) of 69 synthetic cannabinoid street samples obtained by a local police force. The introduction of the Act was associated with a number of significant changes to the synthetic cannabinoid market, including the integration of synthetic cannabinoids into the existing illicit street market, new dealers, the adoption of more targeted and aggressive supply practices, and variability in the content and potency of synthetic cannabinoids. Combined, these changes have increased the risk of harm to homeless users and homeless sector staff and resulted in a concomitant increase in the demand on emergency services. The foreseen concerns that the Act would result in detrimental market changes and increased harms to vulnerable user groups have been manifested in the homeless population. The failure of the Act to reduce synthetic cannabinoid use within this group, combined with the increased risk of individual and societal harm, highlights the importance of reducing the demand for synthetic cannabinoids.

Co-creating dementia care: manoeuvring fractured reflexivity in service design

PurposeThis study aims to theorise and empirically investigate how vulnerable users suffering from cognitive impairments can be involved in service design.Design/methodology/approachThe data were collected through an ongoing field study following the processes of designing new forms of dementia care. The data consist of document studies, observations and interviews with actors involved in the service design process.FindingsThe findings demonstrate how the involvement of vulnerable users with cognitive impairment in service design requires the ability to manoeuvre users' “fractured reflexivity”. The design process was found to be constrained and enabled by three interrelated features: cognitive aspects, social aspects and representativeness.Practical implicationsThis paper provides insight into concrete ways of involving vulnerable user groups in service design. The introduced concept – fractured reflexivity – may create awareness of how the involvement of users with cognitive impairment can be difficult but is also valuable, providing a means to rethink what may enable involvement and how to manage the constraints.Originality/valueAlthough design processes rely on reflexivity, there is limited research addressing how reflexivity capacity differs among actors. The authors contribute by exploring how fractured reflexivity may aid the analysis and understandings of intertwined issues related to the involvement of users with cognitive impairment. Therefore, this study initiates research on how service design entails enactments of different modes of reflexivity. The paper concludes with directions for future research avenues on service design and reflexivity modes.

How do people use Frankfurt Mainkai riverfront during a road closure experiment? A snapshot of public space usage during the coronavirus lockdown in May 2020

ABSTRACT In a one-year long experiment, the City of Frankfurt has limited the vehicular access to an 800 m stretch of its Mainkai riverfront as part of its plans to improve quality of life and support green mobility. With pre-intervention data collected in July 2019, this article presents the first results on how pedestrians, cyclists and other user-groups have been using this open public space in May 2020, i.e. post road closure and during the coronavirus restrictions. Based on pedestrian counts and behavioural observations, the authors report on a changed pedestrian mobility, spatial distribution and different stationary activities such as playing, sitting and socializing. The results show an increased peak hour frequency among cyclists (+45%) and pedestrians (+20%) on Mainkai street, along with more vulnerable user groups including including children cycling independently (+1150%) and people with restricted mobility (+25%). The study underlines related initiatives world-wide that pedestrianization acts as a catalyst for safer and healthier urban environments. Particularly, under the impression of an ongoing coronavirus pandemic, the study suggests that (temporary) road closure to cars is a key element in qualifying public space that attracts different user-groups and caters to an increased need to become physically active and engage socially while keeping distancing rules.

Empathic handover: how would you feel? Handing over dementia experiences and feelings in empathic co-design

It is difficult to inform design with experiences from people with dementia. When it comes to involving this vulnerable user group and connecting multidisciplinary design teams, current empathic co-design methods and tools are scarce, seem fragmented and lack a coherent and structured approach. In response, we provide guidance to design teams by proposing a novel, empathic co-design approach that enables a user researcher, who encounters people with dementia, to transfer insights to team members who do not. Our proposal addresses three sequential co-design activities facilitated by an empathic principal designer: (1) individual harvest meetings, (2) collective handover workshops and (3) empathic ideation workshops. Using a case study involving a dementia simulator, we illustrate how the approach contributes to understanding users, transferring insights and translating empathy into design. The positive evaluation of the simulator led us to conclude that the approach not only guided the design team by offering a practical and coherent process, but also enabled individual team members to be receptive, inclusive and committed to people with dementia.

Developing an audit checklist to assess outdoor falls risk.

Falls by older people (aged 65+) are linked to disability and a decrease in mobility, presenting a challenge to active ageing. As such, older fallers represent a vulnerable road user group. Despite this there is little research into the causes and prevention of outdoor falls. This paper develops an understanding of environmental factors causing falls or fear of falling using a walk-along interview approach with recent fallers to explore how older people navigate the outdoor environment and which aspects of it they perceived facilitate or hinder their ability to go outdoors and fear of falling. While there are a number of audit checklists focused on assessing the indoor environment for risk or fear of falls, nothing exists for the outdoor environment. Many existing street audit tools are focused on general environmental qualities and have not been designed with an older population in mind. We present a checklist that assesses aspects of the environment most likely to encourage or hinder those who are at risk of falling outdoors, developed through accounting for the experiences and navigational strategies of elderly individuals. The audit checklist can assist occupational therapists and urban planners, designers and managers in working to reduce the occurrence of outdoor falls among this vulnerable user group.

Only available to a selected few? Is it feasible to rely on a volunteer workforce for complex intervention delivery?

This paper recounts the process of undertaking a randomised controlled trial which was designed to examine the effectiveness of an intervention for socially isolated older people aged 75years and over. It describes the reasons for early cessation of the study and raises the implications of this outcome for policy, practice and research. The intervention under investigation was designed to alleviate loneliness and foster companionship. It involves participants being linked with a small group of others through a teleconferencing system with each group being facilitated by trained volunteers. There was a requirement to recruit and train a minimum of 30 and a maximum of 60 volunteers over 1year to facilitate 20 friendship groups to meet the number of older people required to be recruited to the study. Problems with recruiting and retaining the volunteer workforce by the voluntary sector organisation, who were commissioned to do so, led to the study closing even though older people were recruited in sufficient numbers. The paper draws upon analysis of various data sources from the study to identify the potential reasons. The discussion raises considerations regarding the extent of infrastructure required to deliver community services to vulnerable user groups at scale, identifies some of the issues that need to be addressed if such volunteer-initiated services are to be successful and informs future research programmes in this area.

Evaluation of fatal school bus related crashes and near-term crash mitigation strategies

School bus crashes are rare in comparison to other crash types, but considering all crashes that occur in and around school buses, they begin to become a noticeable problem and one that tends to attract national attention. As defined by the Fatality Analysis Reporting System (FARS), a school bus related crash is a crash that either involves a school bus or a crash where the presence of a school bus is considered as a major contributing factor. Ten years of data indicate that the number of fatal school bus related crashes has remained nearly stagnant despite an increase in the number vehicle safety systems available on the market. The findings also highlight the importance of protecting the non-bus occupants since they are the most likely to incur a serious or fatal injury in the event of a crash. As the most vulnerable user group, pedestrians (typically school-aged children) are especially at risk when crossing the road while boarding or exiting a school bus. Until new technologies for reducing school bus related crashes are designed and implemented, school transportation safety can be improved by increasing awareness of school bus stop laws and by implementing existing transportation safety initiatives at school bus stop locations.

A little knowledge

Errors made by injection-experienced and injection-inexperienced participants were compared to test whether injection experience relates to use errors among potential users of a new injection device. In our sample, healthcare professionals (Group 1) made the fewest errors overall while there was also a trend for injection-experienced laypeople (Group 2) to make more errors than injection-inexperienced laypeople (Group 3). Furthermore, the types of errors made by each of the two layperson groups appear distinct from each other, with the pattern of errors made by injection-experienced laypeople more closely resembling the pattern among medical professionals. We speculate that medically experienced laypeople might inherit the “worst of both worlds” in that, as laypeople, they make errors due to inexperience with medical procedures and that also, like healthcare professionals, they make errors due to negative transfer from past experience with medical procedures. We suggest that experienced laypeople require special consideration as a potentially vulnerable user group.

MOTORCYCLE HELMET WEARING IN VIET NAM: LEGISLATION, COMPLIANCE AND CURRENT CHALLENGES

BackgroundWith motorcycles representing 95% of Viet Nam's 33 million vehicles, safety for this vulnerable user group is of crucial importance. Motorcycle helmets are an effective road safety intervention that has...

Subject to empowerment: the constitution of power in an educational program for health professionals

Empowerment and user participation represents an ideal of power with a strong position in the health sector. In this article we use text analysis to investigate notions of power in a program plan for health workers focusing on empowerment. Issues addressed include: How are relationships of power between users and helpers described in the program plan? Which notions of user participation are embedded in the plan? The analysis is based on Foucault's idea that power which is made subject to attempts of redistribution will re-emerge in other forms. How this happens, and with what consequences, is our analytical concern. The analysis is contrasted with 'snapshots' from everyday life in a nursing home. The program plan communicates empowerment as a democracy-building instrument that the users need. It is a tool for providing expert assistance to the user's self-help. User participation is made into a tool which is external to the user him-/herself. Furthermore, the analysis shows that the plan's image of empowerment presupposes an 'élite user' able to articulate personal needs and desires. This is not very applicable to the most vulnerable user groups, who thereby may end up in an even weaker position. By way of conclusion, we argue that an exchange of undesirable dominating paternalism for a desirable empowerment will not abolish power, but may result in more covert and subtle forms of power that are less open to criticism. The paper offers insights that will facilitate reflections on the premises for practising empowerment-oriented health care.

User profiles and personas in the design and development of consumer health technologies

Background“The graying of the globe” has resulted in exponential rise in health care expenses, over-worked health care professionals and a growing patient base suffering from multiple chronic diseases, one of which is diabetes. Consumer health technologies (CHT) are considered important catalysts for empowering health care consumers to take a proactive role in managing their health and related costs. Adoption rate and usability of such devices among the aging is far from being satisfactory. Past studies noted the motivation for adoption by the aging is dependent on the suitability/relevance, perceived usability and anticipated benefits associated with usage of technological innovation. Traditional information technology (IT) development adopts a systematic approach without necessarily using a specific user model that personalizes the system to the aging user groups. The aging patient population has unique needs arising from progressive deterioration in both physiological and psychological abilities. These needs are often ignored in the design, development, trial and adoption of consumer health products resulting in low adoption and usage. ObjectivesThe main objective of this research is to investigate the user-centered design (UCD), specifically user profiles and personas, as methodological tools to inform the design and development of CHT devices for an aging population. The adoption of user profile and persona has not received much attention in health care informatics research and, in particular, research involving CHT. Our work begins to fill this void in three ways. We (1) illuminate the process of developing CHT user profiles and personas for a Chinese elder population with a demanding health care needs, i.e., self-management of chronic diabetes, with the hope that the resulting profiles and personas may be used as foundational material for informing the design, development and evaluation of CHT in other similar contexts; (2) call attention to how to further enhance and complement traditional user profile and persona techniques for CHT design by integrating cognitive structures and present behavior that drive health care thinking, future behavior and demand; (3) show how the profiles and personas can be used to inform requirements, design and implementation decisions for a technology aimed at facilitating CHT adoption and diffusion for the elderly. MethodologyTo exemplify process and application, we use an action-research methodology, where user profiles and personas of an aging patient population were developed. The resultant profiles and personas were leveraged to improve the design, development and implementation plans of a smart phone application to assist chronically ill aging Chinese diabetic population capable of disease self-management. ResultsThe results from the study show that user profile and persona can be a valuable methodological approach in capturing the conceptual model of the aging and informing the design and development decisions of CHT. The demonstration of techniques used in this study can serve as a guideline to CHT developers in bringing conceptual user modeling into the design of software interfaces targeted for users with specific health care needs. Specifically, the study provides guidance on the creation and use of profiles and personas to tap into the conceptual models of the targeted elderly population reflecting their preferences, capabilities and attitudes towards using technology in self-management care in general and the smart phone diabetes management application in particular. Insight into the mental model of the aging group has been shown to inform later stages of UCD development (e.g., the creation of prototypes and usability testing) as well as implementation and adoption strategies. The World Health Organization (WHO) predicts that by 2025, 80% of all new cases of diabetes are expected to appear in the developing countries. In fact, the number of diabetic patients in China is estimated to rise to 42.3 million in 2030 from 20.8 million in 2000. Thus, we investigate the Chinese aging population in order to demonstrate the process of developing and using user profile and persona. We hope that the resultant conceptual model of the Chinese aging diabetic population can be used in future research to guide CHT designers interested in designing health care devices for this vulnerable user group.