The Centre Forapplieddisabilityresearch

The Centre forAppliedDisabilityResearch

TheCentreforAppliedDisabilityResearch(CADR)isaninitiativeofNationalDisabilityServices(NDS).CADRaimstoimprovethewellbeingofpeoplelivingwithdisabilitybygatheringinsights,buildingunderstanding,andsharingknowledge.CADR’sappliedresearchagendaishelpingtobuildtheevidencebaseandsupportstakeholderstobetterunderstandwhatworks,forwhom,underwhatcircumstancesandatwhatcost.

Research to Action Guides

Bridgingthegapbetweenwhatweknowandwhatwedo.OurobjectiveistobuildacomprehensiveonlinecollectionofdisabilityresearchandtranslationalresourcesfortheAustraliancontext.OurResearchtoActionGuidesarebasedonthebestavailablelocalandinternationalevidenceandputtogetherbysubjectmatterexpertstosupportresearchenduserstoengagewiththeevidence.Wegatherandanalyseevidenceaboutwhatworks,andpackagethatinformationintoefficientandpracticalresources.

Acknowledgements

ThisresourcewasdevelopedwithsupportofAustraliangovernmentsthroughtheResearchandDataWorkingGroup.ThisResearchtoActionGuidealsoreceivedin-kindsupportfromtheUniversityofMelbourne’sHallmarkDisabilityResearchInitiative.NDSGratefullyacknowledgesthesupportoftheNSWGovernmentinestablishingtheNDSCentreforAppliedDisabilityResearch.

Suggested citation

Anderson,J.,McVilly*,K.,Koritsas,S.,Johnson,H.,Wiese,M.,Stancliffe,R.,Lyon,K.,Rezzani,N.,Ozge,J.(2017).Accessiblewritteninformationresourcesforadultswithintellectualdisability:GoodPracticeSummary.ResearchtoActionGuide, NDS CentreforAppliedDisabilityResearch.*CorrespondingAuthor:

NDSgratefullyacknowledgesthesupportoftheNSWGovernmentinestablishingtheNDSCentreforAppliedDisabilityResearch.

About this Research to Action Guide

ThisResearchtoActionGuidewillassistpeopleandorganisationsthatwanttopreparewritteninformationinanaccessibleway,andinparticularinformationforpeoplewithintellectualdisability.Theavailabilityofinformationinaccessibleformatsisimportantasitwillcontributetotheabilityofpeoplewithintellectualdisabilitytoexercisetheirrighttomakeinformedchoices,andinturnmaximisetheirpotentialtoliveindependentlyandparticipatefullyinallaspectsofcommunitylife.

ThisGoodPracticeSummaryformspartofasuiteofresourcesproducedforCADRonthistopic.ThesuiteincludesaRapidReviewoftheLiteraturethatgivesguidanceonhowtomakewritteninformationresourcesasaccessibleaspossibleforpeoplewithintellectualdisability.TheRapidReviewprovidesafulllistingofreferencesinformingthisGoodPracticeSummary.BothareavailableattheCADRClearingHouse,

AttheendofthisGoodPracticeSummaryisaQuickReferenceGuide;aprint-outperfectforguidanceonthego.

Feedback

Doyouhavefeedback,orasuggestionforaResearchtoActionGuide?.

Accessible written information resources for adults with intellectual disability.

Good practice summary.

What is the problem?

Peoplewithdisabilityhavetherighttobeabletoaccessinformationsothattheycanmakechoicesaboutthingsthatareimportanttothem.

InAustralia,theNationalDisabilityInsuranceScheme(NDIS)hasmadethisprinciplemoreimportantthaneveraspeopleneedinformationtoexercisechoiceandcontrolintheirlives.

Makinginformationaccessibleforpeoplewithintellectualdisability(ID)canbehardbecause:

•allpeoplehavedifferentcommunicationneedsandpreferenceswhichneedtobetaken

intoaccountwhenpreparingandpresentinginformation;and

•manypeoplewithIDhavedifficultyreading.

Howcan thisGuidehelp?

ThisguideisabouthowtocreateAccessibleWrittenInformationorAWI.ThemostcommonwaytopresentAWIisthroughwhatisknownas‘easyEnglish’inAustralia.Thisisalsocalled‘easy-to-read’or‘EasyRead’intheUKandEurope.Peoplehavewrittenguidelinesforpreparing AWI inAustraliaandinternationally.ThisguidecontainscommonfeaturesofAWI,takenfromtheseguidelines.ItincludesimportantthingstothinkaboutwhensupportingpeopleusingAWI,aswellasexamplesofwhatgoodpracticelookslikewhenproducingAWI.Ifyouwanttoknowmoreabouttheresearchbehindtheseguidelines,youcangototheRapidReviewwhichformspartofthisResearch-to-Actionguide.

This Guide has four parts:

1: PreparingAccessibleWrittenInformation

2: ExamplesofgoodpracticeinpreparingAWI

3: MaximisingtheeffectivenessofAWI

4: AWIQuickReferenceGuide–printoutforpractice

Part1:preparingaccessiblewritteninformation

TheprocessofpreparingAWIcanbegroupedintothreeareas:

•formattingdocuments

•writinginaccessiblelanguage

•usingimages

Eachoftheseareasisexploredinthisguide.

Formattingdocuments

FormattingAWImeansthinkingabouthowinformationispresentedonthepage.Thisincludeswhereinformationisplacedonapageandwhatitlookslike.Italsocoversthingslikewhatsortofpapertochoosewhenprintingdocuments.Themostcommonfeaturesofwell-formattedAWIareinTable1.

Table 1: Common specifications for formatting documents

• Text should be broken into short chunks, with plenty of space between lines and paragraphs.7, 10, 12, 13, 15
• One sentence per line, where possible.8, 9, 11
• Use clear headings to break up information.8-10, 12, 13

• Align text to the left margin and do not justify text on the right margin.7-10, 12, 13, 15
• Avoid hyphenating words on the right margin of the text (i.e. do not break up a word on two lines).8, 9, 12, 13, 15
• Avoid laying text out in columns.9, 12, 13

• Use non-serif fonts, such as Arial, Helvetica or Verdana.7, 9-13, 15
• At least 14-point font size.7-9, 12, 13
• Ensure high contrast between text and background.7, 10, 12, 13, 15
• Avoid using block capitals (i.e. all upper case) or italics.7-10, 12, 13, 15

• Use bullet points, boxes and bold text to highlight important information.7-10, 12, 13, 15
• Avoid too many layers of bullet points.9, 12, 15

• Use good quality matte paper that is not too thin.7, 8, 10-13
• A49, 12 or A59 paper size.

• Lines of text of not more than 60 characters.7, 12, 13
• Lines of text of not more than 25-30 characters if using pictures.13
• Sentences of 15 words or less.12, 15 In addition, lines of text should not be shorter than five words long.7

Writing in accessiblelanguage

WritinginaccessiblelanguageisaveryimportantpartofpreparingAWI.Itmeansthinkingabout:

•howtochooseanddisplaywordsandnumbersinyourdocument

•simplelanguagewhichiseasytounderstand

•uncomplicatedgrammarandpunctuation

Someoftheserecommendationsareeasytofollow(e.g.writingnumbersasdigits,notwords).Others,likeusingclearsimplelanguageareharderbecausewhatisclearandsimpletoonepersonmaynotbetoanother.

Table 2: common specifications for writing in accessible language

• Clear, simple, everyday language is best.7-13, 15
• Use personal language (i.e. ‘I’, ‘you’, ‘we’).8, 10, 12, 13
• Use active language (i.e., active voice in contrast to passive voice, where the subject of the sentence performs an action rather than being the receiver of the action).8, 10, 12, 13
• Avoid jargon or complicated words, but if you need to use them, make sure you include an explanation.7-10, 12, 13, 15 Some guidelines recommend a glossary for difficult words.9, 10, 13, 15
• Be consistent – use the same word or form of words when referring to the same thing throughout the document.10, 12, 13, 15
• Use adult language when writing for an adult audience.8, 9, 12
• Avoid the use of acronyms or abbreviations, unless commonly known.8-10, 12, 13, 15
• Sentences should be short and clear.7, 8, 10, 12, 13
• Present one main idea per sentence.7, 8, 10-13

• It is acceptable to start sentences with prepositions such as ‘and’ and ‘but’.11, 15
• Use nouns instead of pronouns13, but if using pronouns, make sure it is clear who or what the pronoun is talking about.15
• Avoid using contractions such as ‘don’t’ or ‘can’t’ – use ‘do not’ or ‘cannot’ instead.7, 8, 13, 15
• Use present tense rather than past tense.8, 9

• Keep punctuation simple. Avoid semicolons, colons, hyphens and too many commas.7-10, 12, 13, 15
• Avoid special characters and symbols (e.g. #, &, %, ~, ?, $).7, 9, 13

• Numbers should be written as digits, not words (e.g. 5, not five).7, 10, 12, 13, 15
• Avoid using percentages. Say ‘1 in 10’ or ‘some’ instead of 10%.12, 15
• Avoid using large or complicated numbers. Say ‘many’ instead of a large number like 7,956.8
• Use the 12-hour clock for time instead of the 24-hour clock.7, 9

UsingImages

ImagesareacommonandpopularfeatureofAWI.Thisincludespicturessuchasphotos,drawingsorsymbols.Theycanbeusedtoaccompany,highlightorevenreplacewords.

Thingstothinkaboutwhenusingimagesinclude:

•typesofimagestouse

•sizeandplacementofimages

Table3containsinformationaboutthingstoconsiderwhenusingimages.

Table 3: common specifications for using images

• Images can be drawings8-10, 12, 13, 15, photos8-10, 12, 13, 15 or symbols8-10, 12, 13
• Choose images that are acceptable for the people you are writing for.9, 12, 13
• Images are there to support the text. Choose an image that best illustrates the point being made.7, 9-13, 15
• Use the same image to explain the same thing throughout the document.7, 9, 13
• Avoid background clutter, so that the background doesn’t distract from the image.12, 13
• Use only one style of image throughout the document.9, 15 (Note: Am I making myself clear? Mencap's guidelines for accessible writing10 and Information for All: evidence based guidance on producing accessible information for people with learning disabilities12 both recommend using a mixture of image types).

• The image should be as big as possible.7, 12, 15
• Use high resolution images.13, 15

• Images should be placed to the left of the accompanying text.7, 12, 13, 15
• Make it clear which part of the text each image relates to.7, 10, 11

• Use coloured images if possible.13, 15
• If using colour images, make sure the colours don’t make the image confusing to look at.7

• Photos are good for showing specific people, places and things that are happening.7, 8, 10, 12, 15
• Ensure photos are clear, and not too busy. Avoid clutter in the foreground and background.7, 8, 10, 12, 13

• Drawings can often convey information better than a symbol or a photo.10, 12
• Drawings should be clear and simple, but some cartoon type pictures or stick figures can be viewed as childish.8, 10, 12, 13

• Symbols should be used with caution as their meaning has to be learned.7 Only use symbols if the intended audience are known to be confident symbol users.8, 10

Part2: ExamplesofgoodpracticeinpreparingAWI

Inthissection,wewillcompareinformationforparentsandcarersaboutchoosinganorganisation toworkwiththeirchildwithdisabilityandaneasyEnglishversionofthesametext.

Figure1showstwopagesfromaninformationguidebytheNSWOfficeoftheChildren’sGuardian.

Itcontainsalotofimportantinformationforparentsandcarers.Whileitiswritteninaclearand

concisestyle,thelanguageandformattingmaypresentdifficultiesforaparentorcarerwithID.

Toimprovetheaccessibilityofthisdocument,theorganisationcommissionedtheproductionofaneasyEnglishversion.Figure2showsthesameinformationpresentedinanaccessibleway.

Figure1:PagesfromSafeSpace:Choosingchildsafeservicesforchildrenwithdisability(pp.6-7)9.Reproducedwithpermission.

Figure 2: Information from SafeSpace: Choose the right organisation to work with your child. Easy English version (p. 9) 10. Reproduced with permission.

SomethingstonoteabouttheeasyEnglishadaptationofthetext:

Formatting:

• Thetextisbrokenintoshortchunkswithlotsofwhitespace.

• Thecolumnshavebeenremoved.

• Importantinformationhasbeenhighlightedinbold.

• Anon-serif14-pointfonthasbeenused.

• Acleanwhitebackgroundhasbeenused,ensuringhighcontrast.

Writing accessible language:

• Themainideashavebeenpresentedinsimpleeverydaylanguage.

• Thelanguageisactiveandpersonale.g.“Youcanlookaroundtheplacewhereyourchildwillgo”.

• Sentencesareshortandclear,withoneideapresentedpersentence.

• Writteninthepresenttense.

• Simplepunctuation.

Images:

• Picturesarealignedtotheleftoftheaccompanyingtext.

• Itisclearwhichpartofthetexteachimagerelatesto.

• Thechosenimagessupportthetext.

• Theimagesareclearanduncluttered.

Part 3: Maximising the effectiveness of AWI

Youmightprepareadocumentusingalltherecommendationsfromtheguidelines.Howeveritwillbeoflittleuseifthepersonwhoreceivesitcannotread.

WhenpreparingAWIitisveryimportanttoconsiderthesetwothings:

• Thesupportneedsandpreferencesoftheintendedaudience.
• Therelevanceoftheinformationtotheintendedaudience.

Supporting people with ID when delivering AWL

The best way to support a person with ID when using AWI is to think about the process as a conversation between the person and a trusted supporter. This means taking as much time as necessary to make sure the person understands the information.

It might be that the person needs to consider the information in the context, situation or a place relevant to what is being discussed. For example, information about medical procedures in a doctor’s clinic, or information about using public transport at a train station.

For some people participation is an important way to increase understanding. An example might be showing a person how to open and close curtains in a room using an iPad and supporting them to practice this activity a few times.

Table 4 contains a number of recommendations to consider when supporting the delivery of AWI with a person with ID.

• Many people will need extra time and support to access AWI, no matter how accessible it is.7-9, 12
• AWI documents can act as a tool for supporters to help a person with ID to understand key issues.10, 15
• Include information for the support person at the back of the document.13
• Provide aids for supporters such as large photos and drawings as a way to promote understanding in discussions.10
• Consider providing information in more than one format (e.g. audio, video) in order to reach a wider audience.8
• Supporters should be aware of the range of AWI that exists on different topics.12

Advice from people with disability about using AWI

AspartofdevelopingthisGuide,weconsultedwithgroupofpeoplewithIDaboutthethingsthattheyfoundhelpfulwhenusingAWI.Someoftheobservationsfromthisconsultationinclude:

• paceofdeliveryandthetoneofvoiceareveryimportant;
• participantslikedhavingsomeonetoexplaindifficultconcepts;and
• thereisalotofvariationinpeople’sindividualneedsandpreferencesforcommunication.

Box 1: Thoughts about support when using AWI from a consultation with a group of people with ID

Part 4: Involving people with ID in the production of AWI

An important way to ensure your AWI is effective is to make sure that the information you are sharing is relevant to your intended audience.

The most effective way of doing this is to involve people with ID at every stage of the production process – including development, production and testing of the AWI resource.

If your document is being distributed to a wide audience, such as a survey or brochure, getting input from people with ID might help to identify issues with language, pictures or formatting.

Some recommendations for including people with ID in production of AWI are included in Table 5.

Table 5: Involving people with ID in the stages of production of AWI

Summary of Good Practice

• Accesstoinformationisanimportanthumanrightforallpeople.
• Peoplewithdisabilityhavetherighttoaccesstoinformationonanequalbasistoothers.
• AWIisagoodwayofsharinginformationwithpeoplewithID
• Weallcommunicateindifferentways.Tailoringinformationfortheintendedaudience,anddeliveringitinawaythatbestsuitstheindividualisthebestwayprovidingeffectiveinformation.
• Startbythinkingaboutandworkingwithyouraudience.Thingstoconsiderinclude:
• Whatisthepurposeofmydocument?
• WhoneedstoknowtheinformationIamwriting?
• Istheinformationrelevantoruseful?
• Istheinformationinthebestformatfortheintendedaudience?
• HavepeoplewithIDhadinputintothepreparationoftheinformation?
• Havethecommunicationneedsandpreferencesoftheintendedaudiencebeentakenintoconsideration?
• RememberAWIisnotusuallyintendedtobereadalonebypeoplewithID.Ideallyasupportershouldbeavailabletoassistwiththedeliveryoftheinformation.
• HasanyconsiderationbeengiventothebestwaytosupportthepersonwithdisabilitywhenusingtheAWI?
• Hasanyguidanceaboutsupportbeenincludedwiththedocument?
• ThinkaboutAWIasthebasisofaconversation.

References

1. Change,Howtomakeinformationaccessible:aguidetoproducingeasyreaddocuments,
2. UKDepartmentofHealth,Makingwritteninformationeasiertounderstandforpeoplewithlearningdisabilities,
3. Mencap,AmImaking myselfclear?Mencap’sguidelinesforaccessiblewriting, (accessed 1/6/17).
4. J.Rodgers,R.J.Townsley,E.S.Folkes,E.J.Tarleton,C.J.Mears,G.Levy,L.Waite,S.Namaganda,J.JonesandS.Thurman,Informationforall:evidencebasedguidanceonproducingaccessibleinformationforpeoplewithlearningdisabilities, (accessed 1/6/17).
5. Scope(Aust)Ltd.,Clearwrittencommunications-theeasyEnglishstyleguide,
6. InclusionEurope,Informationforall.Europeanstandardsformakinginformationeasytoread and understand,
7. G.Freyhoff,G.Hess,L.Kerr,E.Menzel,B.TronbackeandK.VanderKeken,Makeitsimple,Europeanguidelines fortheproductionofeasy-to-readinformationfor peoplewithlearningdisability,
8. M.Nomura,G.S.NielsenandB.Tronbacke,Guidelinesforeasy-to-readmaterials, available here, (accessed1/6/17,No.120).
9. OfficeoftheChildren’sGuardian,SafeSpace:Choosingchildsafeservicesforchildrenwith disability, (accessed 20/11/17).
10. OfficeoftheChildren’sGuardian,SafeSpace:Choosetherightorganisationtoworkwithyourchild-EasyEnglishversion,

The Centre for Applied Disability Research

The Centre for Applied Disability Research (CADR) is an initiative of National Disability Services (NDS). CADR aims toimprove the wellbeing of people living with disability by gathering insights, buildingunderstanding, and sharing knowledge. CADR’s applied research agenda is helping tobuild the evidence base and support stakeholders to better understand what works, forwhom, under what circumstances and at what cost.

Research to Action Guides

Bridging the gap between what we know and what we do. Our objective is to build acomprehensive online collection of disability research and translational resources for theAustralian context. Our Research to Action Guides are based on the best available localand international evidence and are put together by subject matter experts to support researchend users to engage with the evidence. We gather and analyse evidence about whatworks, and we package that information into efficient and practical resources.

Acknowledgments

This work was initially supported with funding from the University of Melbourne’s Hallmark Disability Research Initiative, and then from The Centre for Applied Disability Research (CADR).

NDS gratefully acknowledges the support of the NSW Government in establishing the NDS Centre for Applied Disability Research.

Suggested citation

Anderson, J., McVilly*, K., Koritsas, S., Johnson, H., Wiese, M., Stancliffe, R., Lyon, K., & Rezzani, N., Ozge, J. (2017). Accessible written information resources for adults with intellectual disability: a rapid review of the literature. Research to Action Guide, NDS Centre for Applied Disability Research

* Corresponding Author:

About this Research to Action Guide

This Research to Action Guide, ‘Accessible written information resources for adults with intellectual disability’, will assist individuals and organisations that want to prepare written information in an accessible way - in particular, information for people with intellectual disability. The availability of information in accessible formats is important as it contributes to the ability of people with intellectual disability to exercise their right to make informed choices, and in turn maximise their potential to live independently and participate fully in all aspects of community life.

This Rapid Review summarises the findings of a systematic review of the research literature published by Scope / The University of Melbournein September 2017, and can be found here. It forms part of a suite of resources produced for CADR on this topic. The suite includes a good practice guide that gives guidance on how to make written information resources as accessible as possible for people with intellectual disability. Both are available at the CADR Clearing House:

Feedback

Do you have feedback, or a suggestion for a Research to Action Guide? We welcome your thoughts and ideas. Please contact .

Accessible written information resources for adults with intellectual disability: A rapid review of the literature

This paper provides an overview of the literature that gives guidance on how to make written information resources as accessible as possible for adults with intellectual disability (ID)so that they can exercise their right to make informed choices.1 It is designed to provide individuals and organisations with a better understanding of what the evidence tells us about good practice when preparing written information resources. When compiling this paper, both peer-reviewed research literature and the ‘grey’ literature were sourced by means of a systematic review.

Research questions guiding the systematic review of the literature:

• What needs to be considered when preparing accessible written information?
• What evidence is there to support the recommendations made by the various guidelines with respect to preparing accessible written information resources?
• What does the evidence say about the factors that should be considered when supporting a person using accessible written information resources?
• Background

The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), in Article 9, affirms the right of people with disability to access to information. Specifically, the UNCRPD requires signatories to the Convention to promote the “design, production and distribution of accessible information…”.1 Universal access to information is also a core component of the United Nations’ 2030 Development Agenda, and is reflected in Sustainable Development Goals target 16; which is dedicated to the promotion of just, peaceful and inclusive societies by promoting public access to information.2 In Australia, the National Disability Insurance Scheme (NDIS) has made a commitment to providing clear and accessible information to participants.3 However, while the importance of information accessibility is universally agreed, what defines universally accessible information; the extent to which its design is based on evidence; and the availability of that evidence, is not well understood.

In accordance with Article 9 of the UNCRPD, accessible information can be defined as information prepared in a way that allows people with ID to access it “on an equal basis to others”.1 The term Accessible Written Information (AWI) in this review refers to printed and printable materials prepared in an accessible way. While newer technologies such as digital and audiovisual platforms undoubtedly have the potential to change the way that information is presented, this review focused on written and printable material for a number of reasons. Firstly, despite an increase in access to information technology overall, in Australia people with disability still have lower levels of access to computers and the internet than those without disability4, whereas printed and printable resources are a more widely available option. In addition, some people with ID may have difficulty reading on a computer screen or locating and navigating web-based information using a mouse or trackpad.5 Finally, accessible printed and printable resources remain in widespread use, and we anticipated a broader evidence base for print-based materials would be available than for the newer technologies.

Preparing information in a way that is accessible to people with intellectual disability (ID) presents particular challenges. Many people with ID have difficulty reading, and comprehension levels for adults with ID are likely to be significantly lower than those of adults in the general population.6 In response to these challenges to develop accessible written information, some organisations have developed a simplified way of writing and presenting information. Such approaches are commonly referred to as ‘Easy Read’ or ‘easy-to-read’ in the UK and Europe, and ‘easy English’ in Australia. This style of presenting information to people with ID has proven popular, and a number of guidelines have been produced to assist with the production of such accessible information.7-15

The take-home message

Making information accessible means more than just making it easier to read – it also involves delivering the information to people in an accessible way, so that the person’s choice and control over the information is maximised. It is more than just about making the words simple; it’s about making the information understandable and useful to the person. This process will inevitably need to take into account not only generic guidelines on how to write AWI, but also the individual circumstances of the person; their needs and preferences. Producing AWI is therefore only the first step. The important next step is then creating a communications environment in which the person can interact with, and use the AWI.