Automated services: The experience of people with Acquired Brain Injury
A study of people with Acquired Brain
injury and their experience of automated services, specifically, Automated
Teller Machines (ATMs), Automated Ticketing Machines and Telephone Interactive
Voice Response units (IVRs).
November, 1999
Executive Summary and Recommendations
ARBIAS is a specialist non-government agency providing a range of
services to people with acquired brain injury. During their direct work
with people who have an acquired brain injury, the case managers at ARBIAS
have been accumulating anecdotal evidence that suggests these people experience
substantial difficulty and frustration using automated services.
For some people with an acquired brain injury the rapid development of automated services in the community has sometimes meant the inability to access a much needed service. As automated services become more and more common, it became imperative that the problems and challenges associated with automated services for people with an acquired brain injury be investigated, so that appropriate, effective strategies for management be identified.
The purpose of this study was to research the difficulties experienced by people with cognitive impairment due to mild, moderate and severe acquired brain injury in using automated services, specifically automated ticketing machines, automated teller machines, (ATM's), and telephone interactive voice response units (IVR's).
Methodology
The Goals of the Study
2. To identity the problems that people with ABI report when they try to access certain forms of automated services.
3. To identity the problems that people with ABI encounter when accessing certain forms of automated service delivery by independent observation.
4. To assess the impact of training in increasing the usability of automated services by people with ABI.
5. To make appropriate recommendations regarding people with ABI in relation to the use of automated services.
The Process of the Study
1. Literature and projects review
2. Survey of VCASP agencies.
3. Practical investigations were conducted in three phases.
A survey by questionnaire was conducted with 94 people who had been assessed as having an acquired brain injury.
The purpose of the questionnaire was to gather demographic information and investigate participants' awareness of automated machines, frequency of use and non-use and difficulties with use.
PHASE TWO
Practical testing was undertaken with 26 people who had completed
Phase one. The purpose was to observe the participant's capacity to satisfactorily
complete a set of basic tasks using the three automated services. The testing
had two components:
- a quantitative assessment of the practical testing of the tasks involved in using three automated services;
- a qualitative component, whereby the participants stated the problems they perceived themselves to have in using the automated services.
A pilot training study, targeted specifically the use of automated banking machines. Five individuals who had been previously identified in phase two as having substantial difficulty with the ATM task participated in phase 3.
The participants' profiles
Degree of cognitive impairment of the 94 participants in Phase One
All participants of this study were ARBIAS clients. For the purposes of this research, participants' neuropsychological assessment reports were consulted and each participant recorded as having mild, moderate or severe impairment. As the selection of participants for this study was random, the degrees of impairment amongst participants is not evenly represented.- 29% of the participants had mild impairment
- 40% of the participants had moderate impairment
- 31% of the participants had severe impairment
Demographics
GENDER: Of the 94 participants, 84 were male and 10 were female.AGE: Of the participants, 27 were less than 40 years of age (29%) and 67 were between forty and sixty-five (71%). More than two-thirds of the participants were over 40 years old.
EDUCATION: In terms of education, all participants had reached at least primary level and the majority had reached secondary level (80%). A smaller proportion had also done tertiary studies (11%).
INCOME: The source of income for 83% of participants was either a pension or unemployment benefit. Only 5% were currently employed.
Degree of cognitive impairment of the 26 participants in Phase two
Participants who took part in phase 2 had completed phase one, and were willing and able to undertake the practical testing of phase 2.- 23% of the participants had mild impairment
- 50% of the participants had moderate impairment
- 27% of the participants had severe impairment
Demographics
GENDER: Of the 26 participants, 23 were male and 3 were female.AGE: Of the participants, 46% were less than 50 years of age and 54% were over 50 years of age.
EDUCATION: In terms of education, all participants had reached at least primary level and the majority had reached secondary level (84%). A smaller proportion had also done tertiary studies (8%).
Income: The source of income for all the participants was the disability support pension.
Automated Ticketing Machines for Public Transport
The results from this section of the study give a profile of public transport users and non-users who have an Acquired Brain Injury. In particular the data highlights aspects of the automated ticketing machine process which are of particular difficulty for people with an ABI. Recommendations concerning the design of these machines and appropriate customer service are made.People with ABI and the use of public transport
- Of the 94 participants 80%, responded that they used some form of public transport.
- Of the 20% of non-users, more than half had a severe impairment.
TYPES OF PUBLIC TRANSPORT USED
- The majority of the public transport users (63%), travel on the tram
- 47% of participants ride the bus
- 44% of participants who use public transport, use the train
- some participants use more than one form of public transport
FREQUENCY OF PUBLIC TRANSPORT USE
- Across the whole group of users, approximately 25% of participants reported using public transport on a daily basis.
- 45% use public transport on a weekly basis
- 30% use public transport on a monthly basis
- In each of the three groups of participants, weekly use of public transport was the most frequent response.
People with ABI and the purchase of tickets
Regardless of the degree of impairment, personal service was usually the most common mode of ticket purchase- 57% of participants purchased their tickets using the service of a person, at a railway station, a shop or from the driver on buses.
- 31% of purchasers used a ticketing machine
- 12% of users said they evaded purchasing a ticket
People with ABI and fare evasion
As the degree of impairment of participants increased, so too did fare evasion.Of the participants who use public transport, 12% reported they evaded purchasing a ticket on public transport as they had difficulties with the ticketing machine.
The main difficulties reported were, not having the necessary coins to purchase the ticket from the machine and inability to understand the instructions.
People with ABI and the use of automated ticketing machines
About one third of the participants (31%), reported that they usually used an automated ticketing machine.The mildly impaired participants used a ticketing machine more than both moderately and severely impaired participants.
Less than one third of moderately and severely impaired participants used the ticketing machine.
People with ABI who have used an automated ticketing machine
Of the 80 participants who use public transport, 60 reported they had used a ticketing machine.- The majority 62% reported they had problems using them
- 38% reported they did not have problems using them
- The majority of machine users from each group, regardless of the severity of their impairment, reported having problems.
People with ABI and problems using automated ticketing machines
The questionnaire results indicated that moderately and severely impaired participants are less likely to use ticketing machines than mildly impaired participants.- Of the 37 participants who reported having difficulties using the machines, the majority of these participants reported having more than one difficulty.
- Over two thirds of these participants, (68%)reported they had difficulties with the coins necessary to purchase a ticket.
- More than half (54%), reported they did not know the zone they were travelling in.
- Almost half (49%), reported they did not press the correct buttons.
- About a quarter, (27%), reported they couldn't understand the instructions.
- About a quarter, (27%), reported they forgot to take the ticket or their change.
People with ABI and validating machines
Participants were asked if they understood the term 'validate'- 76% reported they understood the meaning of the term validate,
- 24% said they did not understand what this term meant.
- participants understanding of the term 'validate' decreased as their degree of impairment increased.
People with ABI and the problems they have using validating machines
- The main difficulties reported concerned 'balance' and inserting the ticket correctly.
- Over one quarter of the participants did not know where to look for the validating machine.
- Inserting the ticket correctly was the most problematic issue, with half of the participants (50%), inserting the ticket incorrectly or simply not knowing what to do. However, a number of the participants commented that the red arrow on the ticket helped them know which way to insert the ticket. Once the arrow had been pointed out to other participants and the researcher explained its function, participants' performance generally improved.
Implications for the physical design of automated ticketing machines
The practical testing revealed that the main difficulties were reading the instructions and following the instructions, knowing the appropriate zone, and taking the ticket and change.It was also discovered, however, that when prompted by the researcher; these individuals were able to press the appropriate buttons to complete the task. Many individuals commented that "if you weren't here I wouldn't be able to do it."
It is recommended that using the ticketing machine is not contingent on reading the instructions and that machines be designed with the additional feature of a prompt such as flashing lights or arrows or alternatively, a spoken instruction. This would reduce people's dependence on the written instructions.
Balance was an issue throughout the ticketing task regardless of the degree of cognitive impairment. A number of participants needed assistance keeping themselves upright as they moved through the tram while it was moving as well as being an issue as participants used the machine.
It is recommended that the designers of automated ticketing machines investigate ways these machines could be accessible from the sitting position so that individuals with an ABI can use them without worrying about keeping their balance.
Implications for personal service
Given that more than half of all participants purchase their tickets through personal service:It is recommended that the availability of ticketing outlets be increased with particular emphasis given to installing outlets close to public transport stops.
It is recommended that train stations be constantly manned so that people who cannot use ticketing machines be able to purchase tickets from the stationmaster.
It is recommended that short advertisements on the television and radio be introduced reminding people that they can purchase a ticket before they use public transport and informing them of the types of places they are available.
Implications for Training
The data from the practical testing indicated that for people with ABI who want to use automated ticketing machines they probably will have difficulties. The presence of the researcher directing and prompting individuals through the task assisted their performance considerably.It is recommended that a training model in using automated ticketing machines for people with ABI be developed.
It is recommended that the public be made aware of such a model when developed and trainers be available to people with ABI who want to learn how to use the ticketing machines.
Education about machines
There was a large proportion of participants who had never used a ticketing machine. Machine use could be encouraged it a simple, concise advertising campaign was made accessible to the general population.It is recommended that a public awareness campaing be developed that includes simple instructions presented visually and verbally through mainstream media i.e television and radio. In conjunction to this, written advertisements should contain a minimum of information presented in clear, straightforward, terms accompanied by relevant diagram for each step of the ticketing purchase.
Automatic Teller Machines (ATMs)
The results from this study give a profile of ATM users and non-users who have an Acquired Brain Injury.The data highlights the areas of basic ATM transactions which are of particular difficulty.
It makes recommendations to assist in alleviating some of the difficulties.
It also articulates related issues which concern the use of ATMs by people with ABI.
People with ABI and the use of ATMs
About two thirds of the participants (65%), reported that they had used an ATM. The survey revealed that use of ATMs decreased with the severity of the impairment of the person. Mildly impaired persons used ATMs more than people with moderate impairment who in turn used them more than people with severe impairment. Participants with severe impairment were the only ones in which the majority did not use ATMs.The ATM is used in a limited way by this group of people. The main transactions by the ATM users group were withdrawals (97%) and obtaining a balance of account (25%). It is interesting to note that none of the participants used an ATM to deposit money, or transfer money, which are more complex transactions.
The major factor of appeal for two thirds of the ATM users was convenience, with about one third saying they found them quick and easy to use.
SAFETY was an issue for the majority of users, and indicates the need for ATMs to be located in well lit public places to reduce the fear of attack
The MAJOR DIFFICULTlES reported by participants concerned:
- inserting the ATM card in the correct way (41%).
- difficulty remembering their PIN number (34%)
- remembering the correct order of their PIN (23%)
- taking the card, money or receipt (20%)
ANXIETY was a significant issue for a number of participants who required constant reassuring during the testing. This may be related to the participant's cognitive impairment and their awareness of their inability to successfully negotiate certain steps of the tasks. However; it was also evident that some participants were very aware of people behind them in the queue and this acted to heighten their anxiety.
SELF-REPORTS from the study indicate that individuals with mild, moderate and severe ABI impairments are generally aware of the difficulties they experience. Furthermore, the specific problems they report with using ATMs are generally consistent with outsider observations. This indicates, at least at a basic level, that the ABI population used in this study had not lost insight into their abilities with regard to using ATMs.
Implications for the physical design of ATMs
A number of difficulties with ATM use related to the PHYSICAL DESIGN of the machine. This has implications for design improvements that would lead to greater usability of the system for people with ABI. It is recognised that the major banks have a variety of ATM designs currently in use and this situation provides obstacles to their use by people of varying cognitive abilities.There was no participant in the study who had prior experience with the same design as that used in the practical testing. This design included features such as:
- Instructions enclosed within a narrow visor which needed to be manually adjusted for height.
- Colour-coded keys with small print on them to identify their function.
- A decimal point was required in the amount entered forjhe transaction to continue.
- A number pad located to the right side of the user.
- A number of participants indicated that they were familiar with a different ATM design which had other features including:
- Instructions appearing in large print on the screen with arrows pointing to each option.
- A key pad situated directly below the user.
- No decimal point required when the amount was entered for the transaction to continue.
It is recommended that a standardised design for ATMs be introduced which takes into account the needs or people with varying cognitive abilities and introduces measures to improve the usability of the system. It is recommended that the design of such a standard have less reliance on written instructions and greater use of auditory and visual prompts to guide users through the process.
Implications for customer service
It is important to note that only one person used bank literature as a source of information when they needed assistance using an ATM. It is also a major concern that a number of participants who reported they had required assistance during an ATM transaction received it from a person other than a bank employee. Some people turned to a friend, others to an unknown person in the queue. In some instances the transaction was done for them.Obviously such a practice is highly undesirable as it leaves the individual concerned vulnerable to attack and exploitation.
It is recommended that users of ATMs who have difficulty doing transactions be actively encouraged by the display of appropriate signs around the ATM, and large posters in the bank, to contact a bank customer service officer for assistance.
Many participants had difficulty remembering the PIN used in the study. This may have been because the number had no personal meaning to them.
It is recommended that individuals with ABI are given assistance to nominate a PIN which has some personal relevance to them and will therefore be easier for them to remember. This could be made possible if customer service officers were made aware of the importance of prompting individuals with ABI to choose an appropriate PIN.
It is recommended that customer service officers be given training that focuses on the particular needs of people with ABI and be made aware of compensatory strategies that can be used to assist this group of people.
Exemption from Bank Fees
During the process of this study, the researchers became aware that a number of banks have introduced over the counter exemptions from bank fees for people with a disability who are reliant on teller service. However, when the researchers raised this matter with customer service officers at different banks, few staff seemed to be aware of the exemption or the procedure by which they could be obtained. Furthermore, inquiries made through information telephone services and bank branches did not yield any readily accessible information available in this area.It is recommended that simple, clear literature be available to the public informing them of bank charge exemptions for people with a disability.
It is also recommended that customer service officers have the current information readily available regarding details and procedures in which bank charge exemptions can be obtained.
Implications for Training
The data from the practical testing of phase two indicated that for people with ABI who want to use ATMs there is a need for training.The results give an understanding of the training needs of people with ABI by highlighting the areas of basic ATM transactions which cause particular difficulty such as inserting the card correctly, remembering the PIN and understanding the instructions.
It demonstrated that trainers need to be aware of the issue of people's anxiety and that this can be affected by environmental factors such as the number of people waiting to use an ATM. This factor has implications for the time and place of training. Bank staff may be able to provide information on quieter times of ATM use. In addition, consideration needs to be given to the availability of practice machines that replicate an actual ATM which could be located at the bank.
During the study the ANZ bank generously allowed the researchers the use of a 'Junior ATM'. However when it was used for training purposes in phase three, (at the ARBIAS office), it quickly became apparent that as the design of this machine was different to other ATMs, it added to the difficulties participants were having, so the use of the Junior ATM was discontinued.
The provision of a pilot training program in phase 3 revealed a substantial improvement in ATM usability across the participants. It also highlighted some of the difficulties involved in doing this type of research with people who have an ABI. The training program (detailed previously) was based on a system of constant positive reinforcement whereby small achievements are reinforced and replaced over time with greater responsibility, more independence and appropriate reinforcement. Also, the technique of training by constant prompting and repetition in a simulated artificial setting allowed adequate time for learning before the person entered the real environment with its myriad distractions and stressors. This training technique focussed exclusively on achievement through doing and not failure to do.
It is recommended the impact of training on ATM usability for individuals with an ABI be further investigated with a particular focus on the development of a training package which could be accessible to banks, ABI disability groups and all health professionals.
Telephone Interactive Voice Response Units (IVRs)
(For the purposes of this report, an IVR Unit will be referred to as automated telephone service.)The results from this study highlight aspects of the automated telephone process which are of particular difficulty for people with an ABI. Recommendations concerning the design of the automated telephone process are made.
People with ABI and the use of automated telephone services
Of the 94 participants it was established that 40% had used an automated telephone service and 60% had not.The survey revealed that the use of an automated telephone service decreased with the severity of the impairment of the individual. Mildly impaired persons had used an automated telephone service more than those people with moderate impairment who in turn used them more than the severely impaired participants. The majority of participants with severe impairment had not used an automated telephone service.
People with ABI and the problems they have using automated telephone services
The 38 participants who had used an automated telephone service were asked: tDid you experience any problems?' Of these:- 68% said they had problems
- 38% said they did not
- The greatest areas of difficulty that participants reported concerned understanding the instructions and forgetting the instructions.
- Responding to the instructions by pressing the appropriate button was problematic for 42% of the participants.
- A number of the participants (38%) reported that they had a telephone that did not enable them to use the automated service.
- Delays, in this context, experienced by 15% of participants, usually referred to getting the engaged signal when they rang.
Implications for the design of automated telephone services
The design of the system used during the practical testing was such that a customer service operator was provided as the last menu option. If this system was revised so that operator assistance was one of the first two options, a lot of confusion and anxiety could be avoided.It is recommended that the design of automated telephone services be reviewed to allow greater accessibility by people with cognitive impairment
It is recommended that as part of a review; consideration be given to providing the customer service operator as one at the first two telephone menu options rather than the last
It is recommended that the design include the facility for users if they are having problems, to press 0 at any time so they can be connected to an operator
It is recommended that instructions be kept short, simple and to a minimum.
A Final Word
A balanced approach to the application of technology in the market place needs to be taken where people with ABI are concerned. As with a proportion of individuals in the broader community automated services such as ticketing machines, ATMs and automated telephone services are not suitable for all people in the ABI community.For the ABI community especially, it is essential that the personal element of service be maintained. It is also imperative that customer service officials be made aware of the particular needs of people with ABI.
It is also essential that automated services be designed in ways that allow for their accessibility to as many people as possible.
Preliminary findings from the training pilot suggest that the performance of people with ABI to successfully negotiate ATMs can improve.
To meet the particular need of this group of potential users, the optimum type of training needs to be appropriately designed and sensitively implemented. This study has highlighted the need for this area to be further investigated.
Finally, it is important to acknowledge that often in improving physical design for special need groups, the benefits can flow onto the rest of the community.
Given that Australia is facing a growing ageing population with the consequent cognitive declines that this can bring, increasing the usability of automated services for people with ABI may mean substantial benefits for many others.
If after having read this precis, you would like to receive a copy of the complete and comprehensive report, please do not hesitate to contact:
ARBIAS inc.
226 Gertrude Street
Fitzroy 3065
Victoria
Telephone (03) 9417 7071 Facsimile (03) 94~7 7056
Email: arbias@netlink.com.au
http://www.vicnet.net.au/-arbias/