Umeå University Institution for Psychology Master thesis spring 2005

Grocery shopping for persons with a visual impairment

Jonas Andreen Supervisor: Gregory Neely

Grocery shopping for persons with a visual impairment

Jonas Andreen

Abstract. Not everyone finds it easy shopping for groceries. This qualitative study investigates, with observations at two grocery stores and semi structured interviews, what obstacles persons with a visual impairment run into at the grocery store. Differences were observed between five persons with partial sight and three persons who were blind in performing series of tasks in a grocery store. Results show that tasks that involve more senses than sight do not generally pose as obstacles but tasks that only involve sight, such as reading expiration dates, pose as large obstacles. Implications for this are discussed. Key words: visually impaired, blind, partially sighted, ADL-index, qualitative study

For most of us going to the grocery store is a part of everyday living. We think nothing of it: going there, picking up what we need, paying for our items, and going home again. But there are those that have difficulties completing these things.

Consumer items and services should be available to everyone in society. It should be possible for everyone to get to a specific product or service and once it has been obtained it should also be possible to use it. Today there are many disabled consumers who can not use their finances in an effective way. They have a hard time getting to the store and, once there, they have difficulty getting sufficient information (Konsumentverket, 2002).

On some levels there has been a lot done to improve this situation for people with some form of impairment. Buildings are today designed to allow for wheelchairs, elevators are installed in houses, etc. There is extensive literature on making public places more accessible. In Sweden, many books have been written on the subject (Handikappombudsmannen, 2004; Forsberg, 1996; Andersson, 1998; Synskadades Riksförbund, 1981; Månson, 1999; Svensson, 2001). All of these books talk about making the municipal areas – such as roads, libraries, employment offices and museums – more accessible for different kinds of disabilities.

A group that has not gotten so much attention in this literature is persons with a visual impairment. For these people it does not matter that the entrances of a store is wide enough for a wheelchair. Their problems are of a more basic type. They have a hard time to navigate, not because they can not get past obstacles, but because they can not find the obstacles in the first place. There are many different things in a grocery store that requires sight, and aids – such as Braille – rarely exist. People with a visual impairment are therefore often dependent on help, either from someone at the store or from someone who accompanies them.

Some work has been done to map the accessibility of public places for persons with a visual impairment. Hetherington (2000) investigated museums in the London area to see how they had changed from being places of only sight to being places for several senses. Persons with visual impairment want to experience the works of art,

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but not being able to see they instead want to touch and smell and listen to them. This is not done today because if every visitor touched the rare items of the museum they would deteriorate and break. Hetherington continues to write that access comes in many different shapes and forms and simply making the entrances of the library accessible does not make the works of art in the museum accessible. A solution that some museums have used is to make replicas of some of its items and display the real item behind glass so that visitors can touch the replica without destroying the real version. Today it is also more frequent that museums provide taped tours of the museum with detailed descriptions of the works. This is another way the museums has become more accessible.

A few reviews have been written on the subject of accessible libraries. These (Kinnell, & Creaser, 2001; Wilhelmus, 1996; Saumure, 2004; Claire, 2002) mostly deal with what has been done to improve the visually impairer’s situation and what further can be done. Kinnell and Claire’s works are based on surveys of several libraries in the UK where persons with visual impairment have answered what services they use when they visit their library. Wilhelmus gives a historical perspective on the visually impairers issues in libraries and addresses the changes that have been done to academic libraries since the ADA (Americans with disabilities act) was introduced. Saumures work is based on interviews with undergraduates who are visually impaired. Results show that they feel there are limitations to library materials and to improve access there needs to be better cooperation between libraries (thus broadening the availability to Braille materials).

Rather than mapping accessibility of certain areas some studies address what solutions there are to accessible problems. Gumpel, & Nativ-Ari-Am (2001) reported on a study where young adults with a visual impairment were trained and observed in different grocery stores to perform a list of tasks. They were given two different kinds of training before the observations, either task-analysis training – where the behavior of each task is discussed and learned with an expert –, or self-monitored training where the participants themselves learn the correct behaviors by looking at a different card that describes the correct behavior for each task. The participants then got a list of tasks to complete in a grocery store while “thinking aloud”. Results showed that the young adults improved their abilities to shop for groceries independent of training technique.

There have been a number of attempts to use technology in aiding the visually impaired. One such attempt involves a head-worn camera and headphones. The camera captured the surroundings in front of the user, encoding the picture in a portable computer and relaying it acoustically to the user. This makes navigation easier for the visually impaired person, obstacles are avoided and walls and other surroundings are recognized (Nagarajan et al., 2004).

Another attempt at increasing mobility was conducted by Strothotte et al. (1996). Here a two stage platform was used with a journey planning system and a journey executer. With this system persons with a visual impairment could plan their journey at home with an ordinary computer and then bring with them a much smaller mobile computer that audibly gave the directions to the preprogrammed location. This

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successfully made the participants more mobile and broadened there navigational capacity.

One limitation with these studies is that they go little or nothing into what problems exist or why problems exist, merely that things have changed for the better during the last few years and that there exist a range of solutions for better access. It is important to go beyond the mapping of accessibility and start investigating where and why problems exist. What can a person who is blind do and what does she/he need help with? Perhaps there are differences between different kinds of visual impairment, and maybe these differences needs to be observed in the grocery store in order to gain a good understanding of what it means to be visually impaired in that surrounding? Only when we answer these questions can we start to address the solutions of making the grocery store, and many other places, more accessible.

Every person with a visual impairment has their own way to look at the world and it’s very difficult to describe for those with normal sight how persons with visual impairment perceive things. Despite this two main categories of visually impairment can be drawn: blindness and partial sight (Blom, 2003). There exists a difference between these two groups and that is important to take into consideration when looking at visually impairer’s problems in the grocery store. Maybe there are things that people that are blind and those who have partial sight complete equally well and others that those who have partial sight handle much better?

In order to investigate where and why problems exist, qualitative observations and interviews were conducted on eight persons with visual impairment. The observations were done at two grocery stores and consisted of a list of tasks that each participant had to try to complete as independently as possible. After the observation a semi structured interview was held where the observation was discussed and also information about how the participant usually shopped for groceries. At the end of the interview a discussion about a certain concept was held. This concept was conceived by Lindberg (2002) and mainly consists of a special glove (the glove) that one uses for navigation. This is to be used at libraries and not only helps the person to find a

specific shelf but also specific books and information about the books. It functions by pointing in the direction one wants information about and the system gives feedback through a pair of headphones about what lies in that direction. Once at the right area of the library one point at different shelves and information about what they contain is fed through the headphones. Finally, when the right shelf has been found, one point at different books and

information about their title, author and what they are about is fed through the headphones, thus making the wearer more independent when visiting the library.

Opinions and thoughts about how technological aids, including the glove, could improve the situation in grocery stores were collected during the interviews.

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Methods

Participants Participants were recruited through the Swedish national association for the visually impaired (SRF); the low vision clinic in Umeå, Sweden; and by word of mouth. Different sources for test subjects were used in order to get a mixed group of participants. It was important to observe and interview those who are not as engaged in visually impairer’s issues because they may have different opinions than those who actively pursue disability issues.

Participants were selected for their age, gender and visual impairment. In order not to cloud the results only participants with a visual impairment, and no other impairment, were selected.

Five partially sighted (3 males and 2 females aged 31-57) and three blind participants (1 male and 2 females aged 21-45) were selected for the study. The reason for the fewer amount of blind participants was because of the difficulty of finding participants with that form of visual impairment.

When selecting participants for the different groups the following definitions were used:

• Blindness: A person who can not use any, or very little, of her/his vision for the

planning and/or execution of a task for which vision is essential (Blom, 2003). • Partial sight: A person who has impairment of visual functioning (inability to

read standard written text and orientate themselves) even after treatment and/or standard refractive correction, but who uses, or is potentially able to use, vision for the planning and/or execution of a task for which vision is essential (WHO, 1992).

Each participant’s state of visual impairment was reported by the Swedish national association for the visual impaired or by the low vision clinic. With two of the participants the state of visual impairment was not known and the participants were then asked if they could use any, or very little, of her/his vision for the planning and/or execution of a task for which vision is essential. Depending on answer they we put into appropriate group.

Apparatus

Cassette recorder with extendable microphone was used to record the interviews. Some of the participants used long cane. This was allowed to be used during the observation in order for the situation to feel as normal as possible for the participant.

During the interviews a prototype of the glove was showed to the participants and they got to try it on. This was to broaden the imagination of the participants and show how someone else had tried to solve some of the problems that were faced during the observation.

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Instruments

A formalized version – same specific scheme for every participant – of ADL-instrument was used to collect empery. ADL-instruments stands for activities of daily living and measures how independent a person is at specific activities (Socialstyrelsen, 1997; Hulter Åsberg, 1990). The scheme in this paper differs from the usual ADL-index in the way that it is not out to discover every aspect of daily living but rather see what problems exist in the grocery store. The existing test, Kenny self-care evaluation (Scoening, 1968), was therefore changed and now entirely focused on the grocery store. The test itself was kept intact in its layout and procedure, only the tested area and point system was changed. The index consists of a list of tasks to complete and each task (when completed) gets a score. The scores are distributed according to how much help the person needed to complete the task:

0 points: Totally dependant on help to complete task 1 point: Needs some help to complete task 2 points: Totally independent of help to complete task

After all the steps in the test were completed a total score was summarized. The higher the score, the more independent the person was considered to be. This score was used when comparing different groups.

For the observation five areas of interest were created, as seen in Figure 1. For the actual observation, a test with tasks to complete was created based on these areas. A pilot test was conducted with a partially sighted participant in order to verify the viability of the tasks. From the results from the pilot test a final test was created and used successfully for all remaining participants.

Movement • Get to and from store • Enter/exit store through

doors • Walk about in store

Navigation • Find way to different

locations in store • Find goods on store shelves • Find member of the staff

Instrumentation • Use cart/basket • Use a scale • Put goods on conveyor belt • Pay for goods • Put goods into bags

Communication • Ask for expert help about a

certain item • Pay for goods

Discrimination • Discover differences

between fruits/vegetables • Find a specific

fruit/vegetable • Decide freshness and

ripeness of fruits/vegetables • Discover differences

between items on shelves • Find a specific item on

shelf • Decide freshness of item

through expiration date. Figure 1. Areas of observational interest

Reliability and validity of ADL-instrument By observing what tasks the participants need help with – when they run into obstacles – and where they can manage themselves, measure of their independence can be made. This makes the ADL-index a valid instrument because it measures that exact thing, the degree of independence.

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It is important to view the summarized index as a more complex instrument than simply a single number for an individual’s independence. If one were to compare only the total score for each participant the instrument would not be valid because it does not show differences amongst the individual steps in the test (Törnquist, 1995). One group might be very skilled at navigation but not at discrimination and the other might be god at discrimination and not at navigation but they would still get the same scores in the end. Only when you compare scores between different steps in the test will you have a valid instrument. One way to test if the instrument truly studies what it is supposed to study is to bring in an expert and evaluate the findings. If he/she concurs that the findings are what would be suspected it is a valid test (Törnquist, 1995).

Results were discussed with an experienced staff member of the National association for the visually impaired. The expert concurred that the finding were realistic and that the method used, ADL-indexing, was in fact what they themselves used when investigating a person with a visually impairments needs.

The reason only three different scores are used for each task is because of the difficulty to discriminate between a ranges of scores. It is very easy to recognize the extremes (0 and 4) in a score range from 0 to 4 but not what lies in-between (1, 2 or 3) (Medicinska forskningsrådet, 1980). By using a range of three some of the complexity is lost, but on the other hand one gains the ease of giving every participant the correct score, thus improving reliability.

The tasks in the test are very similar to the skill steps that Gumpel (2001) used when observing young visually impaired persons shopping for groceries.

Procedure Observations

Observations were made by giving the visually impaired person a range of tasks to complete in a grocery store.

All observations took place in a way that other shoppers could not understand that a test was taking place merely that the observer was the participant’s assistant. In order for a non-stressful and calm environment, as often as possible, the observations took place at a time of day when there were few other customers in the store.

It was important that the grocery store selected for the observations had not been visited by the participants before. To ensure a nonbiased result two stores, similar in look and layout, were chosen and depending on if the participant had previously visited the first store the observation took place in the second store.

The day before the observation took place participants were phoned and instructed about the observation. Instructions to be used during the observations, information about the interview and information about the project in general were presented. The participants were told that they had to try to complete the tasks themselves before asking for help, that they would try to be as independent as possible. They were informed that all data was to be handled confidentially.

At each of the two stores the order of tasks in the observation was adjusted to the order of the items appearing in the store. For example at one store the fruit

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department comes first while it comes last at the second store. Consequently the orders of the tasks were adjusted accordingly.

Before the observation began each participant was asked if they had any questions, after which the observation started. After each completed (with or without help) task a score was noted and the participant was then instructed of the next task until all the tasks were completed. Although time was not a factor every observation was timed in order to get an overall idea of how long the observations lasted. The interview followed immediately after the observation.

Interviews The interviews were held in the form of semi structured interviews so that all were conducted in the same way but still had room for participants to talk freely when they so desired. This also made it possible to look at differences between groups and made it harder for the interview leader to adapt to the interview situation over time.

The interviews began with some demographic questions such as age and occupation, following with questions on the participant’s grocery shopping habits and then the observation was discussed. Here questions were focused on how the participants experienced the tasks, what was difficult, and how they would like to improve the situations they ran into. Finally a presentation of the glove was held and the participant got to comment on: if it could help them in the situations they just ran into, and how they thought it could be improved or changed so that it better suited the grocery store?

The interviews took place at two different locations (depending on what store was used); both at after-school recreational centers that were located near the stores. These locations provided secluded and quiet rooms nearby the store, which was important because the interviews had to be conducted as soon as possible after the observation so that the participants did not forget what they had just experienced.

All interviews were taped and then transcribed. In the transcription process each answer to the questions were identified and written down. Information such as pauses or coughs during the interview was not written down.

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Results

Observations Observational time

On average it took 34 minutes for the participants to complete the observations.

0,0 0,5 1,0 1,5 2,0Movement (all categories)

Instrumentation (all categories)

Navigation (all categories)

Discrimination (fruits)

Navigation (to packages)

Instrumentation (scale)

Discrimination (packages)

Figure 2. Average points in categories for all participants. Higher values mean more independence.

Movement Two participants needed to ask for help in order to find way through the automatic gates located before entering the shopping area. Otherwise the participants gained high scores as seen in Figure 2.

Navigation Most of the participants – averaging 1,5 points – had no problems navigating within the store, some finding specific locations after only a short search, while others had to search for a longer time. There were a few things that most managed to do without help: All but one managed the tasks of finding a member of the staff as well as finding the checkout line. Everyone managed to find the exit of the store and navigating to the starting point. On the other hand, there were a few things that some needed help with, such as finding the raspberry desert crème (as seen under navigation to packages in Figure 2, averaging under 1 point). In this task seven out of eight asked for my help in order to complete it. Also four participants had to ask for help in finding the fruit department. None of the participants needed the observer to complete the navigational task, but instead asked for hints on how to navigate to the specific locations. Overall navigation posed no great obstacle (as seen in Figure 2) but navigating to packages posed a larger obstacle.

Discrimination The areas of the observation that dealt with discrimination packages were where most participants had to ask for help (where the lowest scores were gained as seen in Figure 2). Discrimination can be divided into two fields: discrimination between

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fruits, and discrimination between packages. As seen in Figure 2 tasks involving discrimination between fruits proved not to be difficult for the participants. One participant had initial difficulty discriminating apples and tomatoes but managed after using smell. Discriminating between different packages of raspberry dessert crème proved to be very hard for many of the participants (gaining low scores) and they needed to ask for help or even let the observer complete the task for them. A majority of the participants were unable to read or even locate expire date of the raspberry desert crème.

Instrumentation All of the participants managed to either carry a shopping basket or roll a shopping cart, depending on what they chose. They also had no difficulty placing the groceries on the conveyor belt or to put the groceries into a bag. This is clearly shown in Figure 2 where overall instrumentation got a high average point. The only instrumentation that proved troublesome was the scale (as seen in Figure 2 with an average of 0,9 points). On this task two of the participants managed to use the scale themselves, three needed assistance and three needed the observer to complete the task for them.

Communication None of the participants had problems communicating with staff when asking for items or paying for items at the checkout.

0,0 0,5 1,0 1,5 2,0Movement (all categories)

Instrumentation (all categories)Navigation (all categories)

Discrimination (fruits)Navigation (to packages)

Instrumentation (scale)Discrimination (packages)

0

0

Figure 3: Average points in categories for 3 blind and 5 partially sighted participants. Higher values mean more independence.

Partial sight

Blind

Differences between participants who were blind and participants with partial sight As seen in Figure 3, participants who were blind gained fewer points than participants who were partially sighted. They had a harder time to locate and use instruments, especially the scale (where persons who were blind got 0 points and persons who were partially sighted 1,4 points on average), and were totally dependant on the observer to find the raspberry desert crème (while participants with partial sight found it with some help). A partially sighted woman managed to read text from packages if she looked very closely at them while none of the blind women were able to read text at all. Also the partially sighted woman was able to navigate to the

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raspberry desert crème without help, using her vision, while the woman who was blind was unable to do so. When it came to discrimination between fruits participants who were partially sighted received slightly better scores than participants who were blind.

Interviews Demographic data

Employment One out of eight of the participants had an active job at the time of the interview. Some had had jobs before they became visually impaired and others had had jobs while visually impaired but lost them because of cutbacks at the workplace.

Four participants were at the time of the interview taking a course at the Swedish National Association of the Visually Impaired (SRF) that would help them to adjust to the working environment and in the end help them get a job. One participant studied at high school and one helped SRF with computer related issues such as their homepage.

What education, relevant to them being visually impaired, did the participants have? Four of the participants said they could read Braille very well and the other four said they could manage to read some Braille but that they were not efficient at it. Six of the participants had learned to use computers to aid them in everyday life. Three used an enlarged screen for their computer to see together with audio feedback, while the others used only audio and Braille feedback.

To what degree was the participants visually impaired? Three participants were totally blind. The others had partial sight and could potentially use their vision for navigation. Within this group the degree of impairment ranged from being almost blind, having large difficulties to read any written text even with magnification, to being able to read larger text sizes without the help of magnification.

When did the participants develop their visually impairment? Half of the participants were born with their visual impairment. The other four developed their impairment at different stages of their lives after having had normal vision.

What was the cause of the participant’s visual impairment? None of the participants had similar causes for their visual impairment. To quote a few: benign tumor near the optic nerve, diabetes, and pelvospondylitis – a form of rheumatism. None of the participants were visually impaired because of physical injury. One participant did not know what had caused the visual impairment.

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What aids did they use? Five of the participants used a long cane to help in navigation; the others did not use long canes. All participants who were partially sighted used some form of magnification to help in reading text and in navigation. Glasses and magnifying glasses were mainly used to read text and binoculars to read text from afar and also to make the surroundings more clear – helping in navigation. Six of the participants used computers, those with magnified screens and those with speech synthesis and Braille output. Finally one participant used a tandem bicycle in order to make the outdoors more accessible.

About shopping for groceries Did they usually shop for groceries?

All of the participants usually went shopping for groceries.

How did they shop for groceries? Four of the participants usually went around in the store picking out what they need. If they could not find something they went and asked for help, either from the staff or just someone standing nearby. They all had a store they preferred; one they usually went to, where they had learned where most things are located. The remaining four participants (three blind and one partially sighted) usually did not go by themselves in the store but asked someone from the store to accompany them while shopping, using their sight when needed.

Did they shop themselves or with someone? Four of the participants usually went to the store alone and once there either shopped alone or asked for help at the cash registry. Three participants sometimes went alone and sometimes with someone depending on when a helper was available to them. One person almost always went with someone to the store.

What stores did they usually go to? All of the participants usually went to the store nearest to their home. Those who had less difficulty at seeing also used a few other stores such as those down town while those who were blind or almost blind never visited other stores then the one they were familiar with.

About the observation How did the participants felt the observation went?

All of the participants felt the observation went well. They did not express any discomfort or other negative feelings about it. Two participants said that it was an unusual situation for them to be apart of an observation but that they understood the purpose of the tasks.

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What did they think was difficult? There were two types of problems that the participants talked about; one relating to lack of sight, and one relating to lack of logical placement of items in the store. Addressing the issue of sight almost every participant said they had difficulty to discriminate the raspberry desert crème from other items in the shelf. They also said they had difficulty to read small labels on the spice jars making it impossible to discriminate between different spices.

“To find specific spices was hard. The text is so tiny on the jars, so much text on such little space. And the jars are so narrow.” - Woman, partially sighted

When looking at logical placement of items in the store one participant experienced problems at the fruits department because fruits and vegetables did not have specific areas but instead were mixed, in this case making it hard to distinguish between apples and tomatoes. Three participants also commented on the location of the raspberry desert crème, they had thought that it would be located near the jams and fruit juices but when it was not they had difficulty finding it.

“When I was going to find the raspberry desert crème I first found the fruit juices and then I thought that the fruit desert crèmes must be nearby. But then came the baby foods and then kitchen utensils and then it became difficult, it just wasn’t logical.” - Woman, partially sighted

What did they think was easy? Three of the participants commented that the fruit part of the test was easy. Two participants said that they almost always found the fruits department in a corner of a store or alongside one of the walls of a store and that this knowledge had helped them in this observation.

“The fruits were easy to find but that’s because of my trick, I walk along the walls until I find it. That also works with the delicatessen and the dairy because those places need to be along walls. If you stick to the right side of the wall as soon as you enter you are bound to end up at one of these places.” - Man, partially sighted

Another similar “trick” was used by one of the participants; by looking at the way the lights were arranged in the sealing, like sailors used the stars, one could use them as help in navigation. Two of the participants said they though it was easy to find someone of the staff; mainly by looking for specific sounds that staff produce – such as unpacking items or pushing boxes etc. Finally one participant who thought it difficult to read labels close to the floor, said she sometimes took the price-tag from its holder and could then stand up straight and read it without difficulty, thus making an otherwise difficult task an easy one.

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How did they feel about needing to ask for help? Half of the participants said they had no difficulties in asking for help, it felt normal to them. In contrast the other half of the participants said it was not always easy to ask for help because then their impairment was revealed, and in addition they had to rely on staff that might not always be willing, or have the time, to help.

If they got to decide, how did they want to go about shopping for groceries? Those who had partial sight wanted clearer markings of the paths, and that a standard was set for all stores so that they always knew where to look for information. They wanted signs that were in the height of the eyes so that they are easy to spot and also have high large contrast text and Braille so that everyone can read them. This also applied to the items in the shelves, or at least the tag where the price information is. One person commented on the location of the price tags, that when you have to go very close to read them it is impossible to do so when they are very close to the floor. Two participants wanted the stores layout to be constant and not change so much as it did today. They said that the key to being able to find things in a store is for everything to have a fixed location. When the store refurnished they had a very difficult time to find the items they were looking for.

“I wish they wouldn’t change in the store so often. I learn where things are in the store and when they change the places it is very difficult to find them again.” - Woman, partially sighted

Finally two participants wanted better service from the staff. Maybe that the store had a dedicated person who handled all elderly and impaired so that one always knew who to turn to for help.

What ideas did they come up with to solve the obstacles they ran into at the store? As mentioned above one solution that the participants mentioned was larger and easier text to read, in better locations. Then there were three suggestions based on IT-artifacts. The first suggestion involved a pen with a scan function so that text could be fed into it and then read aloud or at least with large letters on a display. The second suggestion also circled around scanning text but with the extra feature that you could select what language it would scan in, so that you could read text on packages containing foreign texts and read it aloud.

“Maybe if you had a device that you moved across the text on the package and that read the text with speech. It would even be possible to read different languages, because there are different languages on some packages and then you could choose language.” - Man, blind

The third suggestion focused on the barcode on each package being tactile so that you could locate it if you were blind and then scan it with a hand scanner. The scanner

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would then read aloud information about the package such as name, price and content. The participant said that this would not mean such a big cost for the manufacturers and it would use technology that existed today.

How did they feel about the observation? None of the participants said they felt uncomfortable or strange about being observed. Two of the participants said that they usually did not go in the store themselves but instead asked someone from the staff to help them – that made this situation unusual for them. When asked if they thought they behaved differently because they were being observed they all said no, however some commented that the test situation made them less free than they usually were when they went shopping for groceries alone.

About the glove What did they think about the glove?

Six of the participants said it was an intriguing concept and they thought it could improve the situation for the visually impaired, especially the blind. One person thought it was over the top to have such an advanced thing for just one place and suggested that it would prove more useful if it worked everywhere in society. The participant suggested it being used to navigate the streets of a city, or maybe in an airport which has very large areas that are hard to navigate in.

“To orientate oneself in this way is smart but a bit overkill for a library. Rather it would be useful for larger open areas such as an airport or down town.” - Man, partially sighted

One participant was skeptical to the idea saying that it sounded too technical and would have to be failsafe in order to work properly, and that it would mean lot of extra work for the staff to administer the system.

What did they think about it being applied to the grocery store? Four of the participants said it would suit the grocery store very well, especially for the blind. Three of the participants said that they saw potential in the concept but that it would mean a lot of work for the store to add every item to the system – thinking that a grocery store has much higher volume of new items than a library. The main concern that many of the participants expressed was that if only the price strip below the products was marked one would never know for sure that you got the right product because sometimes items are in the wrong places. One participant said that it would prove hard to hold the cane in one hand, a basket in another and also have this glove on one of your hands – it would have to be very inconspicuous in order to work.

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What did they think would have to be changed with the concept in order for it to work in the grocery store?

One participant said it would be good if you could feed your shopping list to the glove and it would then help you find the specified items in the order they appear in the store.

“If it could be so advanced that you could tell the glove that I want that specific item. Then it could guide you to that item. Already when I enter the store I would feed it the items I want. Then you could visit a store where you don’t know anyone of know how it looks.” Woman, partially sighted

This could be done at a computer with a scanner and then fed into the glove. Then when you went to the cashier they would know what you wanted to buy, by reading it of the glove, and could then check off the things you had picked up in the store ensuring you had the right products. One participant commented that the amount of information gained from the glove should be limited. Best would be if it only gave information about what name the product had, what price and maybe if it contained anything allergic such as nuts. The other participants did not want to speculate on this issue because they said they either lacked the knowledge or could not think of any changes to the concept.

Differences between participants who were blind and participants with partial sight

To a greater extent than participants who were partially sighted, participants who were blind commented on the difficulty of finding the raspberry desert crème and to locate and read the expiration date. When asked how they would like it to be when shopping for groceries participants who were blind focused their answers on greater help from staff while participants who were partially sighted focused their answers on better markings of the items. Both participants who were blind and partially sighted talked about IT-based solutions making them more independent in the grocery store. When asked about the glove participants who were blind were very enthusiastic but at the same time more skeptical than participants who were partially sighted. One participant said that the glove would be a revolution for many persons who are blind but only if it is failsafe.

“…but it’s not enough to mark the price strips below the products, you need to mark every product so it’s impossible to take the wrong product by mistake. It would be really frustrating to come home realizing that you have bought the wrong items, and perhaps expensive.” Man, blind

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Discussion The goal of this study was to investigate what obstacles persons with a visual impairment run into when shopping for groceries and if there are any differences between persons who are blind and persons with partial sight.

Many interesting things happened during the observations and they in a good way shed light on how it is to have a visual impairment when shopping for groceries.

The results indicate clearly that none of the participants had trouble to move around in the store. They detected obstacles and other shoppers easily, either with their cane or with the little sight they had left, and could move around them. Problems first arose when they had to go to specific places, such as the raspberry desert crème. This proved to be very hard for many of the participants. Because they had never been to the store before they lacked a cognitive schema over that location and had to resort to trial and error. This sometimes took very long time but it was probably the only way for them to find it because this type of product has no particular touch, smell or sound. A few participants brushed past the correct place without knowing how close they were and moved on while others still had enough vision to recognize the shape of the item. What posed the greatest problem for participants with partial sight was that the raspberry desert crème was not located near the jams and other fruit items but on a separate place in the store. They did not think it was logical and when you can not navigate on sight, smell or sound maybe the only thing left is to use your mind and try to figure out where the item can be located. Gumpel (2001) showed that young adults that were allowed to walk around in a grocery store and learn where things were located had an easier time to find items the second time they visited the store, thus showing that memory serves a large role when shopping for groceries. Although the participants had not visited this particular store they still used their cognitive schemas from other stores to help in navigation. These kinds of strategies were used to find the fruits department and perhaps the reason why that location was easier to find than the raspberry desert crème. One participant said that the fruit department usually was located in a corner of the store, that cognitive schema now helped in completing the task. Another reason the fruits department was easier to find, one participant explained, was because of the smells that emanated from there.

Not surprisingly the things that were the hardest to complete were tasks in which sight was needed. For a blind person it proved impossible to find a package of raspberry desert crème or to find its expiration date. Even if the person managed to find a package that resembled raspberry desert crème in shape it was impossible to know if it was actually raspberry desert crème or perhaps orange juice. Fruit is much easier to discriminate. This was clearly shown in the observation when almost none of the participants had troubles with discriminating fruits but a very hard time to discriminate between packages. This is probably because of the greater range of senses used when discriminating fruits. One can smell and touch or even taste the products thus making it much easier than the packages where you can not even use touch to find out what it is. Grouios et al. (2001) writes that those who have been

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blind from birth have compensated their lack of sight with greater sense of weight discrimination and touch. This comes to good use when touching different fruits for ripeness and freshness but has little value when touching different packages because they resemble each other to much.

When it came to using instrumentation almost nothing proved to be difficult for the participants: not even when holding a long cane and a basket in one hand while using the other hand to feel for items. The only place where the participants had troubles was using the scale. First of all it was hard to find in the store, not always resembling what the participant thought it would look like. Secondly it was hard for the partially sighted and impossible for the blind to read what the scale said. This again is a problem of sight. Gill (2002) writes about instrumentation for the visually impaired and that one must think inclusive when designing these items. That means that technologies that are used by many different people need to work for all of them. Using Gills thinking when addressing public terminals, the scale in this observation could easily be equipped with audible feedback as well as a visual display, that way increasing the potential number of users.

Finally, none of the participants had any trouble locating someone from the staff asking them for help. They searched for specific sounds that staff made when opening boxes or placing items in the shelves and this method proved surprisingly powerful.

Strengthening the findings from the observations the participants thought that the places where they needed most help was where they could not substitute their lack of sight with other senses. Almost every one of them said that they found reading text and identifying packages hard to do because they had no way to sense what was in the package. When it came to fruit it was no problem because they could use their smell and touch.

When asked how they would like to go about shopping for groceries most participants talked about this broadening of the senses. They wanted larger signs that could be sensed tactically, signs that followed a set standard that was the same for every store so that they always knew where to find them. The participants also said that they relied heavily on their cognitive schemas to guide them. They said that if stores did not change their layout so often it would be much easier to learn where things are located. This again follows the work of Gumpel (2001) where memory (more specifically our cognitive schemas) was shown to be of great importance and aid when shopping for groceries.

When asked about how the participants thought things could improve living conditions for them, a range of ideas all revolving around being able to see without their sight, using their other senses as guides were mentioned. Two ideas revolved using scanning techniques to read aloud the text of the packages. Another idea used tactile markings of the barcode on the packages so that the customer then can scan it with a handheld device that audibly informs of name, price and content. All ideas the participants came up with revolved around reading text and none spoke about improving navigation. If this is because they do not consider navigation difficult or if they simply did not think about it at the time is impossible to determine; however, the observational data would support the former.

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This study set out to discover the obstacles visually impaired people run into at the grocery store. It is clear that areas that only enable sight, such as reading expire-date of packages, prove to be large obstacles for persons with a visual impairment. On the other hand areas that enable sight plus other senses, such as when discriminating fruits, greatly improve the odds of finding the right items. An area that initially was thought to prove difficult was navigation but because navigation involves not only sight but audition, haptics, smell, and awareness of flow and motion it proved to be less troublesome for the participants because they could substitute sight with other senses. Brewster (2002) found that when using both sound and haptic feedback the ability to read tables were greatly enhanced then if only read by touch. The conclusion is that if you have to put weight on one issue when it comes to grocery shopping for persons with visual impairment it is to enrich the sensations that today only involve sight. Reading text on packages is impossible for the blind and no other sense can exchange that ability, they need to be labelled tactically or even with smell in order for the visually impaired to discriminate between them.

Differences between participants who were blind and participants who were partially sighted

The only observed difference between the groups was that participants who were blind had a harder time to complete tasks that required sight. They were just as good at discriminating fruits and perhaps even better at listening for specific sounds – although this is speculation based on the fact that they are more dependant on sound and have perhaps adjusted better to it than persons who can still depend a bit on sight. Navigation was harder for participants who were blind because they had no other way than touch to feel the differences between packages. Finding the fruits department proved no trouble because they could use their smell and touch to know they were there. The conclusion of these findings is that packages has to be made readable for people who are blind and navigational aid applied to places where there are many similar packages that are hard to discriminate.

Thoughts on the glove If a glove of this nature should ever be developed for the grocery store the emphasis has to be on finding different packages. There were fewer obstacles when dealing with fruits and when navigating so these areas are of less importance. The number one concern is to make text on packages available to those without sight and also the ability to find those packages. From the interview a few ideas that could enhance the glove was provided. One was to enable the glove with a shopping list feature so that one can feed a shopping list into it and it guides you to the right items in the store. This thought falls in the line of Strothotte (1996). Here a two stage system was used for aid in navigation. One part of the system dealt with planning a specific route and one dealt with executing that route. In the same way a shopping list could be fed into a planning program and then an executive program could be run from the glove helping the wearer find its way to all items on the shopping list. Perhaps it would also be possible to adjust the output of the glove to suit different personalities. One

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participant said that it would be tiring if the glove spoke too much about what was in different packages – name and price was enough. There are probably those that want much more information than this and this should be possible to adjust. Overall the participants thought it could be a very useful tool for them; especially participants who were blind who all said that they thought it would increase their independence greatly. Three of the participants with partial sight also commented that they thought the glove would make persons who are blind more independent.

Methodological discussion

Many test subjects were gathered through the SRF but it has to be acknowledged that this group of people could be more active in the visually impaired sphere than those who are not members – which could lead to a biased result in that they are more open to new ideas than those who are less involved. To counter this, a few of the participants were found through the low vision clinic – asked by the staff when they visited the clinic if they would like to participate.

External validity was gained by doing observations outside the laboratory in a normal setting. The test only contained steps that one commonly does at the grocery store and they were conducted in an ordinary grocery store. No special help was received from the people working in the store except the help they give to any customer. Only the managers of the stores knew of the observations and thus other people working there treated the test persons like any normal customer.

The reason, as stated before, for using two different stores was to ensure that none of the participants had visited it before. One could argue that instead of using stores that the participants were unused to one could use the stores they usually went to. This would not have been appropriate though because some stores are differently suited for people with a visual impairment than others and would have lead to a biased result.

The order of tasks involved in the observations was adapted to the layout of the store and consequently different depending on what store was used. Tasks were selected to follow a simple line from the entrance to the exit and not involve crisscrossing within the store. Another way would have been to randomize the tasks but instead this method was selected making the observations easier to execute for the observer and less time-consuming for the participants.

Some of the test subjects might have been uncomfortable with the situation of being observed. In order to compensate for this a question during the interview addressed this issue and the participants commented on how they felt during the observation. None of them said that they felt uncomfortable about the situation.

It can be argued that the observation consist of to few steps in order to measure the everyday activities one does at a grocery store. It is here important to recognize that tasks may be correlated and that instead of testing many similar tasks it is enough to test one of them and correlate the results to the others (Medicinska forskningsrådet, 1980). One example is ordering something at the delicatessen and asking someone from the staff for advice. If a person can do the first she/he must be able to do the second. Another example is finding items on a shelf. One only needs to test if a

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person is capable to find one specific item from a shelf and not two items from two shelves because shelves and items are about the same and requires about the same abilities and movements. The observation is made to entail as many different activities as possible in as few steps as possible in order for the participant not to get tired or bored.

Further research

Further research should focus on larger groups and a more controlled environment. Perhaps observations should take place both in a controlled lab environment, so that comparisons between groups can be made; and in the shopping environment that the participant is familiar with, so that the social context is observed. This would make it possible to investigate differences between known environments such as the local grocery store and novel environments such as grocery stores out of town. With larger groups one could detect differences between gender and age and further investigate the differences between persons who are blind and persons with partial sight.

Greater emphasis on problem solving should be made to gain information about each step in the visually impairers thinking when an obstacle is approached.

Several of the participants said during the interview that the glove should not be confined to libraries and grocery stores but should be used in any situation where navigation and discrimination is a problem. Further research should investigate how the glove would work in outdoor environments as well as large indoor environments such as airports.

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Acknowledgements

Many thanks to the managers of ICA Mariehem and ICA Ålidhem for allowing the observations to take place in their stores. Also thanks to the after-school recreational centres at Ålidhem and Mariehem. Thanks to SRF Umeå, SRF Västerbotten and Syncentralen Umeå for participant contacts and expert advice. Finally thanks to all of the participants whom without their help this would never have been possible.

Svensk sammanfattning [Swedish summary] Alla tycker inte att det är lätt att handla matvaror. Denna kvalitativa studie undersöker, genom observationer på två matvarubutiker och genom semistrukturerade intervjuer, vilka hinder personer med synskada stöter på när de går och handlar matvaror. Fem personer som är synsvaga jämfördes med tre personer som är blinda i en rad uppgifter i en matvarubutik. Resultaten visar att uppgifter som involverar fler sinnen än synen inte generellt är några hinder medan uppgifter som enbart involverar synen, så som att läsa bäst-före-datum, innebär stora hinder. Implikationer för detta diskuteras i rapporten.

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