The Living Lab Approach for Vision Testing Tool for Intellectual Disabilities and Autism Spectrum Disorder in South Korea

Backgrounds:

Article 25 of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) addresses the right to health for people with disabilities. Despite these standards, health check rates of individuals with intellectual disabilities (ID) (46.7%) and autism spectrum disorder (ASD) (40.7%) in South Korea are significantly lower compared to those without disabilities (67.8%). Especially, vision testing poses a challenge for ID and ASD, unlike the ease experienced by those without disabilities. However, South Korean government has not provided vision testing system focusing on reflect needs of persons with developmental disabilities. Meanwhile, the living lab model is known to innovative approach to consider values and strategies such as user-centered, co-creation, real-life setting, involvement of multiple stakeholders, and value sharing. Therefore, this study aims to identify the challenges posed by vision testing for ID and ASD and develop a prototype of a vision testing tool using living lab method.

Methods

The living lab participants consisted of 7 people who are three team researchers, a mother of adult ID, a mother of adult multiple disabilities (ID and ASD), an optometrist, and the head of the Day Care Center for ID. The Living Lab was conducted over six sessions, starting in October 2023, and ending in January 2024. In sessions 1 and 2, we researched users’ need, then in sessions 3 and 4, we developed a vision testing tool prototype based on user needs. Final 5th and 6th sessions verified and evaluated the living lab operation and prototype. The living lab evaluation was divided into two parts: evaluation of the living lab operation and evaluation of the prototype. User-centered, co-creation, real-life setting, multiple stakeholders, and value sharing were important while analyzing the living lab operation. We assessed prototypes for sufficiency, applicability, usability, and validity.

Results:

The results of the Living Lab are as follows. Firstly, we discovered ID and ASD's health-related needs and the necessity for vision testing suited to them. Second, An ID/ASD vision test prototype was developed based on stakeholders' opinions. The Korean vision testing tool used complex symbols and objects. In the living lab, we recreated it using ID and ASD-friendly symbols and everyday items like cups and spoons. Thirdly, we tested and supplemented the vision test prototype for ID and ASD. The prototype demonstrated that ID and ASD individuals found it easier to recognize compared to the existing Korean vision test tool. Additionally, in terms of applicability, it was found to be suitable for ID and ASD but needs to be supplemented with a configuration that is easier for ASD to use. Lastly, upon analyzing the Living Lab operation, it was evaluated that the development of a vision testing tool for ID and ASD was conducted by incorporating user-centered, co-creation, multi-stakeholder, and real-life setting.

Conclusion:

Existing vision testing tools primarily target to individuals without disabilities and are not suitable for those with ID and ASD. Our prototype has been designed to address the gap and is expected to improve healthcare accessibility for those with ID and ASD.