Bridging the digital divide for people with aphasia: a study protocol for codesigning web accessibility tools and guidelines

Introduction Aphasia is a language impairment that affects one-third of people who experience a stroke. Aphasia can impact all facets of language: speaking, understanding, reading and writing. Around 60% of people with aphasia have persistent language impairments 1 year after their stroke, requiring...

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Main Authors: Leanne Togher, Jennifer Lee, S Alexander Haslam, Jessica Campbell, David A Copland, Sarah J Wallace, Ciara Shiggins, Kirstine Shrubsole, Bridget Burton, Peter Worthy, Ryan Deslandes, Phill Jamieson, Kim Barron, Annie Hill, Janet Wiles
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Language:English
Published: BMJ Publishing Group 2025-08-01
Series:BMJ Open
Online Access:https://bmjopen.bmj.com/content/15/8/e099273.full
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author Leanne Togher
Jennifer Lee
S Alexander Haslam
Jessica Campbell
David A Copland
Sarah J Wallace
Ciara Shiggins
Kirstine Shrubsole
Bridget Burton
Peter Worthy
Ryan Deslandes
Phill Jamieson
Kim Barron
Annie Hill
Janet Wiles
author_facet Leanne Togher
Jennifer Lee
S Alexander Haslam
Jessica Campbell
David A Copland
Sarah J Wallace
Ciara Shiggins
Kirstine Shrubsole
Bridget Burton
Peter Worthy
Ryan Deslandes
Phill Jamieson
Kim Barron
Annie Hill
Janet Wiles
author_sort Leanne Togher
collection DOAJ
description Introduction Aphasia is a language impairment that affects one-third of people who experience a stroke. Aphasia can impact all facets of language: speaking, understanding, reading and writing. Around 60% of people with aphasia have persistent language impairments 1 year after their stroke, requiring ongoing healthcare and support. In recent years, the internet has become a key resource for the self-management of chronic health conditions. Navigating web content, however, requires language use, and as such, people living with aphasia are more likely to be excluded from digital health and support services. Web Content Accessibility Guidelines exist; however, they do not fully address the unique and diverse needs of people with aphasia, and a significant proportion of websites (over 90%) do not fully adhere to them. This protocol paper describes the first two stages of the Bridging the Digital Divide project, which aims to codesign and develop (a) a web-browser extension to re-render webpages to an ‘aphasia-friendly’ (accessible) format, (b) training tools to help users and health professionals customise the web-browser extension and (c) guidelines for developing communication-accessible websites.Methods and analysis The research will be conducted using experience-based codesign. In Stage 1a, focus groups will be held with (1) people with aphasia, (2) family members or significant others and (3) health professionals working with people with aphasia. Participants will be asked to share their experiences of accessing (or supporting a person with aphasia to access) healthcare, information and support services on the web. The nominal group technique (NGT) will be used to identify priorities for improving web accessibility for people with aphasia. Focus group data will be analysed using reflexive thematic analysis, and prioritisation data will be analysed using inductive qualitative content analysis. In Stage 1b, eight codesign workshops will be held with representatives of the three key stakeholder groups to iteratively codesign and develop a web-browser extension, training tools and guidelines to support web accessibility.Ethics and dissemination Ethical clearance for Stage 1a and Stage 1b of this project has been approved by the University of Queensland Human Research Ethics Committee (Stage 1a approval number: 2023/HE000528, Stage 1b approval number: 2024/HE000721). The outcomes of this research will be disseminated in peer-reviewed journals and presented at national and international conferences. A dissemination and celebration event will be held at the completion of the project.
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spelling doaj-art-36bc32d56e714af2acaddcec4a54f1f52025-08-20T04:02:18ZengBMJ Publishing GroupBMJ Open2044-60552025-08-0115810.1136/bmjopen-2025-099273Bridging the digital divide for people with aphasia: a study protocol for codesigning web accessibility tools and guidelinesLeanne Togher0Jennifer Lee1S Alexander Haslam2Jessica Campbell3David A Copland4Sarah J Wallace5Ciara Shiggins6Kirstine Shrubsole7Bridget Burton8Peter Worthy9Ryan Deslandes10Phill Jamieson11Kim Barron12Annie Hill13Janet Wiles14School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, AustraliaQueensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, AustraliaSchool of Psychology, The University of Queensland, St Lucia, Queensland, AustraliaQueensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, AustraliaQueensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, AustraliaQueensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, AustraliaQueensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, AustraliaSchool of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, AustraliaQueensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, AustraliaQueensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, AustraliaSchool of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, AustraliaQueensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, AustraliaQueensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, AustraliaCentre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, AustraliaSchool of Electrical Engineering and Computer Science, The University of Queensland, St Lucia, Queensland, AustraliaIntroduction Aphasia is a language impairment that affects one-third of people who experience a stroke. Aphasia can impact all facets of language: speaking, understanding, reading and writing. Around 60% of people with aphasia have persistent language impairments 1 year after their stroke, requiring ongoing healthcare and support. In recent years, the internet has become a key resource for the self-management of chronic health conditions. Navigating web content, however, requires language use, and as such, people living with aphasia are more likely to be excluded from digital health and support services. Web Content Accessibility Guidelines exist; however, they do not fully address the unique and diverse needs of people with aphasia, and a significant proportion of websites (over 90%) do not fully adhere to them. This protocol paper describes the first two stages of the Bridging the Digital Divide project, which aims to codesign and develop (a) a web-browser extension to re-render webpages to an ‘aphasia-friendly’ (accessible) format, (b) training tools to help users and health professionals customise the web-browser extension and (c) guidelines for developing communication-accessible websites.Methods and analysis The research will be conducted using experience-based codesign. In Stage 1a, focus groups will be held with (1) people with aphasia, (2) family members or significant others and (3) health professionals working with people with aphasia. Participants will be asked to share their experiences of accessing (or supporting a person with aphasia to access) healthcare, information and support services on the web. The nominal group technique (NGT) will be used to identify priorities for improving web accessibility for people with aphasia. Focus group data will be analysed using reflexive thematic analysis, and prioritisation data will be analysed using inductive qualitative content analysis. In Stage 1b, eight codesign workshops will be held with representatives of the three key stakeholder groups to iteratively codesign and develop a web-browser extension, training tools and guidelines to support web accessibility.Ethics and dissemination Ethical clearance for Stage 1a and Stage 1b of this project has been approved by the University of Queensland Human Research Ethics Committee (Stage 1a approval number: 2023/HE000528, Stage 1b approval number: 2024/HE000721). The outcomes of this research will be disseminated in peer-reviewed journals and presented at national and international conferences. A dissemination and celebration event will be held at the completion of the project.https://bmjopen.bmj.com/content/15/8/e099273.full
spellingShingle Leanne Togher
Jennifer Lee
S Alexander Haslam
Jessica Campbell
David A Copland
Sarah J Wallace
Ciara Shiggins
Kirstine Shrubsole
Bridget Burton
Peter Worthy
Ryan Deslandes
Phill Jamieson
Kim Barron
Annie Hill
Janet Wiles
Bridging the digital divide for people with aphasia: a study protocol for codesigning web accessibility tools and guidelines
BMJ Open
title Bridging the digital divide for people with aphasia: a study protocol for codesigning web accessibility tools and guidelines
title_full Bridging the digital divide for people with aphasia: a study protocol for codesigning web accessibility tools and guidelines
title_fullStr Bridging the digital divide for people with aphasia: a study protocol for codesigning web accessibility tools and guidelines
title_full_unstemmed Bridging the digital divide for people with aphasia: a study protocol for codesigning web accessibility tools and guidelines
title_short Bridging the digital divide for people with aphasia: a study protocol for codesigning web accessibility tools and guidelines
title_sort bridging the digital divide for people with aphasia a study protocol for codesigning web accessibility tools and guidelines
url https://bmjopen.bmj.com/content/15/8/e099273.full
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