When discussing inclusive design, don’t leave out users with invisible disabilities

By Christa Keizer & Michele McDanel 
What’s the first thing that comes to mind when you think of “disability”? In the context of product design, we might first think of vision loss, hearing loss, web content accessibility guidelines (WCAG), screen readers, and/or wheelchairs. These are all, of course, extremely important to consider in design, but to be truly inclusive, we must also design for users with barriers that may not be immediately obvious. Invisible disabilities are those that might not be immediately apparent; in some cases, they may not even be medically diagnosed. (Half of people with disabilities cannot afford healthcare.) 

Those who identify as having an invisible disability face social stigma and therefore do not always disclose their disability to those around them.  

Lesser-known invisible disabilities as defined by the medical model of disability include:  

• Learning difficulties like dyslexia (difficulty with reading), dyscalculia (difficulty with numbers), and dysgraphia (difficulty with writing);  
• Developmental coordination disorder or dyspraxia; 
• Mental health conditions like depression, anxiety, post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), and bipolar disorder;  
• Developmental disabilities like autism and ADHD;  
• Pain-related conditions like fibromyalgia, migraines, arthritis; 
• Digestive and immune disorders like celiac disease, irritable bowel syndrome (IBS), diabetes;  
• Reproductive conditions like fibromyalgia, polycystic ovary syndrome (PCOS), endometriosis, and premenstrual dysphoric disorder (PMDD); 
• And many others. 

We might also consider users who are not medically disabled but are invisibly disabled by something, like the stress of a global pandemic.  

No person is broken. Fix the system. 

More than 1 billion people worldwide live with a disability. The unemployment rate of disabled people is twice that of non-disabled people and half of people with disabilities cannot afford health care. The social model of disability argues that the disability divide is created by failures of systems, not the disabilities themselves while the medical model of disability often sees disability as the subject needing to be “fixed.” Using the social model of disability, we ask ourselves if the technology we develop creates or removes barriers for users who are already experiencing challenges in a physical world that was not designed for them. For example, an overwhelming interface may be disabling to information workers who have sensory processing challenges and notifications may be disabling to a user who is trying to focus on a project.  

How might we design for users with invisible disabilities? 

Researching and designing for users with invisible disabilities is more achievable than ever. Here are three tips to get you started:  

1. Do your homework early and often 

Starting your project with a literature review can give you and your team an initial look into users’ attitudes, perceptions, behaviors, and challenges, helping you generate hypotheses that can later be tested.  

You might consider immersing yourself in social media content created by people with disabilities. Although this method may be a bit unconventional, social media can be a uniquely valuable source of lived experience from the disabled community. Simply searching for the name of the disability along with a topic you’re exploring (e.g., email, productivity, communication) can elicit honest product reviews from users with disabilities. In the example below, Molly Burke shares her experience using makeup palettes and Laura Hammock shares her favorite organizational applications. (Be sure to then validate your generated hypotheses with primary research, of course.)  

2. Include research participants with disabilities.

When researching disabilities, keep “Nothing about us, without us” in mind. A literature review can’t replace primary user research, so avoid making assumptions (especially those that are based on stereotypes) about disabled user groups without incorporating their lived perspectives.

15 percent of people experience a disability, so researchers should make a habit of including disabled users in their studies.

Research shows individuals are open to disclosing their invisible disability if the disclosure is expected to yield positive results. This indicates that potential research participants may be open to disclosing their invisible disability to be part of a research study. Check out this practical guide to inclusive research for more tips on running inclusive research studies.

3. Employ universal design principles.

We can also critically assess our products using the universal design principles, which were created in 1997 by designers, architects, engineers, and researchers to evaluate the universal accessibility of environments and products. Universal design principles include:

• Equitable in use: The design is useful and marketable to people with diverse abilities.
• Flexibility in use: The design accommodates a wide range of individual preferences and abilities.
• Simple and intuitive: Use of the design is easy to understand, regardless of the user’s experience, knowledge, language skills, or current concentration level.
• Perceptible information: The design communicates necessary information effectively to the user, regardless of ambient conditions or the user’s sensory abilities.
• Tolerance for error: The design minimizes hazards and the adverse consequences of accidental or unintended actions.
• Low physical effort: The design can be used efficiently and comfortably and with a minimum of fatigue.
• Size appropriate for user: Appropriate size and space is provided for approach, reach, manipulation, and use regardless of user’s body size, posture, or mobility.

Universal design principles can be used throughout the design process to ideate new solutions and critique existing experiences.

Wrapping it all up

Inclusive research is the first step to building a more accessible future for everyone. While it may seem intimidating to incorporate disability into your user research, a great first step is talking with your team about how you’ll design for users with disabilities. We have included additional articles, some discussion prompts, and an outline for a disability workshop below to help you with those efforts.

Resources

Further reading

AI and Accessibility: A Discussion of Ethical Considerations

Our Responsibility: Disability, Bias, and AI

What is Universal Design | Centre for Excellence in Universal Design

Disability Statistics | The National Disability Authority (nda.ie)

Discussion prompts

• Do you or someone you know have an invisible disability? How is their workday, behaviors, or work style unique from yours?
• Think of a time when users with invisible disabilities may have been disproportionally impacted by a proposed design solution. Were these users in your research samples? Why or why not?
• What’s an upcoming project that would uniquely impact someone who:
  • Has memory lapses from a former brain injury?
  • Has difficulty making mathematical calculations (dyscalculia)?
  • Prefers written communication over meetings?
  • Is color blind?

45-minute invisible disability workshop

1. Divide your group into teams of three.
2. Assign each group with a unique scenario and a unique invisible disability. Examples might include: joining an online meeting with social anxiety, managing daily tasks with a brain injury, attending an hour-long remote workshop with ADHD, going to a workplace cafeteria with autism.
3. Allow each group to spend 15 minutes to research their group’s disability online using social media and reputable academic sources.
4. Allow each group to spend 15 minutes plotting their findings on an empathy map. (Groups can use PowerPoint, Microsoft Whiteboard, or any other collaborative software.)
5. Give time for each group to present what they learned using the completed empathy map.

What do you think? How will these ideas and resources help you better understand and design for those with invisible disabilities? Tweet us your thoughts at @MicrosoftRI or follow us on Facebook and join the conversation.

Christa Keizer is an Outlook Calendar design researcher who passionately advocates for inclusive design, mental health, and sustainability.

Author note: In this post I use both person-first language (PFC) and identity-first language (IFL) interchangeably. I am using both models because as a disabled person myself, I personally use identity-first language when describing my disabilities, while some disability communities prefer person-first language. My intent is to always use language that each community prefers.

Michele McDanel is a builder, an organizer, and a storyteller with a bachelor’s degree in Communications and an MBA. She is energized by solving problems and meeting business needs through communications and customer experience solutions that raise the bar. Michele enjoys building relationships and managing teams; and overall, just figuring out what the “special sauce” is that will be the competitive differentiator for a business and its solutions. She joined the Customer Insights Research team in 2019 to amplify the great UX research and data science work they do, and to showcase the thought leadership of the team across internal and external communications, events, and social media.