title: Creating low vision and nonvisual instructions for diabetes technology:  an empirically validated process.
abstract: BACKGROUND
  Nearly 20% of the adults with diagnosed diabetes in the United States also have visual impairment. Many individuals in this group perform routine diabetes self-management tasks independently, often using technology that was not specifically designed for use by people with visual impairment (e.g., insulin pumps and pens). Equitable care for persons with disabilities requires providing instructions in formats accessible for nonreaders. However, instructions in accessible formats, such as recordings, braille, or digital documents that are legible to screen readers, are seldom available.
  
  
  METHODS
  This article includes a summary of existing guidelines for creating accessible documents. The guidelines are followed by a description of the production of accessible nonvisual instructions for use of insulin pens used in a study of dosing accuracy. The study results indicate that the instructions were used successfully by 40 persons with visual impairment.
  
  
  CONCLUSIONS
  Instructions in accessible formats can increase access to the benefits of diabetes technology for persons with visual impairment. Recorded instructions may also be useful to sighted persons who do not read well, such as those with dyslexia, low literacy, or who use English as a second language. Finally, they may have important benefits for fully sighted people who find it easier to learn to use technology by handling the equipment while listening to instructions. Manufacturers may also benefit from marketing to an increased pool of potential users.
authors.affiliation: Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA. ann.s.williams@case.edu
authors.forename: Ann S
authors.initials: AS
authors.lastname: Williams
mesh_terms: D001296:Audiovisual Aids / Q000592:standards; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation* / Q000592:standards; D032882:Comprehension; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000628:therapy; D016503:Drug Delivery Systems / Q000295:instrumentation* / Q000592:standards; D004867:Equipment Design; D017408:Guidelines as Topic; D006297:Health Services Accessibility / Q000592:standards; D054625:Healthcare Disparities / Q000592:standards; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D009633:Nonverbal Communication; D013067:Speech Perception; D014110:Touch; D014796:Visual Perception; D019987:Persons with Visual Disabilities / Q000523:psychology*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin