Article from the Boston Globe’s On Call Magazine, October 2000

By Helen Osborne, MEd, OTR/L
President of Health Literacy Consulting

Visual impairments do not need to get in the way of effective communication. Keeping that in mind can help ensure your patients get the information they need.

More than 39,000 Massachusetts residents are said to be legally blind. About 80 percent of those who are newly diagnosed are 65 years or older. That does not mean they all have had a complete loss of sight. Many have usable vision. They may, for instance, see shadows or perceive the difference between light and dark. Each person’s vision is very different,” says Joe Weisse, public information officer at the Massachusetts Commission for the Blind. “Blindness is not an either-or situation. Variables, such as light, contrast, glare, or shadows, can enhance or hinder a person’s utilization of vision.”

“Legal blindness,” refers specifically to vision that is no better than 20/200 with correction or to a restricted visual field of 20 degrees diameter or less. It presents obvious challenges to healthcare professionals who need to communicate with patients about their health. But it is not the only sight-related challenge you are likely to face. Some of your patients may be visually impaired without being legally blind. That simply means their vision does not meet their specific needs.

The visual difficulties of your patients do not have to be a barrier to effective communication. Use these strategies to improve your communications with patients who are blind or have visual problems:

Provide reasonable accommodations. The 1990 Americans with Disabilities Act, specifies that healthcare facilities must make reasonable accommodations for people who are blind. Accommodations may include providing information in large print, audiotape, or Braille formats. Or it may include having a person available to read information aloud.

Appreciate that not all patients will disclose their blindness. It is entirely up to an individual whether or not to disclose his or her blindness. Some patients may be uncomfortable talking about their vision loss, especially at initial meetings. Weisse suggests that as a matter of practice you should ask all patients, “Would you like that information in any other format?” Talk with patients about function, rather than vision. Ask, for example, “How can I help?” rather than “How much can you see?” When you speak you think may be visually impaired, don’t hesitate to use everyday words such as “see” and “look.” These words are a natural part of conversation, and not using them can create an uncomfortable situation.

Find out if a person wants assistance. The fact a person is legally blind does not mean that person either wants or needs assistance. “Always let the individual who is blind take the lead in being responsible for his or her own healthcare,” says Aloma Bauma, assistant director of community relations at the National Federation of the Blind. “Ask, don’t assume. Blindness is a condition in which it is often easy to find alternative techniques.”

Create written information that is easy to see. When producing written materials, consider the print size, layout, contrast, and paper. Use large print. While 14-point type is considered large print, 16- to 18-point type may be preferable. Make sure, however, not to make letters so large they cannot be read with a magnifier. Set your margins so that they are at least an inch wide on all sides, and have at least 1 1/2  spaces between lines of type. Make sure that there is significant contrast between the lettering and background, such as black print on white or light colored paper. Use a matte rather than glossy paper to reduce glare, making the document easier to see.

Provide clear directions. People want to be as independent as possible when getting from one place to another. You can help by giving detailed directions that make use of landmarks. Be sure, however, you talk about “left” and “right” from the person’s perspective, not your own.

Use both print and Braille for signs. Employ both print and Braille to identify offices, room numbers, departments, building directories, elevator call buttons, and elevator door jams – those panels by the door that indicate the floor number. Make sure printed signs are written in large letters with contrast between foreground and background. Check also that the background of the sign contrasts with the color of the wall.

Learn about low vision aids and devices. There are low vision products, such as magnifiers, talking scales, and talking blood pressure gauges, that can help people meet their personal healthcare needs. Be able to recommend at least one or two sources where people can obtain these products. Two possible sources are:

• The Store at VISION Community Services at the Massachusetts Association for the Blind, 23A Elm Street, Watertown. This store stocks more than 200 adaptive aids and supplies for independent living.
• The “Aids and Appliances” section on the National Federation of the Blind Web site, www.nfb.org.

Resources You Can Use

Service agencies for the blind, and consumer organizations of the blind can provide information, training, peer support, and access to low-vision aids and appliances. Two local agencies are the Massachusetts Commission for the Blind and the Vision Community Services at the Massachusetts Association for the Blind. The National Federation of the Blind is a nationwide consumer organization.

The Massachusetts Commission for the Blind provides services to all legally blind residents of Massachusetts, enabling them to be as independent as possible in their home, employment, and community. The Massachusetts Commission for the Blind offers training in independent living skills as well as employment-related education and placement services. Joe Weisse is the public information officer at the Massachusetts Commission for the Blind, 88 Kingston St., Boston 02111. He can be reached by phone at (617) 727-5550 ext 7491 or (800) 392-6450 ext. 7491.

VISION Community Services at the Massachusetts Association for the Blind provides services to people who are visually impaired. These services include a store of low vision aids and appliances, support groups, volunteer programs, Braille recording studios, and the Verizon Disability Phone Program, which provides phones to people who are legally blind, visually impaired, or hearing impaired. To learn more, call (617) 926-4232, or (in MA only) (800) 852-3029, or visit the Web site at www.mablind.org

The National Federation of the Blind is the nation’s oldest and largest consumer civil rights and advocacy organization of the blind. One division is the National Diabetes Action Network, providing information specifically related to diabetes and blindness. Aloma Bouma is the assistant director of community relations at the National Federation of the Blind, 1800 Johnson Street, Baltimore, MD 21230. She can be reached by phone at (410) 659-9314. She can also be reached by fax at (410) 685-5653. The e-mail address is Nfb@iamdigex.net. The Web site is www.nfb.org

Some of the information in this article is adapted from the forthcoming book, Overcoming Communication Barriers in Patient Education by Helen Osborne, Aspen Publishers, Inc. to be published in November 2000. This book offers practical strategies healthcare professionals can use for teaching patients who have poor reading skills, are older, have visual or hearing impairments, speak little or no English, or come from other cultures. To order a copy, contact Aspen Publishers, Inc. through their Web site at www.aspenpublishers.com, or by phone at (800) 638-8437.