Minerva Rivas Velarde

Background: The United Nations’ third Sustainable Development Goal emphasizes ensuring healthy lives and promoting well-being (WB) for all, which requires effective assistive technology (AT) for persons with disabilities. In low- and middle-income countries (LMICs), however, AT remains largely inaccessible, and high abandonment rates indicate that many existing solutions fail to meet users’ needs. To improve AT design and effectiveness, a deeper understanding of users’ lived experiences and the ways AT influences WB is essential. Objective: This study aimed to explore how technology creates opportunities or barriers in the daily lives of persons with visual disabilities in LMICs and how it affects their WB. Methods: We conducted a qualitative narrative study guided by deductive qualitative analysis, using the capability approach (CA) and disadvantage theory (DT) as theoretical frameworks. Nineteen adults with visual disabilities from Cali, Colombia, participated in in-depth, semistructured interviews. A focus group (n=5) deepened the exploration of shared experiences. Data analysis followed three stages: (1) deductive coding using Nussbaum list of central capabilities and key CA constructs (functionings, conversion factors, and agency); (2) recoding through DT concepts (insecure functioning, corrosive disadvantages, and fertile functionings); and (3) inductive analysis to capture emergent sociocultural themes. Results: AT shaped both opportunities and constraints in participants’ lives. While functionings such as employment, mobility, and affiliation were highly valued, they often remained insecure due to systemic barriers. Corrosive disadvantages—such as unemployment, exclusion, and limited spatial autonomy—undermined multiple capabilities simultaneously. Conversely, fertile functionings such as equitable employment, adaptive sports, and access to well-designed AT supported agency and resilience. The inductive analysis revealed 3 interconnected themes: the aspiration to explore and expand movement, the desire to appear attractive, and the adoption of nonconfrontational strategies to maintain social harmony. These findings highlight how emotional, aesthetic, and cultural dimensions shape the experience and meaning of AT. Conclusions: While AT research in LMICs often emphasizes availability, it rarely addresses how social norms, structural violence, and fear affect meaningful use. The combined CA and DT lens reveals that AT can either enable or constrain WB depending on how it aligns with users’ lived contexts. Designing for fertile functionings—those that support agency, safety, and resilience—is essential. Participatory, context-sensitive design must prioritize not only functionality, but also aesthetic dignity, cultural relevance, and emotional security. Including the voices—and silences—of persons with disabilities in the Global South is crucial for transforming AT from a mere tool into a catalyst for real freedom and WB.

Importance: Current interpretation services for Deaf patients who use sign language are often ineffective or unacceptable. In-person interpretation is frequently unavailable, and while video remote interpreting (VRI) remains underused, its scalability may be a solution given interpreter shortages and cost barriers. Existing research focuses on user and interpreter preferences, leaving a critical gap in understanding how interpretation formats affect communication quality. Objective: To evaluate the effectiveness of VRI in improving communication outcomes between Deaf patients and physicians compared with usual communication tools, such as self-arranging interpretation, lip-reading, note-taking, and the use of images. Design, Setting, and Participants: This randomized clinical trial was conducted in Colombia at a public hospital from August 2023 to October 2024, involving Deaf adults who use Colombian Sign Language as their primary language. Participants were randomly assigned to either the control or intervention group. The data were analyzed between January and May 2025. Interventions: Patients were divided into 2 groups: an intervention group that received a medical appointment via VRI and a control group that received one via the current standard of communication. Both the Deaf participants and the health care professionals were blinded to the allocation. Main Outcomes and Measures: An assessment of communication using the Doctor-Patient Communication scale. Results: Data were collected from 210 Deaf participants, including 123 (58.6%) women and 87 (41.4%) men, with a mean (SD) age of 42 (13) years (range, 18-84 years). Overall, 108 participants (51.4%) reported using VRI. The intervention revealed that having VRI did not always result in improved communication between Deaf individuals and physicians. While those using VRI were more likely to report positive outcomes in certain areas, such as being encouraged to express themselves (odds ratio, 1.90; 95% CI, 1.13-3.18; P = .02), there was no difference in other areas, such as understanding the doctor (OR, 1.33; 95% CI, 0.79-2.23; P = .28). Conclusions and Relevance: In this randomized clinical trial of VRI in the health care context, some aspects of clinical communication were improved, but others were not. This suggests that critical preconditions have to be met for this technology to achieve its intended impact. Trial Registration: ClinicalTrials.gov Identifier: NCT05966623

Objective: To compare, from an empirical perspective, the use of photovoice and interviews as qualitative research techniques in health research involving deaf individuals. Methods: Two qualitative approaches were compared. Findings from a photovoice study conducted through a participatory action research framework were contrasted with results from semi-structured interviews involving the same population. Results: Major differences between the results are identified, with some notable similarities. Photovoice provides a more in-depth and abstract elucidation in the nature of their narratives of the challenges and supports of the Deaf community in the healthcare context. Conclusions: This article should serve as a guide for other qualitative studies planning to use the techniques of photovoice and/or interviews with Deaf individuals. Depending on the research objectives, one technique may be more beneficial than the other. Both techniques are complementary and may even be used within the same study. If the research objective is to deep into individual experiences and understanding context, emotions, and personal meaning through dialogue and interaction, interviews would be the most appropriate technique. If the research objective is to empower marginalized groups, stimulate critical reflection, and engage the population in driving change, such as acquiring new knowledge, raising awareness of specific challenges, or influencing political decision-making, photovoice would be a more suitable method.

To ensure that nurses are equipped to provide effective care, it is essential to examine available evidence on how nursing curricula have adapted to meet the unique health needs of persons with disabilities. This study assesses how pedagogical strategies and interventions have changed in nursing education to develop disability competencies. It also examines whether such curriculum changes have been evaluated to assess their effectiveness in developing competencies. A systematic review based on a literature search in Web of Science, PubMed, Medline, PsycInfo, ERIC, CINAHL and Google Scholar. The study includes peer-reviewed papers, either qualitative or quantitative, that describe the development of disability-related education in undergraduate or postgraduate nursing training. With no time frame or publication restriction. The quality of the paper was assessed using the Mixed Methods Appraisal Tool (MMAT). 46 studies have met al.l inclusion criteria and were included in the final analysis. In total, were 2803 articles found in the initial search across seven online electronic databases. Finally, a thorough review was conducted, incorporating 46 studies. Most of the studies come from high income countries. Among the 46 studies reviewed, 16 employed qualitative methodologies, 22 studies adopted quantitative descriptive designs, relying primarily on cross-sectional surveys and pre-post evaluations. Seven studies used mixed methods.Three major themes emerged from this analysis a) enhancing nurses’ understanding of disability, b) pedagogical strategies to work with persons with disabilities and their families in a clinical setting, and c) diverse approaches to clinical simulation in nursing education. The results show that most educational interventions are not assessing their impact in developing disability competencies. Many interventions aim to raise disability awareness, challenge prejudice, and promote more inclusive attitudes toward individuals with disabilities. While these goals are important, there is limited evidence demonstrating their effectiveness in enhancing nursing practice competencies. Research on strategies that equip nursing students with the core skills needed to provide quality care to people with disabilities remains scarce.

Background: Visual impairment (VI) significantly impacts quality of life, particularly in autonomous pedestrian navigation. Limitations in independent navigation lead to frustration, diminished confidence, and risks to bodily integrity for individuals with VI. In Colombia, the pilot country of this study, approximately 2 million people live with some form of visual disability. Globally, only 1 in 10 people requiring assistive devices have access to them, with factors such as deficient product design stemming from limited knowledge of user expectations, local needs, and environmental constraints, posing significant challenges, particularly in low- and middle-income countries. Objective: We aimed to evaluate the feasibility and limitations of applying the human-centered design (HCD) principles outlined by the International Organization for Standardization (ISO) 9241-210:2019 standard in assistive technology (AT) development for individuals with VI in Colombia. Methods: We developed a prototype navigation device using the HCD principles, emphasizing a thorough analysis of user needs and environmental contexts. The project leveraged multidisciplinary collaboration to address challenges associated with user engagement and design adaptability while managing legal and bureaucratic constraints. The navigation system integrates artificial intelligence algorithms, specifically developed by the research team as part of this work, to enhance its adaptability and responsiveness to diverse environments. The development process featured iterative prototyping cycles, incorporating user feedback at each stage, all within the boundaries of applicable regulatory frameworks. Results: The development and evaluation of the initial prototype highlighted both the feasibility and key limitations of applying the ISO 9241-210:2019 HCD principles in AT for individuals with VI in the Colombian context. The prototype met several user-defined expectations by prioritizing affordability; extended battery life; autonomy in internet-constrained environments; and improved ergonomics, concealability, aesthetics, and obstacle detection. These achievements demonstrated the potential of HCD to guide context-sensitive innovation. However, the process also revealed significant barriers: limited legal and procedural clarity for engaging users in design phases, difficulties navigating ethics committees, and a lack of practical guidance within the ISO standard itself. These constraints, compounded by challenges in interdisciplinary collaboration, limited the depth and adaptability of user involvement across development stages. Conclusions: Implementing HCD principles in AT development shows promise for creating effective and affordable solutions tailored to user needs and contexts. However, legislative and methodological barriers must be addressed to fully realize HCD’s potential. Future efforts should focus on aligning research methodologies with hardware and software development practices while integrating legislative frameworks to enhance the accessibility and effectiveness of AT innovations.

The integration of Indigenous perspectives and knowledge with biomedical approaches in neurosciences can significantly broaden the understanding of the human brain and mind. Drawing upon the writings of Elders in Canada, we refer to this integration as Two-Eyed Seeing or Etuaptmumk. We discuss how Two-Eyed Seeing and other dual perspectives can bring both breadth of knowledge and humility to the development of research and clinical practices for brain health. In this forward-looking discussion, we include both traditional academic and non-academic traditions and the work of Indigenous scholars on methodologies, life, health, culture, language and history. To describe challenges and consider solutions, we offer broad strategies for allyship, humility and universalism and situate them in four specific examples pertaining to disability, suicide, migration and the environment. We further advance the power of Two-Eyed Seeing in the context of new considerations for communication and public engagement. Two-Eyed Seeing, per se, is only one approach, but as neuroscience becomes ever more global, inclusive and ethically proactive, it must universally see the world of brain and mental health through the eyes of both reductionism and holism.

BACKGROUND Visual impairment (VI) significantly impacts quality of life, particularly in autonomous pedestrian navigation. Limitations in independent navigation lead to frustration, diminished confidence, and risks to bodily integrity for individuals with VI. In Colombia, the pilot country of this study, approximately 2 million people live with some form of visual disability. Globally, only 1 in 10 people requiring assistive devices have access to them, with factors such as deficient product design stemming from limited knowledge of user expectations, local needs, and environmental constraints, posing significant challenges, particularly in low- and middle-income countries. OBJECTIVE We aimed to evaluate the feasibility and limitations of applying the human-centered design (HCD) principles outlined by the International Organization for Standardization (ISO) 9241-210:2019 standard in assistive technology (AT) development for individuals with VI in Colombia. METHODS We developed a prototype navigation device using the HCD principles, emphasizing a thorough analysis of user needs and environmental contexts. The project leveraged multidisciplinary collaboration to address challenges associated with user engagement and design adaptability while managing legal and bureaucratic constraints. The navigation system integrates artificial intelligence algorithms, specifically developed by the research team as part of this work, to enhance its adaptability and responsiveness to diverse environments. The development process featured iterative prototyping cycles, incorporating user feedback at each stage, all within the boundaries of applicable regulatory frameworks. RESULTS The development and evaluation of the initial prototype highlighted both the feasibility and key limitations of applying the ISO 9241-210:2019 HCD principles in AT for individuals with VI in the Colombian context. The prototype met several user-defined expectations by prioritizing affordability; extended battery life; autonomy in internet-constrained environments; and improved ergonomics, concealability, aesthetics, and obstacle detection. These achievements demonstrated the potential of HCD to guide context-sensitive innovation. However, the process also revealed significant barriers: limited legal and procedural clarity for engaging users in design phases, difficulties navigating ethics committees, and a lack of practical guidance within the ISO standard itself. These constraints, compounded by challenges in interdisciplinary collaboration, limited the depth and adaptability of user involvement across development stages. CONCLUSIONS Implementing HCD principles in AT development shows promise for creating effective and affordable solutions tailored to user needs and contexts. However, legislative and methodological barriers must be addressed to fully realize HCD’s potential. Future efforts should focus on aligning research methodologies with hardware and software development practices while integrating legislative frameworks to enhance the accessibility and effectiveness of AT innovations.