This talk was presented at the San Diego Accessibility Meetup on August 1, 2022. It explains the basics of affordances, signifiers, cognitive load, and how we can design to reduce the effort needed by our customers to understand and use our products. This also includes updated information on Long COVID and why we need to focus more of our attention on cognitive accessibilty.

1. Inclusive Design for Long
Covid and Brain Fog
Ted Drake, Intuit

2. 1.4 M - population in San Diego
942k reported COVID: 67%*
235,500 experienced Long-COVID/Brain Fog: 25%

3. Common COVID Long Haul (PASC) Symptoms
● Chest
○ Shortness of breath
○ Long lasting cough
○ Sore throat and difficulties
swallowing
● Heart
○ Blood clotting (deep vein
thrombosis and pulmonary
embolism)
○ Chest pains
○ Heartburn
○ Palpitations
○ New onset of diabetes and
hypertension
● Other
○ Blurred Vision
○ Changes in oral health
○ Diarrhea and bouts of vomiting
○ Extreme fatigue
○ Kidney problems
○ Tinnitus
○ Low grade fever
● Pain
○ Headaches
○ Joint pain
○ Muscle weakness
○ Needle pains in arms and legs

4. Long Haul Cognitive and Neurologic Symptoms
● Anosmia, Parosmia, Phantosmia (change in sense of smell and taste)
● Anxiety and Panic Attacks
● Changes in mood, sometimes accompanied by depression and
other mental health problems
● Inability to concentrate (brain fog)
● Memory lapses
● Numbness, Tingling, Vibrations
● PTSD
● Sleep difficulties, Insomnia

5. Gareth Ford Williams (BBC, Ab11y, Design Leader)
Cognitively I think I am still struggling. I'm definitely not as sharp as I was 2 years ago.
Design flaws and issues that I would I would have expected me to spot
quickly and work-through, I am still spotting them, but not as quickly and
designing solutions or research methodologies. It‘s definitely a lot harder
than it used to be.
I'm still capable, just a lot slower, which can be frustrating.
It's funny though because trying to remember the me from 2 years ago is becoming
increasingly more difficult...

6. Anxiety, Panic Attacks, and PTSD
"Knowing how terrible it makes you feel and not knowing when all of this
will end or what will happen to you next is the most terrifying part of this
illness," she told Business Insider. "We are the guinea pigs. We are the ones
that have to figure it out for everyone else. I have never felt so alone or
scared."
- Martha Barrera
- 30% diagnosed with neurological or psychological symptoms
- Many long COVID patients report dismissive attitudes by medical
providers, which can make seeking care—whether psychological or
physical—even more challenging

7. Cognitive Design Basics

9. Affordance

10. Affordance:
Affordances represent the multitude of possibilities
available to any person or animal in their environment.
Perceived Affordance:
Perceived affordances describe the relationships that
actors perceive within an environment.

11. False affordance
An element in the digital space affords something else that is
unexpected — like turning on your lights instead of the TV with the TV
remote – or no action at all.

12. Signifiers
A "signifier" is some sort of indicator, some signal in
the physical or social world, that can be interpreted
meaningfully.

13. Affordance and Signifier
The doors have the affordance of
opening in one direction.
Each side has different shaped
handles.
● Which signifier suggests a pull
direction?
● Which signifier suggests a push
direction?
What if they were switched?

14. Loan amount input - QuickBooks Capital

15. “As a rule, people don’t like to puzzle over things.
They enjoy puzzles in their place– when they want to
be entertained or diverted or challenged– but not
when they’re trying to find out what time their dry
cleaner closes.”
–Steve Krug, Don’t Make Me Think

16. Design for Long COVID
and Brain Fog

17. When technology communicates and behaves well,
it enables you to do what you want to, on your terms.
It communicates in ways that allow you to focus, and
achieve the level of concentration you need to accomplish a
task.
- Respecting Focus: A behavior guide for Intelligent Systems
(Microsoft)

18. Cognitive Load
Cognitive load is the amount of working memory or short-term memory
someone is using.
Minimizing the cognitive load it takes to use your product or service
makes it more accessible for people with cognitive disabilities.

19. How can we improve the product experience?
● Simple instead of Complex
● Easy to understand content.
● Which content actually serves a purpose. Leave out all the rest.
● Intuit’s readability target is 5th to 8th grade.
● Use videos and illustrations to support content
● Clear affordances and signifiers
● Use headings and lists to make content scannable
● Consistent layout
● Label icons with visible text
● Don’t Make Me Think

21. Design for Short Term Memory
● Focus on Recognition instead of Recall
● Highlight what the user clicks on
● Provide tools that aid in decision making
● Have the system do some of the work for the user
● Response time must be fast
● Change the color of visited links
● Provide help in context instead of external resource

22. WCAG 3.0 and COGnitive Accessibility Guidelines
Cognitive and Learning Disabilities Accessibility Task Force (Coga TF)
UX Principles that include Cognitive Accessibility (Ab11y)
COGA: Cognitive Accessibility User Research
Making Content Usable for People with Cognitive and Learning
Disabilities

23. Questions?