Patient perspectives on clinical environment accessibility: a qualitative study in severe vision loss

OBJECTIVE: Eye care providers have a responsibility to accommodate patients with visual impairment; however, few studies have explored the accessibility of eye clinics. It is critical to involve stakeholders in these discussions to design spaces with thoughtfulness and intentionality. This study aimed to identify challenges and practical solutions for the accessibility of eye clinic design. DESIGN: An observational, qualitative study. PARTICIPANTS: Participants with visual impairment and blindness were recruited for interviews through "Get Together with Technology", an initiative through the Canadian Council of the Blind that brings together people with vision impairment to use adaptive technology. METHODS: Participants completed 45-minute semi-structured interviews using video conferencing. Audio recordings were transcribed, de-identified, coded, and analyzed for themes. RESULTS: Twenty adult participants were interviewed from across Canada. Eleven participants had a self-reported visual acuity of counting fingers or less. The most common self-reported primary diagnoses were retinitis pigmentosa (5/20) and glaucoma (3/20). Three major themes were intentionality of accommodations, confidence, and design features. Most participants with early-onset vision loss reported greater confidence in navigating eye care clinics. Participants with late-onset vision loss endorsed barriers to adapting to new skills and technologies. Participants identified challenges and practical solutions for specific clinic features, including paperwork, staff interactions, signage, obstructions, lighting, and transportation. CONCLUSIONS: This study highlighted the diverse needs and lived experiences of patients with visual impairment and blindness who access eye care services with respect to accessibility in clinic design. Through a solutions-focused worldview, this study identifies practical suggestions and modifications for health services to meaningfully accommodate patients with visual impairment.