## Abstract

Although cell phone use has grown dramatically, there is a gap in cell phone access between people with disabilities and the general public. The importance of cell phone use among people with intellectual disabilities and studies about use of cell phones by adults with intellectual disabilities was described. Our goal was to determine the extent and scope of cell phone use by 83 adults with intellectual disabilities, reasons for nonuse, and factors affecting use. Results suggest a gap in the use of cell phone technology between people with intellectual disabilities and the general population. When used, they are employed primarily for emergencies, storing telephone numbers, and day-to-day communication. Chief reasons for nonuse include cost, perception of not needing one, and lack of accessibility.

Cell phone use has grown dramatically. By the year 2000, its use reached a small majority in Canada (56.2%), 57% in the United States, 60% in Australia, 74% in Germany, 72% in Singapore, 90% in the United Kingdom, and 93% in Italy (Canadian Council on Social Development, 2002; Yuland, 2001). In fact, according to the Cellular Telecommunications Industry Association (CTIA), use of cell phones has become so commonplace that even social norms are being re-examined (e.g., proper methods for receiving and placing calls during social functions, establishment of “cellular free” cars on trains, prohibitions in some states of using a cell phone while driving a car).

Introduced in the 1980s, early models of these transportable communications devices included large battery packs and carrying cases and cost thousands of dollars. Today, cellular telephony is more powerful, smaller, and less expensive than ever before (Vanderheiden, 2000). For example, most cell phones are smaller than a pack of cigarettes and cost less than an average of $50.00 each month; some models are capable of a wide variety of communication tasks, such as transmitting computer files, paging, maintaining continuous communications through e-mail and voice mail connections, and even “surfing” the Internet (Cellular Telecommunications, 1999) as well as playing games, taking digital photos, and video-calling. Unfortunately, like many other technologies, a digital divide exists between people with and those without disabilities in their access to and use of cell phones. The disparity in cell phone use in Canada in 2000, for example, was nearly 20 percentage points, with cell phone use much lower (36.6%) among persons with disabilities. Gaps in usage between people with and without disabilities occurred across all age groups. There are many explanations for this digital divide, including uneven access to technology either based on ownership or availability (Warshauer, 2002). Clearly, the cost of owning a cell phone and the monthly service charges are major barriers for many people with disabilities who have limited incomes. Lack of accessibility due to the person's disability is also a likely reason for this particular digital divide. Cell phones are just not designed with accessibility features for many people who have disabilities despite laws, such as Section 255 of the Telecommunication Act of 1996 in the United States, that were established to ensure that telephone and telephone services are accessible to people with disabilities. Below are a few examples of how today's cell phones continue to be inaccessible for individuals with a variety of disabilities, despite the findings that all the technology that is needed to ensure accessibility of cell phones exists today (Sutton & Sajka, 2002; Trace Center, 2002). S. M., a person with physical and speech disabilities, stated: I cannot use these damn cell phones. The push-button numbers are too small for my fingers. Every salesperson tells me they don't have anything for me. They suggested I should buy a voice-activated memory phone that will dial a number when I say Fred or Sally or Shirley. (Trace Center, 2002). That would not help her because she has a speech disability and cannot use voice-activated systems. L. A. added: “I'm blind, and I searched for a cell telephone with Braille on the numbers. Or one that speaks when I press the number. I can't find one. Why?” (Trace Center, 2002) There has been limited research into the use of cell phones by people with intellectual disabilities. Taber (2003) conducted one of the only studies to date on use of cell phones for this population by training six students with moderate intellectual disabilities to use cell phones for safety in the community. The investigator found cell phones to be an effective means to assist people with intellectual disabilities when lost in the community. Other research has been conducted on technology use in general by people with intellectual disabilities. Wehmeyer (1995, 1998, 1999) conducted one of the most comprehensive studies and found technology to be underutilized across all domains. The major barriers to technology adoption by people with intellectual disabilities were identified as (a) lack of funds, (b) lack of training, (c) lack of information about benefits, (d) complexity, and (e) assessment. Parette and VanBiervliet (1992) found similar limited usage of technology by people with intellectual disabilities and identified lack of training and costs to be major barriers. Cell phones appear to offer the potential to overcome many of these barriers to the use of more specialized assistive technologies and to benefit people with intellectual disabilities in the following ways: • Improving health and safety (e.g., a means for contacting someone if stranded or if your wheelchair breaks down, risk reduction for crimes or abuse, emergency or routine communication regarding health concerns) • Managing transportation issues (e.g., contacting paratransit about a needed change in time or location) • Communicating with employers (e.g., job related topics, communication while traveling) • Communicating with family members, friends, or attendants • Difficulty finding accessible pay phones; the number of pay phones has decreased 53% in the last 5 years (Federal Communications Commission, 2004) • Serving as a memory aid for storing important telephone numbers • Enhancing image (rather than the stigmatizing effects of many assistive technology devices, cell phones demonstrate communication competence and versatility to the public) Further examples of the potential benefits of cell phones are in the area of safety. Current law requires the ability for new cell phones to be able to broadcast their location to 911 emergency services. When these new phones are fully implemented, people with disability could call 911 and be found, even if they are lost and unable to give directions (Abascal & Civit, 2001). Smith-Jackson, Nussbaum, and Mooney (2003) found that people with disabilities who used cell phones cited safety and security (getting help) as key reasons for their use. In another study on using cell phones for memory reminders, a family member found “it comforting to contact his son in case he were to get lost” due to his poor reading abilities (Wade & Troy, 2000, p. 318). Given the apparent importance of cell phones for individuals with a variety of disabilities, our purposes in this study were to (a) explore the extent and scope of cell phone use by adults with intellectual disabilities, (b) determine reasons for non-use, and (c) delineate factors that predict the use of cell phones. ## Method This research was developed as part of the Assistive Technology and Cognitive Disability Collaborative (Assistive Technology Collaborative), funded by the National Institute on Disability Rehabilitation Research. In partnership with the Brain Injury Association of America, The University of Akron, Temple University, and Spaulding Rehabilitation Hospital, the Assistive Technology Collaborative seeks to examine the potential of electronic organizers to enhance the independence of persons with cognitive disabilities (i.e., children and adults with traumatic brain injury as well as those with intellectual disabilities). The first stage of a larger research agenda included a survey of adults and children with traumatic brain injury and adults with intellectual disabilities to examine the use of and preferences related to electronic organizers. For our purposes in the present article, we drew exclusively upon survey data involving adults with intellectual disabilities and focus only on their use of cell phones. ### Instruments and Measures The Assistive Technology Collaborative research team developed a “core” survey focused on the use of electronic organizers to be utilized at each data-collection site. The focus was on the following topics: (a) interviewee's demographic background, (b) self-perceived abilities related to technology use (e.g., ability to read, spell, copy information, push buttons), (c) current organizational strategies and satisfaction with these strategies, (d) the broad range of technology used by participants, and (e) characteristics of electronic organizer use and non-use. In addition to this core survey, investigators at project sites added questions of relevance to their particular population and interests. For adults with intellectual disabilities, additional questions on learning style, supports, education, and work history were developed. Moreover, parallel sets of questions were developed to gather information related to access to and use of cell phones, computers, and the Internet. Flash cards were created to pictorially display the answer categories in order to assist persons in remembering and understanding the potential answers and to assist those who communicate nontraditionally. The survey, designed to be administered in a face-to-face interview, takes approximately 1 hour. ### Sampling and Recruitment Data collection occurred at three sites; at one, adults with intellectual disabilities were surveyed; at another, adults with traumatic brain injury; and at the third, children with intellectual disabilities and traumatic brain injury as well as their parents and teachers. To focus on the sample and recruitment of adults with intellectual disabilities, we potentially included individuals in the sample if they were (a) identified as having intellectual disabilities by state organizations or professionals serving them; (b) capable of communicating answers to simple, closed-ended questions about their experiences with and attitudes related to technology (ability to communicate answers was either discussed before hand with organizational staff members or informally assessed while setting up the interview over the phone); (c) 18 years of age or older; and (d) lived in Pennsylvania. No technology experience was required. Because the research team did not have access to a comprehensive list of persons to use as a sampling frame, random sampling was not feasible. Instead, the team developed a convenience sampling strategy designed to maximize diversity among participants, targeting diversity with regard to ability level, type and level of support (e.g., competitive work setting, supported work, and sheltered workshop), race and ethnicity, and gender. To construct the sampling frame, we mailed invitations to participate to approximately 370 disability organizations and professionals serving people with intellectual disabilities in the Philadelphia area and across Pennsylvania. In these invitations we explained the purpose of the research, the basic details of the interview (approximately an hour, at a place of their convenience), and the honorarium of$25 per participant. Organizations and professionals were asked to distribute these flyers to appropriate individuals and assist them to call, mail, or fax their individual contact information. Approximately 125 persons submitted contact information from 30 different disability organizations. Several of these responses came from organizations that had multiple people interested in the project.

All requests were sorted by location, concentrating collection in the Philadelphia area but also gathering between 5 and 10 interviews in each of the following cities: Harrisburg, Allentown, Scranton, Erie, and Pittsburgh. Organizations were categorized by residential, work, day activity, and advocacy to ensure that we interviewed individuals in self-advocacy organizations, independent living situations, group homes, nursing homes, competitive work sites, and sheltered work sites. A cap of 5 individuals was placed on each organization; if more than 5 people were interested per site, agencies were asked to either randomly select 5 or to maximize the diversity. Finally, selection was based on date of submission of contact information and ease of scheduling.

Project staff conducted 86 interviews, 3 of which were excluded from analysis due to the interviewee's difficulties communicating answers, for a final sample of 83 individuals. Interviews lasted approximately 1 hour and were conducted in private settings convenient for the individuals. All interviewees were paid $25, regardless of whether they completed the survey. Approximately half of the surveys were administered by interviewers without disabilities and the other half, by a team of two persons: one with an intellectual disability and the other, without a disability. The recruitment strategy makes it impossible to estimate a meaningful response rate. To determine the reliability of the survey, the research team incorporated a consistency question into the survey design. Both at the beginning and at the end of the organizational strategies section, the interviewer asked the respondent to select the primary organizational strategy used to keep track of appointments; 72% of participants provided the same answer. Although this may be considered a low rate of consistency, we hope some of the inconsistency is due to the fact that many people used multiple organizational strategies and, therefore, some participants may have offered another strategy used. The demographic profile of the final sample is shown in Table 1. Table 1 Demographics Variables of the Study Participants ## Findings ### Cell Phone Use Forty-two percent of participants reported ever having used a cell phone, 31% reported current usage, and 27.7% reported that they use a cell phone on a regular basis defined as “at least several times for 2 weeks or more.” Participants were also asked whether they used land-line phones on a regular basis. Of the 83 participants, 89.2% reported using land-line regularly. Clearly, the majority of participants used land-line telephones, with a much smaller percentage using cellular phone technology. The frequency of current cell phone use is illustrated in Table 2. Of the 26 adults who stated that they currently use cell phones, 34.6% noted that they used it everyday, the same percentage reported using it several times each month, and a smaller percentage reported using their cell phone either several times each week, rarely, or never. Forty percent of adults who used a cell phone reported that someone helped them in using it. Table 2 Frequency of Current Cell Phone Use As shown in Table 3, in addition to the use of cell phones, participants stated that they used a variety of methods to “keep track” of telephone numbers. The three most frequently used methods were (a) use of paper address books, (b) remembering the number or “doing it my head,” and (c) writing the number down on a piece of paper. Most respondents claimed that their current method of remembering telephone numbers worked for them, and approximately one half reported that someone helps them remember telephone numbers. Table 3 Frequency in Methods of and Satisfaction With Keeping Track of Telephone Numbers ### Characteristics of Cell Phone Use Among current cell phone users, the most common uses of the cell phone (displayed in Table 4) included emergency use, storing phone numbers, day-to-day communication, and storing calendar information. Monthly service costs ranged from$20 to $100 per month, with the majority (87.5%) costing between$20 and $50 each month. Table 4 Frequencies: Reasons for Cell Phone Use (n = 26) ### Cell Phone Non-Use Participants provided several different reasons for non-use of cell phones. As shown in Table 5, expense was a key barrier for both those participants who had never tried a cell phone and those who had previously used a cell phone but no longer did so. In addition to cost associated with cell phones, the belief that a cell phone is not really needed was also listed as a reason for non-use by adults who had either never tried a cell phone (16%) or 2 adults (18.2%) who had tried a cell phone but were not currently using one. Less frequently noted as reasons for non-use were difficulty in use and discouragement from others. Table 5 Frequencies: Reasons for Non-Use of Cell Phones ### Factors Affecting Cell Phone Use In order to study the factors affecting adoption of cell phones, we asked participants to respond yes or no as to whether they had ever used this technology. Forty-two percent (42%) reported that they had used a cell phone. Chi-square analyses were conducted to examine the impact of a variety of factors on this dichotomous variable. Table 6 summarizes these analyses (due to the long list of self-reported abilities tested, only those abilities indicating significance are included in the table). As shown in Table 6, neither gender, race, education, nor residential status were associated with the cell phone use. However, age and employment status were significantly related to its use, with those who were younger, competitively employed, or unemployed more likely to use cell phones than those who were older or in sheltered employments. Individuals with intellectual disabilities who used a variety of technologies (4 or more types) were more likely to use cell phones than those who used fewer types of technologies. The only three abilities significantly related to cell use were the abilities to push buttons, spell, and use a clock. Table 6 Summary of Chi-Square Analysis, Factors Affecting Cell Phone Use ## Discussion It has been said that if one can use a remote control or a regular phone, then one can probably use any of today's electronic technologies. Although this may or may not be true, the vast majority of our sample used these simple types of technology. Regular phones were the only type of technology used at almost the same rate as that of the general public, 89.2% in study versus 94.7% for the general public (Federal Communications Commission, 2004). However, the cell phone usage rate of adults with intellectual disabilities was much lower than expected, with only 27.7% using cell phones compared to nearly 60% in the United States as reported in 2000. As such, there is a gap between adults with intellectual disabilities and their peers without disabilities of more than 30%. Of the 26 adults who reported current use of cell phones, few said that they used it daily, and most reported using it primarily for emergencies, followed by employing the cell phone as a method for storing telephone numbers. Day-to-day communication via cell phone was reported by only one third of the cell phone users. These data suggest that not only is there a gap in the use of cell phones by people with intellectual disabilities when compared to their peers without disabilities, there is likely to be a disparity in the frequency and scope of use as well. Based on the findings of this study, the reasons for non-use are clear and consistent. Whether the participants had ever tried using a cell phone in the past, their major reasons for non-use were quite consistent: expense, lack of perceived need, and difficulty in use. The expense of cell phone use is not just in the one-time cost of purchasing the equipment but, rather, in the monthly service charges. Although these costs ranged from$20 to $100, the great majority of users paid a monthly service charge between$20 and \$50. This amount may seem reasonable for many readers; however, for the majority of people with intellectual disabilities who rely on SSI, this cost amounts to as much as 10% of their monthly income.

Another reason given for non-use of cell phones is the perceived lack of need. Based on our findings, although ability may have some impact on use, lack of experience with cell phones in particular or technology in general is certainly one important reason. Non-use of cell phones may be also an artifact of the rather sheltered environments in which many of the respondents live and work (e.g., unemployment or sheltered employment, living arrangements with little opportunity to engage in community activities). These environments are likely to decrease the real or perceived need for and opportunity to use and benefit from a variety of communication technologies, including cell phone technology.

The third reason given for non-use by several individuals sampled was difficulty in the use of cell phones. Although it might be easy to conclude that the difficulty is due to the self-reported personal difficulties, such as problems with spelling and pushing buttons, another explanation is the fact that most cell phones still lack accessibility features. Despite the move towards universal design and the availability of many, if not all, the technology features needed to ensure universal design of cell phones, most cell phones remain overly complex and confusing (Tobias, 2003). Further, many cell phones still lack features that would reduce the level of difficulty and improve access to cell phones for people with intellectual disabilities.

Technology acts as a double-edged sword for people with intellectual disabilities. On the one hand, it incorporates many characteristics that are inherent barriers to such people (e.g., complexity, high cost, requirements for literacy, and demands for increased speed of decision-making). At the same time, technology contains the as-yet-unrealized potential to overcome many of these same barriers.

Cell phones appear to offer a unique set of characteristics inherent in the cellular business model that holds the potential to overcome these barriers in ways other technologies have not (Roberts & Pick, 2004), including the following:

• Wide adoption, reaching nearly 60% of American public and rapidly rising

• Design similar to home telephones that 89% of study participants already use

• Nonstigmatizing and, in fact, image-enhancing (many people perceive cell phones as “cool” and place them on the table in restaurants or wear them on their belts)

• Consumer product versus specialized assistive technologies (widely marketed with low entry fees, often available for free as promotions or given as gifts, ability to return if unsatisfied)

• Service and repairs widely available and often included in monthly service plan

• Equipment upgrades and replacements often available at low or no cost, which addresses technology's rapid obsolescence

This exploratory study has several weaknesses that should be considered in interpreting these findings and considering directions for future research. The sample size (n = 83) was small and not randomly selected. Thus, we must be very cautious about generalizing findings beyond this sample. Larger and more geographically diverse samples are needed to more accurately document prevalence of use among the population of adults with intellectual disabilities. Another limitation is the lack of income data as well as objective information about ability other than self-reported judgments of ability. Participants were largely unable to provide us with any indication of personal or household income, although we guessed, in part because services tend to be paid through Medicaid, that almost all participants received government disability benefits. We do not know how closely self-perceived ability ratings would correlate with more objective measures of ability. Despite these study limitations, several conclusions and policy recommendations can be proposed.

## Conclusions and Policy Recommendations

Cell phone use by adults with intellectual disabilities is available today, although it may not be accessible to many because of cost, perceived lack of need, or lack of supports. Legislation in the United States (§ 255 of the Telecommunications Act of 1996) and technology advancements point to the conclusion that designing cell phones that are accessible to people with a variety of disabilities is readily achievable (i.e., without much difficulty or expense). According to the Trace Center Reference Design 1 (Trace Center, 2002), one cell phone design can meet all of the U.S. Federal Communication Commission's access requirements.

In addition, the Communication Telecommunications and Internet Association responded to the advocacy call from the disability community. They published a Consumer Guide to Wireless Products (Communication Telecommunications, 2003) to assist people with disabilities in determining what wireless features and functions might be most useful for people who are deaf or hard of hearing, are blind or have visual impairments, are mobility limited, have speech disabilities, or are have cognitive disabilities. This guide provides links to websites in which manufacturers have included one of more accessibility features in their cell phones. For example, for customers who have cognitive disabilities, links are provided to manufacturer's websites where adjustable scroll speed, standard icons, automatic answer, automatic redial, one-touch dialing, menu prompts, or text reminder functions are available in a cell phone.

Of equal importance to the design of cell phones is the importance of the environment in which many individuals with intellectual disabilities live. These environments may provide limited opportunity and support for technology use in general and cell phone use in particular. They might foster unnecessary dependence on others as opposed to use of enabling assistive and generic technologies to promote independence. As such, both policy and practice must be addressed if this particular digital divide is to be reduced. Policy must stress the implementation of § 255 of the Telecommunications Act of 1996 and the Assistive Technology Act of 2004. In fact, one might argue that the definition of an assistive technology device should be expanded to include cell phones for people with a variety of disabilities. Simultaneously, practice must support the inclusion of assistive and generic technologies because they can support the growing independence and community inclusion of children and adults with intellectual disabilities. Technology can make a difference in a person's life. The potential of these technologies must be made accessible and available to children and adults with intellectual disabilities.

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This article was written with support, in part, from the Assistive Technology Collaborative, through a Grant H133A010607 from the National Institute on Disability and Rehabilitation Research. The authors thank the participants who shared their experiences and thoughts about cell phones and other information technologies.

## Author notes

Authors:

Diane Nelson Bryen, PhD (diane.bryen@temple.edu), Professor of Special Education and Executive Director of the Institute on Disabilities, Pennsylvania's University Center for Excellence; Mark Friedman, PhD, Consultant, Institute on Disabilities, Ritter Annex 423, Temple University, Philadelphia, PA 19122. Allison Carey, PhD, Assistant Professor of Sociology, Shippensburg University, 1871 Old Main Dr., Shippensburg, PA 17257-1006