Impacting Employment Prospects for People With Health Conditions Affecting Cognition Through Codesigned Assistive Technology

This PhD study project researches people with health conditions affecting cognition (from here referred to as PHCAC) as stakeholders who help codesign assistive technology, devices that aid in day-to-day life (a variety of which ranges from special designed wheelchairs, to digital software to aid accessibility). It focuses on the aspects of how to improve employment prospects by improving the usability of assistive technologies. It also looks into specific elements that see little research in the development of assistive technologies, such as utilising social context, and longitudinal deployment with accessibility in mind. This is with the intent to see how they impact the design of assistive technologies and, ergo, it’s impact on it’s usability. So far this project has conducted research by assisting in a couple smaller projects that were looking into similar but different topics of research. These topics were things such as "digital meaningful making", and "Enabling digital first" with stakeholders similar to this study (people with acquired brain injuries and sight-impaired respectively) [16]. These were done during the COVID-19 pandemic due to the severe effects that it had on the ability to conduct social research. They also allowed for the principal investigator to gain experience and understand the area around the research topic in more first-hand methods. After these were done, some bespoke work for the project was done to flesh out the beginning of the PhD, a literature review was conducted into the research topic itself. This was done to contextualise all the data that had been collected from the smaller projects. Another study that was conducted looked into the generation of social context data and what it can mean for the development of assistive technology, and it utilised a method of qualitative data generation called a World Café. This was a foundational study to be used as a stepping stone for the technologically based component of the PhD. The next steps of the research detail a shift to focus on the technology itself and its development. After this the research moves onto directly tackling the implementation of automated action taken on bespoke feedback, with the possibilities of how these can be achieved.

social context data and what it can mean for the development of assistive technology, and it utilised a method of qualitative data generation called a World Café. This was a foundational study to be used as a stepping stone for the technologically based component of the PhD.
The next steps of the research detail a shift to focus on the technology itself and its development. After this the research moves onto directly tackling the implementation of automated action taken on bespoke feedback, with the possibilities of how these can be achieved.

CCS CONCEPTS
• Social and professional topics → People with disabilities; Geographic characteristics; Socio-technical systems; Employment issues; Computer supported cooperative work; • Humancentered computing → User studies; Usability testing; User models; Empirical studies in HCI ; HCI theory, concepts and models; Collaborative and social computing design and evaluation methods; Empirical studies in collaborative and social computing; Social engineering (social sciences); Computer supported cooperative work; Social recommendation; Collaborative filtering; Collaborative content creation. KEYWORDS "assistive technologies", "Employment process", "Mental disabilities", "Acquired brain injuries", "Digital assistive technologies", "well-being", "Independent learning skills", "charities"

MOTIVATION FOR THE RESEARCH
Employability and well-being within the workplace are lower for PHCAC than for their colleagues. As a result the public perceptions of PHCAC are lower and that lowers employability which circles back on itself. This contrasts to the amount of support technologies and techniques that exist to support them. From gathered qualitative data on this research sphere shows that people view assistive technology to have low usability or accessibility [9].
Therefore the rationale behind this research is that while technologies and techniques exist to support PHCAC to gain employment, it is imperative to understand and address the weaknesses and strengths of these approaches. This will help improve employability, as well as to help understand the bespoke nature of the issues people face in order to address them effectively [1,7,13].
Stakeholders are often the most qualified individuals to give firsthand accounts of their bespoke problems and can give suggestions that would aid in situations that they have first-hand experience with [4,5,14]. As such it in order to raise usability and accessibility, the needs of the individuals themselves must be integrated within the design process of the assistive technology. Cooperative design work is a strong methodology for implementing the stakeholders into the assistive technology [10].

BACKGROUND AND RELATED WORK
In order to formulate the beginnings of the study we conducted a literature review of 80 papers, during this review we utilised several databases (ProQuest Central, Applied Social Sciences Index and Abstracts, International Bibliography of Social Sciences, JSTOR, Scopus, PsycINFO) to gain as much related works as possible. Once the related articles had been collected we then conducted a thematic analysis on 60 papers, we did this by using the method in works by Braun et al. [2]. The thematic analysis would then be peer-reviewed independently by the secondary authors until each individual was content with the quality of the analysis. From this literature review we drew several key references.
The key references are as follows: • Brohan, Elaine, et al [3]. They reported through a systematic review that people with metal health problems face both stigma and discrimination when trying to find and keep a job. • Perry, Elissa L., Wallace Hendricks, and Emir Broadbent [12], looked into university students with disabilities, their encounters with discrimination, and their work satisfaction in their history. Outcomes of these were that the higher level of discrimination, the lower the level of job satisfaction. • Christian, LeeAnn, and Alan Poling [6], looked into the use of self-management procedures to improve productivity of people with disabilities, within a specified zone. There was a marked improvement with work productivity and they were deemed acceptable by the people within the social context of the study. • Nevala, Nina, et al. [11] showed that despite various implementation of technique (vocational counselling and guidance, education and so on) there was little evidence that these increased work participation. • Walton, Katherin M., and Brooke R. Ingersoll, et al. [15] looked into developing social skills for adolescents and adults with autism spectrum disorder who also have profound intellectual disability it was discovered significant challenges to find extensive research on the efficacy of designs (such as video modeling etc) and methodology for assistive techniques. • Hagner, David [8] suggested interventions that are directed towards the employees and the employer are effective at improving well-being.
These findings will go on to be used to develop the framework for the study, in this case we will be looking into aiding PHCAC improve their well-being and employability. We will be doing this by improving the usability and accessibility of effective assistive technology co-designed by the stakeholders and deployed longitudinally.

DESCRIPTION OF THE PROPOSED RESEARCH 3.1 Main research questions
The nature of this research is a conjoint effort between the schools of social and computer science, as such it is reliant on mostly qualitative data. Consequently the data provided by the participants of the conducted studies will have dramatic affect on the research as it progresses. As such it is difficult to detail a true road map of the research, as certain data may come to light that will entirely shift the focus of the PhD. However, the current proposed research questions and direction focuses on the bespoke problems of the stakeholders, and how to best implement them to make assistive technology more usable and more accessible. To detail this, a few research questions were developed from the findings of the background research.
The developed research questions are as follows: • How can we better input the bespoke issues, requirements, and ideas of the stakeholders into assistive technological design? • Will implementing stakeholder information improve usability and accessibility for assistive technology? • How can longitudinal deployment be used to improve the permeation of assistive technological use?

Road-map to the research
After the already established contributions, the next steps are to firstly develop an assistive technology, utilising the qualitative data that has already been extracted from the stakeholders. Examples include, a phone forum application to help with social interaction or helping find job opportunities etc, a VR experience that can be used to facilitate a job application interview, and so on. After this the prototype of this technology would be deployed longitudinally and thoroughly evaluated to understand the approach and where its strengths and weaknesses lie. For example, utilising an open-source package that can be given to local charities who then improve and pass on to stakeholders, who use it and improve and pass it on to other users and so on.

RESEARCH METHODOLOGY AND PROPOSED EXPERIMENTS
The first method utilised was based in user-focused data gathering. This is because the data that will be gathered is based on opinions, suggestions, and ideas presented by stakeholders, as well as it being utilised heavily in the coming sections. Firstly semi-structured interviews were done to explore the research topic and form the research questions. In specific utilising a novel data gathering technique like a World Café was imperative to get as close to a development workshop for idea generation whilst accommodating as many different social aspects required for an effective social atmosphere and understanding the bespoke problems that apply for the context. After this it is important to utilise the data to create a prototype of an assistive technology utilising the previously gathered qualitative data. This is to see the co-developed designing method and its efficacy in creating supportive interventions for PHCAC and their employability. The method of how this would be developed and the understanding of why it is important that the stakeholders are utilised as much as possible as co-designers is imperative to this segment of the research as it is the hypothesis that they can vastly improve the designed prototypes. The focus of this paper would be to understand and evaluate the method of development itself and why it is important to utilise stakeholder information in this specific context to develop technologies that can impact on bespoke problems people face.
Due to the data already gathered, some examples of potential development opportunities can be described thusly. A virtual reality (VR) tool that provides an experience that can describe people skills and how to upskill themselves. Another given example could be a mobile phone forum where daily reminders of tips the stakeholders can do to practise or improve their own social skills in a work interview setting. These would all focus on the research topic of employability as well as understanding bespoke problem and utilising stakeholder input, as long as these criteria are met the actual technology that is developed could be a variety of things.
The next stage for the research would be to establish the efficacy of the previous developed technology. This would be done via a longitudinal deployment of the model and a ethnographic journal styled data collection over a certain amount of time that would be able to collect feedback on the technology itself. This is therefore distinct from the previous study, which focused on the method of development rather than the technology. This will be down by utilising a method of longitudinal deployment with a focus on accessibility, namely, utilising a open-source packaged tool and deploying it to several charities or work-spaces.

RESULTS AND CONTRIBUTIONS TO DATE
During the first year and a half of the PhD, COVID-19 had forced the UK into lockdown. As such it was extremely difficult to start most social research projects, including this one. To compensate for the lack of progress, the principle researcher took part in various projects that were concurrent and parallel to this one. They included "Utilisation of smart homes for the visually impaired", "meaningful making and its online uses for those with acquired brain injuries", whilst concurrently performing the literature review and the interviews conducted with experts. This contributed in getting experience with performing research projects, as well as developing context for similar research topics to serve as possible inspiration in the near future.
Once data had been gathered a literature review was conducted in order to develop the foundational elements of the PhD project.
Multiple different databases were used to perform a literature review of the research topic, focusing on the social science aspects of the project. ASSIA, Scopus, Google Scholar, IBSS, and Web of Science were used during this. Thematic analysis was then performed on the resulting literature and then analysed by the secondary authors until all parties were satisfied with the quality of it. This was in accordance with the methodology utilised by Braun et al. [2]. The themes drawn from this analysis gave several examples of current methodologies utilised to support people in workplaces, benefits from gaining independence through supported work, how important work is in the daily life of PHCAC, and what problems occur within the workplace itself.
Once the literature review was done, it was understood that a lot of the reference material was from 20 years ago at least. To this end, it was surmised that further background work was needed. As such, it was understood that a preliminary study was needed to contextualise the findings from the literature review by experts in the field who has current experience. To do this, Several semi-structured interviews were performed with experts who were contacted to participate in the PhD research as people who work with PHCAC and understand the problems they encounter with a decent amount of experience. In this case 6 people from various charities that interact with PHCAC for at least 2 years. When the interviews were completed it was surmised to complete a similar thematic analysis as to what was performed with the literature review. Once the thematic analysis was performed on the resulting data it showed that there were many social impacts on a lack of work opportunities as well as compounding problems not being drawn from a lack of resources. This was then used to reinforce the data that would be gathered from the World Café event, as well as further cement the findings gathered from past literature in current day data.
Once the foundations of the PhD project were established the first proper study was decided on how to understand the social context of stakeholders and how it can be used in a more integral fashion with the development of an assistive technology. In order to do this a method would need to be decided on that allowed for the most discussion between stakeholders on the social context. In this case we decided on a World Café and it was performed with 22 participants of a charity, with 6 others to aid in its executions. These had a range of ages (above 18) and genders and experiences to have a more broad wealth of data to draw from. This was performed to generate ideas and data directly from PHCAC in context for their accounts on workplace opportunities and what they think would help them the most. This is with the intention to be used to develop a low-fidelity prototype of a assistive technology that utilises a co-design technique to design. Several design aspects were drawn from the results, a model and several design goals and qualities to take into account were understood.

EXPECTED NEXT STEPS AND FUTURE WORK
Moving forward in the PhD project we will be focusing on the technological aspect of the research, this means that more information on the development of assistive technologies, and how the stakeholder can be integrated into this process. As such a literature review on this topic is to be conducted in a similar fashion to the previous one, namely utilising Braun et al's. methodology [2]. This would be done to collect data on the methodology the next study within the PhD project will use. Once this is done an assistive technology prototype will be developed and evaluated by the stakeholders implemented within the development process, to see how the developed prototype stands up to their specifications.The next research experiment focuses on the designing process of the prototype assistive technology, how it benefits from being co-led with stakeholders (in this case PHCAC) and what the impacts are. This would follow into the evaluative step of the life cycle of the assistive technology, this is to get feedback on the device to see how well the implementation has worked or what needs to be improved upon, and why this is the case.
To fully assess the implementation of the assistive technological and to fully understand accessibility and improve it, a user-centred longitudinal deployment is going to be studied in the last segment of the project. For example, utilising a open-source method of "take one pass it on and improve it" the hypothesis is that when someone improves upon it, it becomes more usable, but also more accessible as anyone can deploy free aid. The plan is to deploy it within already participating areas or ones local to the principal investigator, and then utilise an ethnographic method of data gathering once the prototype has been deployed.