Accessibility Design Features

We conducted a purposeful review of literature in the fields of rehabilitation, education, health literacy, community advocacy, and communication technology to identify design features that may optimize the accessibility of self-reports for people with developmental disabilities.

Based on this review, we proposed specific features that can be used to optimize the content, layout, and administration procedures of self-reports.

Please contact us if you would like more information about all of the proposed features.


The meaning conveyed in each item.

11 features, including:

Context: Item specifies specific interactions, locations, or activities within which the action or task is intended.
Example: “Introduce myself to a new coworker.”

Personal reference language: Item uses first or second person language.
Example: “Look up my doctor’s phone number.”


The arrangement of words, images, and response options.

14 features, including:

Visual integration of items with rating scale: The item and rating scale are visually close to each other.
Example: Wash my hands [] Hard [] Easy

White space: Reduce visual/perceptual demands.

  • 1 inch margins, 1/2 inch between items
  • at least 35% white space

Administration Procedures

9 features, including:

Teaching: Respondents review example items or complete practice items.
Example: It is hard for Maria to remember her PIN number. She picked “hard.”

Validate respondent: Respondents are assured the PRO is about their perspectives, perceptions, or feelings.
Example: “I want to know what you think. There are no right or wrong answers.”

Outcomes of Cognitive Accessibility

Respects autonomy

  • Increased access to healthcare decision-making
  • “Nothing about us without us.”

Improved measurement

  • Improves response consistency
  • Increased usability results in more valid responses

Responsive to policy

  • Enacts the vision of the Affordable Healthcare Act for people with I/DD
  • Address under representation of people with I/DD in healthcare evaluation