RESNA Annual Conference - 2021

Adapted Symptom Screening Application: COVID-19 Symptom Screening for People with Intellectual and Developmental Disabilities

Olivia Shope

Department of Occupational Therapy, Duquesne University

1) Problem Statement/Research Question and Background

            The COVID-19 pandemic has brought on significant challenges for people around the world but has been particularly difficult for those with disabilities. Daily symptom screenings are now a regular occurrence but are not always the most accessible. On Duquesne University's campus, we have an inclusive education program, and one of the faculty members involved reached out for help regarding a student's difficulties with using the symptom screening. The symptom screening questionnaire required by the university requires was not a good fit for a particular student with an intellectual/developmental disability (IDD) who struggles particularly with literacy and numeracy.

At the beginning of the project, the student was being called each morning by one of the student aids to go through the questions and record his temperature, but there were several days that the aid was unable to make that call due to time constraints or prior engagements. It was determined that the student needed a way to complete the form independently. H needed to have the instructions read aloud and phrased in a more comprehensible way. An application that could be downloaded to his phone was decided to be the best option.

2) Methods/Approach/Solutions Considered

            To create this application, direct input from the student and his aid was needed. Weekly meetings with them to test and revise the application and make changes to the functions were scheduled. The most important need to be addressed was that the questions listed in the symptom screening needed to be spoken aloud by the application. It was also concluded that the questions needed to be presented one at a time with distinct buttons indicating 'yes' and 'no'. There also needed to be a feature that allowed the student to input his temperature each day.

Once the application had been prototyped with the questions from the University's screening instrument, it became apparent that some of the symptoms were not described in a way that the client was able to conceptualize. One of the weekly meetings was dedicated to going through each question and having the student identify what was being asked. The questions were then rephrased in language that the student commonly uses and in simpler terminology.

3) Description of Final Approach and Design

            After working with the client and his aid in determining what would be best for them in screening for the symptoms and accessing the data, the final design was developed. The final design included a picture or cartoon portraying the symptom being asked about, the question displayed in text in common language, and the question was read aloud when the client clicked on the picture. The yes and no buttons are clearly displayed, with no in red and yes in green. Only one question has a desired input of 'yes,' which is the prompt about loss of taste and smell. This was easier for the student to understand by phrasing the question as if he was still able to smell and taste his food.

            Once an answer is selected, the application moves on to the next question and goes through each one by one. Once all the questions have been answered, it moves to the next screen which is the temperature input. It was decided that the best approach to take was to have the student take a picture of his thermometer after taking his temperature. The second screen automatically prompts the student by telling him aloud to take his temperature and then take a picture. There is another button on the screen that allows the user to view the data stored in the application. This displays the date, answers given, and the picture of the thermometer from that day.

            Once the application design was complete, the student was educated on how to use all the features, and the student aid was shown how to access the data. A feature was added later where the application records when the app has been used in an online database. This allowed for an easy way to check if the student was using the application consistently. The answers and pictures are only displayed and stored within the application on the student's device to protect privacy.

4) Outcome

This image shows the layout of two screens in the application. The first shows the data collected from the user with a picture of the thermometer displaying their temperature, the date the app was used, and whether the user answered 'yes' or 'no' to each of the screening questions. At the bottom of the screen there are three buttons; one to return the previous date the application was used, one to progress to the next date the application was used, and one button to restart the application and return to the beginning of the screening.
This image provides examples of the code that makes up the application. The code is made up of various blocks of differing colors. Each color is related to a different part of the code, such as variables, lists, and commands.

Feedback from the student and his student aids has been very positive. The student reports that it is easy to use and has been using it most days of the week and it is part of his morning schedule. The student aid has been able to view the data and easily organize it to keep track without calling the student every day to use it. The faculty member that originally requested the application also reports that the student was using it every day during the fall semester and at the beginning of spring semester until the student received his vaccination.

5) Cost

            The application was developed on the free program Thunkable because it was compatible with iOS, but in order to download the application to the student's device, the professional version of the program is needed. The professional version costs $20 a month and is the only expense for the developers.

6) Significance

            COVID-19 pandemic has required changes in many aspects of life and the introduction of several new requirements. This has been especially challenging for people with disabilities. In this case, a symptom screening meant to protect the safety and health of students on a college campus was not accessible to the students on campus with IDDs due to its format and presentation. An application was customized to fit the needs of a specific client, but the code and format is easily changed to fit the needs of others.

7) Acknowledgements

            I would like to thank Colton Vazquez, Alexandria Raymond, Morgan Cargiulo, Dr. Megan Blaskowitz, and Dr. Richard Simpson for their contributions to this project.