Conversational agents are increasingly being introduced in healthcare to enhance access to healthcare and address limited healthcare resources. The aim of this study was to explore experiences of a conversational agent for symptom checking and triage tool assessing the urgency and appropriate level of care implemented in public healthcare from a cognitive accessibility perspective.With a Participatory Action Research approach this study includes: 1) A Participatory Cognitive Barrier Walkthrough in workshops with people with cognitive impairment (n=7), product owner representatives (n=4), and researchers (n=5), followed by a workshop for improvement suggestions; 2) A paired interview with healthcare system specialists (n=2).The data from the study was analysed using reflexive thematic analysis, resulting in five themes: ‘The design of the eHealth service created expectations that were not met during interaction; ‘The eHealth service uses a difficult language’; ‘The eHealth service trigger negative emotions and reactions’; ‘The layout and graphic design of the eHealth service is difficult and sometimes misleading’; and ‘The eHealth service lack in trustworthiness’. The findings show the importance of including people with lived experience of cognitive impairment, to expose and find solutions for cognitive accessibility issues

Background: The adoption of eHealth accelerated during the COVID-19 pandemic. Inequalities in the adoption of eHealth during the COVID-19 pandemic have been reported, but there are few such studies among people with impairment. Objectives: This study aimed to investigate self-reported use and difficulty in the use of eHealth before the COVID-19 pandemic compared to during late social distancing restrictions in Sweden, among people with and without impairment, as well as between different types of impairment. Methods: A cross-sectional survey was distributed twice by snowball sampling to people with self-reported impairment and a general population matched by age, gender, and county. Use and difficulty in the use of six eHealth services were compared between groups using chi-square test and logistic regression with year interaction terms, reported as odds ratio adjusted (aOR) for gender and age with 95% CI. Results: The surveys included 1631 (in 2019) and 1410 (in 2021) participants with impairment, and 1084 (in 2019) and 1223 (in 2021) participants without. Participants with impairment, compared to those without impairment, reported less use and more difficulty in booking health care appointments online, digital identification, and the Swedish national web portal for health information and eHealth services (1177.se), both before and during the pandemic (P = .003 or lower). Video health care appointments were the exception to this disability digital divide in eHealth as video appointment adoption was the most likely among participants with attention, executive, and memory impairments (interaction term aOR 2.10, 95% CI 1.30‐3.39). Nonuse and difficulty in the use of eHealth were consistently associated with language impairments and intellectual impairments. For example, language impairments were inversely associated with use of the logged-in eHealth services in 1177.se in 2021 (aOR 0.49, 95% CI 0.36‐0.67) and were associated with difficulty in the use of 1177.se in 2019 (aOR 2.24, 95% CI 1.50‐3.36) and the logged-in eHealth services in 1177.se in 2021 (aOR 1.89, 95% CI 1.32‐2.70). Intellectual impairments were inversely associated with the use of the logged-in eHealth services in 1177.se in 2021 (aOR 0.19, 95% CI 0.13‐0.27). Conclusions: This repeated cross-sectional survey study, including participants with diverse types of impairment and a control group without impairment, reveals persisting disability digital divides, despite an accelerated adoption of eHealth across the pandemic. eHealth services were not accessible to some groups of people who were identified as being at risk of severe disease during the COVID-19 pandemic. This implies that all people could not use eHealth as a measure of infection protection.

Lifelong learning in higher education (HE), epitomised by Massive Open Online Courses (MOOCs), is valuable for re-skilling and upskilling Sweden's industry workforce in (advanced) digital competencies to remain globally innovative and competitive. Meanwhile, Sweden's non-regulatory approach towards MOOC deployment in HE meant that their accreditation by universities faces strenuous systemic challenges. However, since 2019, one university began accrediting an AI mass-market MOOC following a nationally unique system-divergent innovation, which this case study unpacks by responding to three research questions. First, what were the underlying processes of this system-divergent innovation, and how and why did it occur? Second, what were its key success factors? Furthermore, how sustainable is it? This reflexive case study draws on eight semi-structured interviews with university staff and faculty, which were deductively analysed based on topical literature and concepts from system-divergent innovation and structuration theory. Generated themes were called challenges-as-opportunities and spanned bureaucracy, finances, technological infrastructures, deroutinisation, internal conflicts and external pressure. These themes and their discussion inform policy on three tiers: governmental, sectoral, and institutional. This original work highlights that mmMOOCs' accreditation by universities can play a significant role in bridging lifelong learning and HE in Sweden, and calls for digital maturity and national contagion.

The Web Accessibility Directive (WAD) is part of the European Union’s work for digital inclusion. The WAD obligates that public sector bodies’ websites meet accessibility standards and provide an accessibility statement on the website informing about inaccessible content, and a feedback mechanism for reporting accessibility issues or requesting inaccessible content in an accessible format. The objective of this study was to evaluate how healthcare providers in Sweden have applied accessibility statements on their websites as regulated by law. A descriptive study using a mixed methods approach was conducted, by quantitative descriptive data analysis of the healthcare providers’ accessibility statements compliance to requirements and qualitative data analysis of the written information provided in the accessibility statement. All but one of the 37 evaluated healthcare providers published an accessibility statement. None of the healthcare providers fully met the requirements for accessibility statements, and no one complied with the intention of the law, i.e. to provide accessible health information and eHealth services. There was no or minor progress between the first and the latest published accessibility statement. The possibility to declare no or partial compliance with the law, or claim disproportionate burden, and the lack of enforcement procedures, risk producing symbolic actions e.g., publishing accessibility statements without intention to abide by the law. We suggest that the directives for accessibility statements should be advanced regarding comprehensiveness, understandability, and usefulness. It is suggested that the assessment protocol developed for this study may be used for future evaluations of accessibility statements.

Technology-enhanced learning (TEL) is a research field occupied with how teaching and human learning can be supported through the help of digital tools for increased efficiency, effectiveness, learnability, and pedagogical values by applying verified learning theories supported by analyses of the data generated by the students’ activities. Research in TEL is closely related to a social mandate that is becoming eminent in education nowadays: digitalizing education in an accessible, ethical and sustainable way. Most literature on TEL has focused on technological aspects, pedagogical approaches, ethical considerations or accessibility concerns in isolation, often within different research communities. Also, with generative AI's broad and unpredictable impact, these gaps could widen further. This commentary paper aims to bridge these gaps by offering an integrated perspective addressing all three aspects—technology, pedagogy, and accessibility—while examining intersections and implications from multiple viewpoints. From a historical perspective, various educational technologies have facilitated the scaling of different pedagogies and contributed to students' understanding by enhancing personalized learning, expanding visualization possibilities, and improving access to learning materials. While television and radio enabled remote learning, technological advancements in recent decades have significantly increased accessibility, such as radio and TV learning programs, to the emergence of e-learning platforms, adaptive learning systems, and artificial intelligence-driven educational tools. However, it is essential to acknowledge that, despite these advancements, technology-supported educational tools often remain more accessible to learners from developed countries or those with a high socio-economic background who can afford the costs and possess the necessary skills for effective use of these tools.

The aim of this study was to describe prerequisites for online collaboration for user participation in co-design of online digital services as perceived by people with impairments and to develop requirements for how online collaboration should be designed to be accessible for all participants. An exploratory study was conducted in parallel to activities in two co-design projects. Researchers, accessibility experts, designers and 31 members of disability organisations participated. All participants had lived experience of impairments. Data was co-analysed by all participants using a qualitative thematic analysis with an inductive approach. Sixty-three requirements for accessible online collaboration were identified pertaining to four themes: digital tools and accessibility; preparation of an online collaboration activity; performing and participating in an online collaboration activity; and documenting and evaluating an online collaboration activity. Conclusion: the co-design process can be strengthened by transition to online collaboration, owing to the possibility of having more frequent interaction, economising the participants’ energy and the design process being more transparent. Using accessible online tools, careful planning, and meeting preparation, and establishing a trustful and convivial atmosphere during each activity, are the cornerstones for accessible online collaboration. People with impairment can participate in online collaboration if the activities meet accessibility requirements.

Accessibility influencers play a pivotal role in the broader accessibility movement, leveraging social media to raise awareness and shape public opinion. This study explores the distinct goals, communication styles, and approaches these influential figures employ to make complex legislative content more accessible and engaging. Utilizing netnography for data collection and conducting thematic analysis of interviews, this research highlights the crucial role of accessibility influencers in disseminating knowledge, advocating for universal design, and enhancing digital accessibility. The findings emphasize the importance of integrating accessibility principles into educational curricula, ensuring the development of a workforce capable of creating inclusive environments. Moreover, the study underscores the need for continuous professional development and systemic inclusion of accessibility training across all educational levels.

Web accessibility awareness among development teams has increased with initiatives like the Web Content Accessibility Guidelines (WCAG) and more user-centered development methods. While this awareness has grown, there is a need to explore accessibility from diverse stakeholder perspectives when applying these standards. This study presents findings from a survey of 47 stakeholders who used an internal customized digital tool with design components like patterns, principles, and graphic profiles. This study aimed to gain a deeper understanding of the stakeholders’ experiences when developing accessible public web services with the support of a customized ICT tool. Results show that a knowledge-based digital platform, which is used for assessing and communicating accessibility requirements, can streamline the development process and establish a common baseline for all stakeholders involved in developing accessible public web services. This research highlights the importance of having a holistic perspective from various stakeholders on accessibility and the impact of tailored tools in fostering inclusivity and compliance with web accessibility standards.

Software engineering (SE) models, processes and software development lifecycles have been developing since the early 1960s, with various fashions and trends dominating the development. Currently, lean or agile approaches, like scrum, have received wide and increasing attention. Since the 1990s, when software started to be adopted widely by the general public, the need to focus on human-computer interaction (HCI) grew and HCI development methodologies such as user-centered systems design became popular, addressing the values of actively involving the end users in the development work. For many years, SE and HCI developed in parallel, without involving each other’s disciplines much in the process, but recently the need to effectively integrate HCI and SE has become much more evident and novel approaches, such as Agile UX, have developed. This chapter goes through the historical development of SE and of HCI and surveys the attempts made on integrating the two and concludes with some general recommendations for further development aiming at a seamless integration of SE and HCI for the benefit of all stakeholders involved.

Collaboration is a long and strong academic tradition. Over the years we have seen many investments in increasing collaborations, nationally and internationally, such as Erasmus +, EIT etc. Many of these attempts fall short, there are some collaborations, some development of platforms/infrastructure, but as soon as funding ends, collaboration ends. This paper makes a strong argument for a structured approach to inter-organizational university collaborations where the opportunities and challenges of different alternatives are evaluated. The paper proposes that solutions for national inter-organizational university collaborations can be designed by combining the choice of technical educational platforms with an idea for how to organize the collaborative processes.  

We argue that it is possible to stake out the overall approach for inter-organizational university collaborations. Learning from previous initiatives, there are three main alternatives to choose from; (1) Focus on creating organizational collaborations; (2) Focus on creating and sharing content; and (3) Focus on creating common delivery of courses. It is noteworthy to mention that these are not mutually exclusive alternatives but can and should be combined.