1. Introduction
1.1. Motivation
The stigmatization of people with disabilities has been addressed in many studies on disability and inclusivity. Though the World Health Organization (WHO), through the WHO Policy on Disability (2022), has already defined disability as a health condition confronting environmental barriers, the conception of disability as merely an individual’s own health problem is still prominent among the public. People with disabilities are stigmatized and marked by pity, sorrow and mercy (Monedero, Cuesta & Angulo Reference Monedero, Cuesta and Angulo2014). They are seen as people who will always be dependent on others and who offer little or no value to society (Hahn Reference Hahn1986). This stigmatization results in the exclusion of people with disabilities from society, which further causes poorer health outcomes arising from restricted participation (WHO 2011). Indeed, scholarly discourse on the concept of ableism – which stereotypes disabled people as incompetent and dependent, eliciting reactions ranging from fear and contempt to pity and sentimentality – has advanced considerably. It has been pointed out that it is also crucial for non-disabled people to recognize their privileged position (Nario-Redmond Reference Nario-Redmond2019). Whether the disability is visible or invisible also affects the stigmatization of people with disabilities, and there is an argument that how the characteristics of the disability are understood can be a core factor in recognizing stigmatization (Granjon et al. Reference Granjon, Rohmer, Popa-Roch, Aubé and Sanrey2023).
To reduce this stigmatization, there is a need to switch society’s understanding of disability as an individual problem to a social/environmental problem, or from a “individual model” to a “social model” of disability. The topics of disability and inclusivity are progressive and complex, and the issues that cause stigmatization cannot be addressed simply by looking at the problems of people with disabilities. People without disabilities must also learn the importance of having an inclusive environment that creates a better experience for everyone. As suggested by the United Nations Convention on the Rights of Persons with Disabilities Article 8 (UN 2022), awareness-raising is needed to reduce the acceptance of the view that sees people with disabilities as helpless and to help portray them as people who are empowered. It will also create an understanding of the need to include people with disabilities in society to lead to social inclusion.
One of the ways to raise awareness is through experience. By having people experience a situation directly, the issue introduced in that situation will be imprinted in people’s minds and help them to adopt perceptual outcomes from the situation to cope with the world (Riberio Reference Riberio2014). To date, there have been many types of awareness-raising activities based on experience. For example, Dialog in the Dark (DID) and Dialog in Silence (DIS) were developed by Andreas Heinecke. These activities allow people without disabilities to experience a controlled situation where stimuli are decreased and where their daily lives require adjustments to fit into general society. By such efforts, people without disabilities can be made more aware of the challenges faced by people with disabilities and can improve their behavior when interacting with them. Considering communication as the early stage of interactions, this study aims to find and provide knowledge to support the design of awareness-raising experiences for social inclusion, focusing on ways of adjusting stimuli to fill the gaps in communication. By bringing the findings together, this study can provide recommendations on how to design experiences that raise awareness of disability and inclusivity issues.
1.2. Background
1.2.1. Development of the concept of disability
The perception of disability has changed through the years along with changes in philosophical and sociological trends. One of the oldest perceptions of disability viewed it through the “medical model” or “disability individual model,” which saw disability as the outcome of a person’s health condition (Oliver Reference Oliver1990; Grover Reference Grover2022). This model saw people with disabilities as patients, as sick people whose conditions needed to be improved through medical intervention (Marks Reference Marks1997). The individual model of disability posited that disability arises from impairment – that is, from injuries, illnesses or diseases suffered by an individual. It emphasized the necessity of “treating” the impairment and maximizing the individual’s functional capacity (Oliver Reference Oliver1990). The individual model perspective of disability was considered the mainstream approach to understanding and managing disability in Western societies (Areheart Reference Areheart2008). However, Marks (Reference Marks1997) argued that this point of view supported few social criteria and led to the assumption that people with disabilities would always be dependent on others (Hahn Reference Hahn1986). Recent studies have suggested that, because of this point of view, people with disabilities experience higher levels of poverty, unemployment, and lack of access to services (Byrne Reference Byrne2018). This view has also resulted in the social exclusion of people with disabilities because of a failure to acknowledge social and environmental factors (Soedjito & Matsumae Reference Soedjito, Matsumae, Chakrabarti and Singh2023).
The individual model perception is challenged by the social model of disability. This discourse developed alongside the disability rights movement and the independent living movement (Finkelstein Reference Finkelstein1992), focusing on disability as a form of discrimination and oppression generated by the social, cultural and economic barriers surrounding people with disabilities. This multidisciplinary approach takes into account social and environmental factors and posits that the cause of disability issues is not personal limitations but rather social failures (Oliver Reference Oliver1996). It places the cause of disability on the way society is structured rather than on the attributes of the individual. The social model does not recognize a causal relationship between impairment and disability but instead focuses on causes of disability such as discrimination and prejudice. These theories indicate that disability can be changed from something considered an individual health issue to something considered to be caused by environmental factors. This perspective has been adopted as a fundamental viewpoint in current disability policy. The WHO shifted away from the previous International Classification of Impairments, Disabilities and Handicaps, which focused on the negative aspects of disability, and in 2001 adopted the ICF (International Classification of Functioning, Disability and Health), a classification system for human functioning and disability. The ICF is characterized by its inclusion of perspectives that go beyond impairment, such as environmental factors.
1.2.2. From the discussion of the post-social model
However, there are aspects of this kind of social model debate that are not functioning effectively in today’s society. Even though a better understanding of disability has made headway, there are still many who do not yet understand the influence of environmental factors. This leads to discrimination and the exclusion of people with disabilities because they are still seen as “different” from most of society. This exclusion has caused several social problems. According to Begen & Turner-Cobb (Reference Begen and Turner-Cobb2015), exclusion or ostracism can be a source of social pain, while Almog (Reference Almog2018) provided evidence in the context of the workplace that, when an individual feels excluded from the group, the entire group will fail to perform to its maximum potential.
Meanwhile, theoretical limitations of the social model have also been raised, and various discussions have been held concerning the post-social model. There is a perspective that viewing disability in terms of the dichotomy of the individual model/social model hinders a holistic understanding of the complexities of multi-layered and multi-faceted disabilities (Lang Reference Lang1998). Further criticisms note that the social model perspective risks ignoring the experiences of individuals, neglecting the differences between individuals with disabilities, and even denying their understanding of their own disabilities and experiences (Shakespeare Reference Shakespeare1994; Barnes Reference Barnes, Barton and Oliver1997; French Reference French, Swain, Finkelstein, French and Oliver1997). If functional differences continue to be seen as negative, then people with disabilities who have them will continue to be discriminated against (Corker & Shakespeare Reference Corker and Shakespeare2002). In addition, post-social models have been developed, such as a model of understanding that sees the differences between groups themselves as “ethnic groups” (Lane Reference Lane and Davis1997), as well as a model that proposes a positive perspective on these differences (Swain & French Reference Swain and French2000).
One of the conclusions of discussions of these theoretical models of disability cites the pros and cons of having an inclusive perspective, rather than an integration based on the dichotomy of disability/non-disability. A model proposed by UNESCO in 1994 focuses on the marginalization of people in society due to differences. As defined at the Copenhagen Social Development Summit in 1995, an inclusive society is “a society for all people,” meaning that all individuals have the same rights and responsibilities to play an active role in society. This increases trust, reduces the effects of previous exclusions, and results in health benefits (Begen & Turner-Cobb Reference Begen and Turner-Cobb2015). Alternatively, returning to the theoretical background and from the standpoint of critical disability studies (Kafer Reference Kafer2013; Goodley Reference Goodley2019), there is an attempt to visualize the complex experiences of disability as something that cannot be divided into the individual model and the social model. This conclusion emerged from the perspective that existing discussions on disability studies may be too heavily centered on physical disabilities and white men from the Northern Hemisphere. Kafer proposed the concept of a political/relational model (Kafer Reference Kafer2013; Brilmyer Reference Brilmyer2018), drawing on feminism, queer theory, and crip theory (Sandahl Reference Sandahl2003; Goodley et al., Reference Goodley, Lawthom and Runswick-Cole2014; McRuer Reference McRuer2006; Ray & Sibara Reference Ray and Sibara2018). By situating disability in a political/relational model, this approach criticizes the assumptions attached to the concept of disability and opens it up to different meanings. In any case, the way we think about disability is becoming more diverse, and it involves complex issues that cannot be resolved simply by treating and solving the problems of people with disabilities.
With this idea, increasing awareness of the importance of providing social inclusion is needed to create a better place to live for people both with and without disabilities. In a study on disability awareness training for university staff (Roth et al. Reference Roth, Pure, Rabinowitz and Kaufman-Scarborough2018), the interactions between university staff and students with disabilities produced positive changes in how people worked with those with disabilities. This raised awareness, supported inclusiveness and led to a more positive and successful student experience.
1.2.3. The role of experience in raising awareness
The theoretical development of disability studies suggests the need to position the understanding of disability in a social or relational context. However, since such an understanding is not commonplace, people need to be educated via intervention. From a study on the importance of interventions in creating an inclusive society, Giuntoli et al. (Reference Giuntoli, Idle, Newman, Fisher, Edwards and Robinson2024) stated that changing attitudes can improve the experiences of people with disabilities, and attitudes can be changed by raising awareness. The Cycle of Change by Prochaska and Velicer (Reference Prochaska and Velicer1997) also supports the concept of awareness contributing to behavioral change.
There have been many initiatives to help the majority understand disability. As described in the Motivation section, such initiatives include Dialog in the Dark (DID) and Dialog in Silence (DIS), developed by Andreas Heinecke. DID is a program in which 8 to 10 participants walk around in a dark space with a sight-impaired attendant and experience various things. DIS is a program in which participants wear headsets that block out sound and experience various things with the guidance of a hearing-impaired attendant. Those involved in the development of both programs have pointed out that DID can lead to greater empathy and understanding toward people with disabilities, and a greater awareness of human diversity (Heinecke Reference Heinecke and Steele2009). There is also Disability Equality Training, developed in the 1970s by people with disabilities in the UK, which is a method of raising awareness of the social model of disability. It adopted methods such as facilitation by people with disabilities themselves, helping others to recognize discriminatory social practices used against people with disabilities and working toward resolving them (Gillespie-Sells & Campbell Reference Gillespie-Sells and Campbell1991). This indicates that experiencing the situation in an interactive activity will deliver a more profound impact (Soedjito & Matsumae Reference Soedjito, Matsumae, Chakrabarti and Singh2023) and will also lead to raising awareness of disability and inclusivity issues. However, Crow (Reference Crow and Morris1996) criticizes Disability Equality Training for neglecting impairment and states that it is necessary to understand impairment and recognize subjective experience, questioning whether these methods of enlightenment are actually moving beyond the dichotomy of the individual model/social model toward greater social inclusion. More research into the training benefits of creating a space where people with and without disabilities can act together is needed.
1.2.4. Co-creative design as democratized participatory design
During the design process of solving a problem, the roles are usually divided into a user, who will benefit from the solution, and a designer, who will gather the users’ insights to propose a design concept. One of the approaches that supports this process is the user-centered design approach (Norman & Draper Reference Norman and Draper1986), which considers the designer’s role in facilitating the task for the user, allowing the user to exert the minimum effort in using the design output (Abras et al. Reference Abras, Maloney-Krichmar, Preece and Bainbridge2004). Regarding disability and inclusivity, people with disabilities have been encouraged to be included when designing products for use in daily life, and some research has discussed design practices that are conscious of the post-social model of disability (Hamraie Reference Hamraie2016; Williamson Reference Williamson2019; Lanteigne, Rider & Stratton Reference Lanteigne, Rider and Stratton2022). However, this process has so far treated people with disabilities as users rather than key participants in the design process. Another approach is needed, one that is more inclusive and where people with disabilities and the designer can work and produce results together.
Participatory design, also known as co-design, involves stakeholders in the design process. Co-creative design, a specific kind of participatory design, expects each participant to play creative roles in co-design (Matsumae & Nagai Reference Matsumae and Nagai2018), while participatory design often involves some participants as mere users to be interviewed or observed by the designers. Particularly in the context of designing experiences to raise awareness for diversity, equity and social inclusion, this co-creative design approach is essential because this democratization of the design process ensures creative participatory opportunities for everyone. This also allows all participants to interact in divergent and convergent thinking processes (Guilford Reference Guilford1967; Wang et al. Reference Wang, Hommel, Colzato, He, Ding, Liu, Qiu and Chen2023) to share ideas and create concepts together. For this reason, this research adopts co-creative design as an experimental protocol to obtain knowledge in designing awareness-raising experiences for social inclusion.
1.3. Aim
This study is meant to obtain knowledge to support the design of awareness-raising experiences of disability and inclusivity topics for people without disabilities by comparing two kinds of approaches that address the barrier or the gap between people with and without disabilities. Considering communication as an important factor in creating interactions and sharing ideas (Sumaiya et al. Reference Sumaiya, Srivastava, Jain and Prakash2022), this study focuses on filling the communication gap between deaf or hard-of-hearing (hereafter deaf) and hearing people during co-creative design, which will be discussed later in the Methodology section. Adopting the social model of disability, which focuses on the environment as the area that needs to be improved, this study modifies the environment by two approaches: decreasing audio stimulus communication protocol adapted the hearing to the deaf-oriented environment (the LESS approach), and not decreasing audio stimulus communication protocol adapted the deaf to the hearing-oriented environment (the MORE approach), as is typical in ordinary society. For this, the following research question was asked: How do LESS and MORE approaches influence experiences in raising awareness of social inclusion? It was hypothesized that identifying the salient characteristics of each approach in experiencing a situation would point to different influences on not only how people understand the meaning of disability but also the feelings they have when they interact with people with disabilities, as well as how they behave toward people with disabilities and inclusivity issues. To achieve this, this study analyzes the influences of LESS and MORE approaches with regard to three categories: understanding, feeling and behavior toward social inclusion.
2. Methodology
As noted in the Background section, the topic of disability and inclusivity is a progressive one, where society’s experiences influence its development. Considering the need to explore people’s meaningful experiences more deeply, this study adopted a mixed methodology for data collection to be analyzed both quantitatively and qualitatively, with a small sample size of participants. To answer the research question, participants experienced the co-creative experimental protocol with opportunities to “face the barrier or the gap,” and to update their understanding, feelings and behavior with regard to disability and social inclusion as described in the Background section. Additionally, as described in the Aim section, this experiment organized groups that mixed deaf and hearing participants and assigned co-designing tasks using different communication approaches in audio stimuli conditions, called LESS and MORE, which will be described further in the Experiment: Procedure sub-section. By understanding the influences of each approach on hearing participants’ awareness of disabilities in the social model, this study sought knowledge of how to design awareness-raising experiences for social inclusion by modifying the environment, as represented by the LESS and MORE approaches in this study.
This study followed the guidelines of the ethical regulations of Kyushu University, and ethical approval for this study was obtained from the Research Ethics Review Committee of the Faculty of Design, Kyushu University (Approval Number 565).
2.1. Experiment
2.1.1. Participants
Twelve hearing participants and six deaf participants aged in their twenties were grouped into three LESS groups and three MORE groups. Each group consisted of two hearing participants and one deaf participant. To minimize the influence of intersectional diversity (Jehn, Northcraft & Neale Reference Jehn, Northcraft and Neale1999), participants were recruited to be as similar as possible in all respects apart from the focal factors in this study, auditory diversity: both hearing and deaf participants were Japanese university students in their early twenties living in Fukuoka Prefecture. The deaf participants, all members of the Kyushu Deaf Student Association, were accustomed to communicating with hearing people.
As introduced in the Aim section about the need to raise awareness of people without disabilities, the main subjects of this study were hearing participants, while the supporting participants were deaf participants. Assessments of their prior experiences of interacting with people with disabilities in their daily lives prior to the experiment were conducted to consider the influence of prior experiences on their behavior during the activity. Only one of the 12 hearing participants had prior experience interacting with deaf individuals in their daily lives, which was considered in the cross-analysis in the Discussion section.
2.1.2. Procedure
The experiment was conducted in the form of a workshop in a large room with a back-facing seating layout, with enough distance for each of the six groups to avoid each other’s influence. To restrict each condition (LESS or MORE), an instruction of the “dos and don’ts” was placed on the table, making it so it could only be seen by that group’s members. As described in the Background section, the environment was designed to reflect two contrasting conditions: a deaf-oriented audio environment for the LESS condition and a hearing-oriented audio environment for the MORE condition. In the LESS groups, participants were instructed to properly wear high noise reduction earplugs (3 M 1100 Earplugs) to minimize auditory stimuli and were prohibited from using digital devices to adapt them to a deaf-oriented environment. In contrast, in the MORE groups, deaf participants were allowed to use any devices they normally rely on in daily life, including hearing aids and AI transcription apps, to adapt their diverse hearing conditions to a hearing-oriented environment.
The co-design of a one-day local trip around Fukuoka, a city all participants were familiar with, was the main activity of the experiment, ensuring that each participant had an equal opportunity to participate. To support the activity, an experiment kit consisting of a map, itinerary template, and stationery was placed on each table (Figure 1). The activity adopted a design thinking process with a divergent and convergent thinking process within 40 minutes, and this was divided into four phases (Figure 2). The co-design process began with Phase 2, followed by Phase 3 (after the Introduction in Phase 1), where they generated ideas regarding the trip theme and targeted places to visit (divergent thinking). Through an iterative process, they ultimately decided on a final trip to be put in the itinerary template in Phase 4 (convergent thinking). A camera was placed at each table to record the activity and capture the participants’ conversations. Six cameras were placed in front of each group to record their activity from the start until the end of the activity. Before the start of the activity, the main facilitator explained the flow of the activity by using a presentation slideshow with a sign language interpreter. To ensure all participants received the same instructions, slides and verbal explanations were printed and shown to the participants in each group by the co-facilitators. After all the phases were complete, the participants were asked to respond to a post-activity questionnaire.
Experiment kit on each group.
The flow of the experiment.
2.2. Evaluation
2.2.1. Questionnaire
To measure the awareness level of “disability” and “social inclusion,” the authors used the existing measurement scales with modification: the Disability Awareness Program scale (Ota et al., Reference Ota2020), the Attitudes and Perspectives Toward Persons with Disabilities scale (Myong et al., Reference Myong2021), and the measurement scale from a Disability Equality Training project for taxi drivers in South Africa (Igei et al., Reference Igei2020). With the modification, a total of 15 questions were produced (Table 1 in the Results section). Each question consisted of a 5-point Likert scale, where the negative score represented a low level of awareness, while the positive score represented a high level of awareness. Aside from the score-based questions, the questionnaires also consisted of questions that asked the participants to provide at least five adjectives that they associated with “disability” and “social inclusion.” To measure changes in awareness levels after the activity, the same list of questions was asked both before and after the experiment. Additionally, there were open-ended questions regarding their impressions of the activity, and these were asked after the experiment.
Question-based comparison between the LESS and MORE groups
Despite being distributed to both hearing and deaf participants, the data used for analysis came from hearing participants only, considering the aim of this study of raising the awareness of people without disabilities.
2.2.2. Quantitative analysis
This analysis used quantitative data gathered before and after the experiment that came from the answers on a 5-point Likert scale. The answer to each question was labelled as a “score,” referring to the participants’ awareness level assessed through each question. To determine the increase or decrease of each participant’s awareness level, the “score difference” was calculated by subtracting each question’s scores after the activity from the pre-activity scores. As described in the Background section, awareness should be measured not only in terms of the participants’ understanding of the topic but also in how they feel and behave when interacting with people with disabilities. To this end, the score difference was calculated in categories of understanding, feeling, and behavior. To analyze the differences between the LESS and MORE groups, a t-test was performed in each aspect. Box and whisker plots of the score differences were also used to visualize the differences between the two groups.
Aside from calculating score differences, an analysis of the influence of the questions in the questionnaire was performed to determine the trends of each LESS and MORE group. It was conducted in 3 ways:
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• Score effect
$$ {E}_i={w}_i\times \left({S}_{post,i}-{S}_{pre,i}\right) $$
Ei : Score effect for the question i
wi : Weight of the 5-point Likert scale for question i (−2, −1, 0, 1, 2)
Spost,I: Post-activity questionnaire score for question i
Spre,I: Pre-activity questionnaire score for question i
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• Average of score difference
$$ Average=\frac{1}{N}\sum \limits_{i=1}^N\left({S}_{post,i}-{S}_{pre,i}\right) $$
N : Total number of questions
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• Range of score difference
$$ Range=\mathit{\max}\left\{{S}_{post,i}-{S}_{pre,i}\right\}-\mathit{\min}\left\{{S}_{post,i}-{S}_{pre,i}\right\} $$
max: Maximum score difference across all questions
min : Minimum score difference across all questions
The results of the quantitative analysis provided a visualization of the differences between the LESS and MORE groups’ scores. Considering the sample size and the need for an in-depth analysis of the participants’ experiences, qualitative analysis was performed with the support of the quantitative analysis.
2.2.3. Qualitative analysis
Qualitative analysis was performed to analyze the tendencies found in the quantitative analysis visualization. The data was gathered before, during, and after the experiment and consisted of the adjectives used to describe “disability” and “social inclusion,” impressions of the activity, and video recordings made during the experiment. Each dataset represented each section: adjectives for the understanding category, because they measured an understanding of disability and social inclusion, impressions for the feeling category, because they indicated what the participants felt regarding the activity, and video recordings for the behavior category, because they captured how the participants actually behaved during the interactions with participants with disabilities.
The analysis of the understanding category was performed by calculating the changed amount of positive and negative adjectives provided before and after the experiment using sentiment analysis (Liu Reference Liu2022), and by observing which words were mentioned by the participants only before or after the experiment to analyze the trend of each group in understanding disability and social inclusion. The analysis of the feeling category was performed by coding the words the participants used to respond to the open-ended questions into open coding, axial coding, and selective coding, based on the Modified Grounded Theory Approach (M-GTA) (Kinoshita Reference Kinoshita2007; Kambaru Reference Kambaru2018) to gain insights into each LESS and MORE group’s feelings about interacting with each other. Lastly, the analysis of the behavior category was performed by observing the video recorded, focusing more on group dynamics and the communication style of each group. The observation was mapped in an interaction mapping, which was adopted from Dialogue Performance Analysis (Riessman, Reference Riessman2008) and Conversation Analysis (Mazeland Reference Mazeland and Brown2006). Attention was given to turn-taking (Koutsombogera & Vogel Reference Koutsombogera and Vogel2019), the source of utterances of each participant, and to whom an utterance was directed. Mapping was conducted while observing the video to map the interaction flow between the one deaf participant and two hearing participants in each group.
The results of both quantitative and qualitative analyses were triangulated for cross-checking before drawing a conclusion. The results would be presented at a group level by gathering individual data in each LESS and MORE group, with the aim of finding differences between the LESS and MORE approaches.
3. Results
3.1. Quantitative results
3.1.1. Category-based results
Table 1 shows the results obtained from the category-based analysis of understanding, feeling, and behavior. A paired t-test was conducted to examine differences between the LESS and MORE groups. As could be expected given the small sample size, no statistically significant differences were found (p > 0.05). To illustrate the results, a box-and-whisker plot was generated at the group level by aggregating individual data (Figure 3). While most scores increased, some decreased. Given the potential confounding effects of individual variability, the quantitative analysis was limited to the group level as described in the Evaluation sub-section and the qualitative analysis covered the individual level.
Visualization of the range of score differences between LESS and MORE.
For the understanding and feeling categories, the MORE group had a wider range than the LESS group. While the MORE group had a higher average in the feeling category, the LESS group’s average was higher in the understanding category. Both the LESS and MORE groups exhibited the same range in the behavior category, with a higher average in the LESS group.
3.1.2. Question-based results
A question-based analysis was conducted to compare tendencies in participants’ awareness levels between the LESS and MORE groups, examining the score of each question (Table 1). Among the 15 questions asked, the MORE group responses showed a higher average and wider range than the LESS group, indicating a more varied effect on their views after the experiment. In the score effect and average category, both the LESS and MORE groups had four questions showing an equally positive effect and average and one question with an equally negative effect and average. Meanwhile, in the range category, both groups had only two questions that showed an equally positive range. In addition, the MORE groups dominated the questions with a wider range than the LESS groups. Considering that no statistically significant differences were found in the quantitative results, the tendencies observed in the visualization should be cross-analyzed with the qualitative findings. This provides a basis for triangulating the quantitative and qualitative analyses in the Discussion section.
3.2. Qualitative results
3.2.1. Adjectives associated with disability and social inclusion
The first qualitative results were gathered from the analysis of adjectives used to describe “disability” and “social inclusion” topics, which were meant to measure the participants’ awareness in the understanding category. With at least five adjectives mentioned by each participant, the LESS groups mentioned 30 words in the pre-activity and 32 words in the post-activity regarding “disability,” and 32 words in the pre-activity and 31 words in the post-activity regarding “social inclusion.” Meanwhile, the MORE groups mentioned 30 words in the pre-activity and 30 words in the post-activity regarding “disability,” 30 words in the pre-activity and 30 words in the post-activity regarding “social inclusion.”
Sentiment analysis, which was introduced in the Methodology section, was conducted to distinguish the positive and negative words mentioned. To determine changes in understanding, the number of words mentioned in the post-activity was subtracted from the number of words mentioned in the pre-activity (Figure 4). For the meaning of “disability,” the LESS group had 6 decreases in negative words and 8 increases in positive words, while the MORE group had 4 decreases in negative words and 4 increases in positive words. For “social inclusion,” the LESS group had 6 decreases in negative words and 5 increases in positive words, while the MORE group had 3 increases in negative words and 3 in positive words.
Increased and decreased in words used to describe “disability” and “social inclusion.”
Focusing on the words mentioned only before or after the experiment, both the LESS and MORE groups were observed to cite more new positive words to describe “disability” after the activity. Conversely, both groups mentioned fewer new negative words after the activity (Table 2). For positive words used to describe “social inclusion,” the LESS and MORE groups had almost equal numbers of words mentioned both before and after the activity. The LESS groups did not mention any new negative words after the activity, while the MORE groups mentioned more new negative words (Table 3).
Positive and negative words used to describe “disability”
Positive and negative words used to describe “social inclusion”
3.2.2. Impression of the activity
As described in the Methodology section, the next step involved analyzing impressions of the activity using the coding method of M-GTA. The questions measured the comfortable and uncomfortable moments during the activity, the feeling of interacting with participants under different conditions, the willingness to realize the plan, and overall impressions of the activity.
First, the answers from the participants were categorized in an open coding method. In the LESS groups, there were 16 open codes, including “cross-group interaction allowed them to learn new things,” “felt united,” and “written communication was fun but slow.” In the MORE groups, there were 15 open codes, including “slow conversation was uncomfortable,” “sharing each other’s preferences was fun,” and “cross-group interaction expanded the conversation.” After that, axial coding was performed to categorize similar insights. In the LESS groups, there were a total of 9 axial codes, including “cross-group interaction felt united as if there was no wall.” In the MORE groups, there were a total of 9 axial codes including “a lot of choices in communication tools were uncomfortable but it increased awareness of the need to consider different communication methods.”
The last step was to summarize the codes into one selective coding (Table 4). From the LESS group, the selective coding words included “felt no barrier,” “felt united and erased previous perception,” “increased consideration of using different communication methods,” and “felt like a usual interaction even though it was different.” As for the willingness to realize the plan, 5 out of 6 participants in the LESS group agreed to do it. From the MORE group, the selective coding words included “did not feel enjoyable because of the inconvenience of having too many choices in communication tools,” “increased the realization of the importance of using different communication methods,” and “allowed us to expand the conversation outside the main topic.” As for the willingness to realize the plan, 3 out of 6 participants in the MORE group agreed to do it.
Selective codes in the LESS and MORE groups
3.2.3. Group dynamics
An analysis of group dynamics was performed by mapping the interactions among the participants, which was introduced in the Methodology section. The dynamic observed in LESS group 1 was that D carried interactions more than H1 and H2, while interactions between H1 and H2 were not as intense as interactions with D. In group 2, H1 carried interactions from Phase 1 until Phase 3, until H2 finally took the initiative to interact more in Phase 4. Lastly, in group 3, H2 carried interactions with all participants, while D, who did not really interact in Phase 1, gradually interacted in Phase 2, Phase 3 and Phase 4 (Table 5). It was also observed that H1 and H2 used basic sign language during Phase 1, which was an expected behavior in the LESS approach, as it was a deaf-oriented environment.
Group dynamics in each phase for the LESS group
The dynamic observed in MORE group 4 was that H2 and D had more two-way interactions, even though H1 tried to engage with D and all participants. In group 5, interactions among the participants were intense from the start until the end of the activity. Lastly, in group 6, more interactions between H1 and D in Phase 1 until Phase 3 were observed, while in Phase 4, all participants had intense interactions (Table 6).
Group dynamics in each phase for the MORE group
4. Discussion
4.1. Crossed analysis in understanding
As visualized in Figure 3, MORE had a wider range of understanding score differences than LESS, with a tendency toward a negative score. Despite having no statistically significant difference, a tendency was found in the visualization, so there is a need to look more deeply into the difference between the LESS and MORE groups’ understanding category.
The investigation was done through questionnaire responses and descriptive word (adjective) analysis. Both results indicated that the LESS and MORE groups’ understandings of disability and social inclusion were different. In their understanding of disability, the LESS groups had a more positive understanding that people with disabilities also had positive traits despite the physical condition, while the MORE groups had a more negative understanding that disability was caused by the environment. However, both approaches had advantages and disadvantages so far as changing understanding after the activity (Table 7).
Characteristics of the LESS and MORE approaches to the understanding category
With this analysis, it was concluded that the difference between LESS and MORE in the understanding category is that the LESS approach allowed the participants to have a more positive view of the social aspect of disability, while the MORE approach left subjects with varied understandings of both individual and social aspects that cause disability, with the tendency toward a negative view.
4.2. Crossed analysis in feeling
As with the understanding category, the MORE group had a wider range in the feeling category than the LESS group, which tended to show little to no feeling score change. However, there was no statistically significant difference between LESS and MORE. Thus, much like in the understanding category, the tendencies found in the visualizations of both groups need to be more deeply investigated.
The investigation was done by checking the questionnaire responses and the participants’ impressions of the activity. It was found that the LESS groups tended to feel united, as if there were no barriers between participants with or without disabilities. This confirmed why, in the visualization, the LESS groups showed little to no change in the feeling category. On the other hand, the MORE groups expressed more varied feelings, confirming why the groups had a wider range in score differences (Table 8).
Characteristics of the LESS and MORE approaches to the feeling category
After cross-analyzing the understanding and feeling categories, the last cross-analysis was the behavior category. The cross-analysis would give more confirmation of the differences between the LESS and MORE approaches as analyzed in the previous two categories.
4.3. Crossed analysis in behavior
Unlike the understanding and feeling categories, the behavior category showed the same behavior score ranges between the LESS and MORE groups. Regardless, it also had no statistically significant difference shown by the t-test result, even though the average was higher in the LESS groups, showing that the LESS groups had a slightly more positive change than the MORE groups.
When cross-checking with the other results, it was found that the LESS groups tended to have a more balanced interaction compared to the MORE groups, which resulted in greater satisfaction. Because of the restrictions, the LESS groups chose communication methods that everyone was able to understand, while the MORE groups chose the communication methods they were already used to. However, it was also found that, in the MORE groups that had the same approach as the LESS groups of written communication as their main communication method, interactions were balanced because members adjusted to each other’s communication abilities. H2 in the MORE group 4 was the only participant with prior experiences interacting with people with disability. Observing the group dynamics in group 4, the prior experiences made H2 have more interactions with D. Therefore, it caused unbalanced interactions in the group, especially in the MORE approach, where it was allowed to communicate in as many communication tools as possible. This marked the different advantages and disadvantages of both groups (Table 9).
Characteristics of the LESS and MORE approaches to the behavior category
4.4. Triangulation
As it was hypothesized that LESS and MORE approaches would influence not only how the participants understood disability and inclusivity issues but also how they would feel when interacting with participants with disabilities and behave toward them, a triangulation of the three categories needs to be discussed. Although no statistically significant differences were observed in the quantitative analysis, when considered alongside the qualitative findings, some tendencies emerged that distinguished between the LESS and MORE approaches. Specifically, the MORE groups tended to show a wider range of scores than the LESS groups, suggesting that the MORE approach exerted more varied influences on participants.
From the cross-analysis, it was found that the MORE groups’ participants tended to feel puzzled about the meaning of disability and social inclusion than the LESS groups’ participants did in the understanding category. It was confirmed in the feeling category that the MORE groups’ participants felt less united than the LESS groups’ participants because they had a greater sense of a barrier. The group dynamic tended to be more unbalanced, unlike the LESS groups’ dynamics. It was concluded that the MORE approach did, in fact, have varied influences on the participants because this approach had no restrictions or conditions regarding how they were allowed to communicate. Additionally, having a participant who had prior experiences of interacting with people with disabilities also influenced unbalance of interactions in the MORE groups because the MORE approach triggered two-way interactions between people with disabilities and people who are used to interacting with them. On the other hand, the LESS groups better understood social inclusion as something concrete that they could do by themselves, felt united and showed no differences when interacting with participants with or without disabilities. They tended to have more balanced group dynamics. It was concluded that the LESS approach allowed the participants to have a similar influence on each other because the approach allowed all participants, whether they were hearing or deaf people, to be in the same condition. The LESS and MORE approaches also influenced the participants’ willingness to realize the plan, as there were more participants in the LESS groups who wanted to realize the plan than there were in the MORE groups.
Although the difference between the LESS and MORE groups was evident, one group in the MORE approach exhibited an exceptional effect, one similar to that seen in the LESS groups. Even though the participants operated under the MORE conditions, where each of the hearing and deaf people communicated with a method they were used to (hearing participants by voice and deaf participants by sign language), it was found that this group chose an approach similar to that of the LESS groups, which was using written communications and simple gestures as the main communication method. It was concluded that, regardless of whether they were in the LESS or MORE group, as long as participants were willing to adjust to each other’s abilities, an inclusive environment would be created.
4.5. Findings
The findings of this study are:
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• The LESS approach allowed participants to agree that social inclusion is something concrete that they can create themselves. It allowed them to feel no barriers in interacting with participants with or without disabilities because everyone was in the same condition. This approach also built more balanced interactions because every participant communicated with a method that each of them could easily understand. Thus, it was concluded that being in an environment with less auditory stimulation influences the feeling of having no barriers when interacting with people with disabilities, so they can feel more united.
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• The MORE approach challenged the participants’ previous understanding of social inclusion and left them more reconsidered about how to implement social inclusion. It resulted in more varied feelings when interacting with participants with or without disabilities because the conditions made the differences between them more visible. This approach also resulted in more unbalanced interactions because each participant communicated with a communication style they were used to. Thus, it was concluded that being in an environment with more auditory stimulation, which is closer to the conditions found in current society, will challenge perceptions of disability and inclusivity issues, and the way participants face those issues will depend on what they have experienced in each group.
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• Regardless, when participants adjusted their abilities to each other, the dynamic of the group became more lively and satisfaction increased, as evidenced by one of the MORE groups that chose the LESS group communication style (writing and simple gestures) but still used voice (deaf participants adjusted to hearing participants) and sign language (hearing participants adjusted to deaf participants) when communicating with each other.
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• Co-design allowed all participants to be in the same role and express each of their preferences. Even though each group had fewer interactions in Phase 1, both groups showed that intense interactions became higher throughout the following phases. The concept of democratized participatory design in the activity encouraged participants to share their ideas and preferences when planning a team-based project. With equal participation, they felt comfortable gradually opening themselves up, and the intensity of interactions increased throughout the phase. However, the balanced and unbalanced interactions during the process influenced their satisfaction, as the LESS groups had more participants who were willing to realize the plan than the MORE groups did. Thus, paying attention to maintain the balance during the process is important.
As shown above, the different results found in each group support previous literature in that experience can change perceptions and help people cope with the world (Riberio Reference Riberio2014; Aru et al. Reference Aru, Rutiku, Wibral, Singer and Melloni2016). The participants in the LESS and MORE groups experiencing different environmental conditions led to different ways of viewing disability and inclusivity issues. It also led to different ways of feeling and behaving toward people with disabilities during the interaction. Experiencing a different environment while addressing a social issue challenges perceptions of that issue. This can be a recommendation when designing an experience-based activity as a way to effectively raise awareness of disability and inclusivity issues by focusing on environmental differences.
5. Conclusion
In this study, the authors sought to obtain insights that could be used in designing an experience-based awareness-raising activity by comparing two approaches with different conditions: a deaf-oriented audio environment with decreasing stimuli (the LESS approach) and a hearing-oriented audio environment without decreasing stimuli (the MORE approach). An experiment was conducted by creating an environment where participants with and without disabilities could interact and co-design a plan for a group trip. Considering communication to be an important factor in creating interactions and sharing ideas, this experiment organized groups that had deaf and hearing participants working together. The goal of this experiment was to find characteristics in the LESS and MORE approaches that affected the participants’ understanding of disability and inclusivity issues, their feelings when interacting with participants with disabilities, and their behaviors toward participants with disabilities. To gain a deeper understanding of the participants’ meaningful experiences, this study took a mixed-methodology approach.
The quantitative findings showed no statistically significant differences between the LESS and MORE approaches. However, when considering the qualitative findings, tendencies emerged that distinguished between the two approaches. For the understanding category, participants using the LESS approach felt more positive about the image of disability and social inclusion, while the participants using the MORE approach expressed a more varied understanding of the same. For the feeling category, participants using the LESS approach felt more united and showed no difference when interacting with participants with or without disabilities, as if there were no barriers. Meanwhile, participants using the MORE approach felt that the barriers were more visible between participants with and without disabilities. Lastly, for the behavior category, those using the LESS approach had more balanced interactions between participants with and without disabilities, while participants using the MORE approach had more unbalanced interactions. These findings can help guide recommendations on how to design an experience-based awareness-raising program for social inclusion. Therefore, further exploration into how these recommendations apply in real situations is needed to justify the influence of each approach on the effectiveness of raising awareness through experience.
5.1. Limitations and future research
Although this study carefully examined the focal factors under investigation (e.g., prior experiences), there are inherent limitations to standardizing diverse human interactions. Additionally, the research adopted a mixed-methods approach with a relatively small sample size in order to gain in-depth insights into participants’ experiences. Therefore, increasing the number of participants in future studies would help address these limitations and provide more robust quantitative results.
To minimize the influence of intersectional diversity, the participants’ demographics were intentionally kept as similar as possible in all respects apart from auditory diversity (hearing and deaf). While this choice allowed us to focus on the research question, it also limits the generalizability of the findings. Thus, future research should include a broader range of participant demographics to examine how the findings extend across diverse contexts.
The essential goal of this study was to contribute to an experience design method that fosters awareness of the social model of disability and promotes social inclusion. It highlighted two distinct approaches to filling gaps between diverse groups: the LESS approach, which adapts to the minority condition, and the MORE approach, which adapts to the majority condition. This comparative perspective is the central contribution of the study. To extend these insights beyond the specific focus on auditory diversity, case studies in other disability contexts would be valuable. Such studies could apply the LESS/MORE approaches to experience design to examine how differences in awareness emerge across diverse conditions. For example, the LESS approach may be more suitable when the goal is to ensure that participants feel no barriers in mutual interactions, whereas the MORE approach may be recommended when the goal is to challenge participants’ prior perspectives of the issue being studied.
Since the present research mainly examined hearing participants with the aim of generating design knowledge on how to raise their awareness, future studies should also investigate how participants both with and without disabilities understand, feel and behave toward each other. Moreover, extending this work to other types of majority–minority relations could reveal how the findings vary across different contexts.
Acknowledgments
This work was supported by Japan Society for the Promotion of Science (KAKENHI grant number 22KK0220). The authors would like to express their sincere gratitude to the members of the Kyushu Deaf Student Association, especially Mr. Kazuki Kakihara, who served as a bridge between communities, and to the staff and students of Matsumae Laboratory at Kyushu University for their valuable advice in developing this research and their support for the experiment.
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