The Association between Braille Reading History and Well-being for Blind Adults

By Arielle Michal Silverman, Ph.D., and Edward C. Bell, Ph.D.

Arielle Michal Silverman, Ph.D., is the founder and principal consultant of Disability Wisdom Consulting in Silver Spring, Maryland.

Edward C. Bell, Ph.D., is director of the Professional Development and Research Institute on Blindness at Louisiana Tech University in Ruston, Louisiana.


This manuscript reports on the findings of a survey that was conducted to measure the association between braille reading skills and subjective well-being for legally blind adults. A total of 443 participants completed the survey, which included demographics, braille reading history, well-being measures, and employment. Data suggest that individuals who were primary braille readers since childhood had greater life-satisfaction, self-esteem, and job satisfaction than individuals who reported not using braille as their primary reading medium during childhood. The data also suggest that individuals who became braille readers in adolescence or adulthood had higher life-satisfaction, self-esteem, and employment rates than those individuals who had never learned braille. Findings support the premise that braille literacy is key to life satisfaction and self-esteem in addition to academic and job success.


Braille, education, rehabilitation, well-being, self-esteem, employment


The shift away from braille as a primary reading medium is significant. Toussaint and Tiger (2010) state, “According to theNational Braille Press only 12% of legally blind individuals can read braille, in contrast to 50% of blind individuals who could do so in the 1960s” (p. 181). In their 2015 Annual Report, the American Printing House for the Blind (APH) reported that less than 9% of K-12 students receiving quota funds used braille as their primary reading medium (APH, 2015). Many individuals who become blind later in life prefer to use speech technology or audio-recorded media in place of braille (Goudiras, Papadopoulos, Koutsoklenis, Papageorgiou, & Stergiou, 2009). There are several reasons for the decline in braille instruction, including a lack of braille competency among teachers, negative public attitudes toward braille for people with residual vision, increasing use of text-to-speech technology, and the increasing prevalence of multiple disabilities in blind children (Amato, 2009; Castellano, 2010; Mullen, 1990; Spungin, 1989). This decline in braille literacy has been termed a “Braille literacy crisis in America” (National Federation of the Blind, 2009).

Experts in the field of education of children who are blind or visually impaired have long recognized the relevance of braille for any student whose vision is not enough to read regular print comfortably and at a competitive rate for a sustained period of time (Castellano, 2010; Holbrook, 2009; Ryles, 1996; Wittenstein, 1994). Yet, it is central to keep in mind that each student is different and therefore, when trying to determine the most appropriate reading medium, students need to be evaluated individually and must be reevaluated as they progress and their literacy needs change. Thus, some visually impaired students may benefit most from learning to use print, others from using uncontracted braille, others from using contracted braille, some students may benefit from using both print and braille, and others may need to exclusively use an auditory or tactual medium (Lavigne & Adkins, 2003).

To inform such decision making, research is needed to evaluate the long-term effects of learning braille early in life as compared to other reading media. Undoubtedly, there are innumerable anecdotal accounts of adults who are visually impaired and who were not given the opportunity to learn braille early in life that tell about the tremendous negative impact this has had on their confidence and success (Castellano, 2010; Ryles, 1996; Schroeder, 1996). Several preliminary studies have linked early braille learning with high academic achievement. For example, Ryles (1997) investigated the literacy skills of high school students in grades 9-12 and compared her findings across four groups: (a) youth who were blind or visually impaired and who received “regular braille instruction” during their primary grades (at least four to five times per week); (b) youth who were visually impaired and who received “inconsistent braille instruction” (only two to three times per week); (c) youth who were visually impaired and who received “no instruction in braille” during their primary grades; and (d) “fully sighted” students who received print instruction on a regular basis (four to five times per week). Based on data from 60 youth (n = 15 for each of the four comparison groups), Ryles demonstrated statistically significant differences between these groups on the Woodcock Johnson R and Stanford Achievement Tests of Literacy. Specifically, blind or visually impaired students who received braille instruction four to five times per week had achievement scores as high as the fully sighted students, but students who received inconsistent or no braille instruction were significantly behind their sighted and blind peers as measured by the Woodcock Johnson (p = .03). Bell, Ewell, and Mino (2013) found that youth who were assessed as needing braille, but who were not receiving instruction, were 1.5 years behind grade reading level as measured by the Johns Reading Inventory, while their peers who were assessed as needing braille and were receiving instruction in braille were reading on grade level with their sighted peers. 

Similarly, braille literacy has been linked to higher employment rates. Ryles (1996) interviewed 74 congenitally blind adults of working age and found that among those who had used braille as their primary reading medium during childhood, 56% were employed, compared with only 23% of those who had grown up using print. Regular braille use in adulthood has also been associated with higher employment rates and earnings in a large sample of over 1,000 blind adults (Bell & Mino, 2013). This association is likely bidirectional; not only are competent braille readers more likely to gain high-quality employment, but employment demands warrant greater braille use (Spungin, 1989).

These findings make a strong case for early braille instruction, but they have some limitations. First, past braille studies have not examined associations between braille literacy and subjective well-being, which is an important contributor to quality of life. In one qualitative study, participants identified braille literacy as critical to their self-esteem and acceptance of blindness (Schroeder, 1996), while participants who learned braille in adulthood reported an increased sense of independence and acceptance of blindness after successful learning of braille (Farrow, 2015). Acceptance of disability and positive disability group identification have been linked with higher subjective well-being (including life satisfaction and self-esteem) for people with various disabilities (Bogart, 2015; Nario-Redmond, Noel, & Fern, 2013). Braille usage may facilitate this positive identity development. Therefore, we hypothesized that early braille instruction would be associated with higher subjective well-being.

Second, few studies have examined the potential benefits of learning braille in adolescence or adulthood. Ryles (1996) compared people who learned braille early in life with those who never learned braille, but did not include a separate group of participants who learned braille later in life. For those who lose vision after acquiring print literacy, learning braille may be a time and resource-intensive process. Many adults choose to use audio-recorded materials or screen readers in lieu of learning braille (Goudiras et al., 2009). Yet if early childhood braille learning benefits people in adulthood, there is reason to believe that taking the time to learn braille later in life could confer similar benefit. Learning braille in adulthood may also aid the psychological acceptance of vision loss (Omvig, 2002; Schroeder, 1996).

Finally, a limitation of cross-sectional research is that observed associations may be due to confounding third variables rather than the variable of interest. Although this limitation can never be completely overcome, statistically accounting for known third variables as covariates can help to rule out alternative explanations for an observed correlation (Judd, McClelland, & Ryan, 2009). In the case of early braille learning, children who learn braille early in life also tend to have earlier-onset, more stable causes of blindness (as opposed to gradual vision loss or loss beginning later in life) and to retain less residual vision. It is possible that associations between early braille learning and achievement, such as those reported by Ryles (1996), are actually due to having earlier-onset, stable vision loss and not needing to switch from visual to nonvisual functioning.

The Current Study

We undertook the current study to extend the literature examining links between braille literacy and life outcomes, and to address the limitations of past research. In this study, we surveyed legally blind adults and compared outcomes among three participant groups: those who used braille as their primary reading medium in school (primary readers), those who learned braille at any point in life but did not use it as their primary medium in school (secondary readers), and those who never learned braille (nonreaders). We compared these groups’ scores on life satisfaction, self-esteem, job satisfaction, and employment while statistically accounting for differences in residual vision and age of blindness onset between the groups. Based upon the research from Ryles (1996), we hypothesized that the primary reader group would fare better than the other two groups (who both used a non-braille reading medium during childhood). We further hypothesized that the secondary braille readers, who learned braille later in life, would fare better than those who never learned braille.



 In the summer of 2012, we sent an online survey to electronic discussion groups sponsored by the National Federation of the Blind (NFB) and the American Council of the Blind (ACB) as well as to a registry of previous research participants compiled by Bell and Mino (2013). Five hundred and sixty-four legally blind adults living in the United States participated in the survey in exchange for a raffle ticket. Of these, 443 participants were included in the current study who provided complete data on their braille reading history. The final sample contained 266 females, 168 males, and 9 individuals of unspecified gender, with an average age of 44.66 years (SD = 14.46; range = 18-83 years). Most (79%) were European-American.

Materials and Procedure

Participants completed the survey either online or by telephone dictation to the researcher. The survey was approved by the institutional review board at the first author’s institution, and an informed consent page was provided to the participant prior to beginning the survey. Measures used in the current study included demographics, braille learning history, and the well-being and employment measures described below.

Demographics and Braille Learning History. Participants indicated their gender, age, ethnicity, and current vision status (totally or partially blind), as well as the age at which they first became legally blind. Participants also indicated whether or not they had ever learned braille and, if so, at what age they began receiving braille instruction. In addition, participants were asked to identify their primary reading medium, or the one reading medium that they used most often during childhood. Response options included braille, large print, standard print, audio-recorded materials, and human readers.

We categorized participants into one of three groups based on their braille history. The first group, primary braille readers, reported learning braille as young children and using braille as their primary reading medium. The second group, secondary braille readers, received braille instruction at some point in their lives, but used a different reading medium (besides braille) as their primary reading medium during childhood. The final group of participants consisted of those who reported having never learned braille.

Well-Being. Participants completed the Satisfaction with Life Scale (SWLS) (Diener, Emmons, Larsen, & Griffin, 1985), a well-validated measure of subjective well-being. The SWLS consists of five statements assessing global satisfaction with one’s life as a whole (e.g., “So far I have gotten the important things I want in life”); participants responded to these statements using a scale ranging from 1 (strongly disagree) to 7 (strongly agree); alpha = .89. Participants also completed the Single-Item Self-Esteem scale (“I have high self-esteem”) which has high convergent validity with longer self-esteem measures (Robins, Hendin, & Trzesniewski, 2001).

Employment Outcomes. We asked participants to report their employment status by selecting one of the following options: employed full-time, employed part-time, employed on a temporary basis, student, both a student and employed, stay-at-home parent, retired, or unemployed. In addition to measuring current employment, we asked participants to rate their overall satisfaction with their current job or program of study using a single item ranging from 1 (very dissatisfied) to 7 (very satisfied).

Data Analysis

We used analyses of variance (ANOVA’s) to determine whether the three braille reading groups differed in life satisfaction, self-esteem, and job satisfaction, and logistic regression to test for differences in employment. After conducting a one-way ANOVA or logistic regression for each outcome with braille reading group as the independent variable, we followed up with two planned contrasts to test specific hypotheses about the pattern of differences (Judd et al., 2009). First, in line with the Ryles (1996) findings, we hypothesized that primary braille readers would have better outcomes than those who did not read braille as young children. To test this, we compared outcomes for primary braille readers (Group 1) with all the other participants (Groups 2 and 3). Then, to test differences between learning braille later in life and not learning braille at all, we compared the secondary braille readers (Group 2) with the nonbraille readers (Group 3). In addition to tests of statistical significance, we present effect size estimates for the well-being outcomes using Cohen’s d, which is conventionally used to show the magnitude of pairwise differences between groups on a continuous outcome, and effect sizes for the employment outcomes using odds ratios, which are conventionally used to show the magnitude of differences on a binary outcome (Judd et al., 2009). Finally, to rule out the alternative explanation that primary braille readers may show positive outcomes due to more stable or earlier-onset blindness, we repeated all analyses with two covariates added: presence of residual vision (1 = partially blind, 0 = totally blind) and age when blindness first occurred (1 = before age 2, 2 = between ages 2 and 18, and 3 = age 18 or older). Intercorrelations between braille reading group, vision status, and age of blindness onset were all below the conventional cutoff for collinearity (all rs < .53).


Participant Characteristics

Table 1 shows demographics for the sample as a whole and broken down by braille reading group. A total of 191 participants (43%) were primary braille readers, having begun braille instruction at an average age of 5.2 years (SD = 1.6; range = 3-12 years). Another 199 participants (45%) were secondary braille readers who used a non-braille reading medium during childhood. As expected, they first learned braille much later on average (M = 25.9 years, SD = 15.8, range = 3-63 years). One-fourth of this group began learning braille before age 14, but used print or audio as their primary reading medium; the remaining three-fourths of this group began learning braille at age 14 or older. The final 53 participants (12%) had not learned braille at the time of the study.

Table 1. Participant Characteristics

Entire Sample

Primary Readers

Secondary Readers


Sample size





Male n (%)

168 (38%)

76 (40%)

69 (35%)

23 (43%)

Female n (%)

266 (60%)

112 (60%)

125 (63%)

29 (55%)

Age mean (sd)

44.66 (14.46)

42.71 (15.42)

45.11 (13.59)

49.98 (12.69)

Ethnicity: White/Caucasian

351 (79%)

158 (83%)

147 (74%)

46 (87%)

Ethnicity: Black/African American

14 (3%)

3 (2%)

11 (6%)

0 (0%)

Ethnicity: Hispanic/Latino

21 (5%)

10 (5%)

9 (5%)

2 (4%)

Ethnicity: Asian

12 (3%)

8 (4%)

3 (2%)

1 (1%)

Ethnicity: Native American

2 (0%)

1 (1%)

1 (1%)

0 (0%)

Ethnicity: Other/mixed

27 (6%)

10 (5%)

14 (7%)

3 (6%)

Ethnicity: Declined to state

16 (4%)

1 (1%)

14 (7%)

1 (2%)

Vision status: Totally blind

278 (63%)

164 (86%)

108 (54%)

6 (11%)

Vision status: Partially blind

165 (37%)

27 (14%)

91 (46%)

47 (89%)

Blindness onset: Before age 2

290 (65%)

179 (94%)

94 (47%)

17 (32%)

Blindness onset: Ages 2-18

53 (12%)

12 (6%)

33 (17%)

8 (15%)

Blindness onset: After age 18

100 (22%)

0 (0%)

72 (36%)

28 (53%)

Well-Being Outcomes

The three reading groups showed significant differences in life satisfaction (F (2,440) = 12.87, p < .001), and self-esteem (F (2,440) = 6.75, p = .001). Consistent with the research hypothesis, primary braille readers reported being more satisfied with their lives (M = 5.01, SD = 1.33) than the other two groups (t = 4.99, p < .001, d = .48). Secondary braille readers were more satisfied with their lives (M = 4.57, SD = 1.50) than non-braille readers (M = 3.92, SD = 1.64; t = 2.94, p = .004, d = .28). A similar pattern appeared for self-esteem; primary braille readers reported having higher self-esteem (M = 5.45, SD = 1.58) than the other two groups (t = 3.47, p < .001, d = .33), and secondary braille readers reported higher self-esteem (M = 5.17, SD = 1.64) than non-braille readers (M = 4.50, SD = 1.89; t = 2.54, p = .012, d = .24).


Table 2 shows the employment status for participants aged 18-64 years (n = 419) in each reading group. We looked at both the percentage of participants in each group who held some form of paid employment at the time of the study (either full-time, part-time, or temporary paid employment) and the percentage who reported being unemployed (meaning that they not only held no paid employment, but also were not in school, homemakers, or retired). Contrary to expectations, primary and secondary braille readers were equally likely to have some form of paid employment (56% and 57%, respectively). Both braille reader groups were marginally more likely to hold paid employment than the non-braille readers (42%; Δχ2 (419) = 2.75, p = .097, or = 1.09). Regarding unemployment, primary braille readers were marginally less likely to be in the unemployed category (17%) than the other two groups (22% of secondary braille readers and 29% of non-braille readers; Δχ2 (419) = 3.38, p = .066, or = .85). In addition, the three reading groups differed in their reported satisfaction with their professional lives (F (2,440) = 8.30, p < .001). Primary braille readers reported being more satisfied (M = 5.22, SD = 1.91) than the other two groups (t = 3.97, p < .001, d = .38), while secondary braille readers reported more satisfaction (M = 4.76, SD = 1.92) than non-braille readers (M = 3.93, SD = 2.21; t = 2.53, p = .012, d = .24).

Table 2. Employment Status by Braille Reading Group

Primary Readers

Secondary Readers


Employed full-time

65 (36%)

71 (38%)

15 (31%)

Employed part-time

31 (17%)

30 (16%)

7 (14%)

Employed and Student

9 (5%)

9 (5%)

0 (0%)

Employed total

102 (56%)

107 (57%)

22 (42%)


32 (17%)

22 (12%)

5 (10%)


4 (2%)

6 (3%)

2 (4%)


9 (5%)

8 (4%)

6 (12%)


31 (17%)

42 (22%)

14 (29%)

Finally, we repeated all the above analyses after controlling for the age of blindness onset (congenital, childhood, or adult onset) and vision status (partially vs. totally blind). This was done to test the alternative explanation that primary braille readers might be happier due to having earlier-onset, stable causes of blindness. There were no substantial changes in the associations between braille learning history and life satisfaction, self-esteem, or satisfaction with work. When blindness variables were controlled, the marginal difference in employment rates between the secondary readers and the non-braille readers became stronger and statistically significant (Δχ2 (419) = 4.36, p = .037, or = 1.44). The marginal difference in unemployment rates between the primary braille readers and the other two groups also became statistically significant (Δχ2 (419) = 4.96, p = .026, or = .76). This suggests that participants who were braille literate (either primary or secondary readers) had higher employment rates than non-braille readers. While primary and secondary readers were equally likely to have a job of some kind, primary readers who were not working were more likely to be students, while secondary readers who did not work were more likely to be unemployed.


Braille is essential for literacy among the blind. In this study, we found that braille literacy is uniquely associated with well-being and self-esteem among legally blind adults, even after blindness onset and residual vision were held constant. Participants who learned braille early in childhood reported the highest well-being levels. However, those who learned braille later in life still reported higher well-being levels than those who never learned braille. In addition, participants who were braille literate were more likely to be employed than those who were not, regardless of their age when they learned braille.

These findings complement research suggesting that, contrary to conventional wisdom, people who are totally blind may report higher self-esteem than those who are partially blind (Roy & MacKay, 2002). This may occur, at least in part, because totally blind individuals are more likely to learn braille and other nonvisual ways of accomplishing tasks. Braille literacy may aid people in developing a positive disability identity, even if they are partially blind. Qualitative reports from partially blind adults support this hypothesis (Schroeder, 1996). A positive disability identity is associated with higher life satisfaction and self-esteem (Bogart, 2015; Nario-Redmond et al., 2013), in part because people who identify with their disabilities may be less likely to internalize negative stereotypes (Crabtree, Haslam, Postmes, & Haslam, 2010). Primary braille readers may have had more time to incorporate braille into their self-concept, which may have explained the modestly higher well-being for primary braille readers when compared to secondary braille readers. In addition, braille literacy is critical for access to information among those who are unable to read print efficiently. Individuals who are braille literate are better equipped to participate in professional and social life, which contributes to their overall life satisfaction and self-esteem.

This study’s findings also provide direct evidence for the utility of teaching braille to adolescents and adults who did not learn braille as children. Despite the initial challenge of learning a second reading medium, secondary braille readers outperformed non-braille readers on every outcome, including employment. These results underscore the value of including braille as a core skill in adult rehabilitation programs, even for partially blind learners.

Despite the clear benefits of braille for all print-impaired readers, braille education is declining. System-level intervention is needed to improve braille literacy rates. Some of the main factors blamed for the decline in braille literacy include a lack of positive attitudes toward braille and a lack of qualified university-trained braille teachers (Amato, 2009; Mullen, 1990; Spungin, 1989). Wells-Jensen, Wells-Jensen, and Belknap (2005) found that sighted university students who had interacted with an independent and educated blind person, in this case a blind professor, consistently demonstrated stronger pro-braille attitudes than did other university students who did not have exposure to competent blind individuals. Mullen (1990) stated that while it is not common in the field to find openly opposing statements to the use of braille, many of the statements are not supportive of it, which could be related to low braille competency among teachers. However, using a representative sample of braille teachers, Wittenstein (1994) found that as a group, braille teachers are confident in their braille abilities, recognize the importance of braille, and support its use for their students. Still, the author also found a relationship between the instructors' attitudes toward braille and the type of training received. Instructors who supported the most positive attitudes toward braille received the greatest amount of instruction in braille teaching methods during their university education. In contrast, those instructors who received no instruction in teaching methods had the least positive attitudes. Taken together, these studies suggest interventions to improve future teachers’ attitudes toward braille, particularly introducing them to blind role models and including essential coursework on braille teaching methods. These interventions may be important both for teachers of children and teachers of adults, as our data suggest that legally blind individuals of all ages can benefit from braille instruction.

This study had some important limitations. Most significant is that only 12% of the participants in our sample never learned braille. Overall, our sample was highly literate and educated, and it tended to under-represent legally blind persons who choose not to join consumer organizations, who are less likely than consumer organization members to know braille. Future studies will be useful in examining a larger group of individuals who do not read braille. Additionally, this was a cross-sectional study, so we cannot draw firm conclusions about causality. Unmeasured confounding variables could explain the observed correlation between early braille learning and well-being; for instance, participants who learned braille early may have had other educational resources that supported their well-being. There is a need for longitudinal research with current braille learners, particularly adult braille learners, to discover the real-time impact of learning braille on well-being and community participation.

Implications for Practitioners and Families

Braille is a key tool in the toolbox of the individual who cannot efficiently read print. In this study, adults who began using braille early in life had the best outcomes, even those with some residual vision. These findings speak to the value of introducing braille early in childhood to anyone who is unlikely to read print efficiently as an adult, and teaching braille as the primary reading medium to be used in school. Such early and consistent braille instruction may not only improve academic and vocational performance, but may also improve well-being and quality of life, with these gains persisting into adulthood. It is important to use high-quality reading media assessments which can accurately measure print reading efficiency, such as the National Reading Media Assessment (NRMA), which also incorporates a prognosis of future print reading efficiency (Bell et al., 2013).

Furthermore, adolescents and adults experiencing vision loss may benefit greatly from braille instruction. Secondary braille instruction may allow these individuals to maintain their literacy skills and adjust effectively to vision loss both practically and psychologically. Blindness rehabilitation programs may wish to expand their braille services, and to include braille literacy supports, such as mentoring, to help secondary braille learners incorporate braille into their everyday lives.


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