Survey Study of Blind and Low-Vision Readers of Multimodal Media

By Aaron Rodriguez and Dr. Darren DeFrain

Aaron Rodriguez is the Digital Humanities Librarian at Florida State University.

Dr. Darren DeFrain is Professor of English and the Director of the Writing Program at Wichita State University.

Abstract

This study addresses the critical issue of accessibility for blind and low-vision (BLV) individuals in the field of multimodal media, including comics, news articles, and maps. It highlights prevailing misconceptions regarding the interests and needs of BLV readers and emphasizes the need for more accurate information. The research, based on a sample of 120 BLV participants, reveals the diversity within this group and their varied reading preferences.

Key findings include the reliance on screen readers for accessing materials, frequent encounters with inaccessible media, and challenges faced when attempting to understand complex visual content. Notably, the study indicates potential interest among BLV individuals in graphic narratives, an area currently underrepresented and underexplored.

The study underscores the importance of enhancing screen reader capabilities and providing well-described visual elements to improve accessibility. Furthermore, it highlights the role of the internet in accessing multimodal materials, calling for improvements in search algorithms and web content accessibility.

Keywords

Multimodal media, graphic narratives

Introduction

In 2019, the Vision Loss Expert Group estimated that 43.3 million people were blind and 295 million had moderate to severe low vision (Bourne et al., 2021). Despite 4.3% of the world's population having vision impairment, there is limited research on how blind and low-vision (BLV) readers interact with multimodal media, such as comics, news articles, maps, and other visually based texts. Meanwhile, digital media consumption is rising, with digital book sales comprising 18.6% of the market (Association of American Publishers, 2024), and more people using digital devices and television for news than radio and print publications (Pew Research Center, 2023). The global market for webtoons, a type of digital comic for mobile devices, was valued at $3.7 billion in 2021 and is projected to reach $56.1 billion by 2030, growing at a CAGR of 36.8% (Sanka et al., 2022).

Despite the rise of digital media, a study by Griffin-Shirley et al. (2017) found that BLV users often struggle with application usability, indicating a need for more testing and refinement. Gorlewicz et al. (2018) argue that addressing these issues is crucial for the independence and productivity of visually impaired individuals, which can significantly impact their educational, vocational, and social prospects. Oh et al. (2021) found that "art appreciation aids for the visually impaired will ultimately improve their cultural enjoyment and strengthen their access to culture and the arts" (p. 281). Tennison et al. (2023) provided evidence that BLV readers can effectively use touchscreen-based graphics, comparable to traditional large print and embossed tactile graphics.

As digital media production and consumption grow, the lack of public awareness among sighted individuals contributes to the prevalence of inaccessible multimodal media. Lupón et al. (2021) found that the general public has limited knowledge of visual health concepts, and that typical online information may not be easy for the intended audience to understand. Additionally, existing scholarship on the BLV readership of multimodal media is often plagued by inaccuracies (Hayhoe, 2017). One common misconception is that BLV readers are not interested in or benefit from accessing multimodal media, which negatively affects access to cultural institutions and the availability of accessible translations. Sharif et al. (2023) note that even when accessibility measures like alternative text are provided, they often offer only a high-level overview, failing to accommodate users who want to explore data visualizations in more detail.

These issues highlight the gap between legal requirements for accessibility and actual practice. The ADA mandates that web content of state and local governments and public businesses be accessible (U.S. Department of Justice Civil Rights Division, 2022). Section 405 of the Rehabilitation Act and Title 2 of the ADA also require equal access to educational materials for both public and private higher education institutions (U.S. Department of Education, 2023). Despite these mandates, misconceptions and a lack of awareness continue to impede the creation and distribution of fully accessible multimodal media for BLV readers.

There is persistent lack of accurate information about BLV readers and multimodal media affects production, instruction, and reading practices, even in areas where accessibility is mandated. In our experience teaching university-level courses on comics, we have observed publishers often do not create accessible versions of graphic narratives because they are unaware that BLV readers would use them if available. This issue frequently goes unnoticed by sighted individuals until BLV students need access to materials in educational settings where infrastructure and laws support the creation of accessible editions. Notably, widely used educational texts, such as The Norton Field Guide to Writing and Norton's Back to the Lake (4th Edition), incorporate a high percentage of multimodal material, yet often lack adequate accessibility features.

Much of the challenge lies in creating alt text, which focuses on single images rather than the narrative created by sequential images. Alt text guidelines are not designed for graphic narratives. Moreover, creating alt text is a form of intersemiotic translation, requiring the conversion of visual and written language into written language alone. This process is particularly difficult for instructors. A 2020 study found that primary and secondary teachers lacked confidence in promoting understanding across languages, one of the universal design principles (Capp, 2020). Establishing standards for creating multimodal materials that are born accessible, rather than retrofitting them to meet accessibility standards, could save time and money while increasing equitable access to materials.

This study seeks to provide a more accurate description of the multimodal reading and viewing experiences of BLV individuals. While the findings may not surprise BLV readers, sighted readers might be struck by the extent to which the world is organized around visual and spatial language and cues, and how inaccessible these are to BLV individuals. It is our hope that instructors, publishers, and educational technology creators will heed these findings and base decisions on feedback from BLV individuals to better meet their needs.

Method

The study was approved by the Wichita State University Institutional Review Board (IRB #5279) and qualified for a Category 2 exemption.

Participants

The NFB sent out a participant solicitation announcement to their members list. Participants had to self-identify as blind or low-vision individuals and be 18 years of age or older. A total of 121 individuals responded to the survey between November 2022 and February 2023. For this survey, participants were only included in the analysis if they completed every closed-ended question on the survey. All open-ended questions on the survey were optional. Only 93 respondents (n = 93) met the criteria to be counted in the survey results.

Instrument

Open- and closed-ended survey questions were asked to document the experiences of BLV readers when reading multimodal texts, to identify problems within existing accommodations for BLV readers of multimodal texts and how they handle these situations, and to identify preferences to facilitate more effective and equitable accommodations.

Survey data were processed in two ways: closed-ended questions, using a Likert scale, were counted and presented as such; open-ended questions were systematically transcribed, coded, and categorized to find emergent themes. Close readings of the transcripts were conducted to find relationships in the qualitative data.

Because this research is exploratory in nature, that is it is trying to document something new, we followed an indicative approach to coding open-ended responses. Researchers created and generated codes to explore research questions. In some cases, a single response contained multiple different answers. Each answer is counted in the results.

Additionally, the survey did not define the term "inaccessible" for BLV participants to avoid imposing perspectives and biases on what accessibility means. A fixed definition fails to encompass the diverse experiences and challenges faced by BLV individuals. Additionally, allowing participants to define inaccessibility in their own terms provides a more accurate and authentic understanding of the issues from their unique viewpoints, ensuring that the research captures a comprehensive range of accessibility barriers and their real-world impacts. This approach encourages inclusivity and respects the autonomy and expertise of BLV individuals regarding their own experiences. Similarly, participants self-identified as blind or low vision.

Results

Demographics

All participants identified themselves as either blind or low vision. Among the respondents, zero individuals had mild low vision, five had moderate low vision, 20 had severe low vision, and 66 were classified as blind. An additional two participants fell into the "other" category, which included Cerebral Visual Impairment (CVI) and ocular binarism. Respondents self-identified with these terms as the survey did not provide definitions for blind or mild, moderate, and severe low vision.

Most participants had experienced blindness or low vision since birth, with 36 individuals reporting being born blind and 26 reporting low vision from birth. Fourteen participants began to experience vision loss between the ages of 0 and 19, while seven reported the onset of their vision loss between the ages of 20 and 39. Another seven reported experiencing vision loss between the ages of 40 and 59, and three participants reported losing their vision at age 60 or later.

As for educational attainment, three participants attended some high school but did not complete it, 14 graduated high school or obtained a GED or equivalent degree, 15 had some college education, 7 held associate’s degrees, 25 had bachelor's degrees, and 28 held master's degrees or higher qualifications. One participant selected “other” and wrote that they had earned certificates and certifications.

Reading Behaviors and Preferences

In terms of reading for pleasure, 65 participants reported engaging in daily reading, 14 read weekly, nine read monthly, and five read rarely.

Regarding reading preferences for text-based materials, 20 participants preferred braille, 55 preferred screen readers, seven preferred audio translations, and 11 chose other methods.

When asked to report other reading methods, five respondents indicated audiobooks and screen readers, with an occasional preference or desire for braille. Three respondents primarily preferred braille but also utilized screen readers. One respondent noted that they had difficulty reading without assistive technologies. One respondent preferred using magnification. One respondent noted no strong preference, and one respondent noted their preference depended on the reading context.

Concerning the frequency of reading books in braille, 14 participants reported using braille most of the time, 26 occasionally, 21 rarely, and 32 never.

In contrast, when asked about reading books using screen readers, 35 participants reported using screen readers most of the time, 32 occasionally, 16 rarely, and 10 never.

For reading books with audio translations, 45 participants used audio translations most of the time, 29 occasionally, 12 rarely, and seven never.

When asked to note other reading methods, five respondents noted using magnification software, four noted using large print, four noted using audiobooks, and two noted using OCR apps. Other methods included using book apps, Seeing AI, braille, and BIOTD-Braille Input Output technology. One respondent mentioned relying on family members to read aloud.

Regarding the frequency of using another method to read books, eight participants used another method most of the time, 11 sometimes, nine rarely, and 41 never. A total of 69 participants responded to this question as an answer was predicated on the existence of another reading method. However, 24 respondents did not respond.

Non-Accessible Media

When it came to encountering inaccessible books, 15 participants encountered inaccessible books most of the time, 58 sometimes, 19 rarely, and one never. This study found no statistically significant relationship between current states of blindness and low vision and encountering books that were not accessible (P = 0.322).

When faced with inaccessible materials, 31 participants declined to use them most of the time, 44 some of the time, 16 rarely, and two never.

When asked about experiencing difficulty in understanding books, graphic narratives, videos, or news media, 18 participants encountered daily difficulties, 25 weekly, 16 monthly, and 34 rarely.

When asked to elaborate on their response, issues related to search or content accessibility were prominent, with 12 respondents reporting various challenges. These included malfunctions with search tools, difficulties accessing content from providers like Bookshare and BARD, and trouble interpreting thumbnails without descriptions. Additionally, a lack of audio descriptions, instances of missing content for screen readers, and visibility struggles with light text posed significant problems. Users also encountered barriers with inaccessible infographics, challenges in reading local news via screen readers, and difficulty interpreting graphical data. Accessibility issues on web pages, challenges locating specific content, and economic constraints tied to non-free material rounded out the concerns, highlighting a comprehensive array of hurdles faced in content accessibility.

However, 10 respondents noted personal proficiency or minimal issues when searching for content. These 10 respondents reported encountering no issues and finding searches productive, often utilizing tools like braille notetakers or leveraging their own search experience. Although there were visual struggles noted by some, most were able to locate desired reads and media effectively. Avoiding multimedia content helped a few maintain ease of access.

Four individuals expressed that their issues were more related to content usage rather than access. They could often find the material, but experienced significant challenges in accessing or utilizing it effectively. For some, the problem lies in usage rather than the inability to locate the required materials. The issue is not in finding the resources but rather in how they can access and use the available content to meet their needs.

Three respondents identified economic barriers as significant hindrances in accessing content. These barriers primarily involve difficulties in accessing paywalled content and non-free materials, which are often essential for their searches. The financial constraints lead to limited search results and narrower access to the desired material, making it challenging for these individuals to obtain the content they need without substantial economic impact.

Five respondents discussed the challenges they face during media-specific searches. Difficulties arise when locating specific training materials or accessing electronic copies from publishers, often complicating their research processes. Some rely heavily on public library books for their needs, while others adopt community searching methods to find niche materials. Additionally, there are significant challenges related to obtaining books in specific formats, which hinders access to essential content.

Three respondents provided insights into their habitual search practices or frequency. One often relies on screen reader guides to streamline searches, ensuring efficient and effective access to information. Another habitually conducts daily news searches to stay updated with current events. Conversely, one respondent seldom engages in searches, indicating a potentially lesser reliance on or access to digital content and search tools.

Two participants reported occasional difficulties with particular digital platforms. Issues include unclear menus in digital streaming services, making navigation challenging and confusing. Additionally, there are accessibility problems related to interfaces behind paywalls, complicating efforts to access important information. These occasional platform-specific issues add layers of inconvenience and restrict user experiences.

Finding Multimodal Media

To access materials effectively, it is essential for BLV readers to be able to find multimodal media. When asked about their frequency of using the Internet to find books, graphic narratives, videos, or news media, 55 participants reported daily use, 22 weekly, 10 monthly, and six rarely.

As for visiting libraries to find such materials, two participants visited daily, two weekly, and 11 monthly, while 78 rarely visited libraries for multimodal media.

When asked to optionally report using a different source, 14 respondents reported using NLS BARD, 11 reported using Bookshare, 10 reported using YouTube, 10 reported using the National Library Service, eight reported using the Internet, six reported using Audible, five reported using NFB Newsline, five reported using word of mouth, five reported using Apple Books, three reported using Kindle, three reported using social media, and three reported using the radio. Other respondents reported using Amazon, CELA Library, Talking Book Libraries, touch6dots.com, Project Gutenberg, the Libby app, Scribd, Goodreads, NYTimes Books, Nebula, and other online sites and applications to find multimodal media.

When asked optionally about how often they use a different source to find books, graphic narratives, videos, or news media, 23 participants reported using a different source daily, 12 weekly, 10 monthly, and 25 rarely. Because the question was optional, 23 participants did not provide additional information.

Visual Culture

In evaluating their inclusion in visual culture, participants expressed varied sentiments. Five participants strongly agreed that they felt included, 18 agreed, 39 disagreed, and 31 strongly disagreed.

When asked if they would like to elaborate on their response, 17 respondents reported a lack of sufficient media and audio descriptions with essential details, which significantly impacts their access to content. Nine individuals mentioned their personal efforts to integrate into inclusive environments, often having to go above and beyond to achieve a sense of belonging. Eight participants detailed their attempts to explain the importance of social inclusion and the challenges they face. The benefits and limitations of assistive technology were highlighted by seven people, emphasizing both the progress made and the areas still needing improvement. Additionally, seven respondents described the specific challenges faced within visual communities, which often go unnoticed by others. Six individuals recounted specific instances of exclusion they have experienced, shedding light on pervasive issues. Attempts to include family members or dependents in the visual world were mentioned by three participants. Another three referenced inaccessibility issues specifically related to schools or workplaces. Despite some noted improvements, three respondents emphasized the persistent gaps, illustrating that while there has been progress, significant work remains to bridge these accessibility divides.

When images were translated into text, 62 participants strongly agreed that they felt more included, 25 agreed, three disagreed, and three strongly disagreed. When asked to elaborate on their response, 19 respondents indicated that well-done descriptions provide useful information significantly enhancing their engagement with content. However, 15 mentioned that the quality of these descriptions can vary widely, impacting their effectiveness. Eleven individuals highlighted the benefits of descriptive methods, which contribute positively to their overall experience. Ten respondents emphasized that accurate descriptions not only improve accessibility but also drive advancements in relevant technology. Conversely, seven participants pointed out ongoing issues related to the lack of descriptions, which continue to pose challenges. Personal vision and contextual adaptations were noted by four individuals, who discussed the ways they tailor their experiences to navigate visual content more effectively.

Graphic Narratives

Regarding the frequency of reading comics or graphic novels, 84 respondents reported rare engagement, five read them monthly, three weekly, and one daily.

However, when asked about their level of interest in reading comics or graphic novels, 31 participants expressed interest to a great extent, 28 had some interest, 22 had little interest, and 12 had no interest.

Haptic Feedback

Participants' use of devices with haptic feedback varied. A total of 49 respondents used haptics daily, seven weekly, five monthly, and 32 rarely. When assessing the effectiveness of haptic feedback on devices, 19 found it was effective to a great extent, 39 somewhat effective, 19 minimally effective, and 16 not effective at all.

Addressing Problems in Accessing Multimodal Media

Respondents were asked about challenges they faced accessing multimodal media. Challenges were primarily attributed to the lack of descriptions or alt text, as indicated by 20 participants. Screen reader issues were mentioned by 13 respondents, highlighting the technical difficulties in accessing information. Multimedia content, such as videos and audio, presented barriers for 12 individuals. Layout and design barriers were noted by nine participants, affecting their navigation and comprehension of content. Ads and disruptive content were mentioned by six respondents as significant interruptions in their user experience. Additionally, the availability and cost of accessibility technology were highlighted by another six individuals. Personal vision and spatial understanding were also significant factors, as discussed by four participants, underlining the diverse range of individual challenges impacting content accessibility.

In response to accessibility challenges the most common strategy was to ignore or avoid the problematic content, as reported by 18 participants. Fifteen individuals sought sighted assistance to navigate these difficulties. Eleven participants found alternative sources to access the required information. Advocacy or reporting issues were strategies used by nine respondents, while another nine relied on technical workarounds. Three individuals expressed mixed emotional responses, reflecting the frustration and adaptation involved in overcoming these barriers. Lastly, two participants mentioned using customized settings as a solution to improve their accessibility experience.

Conclusion: Implications for Practitioners and Families

The findings of this study highlight the urgent need to improve accessibility to multimodal media for blind and low-vision individuals. The results emphasize the significant barriers that this demographic faces in accessing visually based texts, such as comics, news articles, maps, and other multimodal media. These findings have far-reaching implications beyond media consumption, impacting education, inclusion, and societal equity.

First, this study reinforces that BLV individuals are a diverse group, including those blind or low vision from birth and those who lost sight later in life. This diversity underscores the necessity for flexible and comprehensive accessibility solutions tailored to the unique needs of each individual.

Moreover, the study points out the heavy reliance on screen readers for accessing text-based materials, highlighting the need to enhance these technologies to interpret visual and spatial information more effectively. Participants' preference for audio descriptions and detailed textual descriptions of visual elements suggests a significant need for improving the accessibility of multimodal materials.

One of the most concerning findings is the frequent encounter with inaccessible media by BLV individuals. This inaccessibility not only limits their access to information and cultural experiences but also leads to the rejection of materials and difficulties in understanding complex visual content. This issue is particularly acute for graphic narratives, where the study reveals a potential interest among BLV individuals, which are currently underrepresented and underexplored. For example, a review of commonly assigned college handbooks and textbooks published by Norton Books, a leading publisher of composition textbooks in the U.S., illustrates this problem.

1. The Norton Field Guide to Writing includes 79 out of 521 pages consisting of paratextual material that combines text and image. Of these 79 pages, six consist solely of photographs with running head, page numbers, and footers as the only text on the page.
2. Back to the Lake (4th edition) includes 181 pages of multimodal composition out of 879 pages. Some pages feature pictures with captions or descriptions, including 24 pages of comics excerpted from Marjane Satrapi’s Persepolis and Brooke Gladstone’s The Influencing Machine.

Additionally, this study emphasizes the crucial role of the Internet in providing access to multimodal materials. BLV individuals heavily rely on online resources but often struggle to find accessible content. This underscores the need for improvements in search algorithms and the provision of accessible web content. These findings strengthen the call for immediate action to address these accessibility issues, ensuring that BLV individuals can fully participate in and benefit from the wide range of available media and information.

Acknowledgement

This project was funded in part through the generous support of the Alfred P. Sloan Foundation and the National Endowment for the Humanities (HAA-281022-21).

References

Ackland, P., Resnikoff, S., & Bourne, R. (2017). World blindness and visual impairment: Despite many successes, the problem is growing. Community Eye Health, 30(100), 71–73.

Association of American Publishers. (2024). AAP statistics. https://publishers.org/data-and-statistics/industry-statistics/

Bourne, R., Steinmetz, J.D., Flaxman, S., Briant, P.S., Taylor, H.R., Resnikoff, S., Casson, R.J., Abdoli, A., Abu-Gharbieh, E., Afshin, A., Ahmadieh, H., Akalu, Y., Alamneh, A.A., Alemayehu, W., Alfaar, A.S., Alipour, V., Anbesu, E.W., Androudi, S., Arabloo, J., ... Vos, T. (2021). Trends in prevalence of blindness and distance and near vision impairment over 30 years: An analysis for the Global Burden of Disease Study. The Lancet Global Health, 9(2), e130-e143. https://doi.org/10.1016/S2214-109X(20)30425-3

Capp, M.J. (2020). Teacher confidence to implement the principles, guidelines, and checkpoints of universal design for learning. International Journal of Inclusive Education, 24(7), 706-720. https://doi.org/10.1080/13603116.2018.1482014

Cooley, T. (2017). Back to the lake: A reader & guide for writers (4th ed.). W.W. Norton.

Cooley, T. (1992). The Norton guide to writing. W.W. Norton.

Digital Accessibility Services. (2024). Write helpful alt text to describe images. Harvard University​. https://accessibility.huit.harvard.edu/describe-content-images

Gorlewicz, J.L., Tennison, J.L., Palani, H.P., & Giudice, N.A. (2018). The graphical access challenge for people with visual impairments: Positions and pathways forward. In D. Cvetković (Ed.), Interactive Multimedia-Multimedia Production and Digital Storytelling. Intech. https://doi.org/10.5772/intechopen.82289

Griffin-Shirley, N., Banda, D.R., Ajuwon, P.M., Cheon, J., Lee, J., Park, H.R., & Lyngdoh, S.N. (2017). A survey on the use of mobile applications for people who are visually impaired. Journal of Visual Impairment & Blindness, 111(4), 307–323. https://doi.org/10.1177/0145482X1711100402

Hayhoe, S.J. (2017). Blind visitor experiences at art museums. Rowman & Littlefield. 

Lee, Y.J., Joh, H., Yoo, S., & Oh, U. (2023). AccessComics2: Understanding the user experience of an accessible comic book reader for blind people with textual sound effects. ACM Transactions On Accessible Computing, 16(1), 1–25. https://doi.org/10.1145/3555720

Lupón, M., Cardona, G., & Armayones, M. (2021). Public knowledge of low vision and blindness, and readability of on-topic online information. Journal Of Optometry, 14(3), 240–246. https://doi.org/10.1016/j.optom.2020.06.005

Sanka, N.S., Mittal, N., & Sanka, S. (2022). Webtoons market size, share, competitive landscape and trend analysis report by types, by revenue model, by application: Global opportunity analysis and industry forecast, 2021-2030. Allied Market Research. https://www.alliedmarketresearch.com/webtoons-market-A16830

Oh, U., Joh H., & Lee Y.(2021).Image accessibility for screen reader users: A systematic review and a road map. Electronics, 10(8), 953. https://doi.org/10.3390/electronics10080953

Pew Research Center. (2023, November 15). News platform fact sheet. https://www.pewresearch.org/journalism/fact-sheet/news-platform-fact-sheet/

Sharif, A., Zhang, A.M., Reinecke, K., & Wobbrock J.O. (2023). Understanding and improving drilled-down information extraction from online data visualizations for screen-reader users. In W4A ’23: Proceedings of the 20th international web for all conference (pp. 18-31). Association for Computing Machinery. https://doi.org/10.1145/3587281.3587284

Tennison, J.L., Goswami, S., Hairston, J.R., Merlin Drews, P., Smith, D.W., Giudice, N.A., Stefik, A., & Gorlewicz, J.L. (2023). Bridging the gap of graphical information accessibility in education with multimodal touchscreens among students with blindness and low vision. Journal of Visual Impairment & Blindness, 117(6), 453-466. https://doi.org/10.1177/0145482X231217496

U.S. Department of Education. (2023, July 18). Protecting students with disabilities. https://www2.ed.gov/about/offices/list/ocr/504faq.html

U.S. Department of Justice Civil Rights Division. (2022, March 18). Guidance on web accessibility and the ADA. https://www.ada.gov/resources/web-guidance/

The Journal of Blindness Innovation and Research is copyright (c) 2025 to the National Federation of the Blind.