are you blind?! regulating accessibility in print september 2011 mark barratt are you blind?!...

ATypI September 2011 | Mark Barratt

Are you BLIND?! Regulating accessibility in print

Mark Barratt

typeface

The choice of typeface is less important than contrast, type size, weight and the spacing of characters.

Quirky, unusual, script and titling faces are obviously highly inappropriate for legible continuous text.

There is no valid research to support the preference for a sans serif typeface (such as Arial or Helvetica) over a seriffed one (such as Times or Century). Seriffed faces are regarded as more ‘readable’ in continuous text for regular reading. This may equally apply to large print texts.

type size

For the partially sighted 9–12 pt type (or an average x-height of 2.5mm) is suggested as a minimum by RNIB. Sometimes 16pt may be needed by some visually impaired readers.

These recommendations obviously depend upon the typeface and weight used. For the general reader type sizes between 8 and 10pt are frequently used. The RNIB aims to set all its texts for usual readers in 12pt.

Remember that different types with the same ‘point size’ have different appearing sizes. The effective size of a typeface is actually related to the height of the lowercase x.

type weight

The tendency has been for setting text in bold because of its contrast on a white page. However, more recent findings suggest that a medium weight or semi-bold may be more legible. The RNIB’s ‘See it right’ was set in New Baskerville semi-bold. We suggest avoiding weights of fonts that appear very light. Aside from the weight of the stroke, the counters of letters are important – they should be open to help legibility.

italic

Traditional italic type should clearly not be used for continuous text for any group of readers. As a means of emphasising important words or phrases it may be appropriate. This is particularly important if body text is in a semi-bold; the use of bold for emphasis will not be enough. Titles of books etc. should be italicised as in text for general readers.

These notes sum up research and experience in designing paper documents for visually impaired people. Written in September 2001, they are based on recommendations from the Royal National Institute for the Blind, The Lighthouse Inc, other research and, where there is no better guide, our own taste and prejudice.

Text Matters

37 Upper Redlands Road

Reading RG1 5JE

United Kingdom

t: (+44) 0118 986 8313

f: (+44) 0118 908 0732

e: [email protected]

w: www.textmatters.com

16pt Arial 16pt PerpetuaThe point size of a typeface is not the same as its apparent size

typography for visually impaired people


Design and layout guide, Plain English Campaign

Type shapeMost fonts can be divided into two groups:

• serif, which have pointed bits (serifs) like this line; and

• sans serif, which are plain like this line.

If serifs are too pronounced, they can be distracting. It is usually best to stick to sansserif fonts, like Arial or Helvetica.

Computer software offers a wide choice of fonts. This tempts novice designers to usemany different fonts in the same document. Don’t!

Font sizeFont size is measured in units called ‘points’. Try to aim for a font size of 12 point. If youare pushed for space, you can go down to 10 point, but don’t go below that.

The Royal National Institute for the Blind recommends a minimum font size of 14 pointfor readers who are likely to be blind or partially sighted. For headings, use a font size atleast two points bigger than the body text.

Avoid using block capital letters for emphasis – it makes words difficult to read, andlooks as though YOU ARE SHOUTING. Stick to bold print for emphasis. Don’t underline.

Avoid using italics as they can be difficult to read.

Line lengthLine length can affect the ease and speed of your reading. Very long and very short linesforce you to read more slowly.

It is helpful to think of line length in terms of the number of characters in the line(including spaces).

A line of body text should normally contain 60 to 72 characters, or about 10 to 12 words

Line spacing (leading)The technical term for line spacing is ‘leading’ (pronounced ‘ledding’). It is measured inthe same units as the font size.


Why Clear Print?

Information is essential to all of us, to help us to make choices and to live our lives independently. By law, all organisations need to provide information in a way that everyone can read. A ’Clear Print’ document will find a wider audience including elderly people and many others with sight problems. Use for correspondence, books, magazines, flyers, forms, menus, programmes and like items held in the hand.

Top tips for achieving Clear Print:

• Document text size should be 12-14 pt, preferably 14 pt. • The font you choose should be clear, avoiding anything stylised • All body text should be left aligned [etc]

Source: Nottingham Disability Forum


Appeal following typeface and size rules of the US Court of Appeals of the Ninth Circuit, covering typeface, size and line length.


US Food & Drug Administration. Nutrition labelling requirements


Lots of questions already:

What’s the problem? How big is it?

Where do these prescriptions come from?

Are they likely to solve the problem?

If they are, is the solution worth the cost?

Are there other ways to solve the problem?

Um...


What’s the problem? How big is it?


Clear print won’t help these people

source: UK Department of Health

Partially sighted

Blind

Unregistered

Registered blind and partially-sighted in England, 2011


Larger print will help some of these people

source: RNIB, unattributed

Uncorrectable sight problem

Normal or correctible vision

RNIB ‘sight problem not �xed by glasses’


Over 65 + sight problems

Over 65

Under 65

Older people and sight problems

Common problems include diabetes, age-related macular degeneration, glaucoma, cataractssources: Office for National Statistics, RNIB (unattributed)


Where do these prescriptions come from?


See it right,RNIB


9pt hamburger hamburger



14pt hamburger hamburgerx-heights, mm gridArial, Garamond


See it right, RNIB

2mm x-height = 11pt Arial

2.3mm x-height = 13pt Arial


Research bibliography (complete)See it right, RNIB


The effect of font and line width on readingspeed in people with mild to moderate visionloss

Gary S. Rubin1,2, Mary Feely1, Sylvie Perera3, Katherin Ekstrom3

and Elizabeth Williamson4

1Institute of Ophthalmology, University College London, 11-43 Bath Street, London, EC1V 9EL,2Moorfields Eye Hospital, London, 3Royal National Institute of the Blind, London, and 4Medical

Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK

Abstract

Purpose: The aim of this study was to evaluate the effects of print size, typeface, and line width on

reading speed in readers with mild to moderate sight problems.

Methods: A total of 43 patients, most of whom had mild cataract or glaucoma with acuity 6/30 or

better (median age ¼ 72; range ¼ 24–88 years), read aloud a selection of texts presented randomly

in four sizes (10, 12, 14 and 16 point), for each of four typefaces [Foundry Form Sans (FFS),

Helvetica (HV), Tiresias PCfont (TPC), Times New Roman (TNR)] at a standard line width of 70

characters and a viewing distance of 40 cm. A subset of letter sizes and typefaces were tested at two

additional line widths (35, 90).

Results: As expected, reading speed increased with print size from a median of 144 words min)1 for

10-point text to 163 words min)1 for 16-point text (repeated measures ANOVAANOVA, p < 0.0001). There was

also a significant effect of typeface with TPC being read about 8 words min)1 faster, on average,

than the other fonts (159 words min)1 for TPC vs 151 words min)1 for the other fonts, p < 0.0001).

However fonts of the same nominal point size were not equivalent in actual size. When adjusted for

the actual horizontal and vertical space occupied, the advantage of TPC was eliminated. There was

no effect of line width (p > 0.3). Data from the present study were extrapolated to the general

population over age 65. This extrapolation indicated that increasing minimum print size from

10 points to 16 points would increase the proportion of the population able to read fluently

(>85 words min)1) from 88.0% to 94.4%.

Conclusion: This study shows that line width and typeface have little influence on reading speed in

people with mild to moderate sight problems. Increasing the minimum recommended print size from

10 points to 14 or 16 points would significantly increase the proportion of the population able to read

fluently.

Keywords: fonts, large print, low vision, reading

Introduction

Publishers and graphic designers frequently ask �whatfont should I use for people with low vision?� Severalorganisations such as the Royal National Institute of the

Blind (RNIB) and American Printing House for theBlind (APH) have developed guidelines (RNIB, 2001;Kitchel, 2004) to improve legibility. Both the RNIB andAPH recommend specific font sizes (12 points or largerfor RNIB; 18 points or larger for APH) and RNIBrecommends a line width of 60–70 characters. RNIBand APH have even developed their own fonts forin-house and public use. However the scientific basis forthe guidelines is elusive at best.

The RNIB has carried out an extensive study ofpatient preferences for various features of large printfonts (Perera, 2004). The study shows that readers with

Received: 13 September 2005

Revised form: 22 December 2005

Accepted: 31 December 2005

Correspondence and reprint requests to: Gary S. Rubin.

Tel.: +44 207 608 6989; Fax: +44 207 608 6983.

E-mail address: [email protected]

Ophthal. Physiol. Opt. 2006 26: 545–554

ª 2006 The College of Optometrists doi:10.1111/j.1475-1313.2006.00409.x

Testing:

continuous reading-aloud

43 patients of eye clinics: mainly glaucoma and mild cataracts

different fonts (abandoned)

result: faster reading from larger type

extrapolated using data from previous population study to general population


When type gets bigger people read it faster

‘Our data suggest a 30% improvement in the likelihood of fluent reading (>85 words min) for every increase of 1 point beyond 10 points. There are several caveats to consider...’

From ‘Effect of font and line width in reading speed in people with mild to moderate vision loss’, Rubin et al

�mean adjusted font size� with an OR of 1.183 (95% CI:1.127, 1.242).These models were applied to the SEE dataset to

estimate the total percentage of the general populationover age 65 who should be able to read fluently usingadjusted font sizes of 10, 12, 14 and 16 points. Standarderrors for the percentage were calculated using a Taylorseries approximation. The predictions, with their 95%confidence intervals are shown in Figure 9. The pointsizes indicated in the figure are referenced to the nominalsizes of the TPC font. For example, the extrapolationpredicts that a change from 10- to 14-point print willincrease the proportion of the general population whocan read fluently from 88.0% to 93.2% for the>85 words min)1 criterion or from 74.3% to 85% forthe >115 words min)1 criterion. A sensitivity analysiswas carried out, adding difficulty level of the textpassage as a categorical variable, however this had anegligible effect on the final estimates.

Conclusions

This study demonstrates that the most significantdeterminant of reading speed and reading fluency for

people with mild to moderate visual impairment is lettersize. Line width is not a significant factor, at least overthe range from 35 to 90 characters. While typeface mayappear to influence reading speed, it is the difference inactual letter size of fonts with similar nominal point sizesthat determines reading speed and fluency. Therefore, apublisher who is constrained by the amount of availablepage space, will not notice a significant difference inlegibility for different fonts.

Our data suggest a 30% improvement in the likeli-hood of fluent reading (>85 words min)1) for everyincrease of 1 point beyond 10 points. There are severalcaveats to consider when making recommendationsbased on these data. First, the sample size of 43participants was relatively small. The sample size waschosen to enable us to detect possible differences inlegibility between fonts. However, the small samplelimits the precision of our estimates of the effects ofpoint size, as indicated by the large confidence intervalsin Figure 9. Second, only linear (or proportional)models were considered. The effect of letter size isprobably non-linear for extreme values. This meansthat the increase in reading speed and the greaterlikelihood of fluent reading with increasing letter sizewill not increase indefinitely. There is likely to come apoint of �diminishing returns� beyond which furtherincreases in letter size will be of limited benefit. Finallythe extrapolation of the MEH data to the generalpopulation over age 65 was based on a particularsample from one region of the USA. The age,educational, and cultural makeup of the SEE popula-tion may differ from those in the UK. It would behelpful to repeat the extrapolation in other populationsamples. Finally, the only measure of reading perform-ance in this study was reading speed. Different factorsmay prove to be important for other aspects such asreading duration or comprehension.

Reading speed and fluency increase with letter size.Although each individual has their own CPS, the pointat which reading speed reaches a maximum, increasingthe recommended print size will significantly increase theproportion of the population able to achieve a criterionreading speed.

Acknowledgements

Special thanks to Glen Harding who wrote the textgeneration software. This research was supported by agrant from RNIB. Some of these results were reportedat Vision 2005, London, UK, April 2005.

References

Arditi, A. and Cho, J. (2005) Serifs and font legibility. VisionRes. 45, 2926–2933.

Table 2. Final multivariable model for words per minute >85

OR 95% CI p-valuea

Subject-level variables

Acuity 0.271 0.019, 3.898 0.337

Age 1.020 0.987, 1.054 0.242

Text-level variables

Mean adjusted font size 1.300 1.186, 1.425 <0.0001

aShows the p-value obtained from the Wald test.

Figure 9. Extrapolation of data from the present study to the general

population over the age of 65, showing the percentage of individuals

who would be expected to read fluently (filled bars: >85 words min)1

and open bars: >115 words min)1). Error bars show 95% confidence

intervals for estimates.

Effect of font on reading speed: G. S. Rubin et al. 553

ª 2006 The College of Optometrists


How many people does this help?

Maybe 2% of the population reading 10% faster


Is ‘fluent continuous reading’ an appropriate test?

Works for novels

Marginal impact of larger font size

Restrictions on layout freedom

On risk-assessment basis, better to focus on language?

Narrative and rhetorical structure, vocabulary, key influencers of comprehension.

But RNIB opposed to risk-assessed approach

Text Matters sample of work [page 6]

Series design and copy editingCentre for Charity Effectiveness toolkit

The Centre for Charity Effectiveness (CCE) at Cass Business School researched and created a toolkit of useful information for small voluntary and community organisations.

We copy-edited the text and redesigned diagrams for clarity and to aid understanding for an audience which could be from a wide variety of backgrounds.

We created a design style for the series of guides that could be extended for similar CCE publications. We designed:: a suite of eight A5 booklets;:: a folded A3 self-assessment ‘map’; and:: a simple custom-printed clear plastic case

to hold all the items in the toolkit.

We also produced web-friendly pdfs and an online version of the toolkit, and have completed the second print edition which includes an extra 44pp A5 guide.

read the project report online

Online toolkit

Printed items


Type size you can read is different from the type size you can read fast and continuously

Threshold reading acuity 2-3 times smaller than size needed for fluency. Source: Waller 2011 citing Colenbrander 2003


If you use more EpiPen® than you shouldIn case of overdose or accidental injection of theadrenaline, you should always seek immediatemedical help. Your blood pressure may rise sharplyand it will need to be monitored.

4. Possible side effects

Like all medicines EpiPen® can cause side effects,although not everybody gets them.

Usual side effects include: irregular heartbeat(including palpitations and rapid heartbeats), highblood pressure, sweating, nausea, vomiting,difficulty breathing, paleness, headache, dizziness,weakness, tremor and apprehension, nervousnessor anxiety.

Accidental injection of the pens in hands or fingershave been reported and may result in lack of bloodsupply to these areas. In case of accidentalinjection, always seek immediate medical help.

If any of the side effects gets serious, or if younotice any side effects not listed in this leaflet,please tell your doctor or pharmacist.

5. HOW TO STORE EpiPen®

Keep out of the reach and sight of children.

Do not use EpiPen® after the expiry date which isstated on the label.

Do not store above 25°C. Do not refrigerate or freeze.

Keep container in the outer carton in order toprotect from light. When exposed to air or light,adrenaline deteriorates rapidly and will becomepink or brown. Please remember to check thecontents of the glass cartridge in the EpiPen®

Auto-injector from time to time to make sure theliquid is still clear and colourless. Replace theAuto-injector by the expiry date or earlier if thesolution is discoloured or contains a precipitate(solid particles).

16 7 8

Patient Information Leaflet

EpiPen® Auto-Injector 0.3 mgAdrenaline

Read all of this leaflet carefully before you startusing this medicine.- Keep this leaflet. You may need to read it again.- If you have any further questions, ask your doctor

or pharmacist.- This medicine has been prescribed for you. Do

not pass it on to others. It may harm them, even if their symptoms are the same as yours.

- If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

In this leaflet:1. What EpiPen® is and what it is used for2. Before you use EpiPen®

3. How to use EpiPen®

4. Possible side effects5. How to store EpiPen®

6. Further information

1. What EpiPen® is and what it is used for

EpiPen® contains a sterile solution for emergencyinjection into the muscle (intramuscular injection).

EpiPen® is to be used for the emergency treatment ofsudden life threatening allergic reactions (anaphylacticshock) to insect stings or bites, foods or drugs orexercise. The reaction is the result of the body tryingto protect itself from the allergen (the foreignsubstance that causes the allergy) by releasingchemicals into the blood stream. Sometimes thecause of the allergic reaction is not known.

Symptoms that signal the onset of an anaphylacticshock occur within minutes of exposure to theallergen and include: itching of the skin; raised rash(like a nettle rash); flushing; swelling of the lips,throat, tongue, hands and feet; wheezing;hoarseness; shortness of breath; nausea; vomiting;stomach cramps and in some cases, loss ofconsciousness.

Diagram 1

1. Grasp EpiPen® in dominant hand (the hand you use to write), with thumb nearest grey cap and form fist around unit (black tip down).

2. With other hand pull off grey safety cap.3. Hold the EpiPen® at a distance of approximately

10 cm (4 inches) away from the outer thigh, as shown in diagram 2a. The black tip should point towards the outer thigh.

4. Jab the EpiPen® firmly into outer thigh at a right angle (90 degree angle) as shown in diagram 2b.(listen for click)

5. Hold firmly in thigh for 10 seconds. EpiPen®

should be removed and safely discarded.6. Massage the injection area for 10 seconds.

Diagram 2

A small air bubble may be present in the EpiPen®

Auto-injector. It does not affect the way theproduct works. Even though most of the liquid (about 90%)remains in the EpiPen® after use, it cannot bereused. After use, place the EpiPen® safely in thetube provided and bring it with you when you visityour doctor, hospital or pharmacy.

As the EpiPen® is designed as emergencytreatment only, you should always seek medicalhelp immediately after using EpiPen®, byreporting to your doctor, nearest hospital or bycalling an ambulance. Make sure that you informthe healthcare professional that you have receivedan intramuscular injection of adrenaline or showthem the container and/or leaflet.

Medicines should not be disposed of via drains orhousehold waste. Ask your pharmacist how todispose of medicines no longer required. Thesemeasures will help to protect the environment.See also section 3 - Directions for use.

6. FURTHER INFORMATION

What EpiPen® contains

The active substance is adrenaline 0.3 mg (300microgram).The other ingredients are: Sodium Chloride, SodiumMetabisulphite, Hydrochloric Acid, Water forInjections.

What EpiPen® looks like and contents of the pack

Clear and colourless solution in a pre-filled pen(Auto-injector).The Auto-injector (single-dose) contains 2 mlsolution for injection.

Marketing Authorisation Holder andManufacturerMarketing authorisation holder: ALK-Abelló A/SBøge Allé 6-8, 2970 Hørsholm, Denmark.Manufacturer: Meridian Medical Techn. Inc.,St. Louis, USADistributor: ALK-Abelló Ltd., 1 Tealgate,Hungerford, Berkshire RG17 0YT

This leaflet was last approved on

For information in large print, tape, CD or Braille,telephone 01488 686016

Korrektur 5 (01.10.2007)

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There is an alternative

Patient Information Leaflets

No rules about type sizes (but some guidance)

Pragmatic testing

‘We take a risk-based approach’


As well as Large Print for people with impaired vision, the Royal National Institute of Blind People (RNIB) also publishes Clear Print guidelines for general use. These have been widely adopted in the public sector. In these notes we take a critical look at what they say about type size, and the evidence on which the standard is based. We support the idea of a minimum type size for normal text, but question the inflexibility which inhibits some organisations from using even slightly smaller sizes for diagrams and tables – features that can make information clearer. We make recommendations for a more flexible and practicable version.

We publish this paper in order to start a debate, and in that spirit have included at the end (page 19) a response from Hugh Huddy of RNIB, who has been responsible for best practice in See It Right.

Simplificationcentre

Technical paper 10

The Clear Print standard: arguments for a flexible approach

Thanks for their help and comments to Professor Gary Rubin, UCL Institute of Ophthalmology, Hugh Huddy of the Royal National Institute of Blind People, and Dr Mary Dyson of the University of Reading.

Rob Waller July 2011

We need

To challenge the visual-disability organisations

encourage more research focused on comprehension

pay less attention to legibility and readability research

are you blind?! regulating accessibility in print september 2011 mark barratt are you blind?!...

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