House of Memories is an innovative dementia awareness training programme developed by National Museums Liverpool (NML). More than 10,000 health and social and family carers have accessed the training. My House of Memories app is a digital resource developed to share tools and techniques from the training, based on the power of objects to elicit deeply held memories. The app provides access to hundreds of fantastic social history objects from museum collections. The app was co-created to be intuitive, easy to use, and accessible using multi-media and multi-sensory approaches to stimulate conversation and interactions between people living with dementia and their carers.
Objectives of the project
The project set out to:
- Create an app for people living with dementia and their carers that provides a meaningful memory sharing activity they can do together
- To engage people living with dementia and their carers in the co-design of the app, to ensure that it was accessible and easy to use for people living with dementia, who may experience a range of impairments
- To digitise a variety of evocative museum objects, brought to life through sound and music, to stimulate exchanges and conversations relating to the person’s life story
- To enable access to museum objects for those who aren’t able to travel to a museum location
- To support access to technology for isolated older people, those living with dementia and their carers (family and professional)
Involvement of disabled users
The project used a co-creation process, with people living with dementia involved from the very early stages.
Initial scoping and consultation with a range of stakeholders (including people living with dementia) indicated that a digital version of House of Memories should be tablet-based to utilise touch screen technology. It was also agreed it should incorporate a digital adaptation of the Memory Tree, a paper-based resource that is shared during the House of Memories training to help express an individual’s interests and personality.
A small, dedicated co-creation group of people living with dementia and their carers worked closely with NML and the app developer on issues of design, content and implementation, as well as testing phases, through a series of active workshops. A wider health and social care stakeholder group was also consulted at key stages in the process. The involvement of the co-creation group was evaluated as part of the funders (More Independent) overall programme evaluation, and was also a focus for Innovate Dementia (a pan-European programme interested in the co-creation process and the best way of ensuring products are truly dementia-friendly).
Innovative inclusive features
The app has a number of design/function features that were directly implemented as a result of the members of the co-creation group – either as suggestions, or as solutions to issues they raised. Dementia affects each individual in a unique way, therefore as much flexibility as possible was built into the functionality.
These innovations include:
- A ‘wobbling’ close button, making it easy to identify and serving as a reminder to people if they get ‘stuck’
- A very clear and concise design which focuses on the 2 key sections of the app – the activity / objects section, and a Find Out More section
- A hint button relating to each object, to enable people with memory issues an opportunity to recall what an object is
- An export feature allowing memory tree/box/timeline to be shared with other app users (such as remote family or friends)
- The ability to save multiple user profiles (to the tablet) for use in a residential or other communal type setting
- A wide variety of options and functions to cater for an individual’s unique preference or need. There is an audio version of text, for those who struggle to read. Users can turn on or off the music, or voice overs and buttons depending on their need/preference. They can increase or reduce the number of objects displayed, and switch video subtitles on and off.
The My House of Memories app was designed to support people living with dementia, who are affected by a range of cognitive impairments, as well as support carers’ ability to connect with the person they are caring for. Cognitive impairments may include (list not exhaustive) the ability to read and understand; short term memory (affecting things like the ability to navigate using IT); and reduced attention span. For many people with dementia there will be additional physical and sensory impairments e.g. visual impairment, mobility impairments, hearing impairment, and spatial recognition that could also affect their use of the app.
Measures taken to ensure W3C’s Web Content Accessibility Guidelines were followed:
The development of the app was undertaken with the full involvement of people living with dementia and their carers. The W3C’s Accessibility Guidelines were covered by the co-creation process, and the input of users in relation to the colour, text size, voicing buttons, text (language and level), and the in-app manual were discussed with end users and their recommendations implemented.
More specifically the group covered aspects of the W3C guidelines in the following ways:
1 Perceivable – creating content that can be presented in different ways
Following feedback from the co-creation group the content that was created in the app included multi- media approaches, e.g. audio versions of the text, as well as the text based descriptions. Sounds and music are included (but can be switched off) to bring the objects to life and give a multi-sensory experience. There are also a small number of videos relating to the objects eg. a video of being on a steam train, to illustrate the museum object, ‘Lion’ (a steam engine). The creation of an animation to show people how to use the app, and the use of video to provide a flavour of the benefits of the app were also incorporated.
2 Operable – providing enough time to read and use content; helping users navigate, find content and determine where they are
The operability of the app was considered throughout, including the original decision to use a tablet for touch screen technology, rather than keyboard and mouse navigation.
A clean design that is intuitive to use and easy navigate was central to the aims of the app, and clearly articulated by the co-creation group. In the design, this translated into a simple and straightforward homepage with large buttons and simple labels.
The text used for each label was tested with the group to ensure the terms were fit for purpose – for example, ‘Start Activity’ was chosen for home page, rather than ‘museum objects’ or something descriptive, to make it absolutely clear what the button was for.
In addition, the title of the buttons are labelled in text, as well as spoken out loud when pressed – this reinforces which button has been pressed and what action is going to take place. This is especially useful for questions like ‘Do you want to exit?’, to enable the individual to reconsider the action before they fully close the app.
The app does not use the ‘swiping’ convention, as although this is commonplace, people living with dementia suggested it could be difficult to control. Instead the big buttons were tested for sensitivity and a balance established to make them easy to press, but not so sensitive that they activate unintentionally. You can also choose an option in the settings for objects to automatically pop-up and enlarge.
Once a personalised memory display (tree/box/timeline) has been created, the items can be played back in an animation accompanied by music. This function incorporates the ability to slow down or speed up the animation, to respond to varying user needs.
In short, all aspects of the app’s design were considered with the group and implemented wherever possible to ensure easy navigation and use.
3 Understandable – making text readable and understandable
The need to make the app as simple as possible and to ensure the words used were understandable was a key concern of the co-creation group. They influenced the design in terms of the size of text, background and font colour, as well as the content development in terms of the level of language and length of text. The result of their input is a readable level of text which is informative enough for the purposes of the app users. Guidelines as to colours which work best for people living with dementia were chosen and contrast considered.
4 Robust – compatibility with future user agents and assistive technologies
The app is both android and iOS based which allows as diverse a use as possible.
There is a function to export a person’s memory tree/memory box/memory timeline – which enables other family members/friends to view the memory activity on different operating systems.
The app was commissioned with a developer on the basis that additions and modifications will be made in the future, and includes a content management system. This enables the inclusion of new packages of objects (including through partnerships with other museums) with relative ease. The app has already been updated and continues to be improved and expanded regularly, with continued input from user groups to ensure the integrity of the project is upheld.
Automated validation tools and/or manual processes that were used to test the accessibility of your project:
The group that were involved in the co-creation were also involved in the testing of the app, and again their recommendations were implemented. The testing was on multiple different devices, and on multiple platform versions.
In addition, new audiences (from care settings) that were not part of the design were consulted, to test how the app works for people without any prior knowledge of the project.
The app has been introduced to many professional care workers and family carers through our training, and we continue to gather feedback and make plans and improvements accordingly.