Smartphone.

Most participants owned a smartphone, and used it regularly. In general, they were well able to use the applications and look up information on the internet. Participants with peripheral visual field defects preferred using a smartphone over a computer or tablet: “[When using] the smartphone, and of course that’s because it is small, it makes me see it better. The smaller something is, the better we [individuals with peripheral visual field defects] can see it (female, aged 56).” Most participants used voice control, a dark mode (i.e. black background and white text), or magnified the font to facilitate smartphone use. However, some difficulties were associated with this as well. For example, some applications did not work properly with magnified text, and the absence of a dark mode in some applications prevented individuals who are sensitive to light from using the application. Additionally, mistakes were regularly made with the dictation function; spoken words were not always properly transformed into text, and these mistakes could not be detected easily because of the visual impairment. Controlling the smartphone so that a web page is being read aloud came with certain difficulties as well: “I have to select what I want to have read aloud. So I cannot say: ‘read this page aloud’. (…). With an article, I might be selecting the text six times, because I have to select the first piece of text, then there is an advertisement, then I have to select the next piece of text, scroll again, select again. (…) That makes me think: ‘well, never mind then’ (male, aged 31).” Another challenge that many participants referred to, was that they had to put in a lot of effort to be able to understand speech when using the screen reader function of their smartphones. However, the possibility of directly connecting their smartphones to their hearing aids or cochlear implants was regarded as useful in this case.

Computer/Tablet.

Computers and tablets were also regularly used by most participants; for example, to visit internet pages and to send e-mails. Participants with decreased visual acuity preferred using a computer or tablet over a smartphone: “There are many options on the tablet to magnify things, and you can just tick on it, and it magnifies, so that is really nice. I do almost everything on my tablet nowadays (female, aged 37).” In contrast, individuals with peripheral visual field loss often mentioned that they were not able to get an overview over the entire computer/tablet screen, and therefore preferred using a smartphone. Other difficulties associated with computer and tablet use were related to visual aspects, such as being unable to distinguish the icons and constantly losing the cursor on the screen. To cope with this, some participants used supportive software: “With that program, I can easily change the font size. […] Now, I need a font size of 28 or 35 to distinguish what I am writing. […] The program also has an excellent screen reader (male, aged 88).” Other participants used a dark mode or a braille display to make computer/tablet use easier. Also, some participants mentioned that they received a computer training from a low vision service; this was considered useful, because they were taught adequate skills to facilitate their computer and tablet usage.

Television.

When watching television, participants were able to enjoy well-structured programs, like the news or certain talk shows, because these are often slowly paced and easy to follow. The faster paced types of television content, however, did cause problems: “Well, when I am watching a movie, (…) when many things are happening, like in an action movie, I overlook half of it. (…) Or when things are happening in the dark, well, I just cannot see it. And I try to, but I notice that I get the feeling that I should not continue watching. It is so exhausting (female, aged 56).” These difficulties caused some participants to avoid watching television at all. Similar to computer and tablet use, another frequently mentioned problem was that a large screen is difficult to oversee for individuals with peripheral visual field loss. To compensate, they used their smartphone or tablet to watch certain programs on a smaller screen. In turn, other participants were forced to sit close to the television to be able to see what was happening. Auditory impairments caused difficulties as well, especially when many people on television were talking simultaneously or when the spoken language was not the same as the participant’s native language. However, directly connecting the television sound to one’s hearing aids or cochlear implants was helpful. Another difficulty was not being able to easily read subtitles. Certain assistive technology could solve that problem: “You can change the background [of the subtitles] and the size. […] I am happy with it, because if there’s someone with a white t-shirt [on television], I cannot read the subtitles (male, aged 52).” Participants also made use of assistive technology that reads the subtitles aloud. Notably, some participants mentioned that they relied on either vision or hearing while watching television. One participant mentioned: “At 8 P.M., we watch television for a while. That is, I listen to what is being said, and my wife watches (male, aged 88).” Another participant experienced watching television differently: “I often watch a soap series with subtitles with my daughter. […] If there are no subtitles, I cannot understand anything (female, aged 41).”

Walking.

Most participants were able to move around on foot, although crossing the street was considered a difficult situation. Participants had difficulties determining the location or direction of approaching cars or cyclists: “But you have to be able to hear where the cars are coming from and if there is a road divider […] and if there is a bicycle path. These are difficult things (female, aged 68).” To make crossing the street easier, participants used a pedestrian crossing or traffic light, or asked others to walk with them. Participants took their time to make sure a traffic situation was safe. Most participants tended to use their hearing to determine whether there was any traffic approaching; hearing aids and/or a cochlear implant were considered helpful in this situation. When they detected a road user with their hearing, they used their sight to locate that road user more precisely. Other problems in traffic that were mentioned were that other road users or obstacles on the sidewalk were being overlooked at times and that electric cars and cyclists were difficult to hear. Other traffic was also difficult to hear when there was background noise: “Some you hear, some you don’t. […] When it is very crowded, I cannot hear whether a car is approaching. When people are working in the garden here, and you have to cross the street there, I cannot hear it, it is disrupting (female, aged 41).” Most participants used a cane or guide dog when walking: “It makes you feel more secure and it makes you walk faster. I really need it; I cannot cross the street without my cane (female, aged 51).” A cane or guide dog had other advantages as well: “Look, people have to see that I cannot see it, because, if I didn’t have a cane, they would’ve thought: ‘Why is that woman walking so slowly?’ or ‘Hurry up!’ […] You can see that parents grab their children when they are walking in front of me. […] People let you go first. Or if you’re hesitating, people ask ‘Can I help you?’ (female, aged 51).”

When finding their way, most participants used navigation applications (e.g. Google Maps) on their smartphone. These applications were considered helpful: “It makes you more confident. The problem when going to a new place is that you don’t recognise the buildings, and now you can just turn it on and then at least you’re in the right street (female, aged 42).” A problem some participants mentioned when finding their way, even when using an application, was to find a specific house. A way participants coped with experienced problems when finding their way was to ask other people for help: “I haven’t been to the city centre in a long time. It has completely changed. I do want to go exploring it there, but I want to go with a volunteer. Look, if I’ve been to a place once, I know the way (male, aged 52).”

Public transportation.

Most participants prepared their journey before travelling with public transportation. “I think it is important to make a plan beforehand, to make sure I know what to look out for. […] That you know where you will sit, close to the travel information screen […] and to the exit. The further you go, the more obstacles you can run into (male, aged 27).” Some participants were able to use their eye sight, which made using public transportation easier. For example, they were able to differentiate buses and could read travel information displays at train stations. Others were not able to use their eye sight for this purpose. As a solution, they used smartphone applications to retrieve travel information and to find their way in train stations. Another way to deal with this was asking others to help them or travel with them, or following other people when stepping out of the train, because this strategy would take them to the station hall. Problems were experienced when trying to understand speech in stations, as this is usually a noisy and reverberating setting. “I do ask others sometimes, but it’s difficult, because often there’s a lot of noise and then I can’t hear what the answer is (female, aged 52).” Some participants also had difficulties understanding announcements in the train or bus (e.g. what the following stop was). They had a practical solution for this problem: “Or when you know beforehand that there will be six stops, and you hear a computer voice six times, then you know [when you have to get out] (male, aged 27).”

Face to face conversations.

There was one predominant finding regarding communicating face to face, namely that having conversations in a busy environment caused a lot of difficulties. “For example, in a group where multiple people talk over each other, I cannot handle that. […] You are expected to smile and enjoy the atmosphere, but I cannot follow the conversation anymore (female, aged 68).” It caused difficulties as well when there were multiple conversations in the same room at the same time: “Yes, it is hard for me to focus on these conversations. Especially when the others are talking loudly, and I am talking to someone with a soft voice, I find it difficult to understand that person. […] So, it is difficult for me when multiple conversations are happening at the same time (male, aged 44).” The fact that there was often a lot of background noise, made it especially difficult to understand conversations: “I hear the conversations that others are having, and I try to understand the conversation that I am in, but quite often there is music playing or something, so it is hard to obtain the information that I want (male, aged 31).” Another difficult situation was when the person talking was too far away to understand what they were saying. Visual aspects caused problems in busy environments as well, for example, it was considered difficult to oversee the conversation and determine who was talking. Lighting conditions mattered as well: “If we go somewhere and it is very dim in a living room, this especially bothers me in the winter, if I visit someone who has ambient lighting, that’s a problem for me, because I cannot rely on my hearing, so I have to properly see the person who is talking (female, aged 56).” The specific difficulties associated with dual sensory loss were mentioned as well: “I notice that people that I know who have a hearing impairment, they can speech read, and that is not applicable to me, so in a busy environment that’s very difficult for me (female, aged 27).” Although most participants owned a hearing aid, some participants did not consider them to be very helpful in these situations: “The hearing aid amplifies everything, so you hear a lot of noise (female, aged 27).” Others did benefit from their hearing aids, for example because the aid took the direction of their gaze into account. Participants also benefited from other aids: “If my husband and I go out for dinner, he has a microphone [which is connected to the hearing aid and cochlear implant], then he talks in the microphone […]. That’s very nice, because I can understand him much better (female, aged 52).” Other compensation strategies in busy environments were explaining the impairments to others, asking others to clarify or repeat what they said, carrying on the conversation in a quiet place, and withdraw from the conversation. Some participants mentioned that they avoided crowded situations; if they made an exception, they carefully considered their choice: “That is often the assessment I make when I go to a birthday party: what does it give me and what does it cost me. If there is an equilibrium, it’s not so bad, but if there’s not, you think: ‘I will pass’ or ‘I will go another time’ (male, aged 27).”

On the other hand, having conversations one-on-one or in a small group (i.e. no more than five people) in a quiet environment, did not cause many difficulties. “With four people […], I think: ‘wait a minute: is the lighting alright? Yes. Can I understand it? It takes some time getting used to the voices. What is the conversation about?’ Well, then it is alright (female, aged 51).” An important factor in comprehending conversations for individuals with DSL was that others did not talk simultaneously and ensured that they spoke clearly. As opposed to busy environments, most participants did benefit from their hearing aids in quiet situations.

Conversations by telephone.

Participants’ experiences regarding telephone conversations varied, however, most participants were able to successfully have a conversation by telephone. Still, some difficulties were mentioned: “Sometimes it’s difficult, because sometimes people talk very fast, or sometimes I cannot understand it for some reason (female, aged 52).” Other challenges that were mentioned were having difficulties remembering a phone number or not being able to understand everything when background noise is present, which can lead to misunderstandings. Once again, hearing aids were used to make telephone conversations easier: “When I call my general practitioner I can hear him directly in my ears [via hearing aids], and I can understand him very well (male, aged 46).” Other strategies regarding telephone use were turning up the volume, explaining to the other person that they were hard of hearing, or only having telephone conversations in a quiet environment.