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Blind and partially sighted adults in Britain: The RNIB survey

Summary: First ever nationwide survey of Great Britain blind and partially sighted adults

Ian Bruce, Aubrey Mckennell and Errol Walker

Royal National Institute for the Blind

Foreword

This report presents the findings of the first ever nationwide survey of blind and partially sighted people in Great Britain. As the country's largest organisation working with and for visually impaired people, we considered it essential that we should obtain a more detailed profile of our 'client group' than existing statistics could provide. We wanted to know the numbers of people with visual impairments, their personal circumstances and needs, and the extent to which those needs were being met.

The survey, conducted between November 1986 and April 1987, took the form of a series of lengthy, detailed interviews with nearly six hundred blind and partially sighted adults, and three hundred children (or their parents) in their own homes by professional interviewers. The survey followed a major study by the Office of Population Censuses and Surveys on disabled people generally (also published by HMSO). It was designed to be complementary to that survey, so that comparisons could be made. This report covers our findings on adults. A separate volume will follow on children.

The findings of our survey are enlightening, but at the same time, very worrying. They show that there are roughly three times more blind and partially sighted people in Great Britain than had previously been estimated - almost a million - and this number is growing as the population ages. Of these, only a quarter are officially registered blind or partially sighted, and of the remaining three quarters, a sizeable proportion are unknown to health and social services. Many visually impaired people, in other words, receive no help at all from statutory authorities. Yet our survey shows a deep well of need, especially among older people (aged 60and over) who make up 90% of all visually impaired people.

This report presents a major challenge to all providers of services, be they voluntary or statutory, in the fields of health, social services, housing, employment, leisure and income support. It has many implications for other spheres of activity, from building to banking, transport to television. RNIB is urgently reviewing its own policies and provision of services in the light of these findings, and we will be encouraging others - not least central and local government - to do the same.

We have collected the evidence, now we must press for action. One person in sixty depends upon it.
John A Wall MA (Oxon) Chairman, RNIB

Acknowledgements

Social surveys of this scale and complexity are possible only with the advice, support and encouragement of many individuals and organisations. First, however, our sincere thanks must go to the hundreds of blind and partially sighted people who allowed us to intrude on their lives, and who coped with our lengthy questions with patience and good humour. Without their cooperation this survey could not have been completed. We hope that this study will result in substantial improvements to the quality and availability of services to them and to all with a visual impairment.

We are greatly indebted to our advisers, consultants and field-workers whose experience of survey work and of policy issues contributed so much to our study. Special thanks must go to the Office of Population Censuses and Surveys' team who worked on the OPCS Survey of Disability in Great Britain. The data they made available enabled us to locate and interview blind and partially sighted people not registered with the local authorities. Their advice on the survey was also invaluable. The team included: Margaret Bone, Karen Dunnell, Jean Martin, Howard Meltzer, Amanda White and Nicola Robus. We are also grateful to Mary Jobbins and Dr Annette Rawson of the (then) DHSS who allowed us to follow up the OPCS sample. The survey was piloted with the help of the London Borough of Newham Sensory Advisory Team and its clients.

The fieldwork was carried out by the British Market Research Bureau. We thank them for the immense amount of work they put into the questionnaire design and fieldwork itself. The quality of the data collected is to be commended.

Professor Gerald Hoinville of City University and Elizabeth Hoinville of the University of London worked respectively on the sampling and computational work on the sample selection. Diana Leat and Jane Ritchie of Social and Community Planning Research advised on the questionnaire content. Jane Fielding at the University of Surrey advised us on the computing and the setting up of the data. Their support has been invaluable.

An advisory committee was set up by RNIB to advise on the survey. Its members were Dr Tim Cullinan, Dr Henry Heath, Dr Adrian Hill, Colin Low, Tom Parker, Dr Michael Tobin and Elizabeth Twining. The knowledge, experience and enthusiasm they brought to the design and development of the survey is gratefully acknowledged. Well over 20 RNIB officers also contributed their advice and experience.

Advice was sought from a number of individuals on issues to be included in the survey. Representing a wide range of disciplines and backgrounds, they brought a wealth of specialist expertise to our work for which we are most grateful. They include: Hans Cohn, Margaret Ford, Judy Baron, Elizabeth Chapman, Louise Clunies-Ross, Dr Allan Dodds, Sally Edge, Raymond Ellis (Leeds City Council), Paul Ennals (SENSE), Dr Lorimar Fison FRCS, Dr John Gill (Research Unit for the Blind, Brunel University), Lucille Hall, Roger Hinds (Dorton House School), Susan Lacroix, Graham Lomas, Tom Maley, D. Mumford (Coventry Social Services), Helen Partington (Social Services, Somerset County Council), Bill Poole, Fred Raffle (Nottinghamshire County Council), Joan Shields, Janet Silver (Moorfields Eye Hospital), Olive Stephenson (University of Nottingham) and Eric Walford.

Many organisations also commented on the scope of the survey, including charities working for visually impaired people and other statutory and private bodies with an interest in their welfare. They were: Association of Blind Asians, Association of Blind Chartered Physiotherapists, Association of Blind and Partially Sighted Teachers, Association for the Education and Welfare of the Visually Handicapped, Association of Visually Handicapped Telephonists, BBC In Touch, Blind Mobility Research Unit, British Retinitis Pigmentosa Society, British Telecom (Action for the Disabled), Circle of Guide Dog Owners, Disabled Living Foundation, Guide Dogs for the Blind Association, Jewish Blind Society, Leeds City Council (Social Services), National Association of Orientation and Mobility Instructors, National Association of Technical Officers for the Blind, National Blind Helpers League, National Federation of the Blind, National League of the Blind and Disabled, National Library for the Blind, North Regional Association for the Blind, Partially Sighted Society, Resource Centre for the Blind (Strathclyde Regional Council), Royal Blind Asylum and School, Royal Commonwealth Society for the Blind, Royal National College Old Students Guild, Saint Dunstan's, SENSE, Scottish National Federation for the Welfare of the Blind, South Regional Association for the Blind, Standing Conference for Ethnic Minority Senior Citizens, Wales Council for the Blind. Our thanks go to them all.

In the day-to-day tasks of managing the fieldwork and analysing the data we were ably supported by the University of Surrey, the University of London's Westfield College Computing Unit and by many RNIB staff including Elaine Dodds, David Mann, Sheena McBride and Jean White. Getting from first draft to print has been a major task and we are indebted to our editor, Christopher Pick, to Keith Riley and his colleagues of HMSO and to Hilary Todd and her team in the RNIB Publications Unit. Their commitment, support and professionalism have enabled us to complete a work which we hope will be seen as a major landmark in the field of visual disability.

Last but by no means least we owe very special thanks to Duncan Watson who, as RNIB Chairman when the survey was commissioned, gave us every support and encouragement.

Any errors and omissions are entirely the responsibility of the authors.
lan W Bruce, Aubrey C McKennell, Errol C Walker

Notes on the Tables and Abbreviations

Percentages

1. Percentages have been rounded to the nearest whole number; 0.5% is rounded up. As a result many of the tables do not total 100%. The percentages quoted in the tables and text are calculated on the basis of weighted data, not on the numbers of people interviewed (see section 2.5).

2. # =less than 0.5%.

3. Weighted data (section 2.4.1)

Population bases are normally given to the nearest thousand. This is the estimated population numbers for that group.

4. Single or multiple answer questions

Where a total % base, “Total 100”, is shown, only single answers have normally been allowed to the question. Where the population base is shown as “Base = 100%”, multiple answers have been allowed, and single responses in the body of the table cannot be added together. In a number of tables a summary figure is given which adds the respondents giving a group of answers; this represents the total number of respondents giving these answers, not the total responses themselves.

5. Number interviewed

This refers to the number of people actually interviewed who form the base of the column concerned. For example, (595) is the total number of people interviewed for the survey.

Not all questions apply to every respondent. Where respondents have not been asked a question, the total number of respondents is given as a note to the table together with a reason for their inclusion or omission. In a number of cases, respondents simply failed to answer a question, and where applicable this is also noted.

The question(s) that generate the answers given in a table normally forms part of the table. Where a subsequent table simply repeats the data, the question is not repeated.

Summary and Policy Implications

Chapter 1, Introduction

This chapter summarises the objectives of the present survey and its relationship with other major surveys of visually impaired people.

Chapter 2, Method

This chapter reviews the procedures followed for questionnaire construction, sampling, fieldwork and analysis.

Interviews were conducted with 595 registrable visually impaired people aged 16 or over in late 1986 and early 1987. Names and addresses for the sample were obtained from two sources: the OPCS survey of general disability (Martin et al, 1988a) and local authority registers of blind and partially sighted people. Non-registered but registrable respondents were selected on the basis of sight test results obtained in the OPCS survey. The results were weighted to give estimates from the sample to population numbers.

Unless otherwise stated, the results in this report relate to registered or registrable blind or partially sighted people aged 16 and over living in private households in Great Britain. Where the term visually impaired is used without qualification, it means all those registered or eligible for registration as blind or partially sighted.

Chapter 3, Demographic characteristics

Size

This is the first study to produce reliable estimates of the numbers of visually impaired people living in private households in Great Britain. According to Department of Health (DOH) registration figures (section 21.3.2), there are 94,000 blind and 54,000 partially sighted people in Great Britain aged 16 or over. Our results (Table 3.1) suggest 300,000 blind people (319% ~over official registration figures) and 457,000 partially sighted people (8460/~over official registration figures) aged 16 or over in private households. Including residential institutions (section 21.3.3) increases the estimates for the numbers of blind people aged 16 or over to 380,000 compared with the DOH figure of 119,000; and for partially sighted people to 579,000, compared with the official figure of 69,000.-Our estimated total for all those registered or eligible for registration as blind or partially sighted people in Great Britain in 1987 is 959,000.

Age, sex and marital status

Compared with the general population the age distribution of the registrably visually impaired population is heavily skewed towards the older age groups. Sixty-six per cent are aged 75 or over compared with 8% of the general population.

While women form 52% of the general population, they comprise 72% of the visually impaired population. The total increases across the three age groups 16-59, 60-74 and 75 +, from 57 to 68 and 75 per cent.

Fewer visually impaired people are married than among the general population -56 and 74 per cent. The discrepancy widens in the older age group, largely because of widowhood. Fifty-five per cent of visually impaired people aged 60 or over are widowed compared with 30% of the general population of the same age.

Single person households

A surprisingly large number (346,000, 45%) of visually impaired people live on their own (Table 3.5). About a third of the 60-74 age group and half the 75 + age group who live alone have done so for 16 years or more.

The higher percentages of older people living alone have important implications. The chapters in which we enquire about who provides help, for example with reading (9), shopping (14) and with daily living tasks (15), show clearly that as a visually impaired person grows older the sources of help change from someone within the home to a relative or friend outside the home, and on to someone from a statutory or voluntary welfare organisation. This change is also influenced by the decrease in the proportion of older people who have close relatives (Chapter 13).

The implication for the new community care initiative is most striking. The informal care network (relatives and friends) provides help with the support of the statutory agencies. However, for a significant proportion of older visually impaired people, particularly those aged 75 + who require most support, this network simply does not exist.

It is reasonable to assume that the ability of older blind and partially sighted people to live alone is finely balanced. Any reduction in statutory domiciliary support services for this group could well result in a significant increase in demand for residential care.

Income and savings

Fifty-seven per cent of visually impaired people live at the extremes of poverty with a household income of less than £70 per week (1987 prices). The proportion increases across the three age groups 16-59, 60-74 and 75 + from 31 to 49 and 65 per cent (Table 3.5). Over half have savings of less than £500.

Few visually impaired people have any savings with which to cushion their low income and have to meet any extra costs their disability creates out of their already low income. The OPCS survey revealed the low income of disabled people. Our survey shows that it may have underestimated the true cost of disability. The high level of unemployment (Chapter 17) and the dependency on social security allowances and benefits (Chapter 18) illustrates the need for adequate levels of allowances and benefits to compensate visually impaired people for the extra costs they incur because of their disability.

Registration status

Only 23% of the 757,000 visually impaired people living in private households eligible to be registered as blind or partially sighted are in fact registered. Younger people are more likely to be registered, as are blind people. For example, 60% of blind people aged 16 - 59 are registered compared with only 13% of partially sighted people aged 75 + (Table 3.14).

While a larger percentage of younger people is registered, in terms of total population numbers the number of older registered people is far greater than the number of younger registered people.

Although the survey covers people who are registered or who would qualify for registration, people with lower residual vision are more likely to be registered than those at the higher end of the registrable residual vision range (section 3.9.4).

The most significant consequence of registration is its role as a trigger or catalyst in the awareness and receipt of services. This theme recurs whenever respondents are asked about their awareness and use of services. Registered people and younger people are always proportionately more aware of services and use them more. This important finding requires providers of services to visually impaired people to reassess their perspective on registration.

Chapter 4, Accommodation

As might be expected, older respondents have resided longer in their present dwelling. Twenty-five per cent of younger compared with 40% of older visually impaired people have lived in their present dwelling for 21 or more years.

Blind and partially sighted people, especially those aged under 60, are more likely to live in local authority rented accommodation than the general population. Twenty-three per cent of people under 60 in the general population but 40% of visually impaired people are local authority tenants. Among 60-74 year olds the figures are 37 and 54 per cent respectively, among those aged 75+, 37 and 42 per cent.

Since higher-income groups tend to be owner-occupiers this pattern is explained by the lower income level of visually impaired people. If they are unable to buy into the property market, this suggests a need for affordable rented accommodation for visually, impaired people.

Chapter 5, The onset of visual impairment

Reported causes

Respondents were often vague about the causes of their visual impair- ment. One in five of those aged 75 and over mentioned nothing more specific than 'old age'. Most of those answering in this way regard the slow deterioration of their vision as part of the natural process of growing old. Cataracts was the specific cause mentioned most often (35%) by those aged 60 or over (Table 5.1).

In so far as the causes of impairment mentioned represent disorders with a known natural history, their distribution across the age groupings reflects facts about the onset of visual impairment. We would expect to find cataracts, a disease of slow onset, most prevalent in the oldest age group. However, it is worth noting that cataracts are by no means insignificant even among the youngest age group, being mentioned by about 1 in 7 of respondents under 60. The numbers saying that their sight problem started at birth declined sharply with increased age.

Time of onset

The length of time over which the eyesight of visually impaired people deteriorates and the age at which they experience deterioration are both important factors in determining the ability to adjust and the kind of help outside agencies are likely to provide. We distinguish between sudden onset, onset at birth, and loss of sight over a more extended period.

Sudden, traumatic loss of vision (the 'military model') is the experience of a small minority of visually impaired people. Fewer than 1 in 10 said that their condition was the result of an accident (including “falling over”), and only 1 in 20 mentioned another sudden occurrence ('happened suddenly/for no reason at all'). Overall the combined mentions in these two categories amounted to 13% (Table 5.1).

Only 8% reported that their sight loss was 'from birth'. The total was 30% among those aged 16-59, and because of the massive increase in age-related visual impairment decreased to 3% of those aged 75 +.

Progressive deterioration rather than sudden traumatic loss of vision is the onset experience of a large majority (86%). Those whose sight loss had become worse from birth, or was not the result of an accident, were asked at what age they first realised that their vision was causing them problems in everyday life. The age skew among visually impaired people might lead us to assume that all those aged 75 + would be recently visually impaired. This is not so; 22% experienced onset under the age of 60; 36% in the previous 15 years; and 37% in the recent past (the rest could not say).

Medical treatment received for sight

A large majority (81%) had seen a specialist about their eye problem. A substantial but smaller majority (58%) had been hospital outpatients, 33% hospital inpatients, and 49% had received some other form of medication (Table 5.4).

Visually impaired people aged 16-59 and 60-74 are more likely either to have undergone an eye-operation or to have been hospital in- patients than those aged 75+. In the same age groups blind people are more likely to have had one of these 'treatments' than partially sighted people.

Ninety-six per cent of registered people compared with 77% of the non- registered (but registrable) had seen an eye specialist. The fact that so many registrable but non-registered people had visited an eye specialist is significant. It confirms anecdotal evidence that eye specialists do not always initiate the process of registration for many of their eligible patients, i.e. the non-registered (but registrable) are known, but not acknowledged by, the statutory authorities. This suggests that eye specialists could do more to ensure and encourage registration, particularly given its trigger effect. This is especially important for blind people receiving social security benefits, where registration is a passport to higher levels of payments.

Chapter 6, Residual vision

Distance vision

Respondents were asked eight carefully graded questions about how much they could see in everyday situations involving distance vision.

Once lay people and even some professionals realise that all registered blind people are not totally blind, they ask 'how many blind people are totally blind?' Our survey answers this question for the first time, but not before one defines “totally blind”. If sighted readers shut their eyes they will quite reasonably think of themselves as, temporarily, totally blind. However, with their eyes shut they can still sense “from the light where the windows are”. Thus our definition of 'totally blind' includes people who have perception of light but nothing more. On this definition, we can say that 18% of blind people are totally blind; this figure consists of 25% of those under 60 and 14% of those 60 or over.

While only a minority of visually impaired people (19% - 12 and 23 per cent of blind and partially sighted people respectively) can recognise a friend across a road, a majority (66% - 49 and 80 per cent of blind and partially sighted people) can at least recognise a friend at arms length (section 6.1.1). However, the importance of distance recognition should not be over-emphasized by sighted readers who may not realise the extent to which visually impaired people use shape and movement for recognition purposes.

Near vision

Two assessments of respondents' near vision capabilities were made. First, we asked about their visual ability to read newspapers, and, second, we administered a simple large-print reading test.

A surprisingly large proportion of blind and partially sighted people (46% - 27 and 57 per cent of blind and partially sighted people respectively) reported that they could read ordinary newspaper print (Table 6.2).

Seventy-two per cent of respondents asked to take our simple test were able to read the card, and 58% (36 and 75 per cent of blind and partially sighted people) could read it comfortably. Only 22% of blind people age 16-59 could read it comfortably.

One of the key questions faced by service-giving organisations is how far it is necessary to produce large-print documents for visually impaired people, especially blind people. The traditional argument runs that, 'as very few blind people can read, it is not necessary'. Our survey suggest otherwise and quantifies the gains of using large print. This is not a panacea, since reading large print is far more tiring than a sighted person would find. Nevertheless the large-print argument seems proved for substantial numbers of blind people.

These results also point to the importance of low vision aids (LVAs), such as hand-held and stand magnifiers, as well as closed-circuit television magnifiers (CCTVs).

Distance and near vision should be considered in tandem. Because of the wide range of causes of sight loss, some visually impaired people enjoy better distance vision than near vision and vice versa. Many blind and partially sighted people experience a significant reduction in their field of vision. Assessing the field of vision loss was beyond the scope of this survey.

Use of spectacles

Eighty-five per cent of blind and partially sighted people with light perception wear glasses (Tables 6.4 and 6.5), including 78% of blind people aged 16 - 59. Because glasses are so common among the general population, it is important to understand that for visually impaired people spectacles are a prosthesis. Their effect is of a quite different order than for sighted people. They are more like a one-legged person's crutch, allowing some amelioration of the condition, not total correction.

People use their glasses for more than one purpose. About 50% use them for each of the following reasons: reading, other close-up work, and distance vision (Table 6.5).

Use of low vision aids

The hand magnifier is the most-used LVA after spectacles (Table 6.6), by 59% overall. However, the total using a hand magnifier is lower among the younger age group (28 and 44 per cent of blind and partially sighted people respectively). Use of all other LVAs runs at under 5%.

During the reading test the interviewer was asked to code any LVAs actually used. The results in Table 6.10 confirm that the LVA predominantly used for reading is spectacles (59%), followed by hand magnifier (13%); other types of LVA were used by no more than 1 or 2 per cent.

Young partially sighted people and older blind and partially sighted people used LVAs most.

The results give some quantitative indication of the substantial under- use of LVAs. While 59% had a hand magnifier, only 13% used it in the test (Table 6.7). Although the test card was printed in 16 point bold, there is no doubt that more respondents would have been able to read it using their magnifier had they been trained and supported in its use.

When we asked respondents if they had the simplest LVA, adequate lighting in the home, only 20% said 'yes'. The reasons given for not having adequate lighting - never having thought about it and not thinking it would help to confirm that many visually impaired people are not aware of the positive benefit of improving lighting levels. The large total (80%) who have done nothing about lighting levels is a public education opportunity for service-providers. The simple use of adequate lighting alone would bring a marked improvement in the use of residual vision for many visually impaired people.

Chapter 7, Large print

This chapter provides further evidence of the importance of large print. For partially sighted people large print is absolutely crucial. Eighty-nine per cent could read the large-print test card, and 82% normally read print (Table 7.1).

While only 12% of blind people under 60 can read ordinary newspaper print (Table 7.2), 42% read the large-print test card (Table 7.1).

These figures provide a strong argument for organisations serving visually impaired people to produce information material, not merely leisure reading, in print as well as in other media. Most important of all is large print, which doubles the access rate to almost half the blind population.

Chapter 8, Tapes and tape services

Nearly half (46%) of all visually impaired people possess a tape player. Ownership is highest among younger people and decreases across the three age groups, 16-59, 60-74 and 75+, from 83 to 53 and 38 per cent. Twelve per cent have an RNIB Talking Book machine; the figures range from 32% of blind people under 60 to an average 6% of partially sighted people of all ages (Tables 8.1 and 8.2).

RNIB Talking Book Service

These data point to the need for further expansion of the RNIB Talking Book Service. A large number of visually impaired people do not know about Talking Books. Fifty-four per cent (over 400,000 people) have not heard of the service, of whom 23% (90,000 people) would like to try it (section 8.3.3.1).

Social services workers will play a crucial role in increasing member- ship of the RNIB Talking Book Service. Some 43% of existing members were introduced by social services workers.

The reading-rate among Talking Book members, especially those aged 60 and over, is impressively high. Almost half the older group read four or more books per month. Given that each book takes about 12 hours to listen to, book-listening is clearly a major activity of elderly RNIB Talking Book members and indicates the importance of this service.

Some 46% of visually impaired people have a tape player of some kind, 4% only have an RNIB Talking Book player, 34% only have an ordinary tape player and 8% have both. These averages mask some interesting and extreme variations. For example, as many as 60% of registered blind people have or have had a Talking Book machine, compared with as few as 3% of non-registered partially sighted people (Table 8.9.b.). This contrast emphasises once again the importance of registration as a trigger of service delivery.

Use of ordinary tape-players also varies widely. For example, 78% of blind people under 60 use one compared with 29% of partially sighted people aged 60 or over.

The use of tape-players varies considerably. While those who have a Talking Book player (12%) of course use it to listen to books, only 3% of blind and partially sighted people use ordinary tape-players to listen to books. The main uses of ordinary tape-players are music (32% of blind and partially sighted people) and information material such as local talking newspapers, national magazines, letters on tape, telephone numbers (14%).

Chapter 9, Readers

Forty per cent of visually impaired people have printed material read to them by a sighted person. The total varies with age, residual vision and registration status. For instance, 74% of blind people aged under 60 but only 28% of partially sighted people aged 60 or over are read to. Seventeen per cent of all blind people under 60 would like to have reading support for the first time or to have more of it. The data suggest that reading support services should be increased significantly for blind non-readers under 60, and to a lesser extent for older blind non-readers as well.

The most frequent reader is someone else in the house (53%), followed by another relative (27%) and a friend/colleague (17%). Readers vary considerably according to the age of the person read to. Eighty-four per cent of young visually impaired people are read to by 'someone in the household', to the virtual exclusion of all other categories. Among older people, 48% are read to by someone in the household, while another relative (30%) and friend or colleague (19%) now feature significantly.

The extent of informal reading is remarkable. Visually impaired people identify printed material as one of the biggest challenges to daily life. Given the frequent need for access to printed material such a crucial service should be available as of right either as a direct service or indirectly through a financial cost allowance.

Chapter 10, Braille

Our study answers another long-standing question, 'How many people read braille?' We estimate that 19,000 blind and partially sighted people have learnt braille well enough to be able read a braille magazine or book. Thirteen thousand remain active braille readers; 10,000 write in braille (section 10.3).

Braille users are proportionately most numerous among the registered blindaged 16- 59 (81%), and lowest among the non-registered partially sighted aged 60 and over, none of whom have learnt braille (Tables 10.2.a, and 10.2.b.).

There is a comparable success rate of braille learning among adults who experience onset of their sight loss under the age of 17 years and between 17 and 59 years. Given that a significant number of successful learners are at the upper end of the latter age range, these figures suggest two conclusions. First, increased teaching among adults aged under 60 would be likely to produce a fair degree of successful braille readers. Second, since only 1% of visually impaired people aged 60 + are offered braille teaching increased provision for this age group would be likely to produce a reasonable number of successful braille readers.

Seventy-five per cent of braille users read magazines in braille, 72% letters and 70% books; 42% read the braille Radio Times (Table 10.8). Nearly half of working blind people use braille. Approximately 80% of readers also write in braille; a third use a writing-frame, half a writing- machine such as a Perkins, and 1 in 5 use both.

Only 11% of blind and partially sighted people who had not learnt braille said that they would like to. About one-third of these had not learnt because they had not been given the opportunity or did not know how to go about it.

Awareness of braille and Moon

More than 9 in 10 visually impaired people had heard of braille, while Moon was known by fewer than 1 in 10 (Table 10.7). Awareness of Moon was concentrated among younger respondents, and was highest (48%) among blind people aged 16 - 59. Since Moon is considered to be much easier to learn than braille, particularly for older visually impaired people, this low level of awareness gives cause for concern.

Our data suggest that for Moon to become a viable embossed tactile medium, awareness of it must be developed among elderly registrably blind people, the penetration and quality of its teaching must be increased and the supply of relevant magazines and books to learners and readers improved.

Chapter 11, Overview of reading habits and communication media

Reading habits

While Chapters 7 to 10 discussed individual methods of reading, this chapter provides data on their use in combination, thus allowing some judgement on the preferred reading media of visually impaired people.

Blind and partially sighted people differ in the reading media they use most and prefer. Among blind people the most used forms were 'personal reader' (33%), 'ordinary print' (29%) and 'tapes' (24%) (Table 11.1). Statutory and voluntary organisations should note the high mentions of a 'personal reader'; this receives little or no outside support and encouragement and is almost always left to the individual initiative of the blind person. While such initiative should not be discouraged it is important for the statutory and voluntary sectors to expand services in this area, especially given the evidence of unmet need among younger blind people (see Chapter 9).

For 2% of registrably blind people, increasing to 12% of those aged 16 - 59, braille was the most frequent reading form. There are two reasons why braille is not the most popular reading form, even among young people. First, as Chapter 10 shows, only a minority of blind people use braille; second, insufficient braille material is produced.

Among partially sighted people ordinary print is the dominant reading form (60%), followed by large print (30%). Preference for large print was higher among partially sighted people aged 75+ (34%). Personal readers and tapes trailed at 12 and 6 per cent respectively.

It is worth noting that so many partially sighted people benefit from large print. Although the commercial sector recognises the demand for large-print books, they still represent only a small percentage of the total numbers of books printed. Indeed it may justifiably be claimed that the print size on much printed material is not large enough even to qualify being called 'ordinary print'; forms are a prime example.

The fact that 12% of partially sighted people use personal readers strengthens the argument in favour of statutory and voluntary sector involvement in promoting this service.

How much do blind and partially sighted people read?

Respondents were asked whether they read more, less or about the same as before their sight problem began. Overall, 9% said that they read more, 21% the same and 69% less. There was relatively little variation in the responses across age groups, except that 77% of blind people aged 75 + said that they read less.

These data are quite startling. Almost one third (30%) of blind and partially sighted people read the same or more than before. Indeed just over one third (35%) of blind people under 60 said they read more than before. While we should not be complacent about the 69% who read less, that so many read the same or more is a remarkable tribute to the people concerned and to the organisations that supply their needs.

Communication media

Writing media

An estimated 10,000 registered blind people write in braille, 70% of whom are aged 16 - 59.

Although fewer than 5% overall use a typewriter, this figure hides an uneven distribution. For example, 25 and 21 per cent of blind and partially sighted people aged 16 - 59 use a typewriter. Almost all the registered blind who write in braille also use a typewriter.

Although we did not ask specific questions about handwriting, the 58% of blind people aged 16-59 unable to read our large-print card (Table 6.3) suggests the approximate number who either might not be able to write at all or who might find it extremely difficult to write legibly. Furthermore, only 25% of blind people under 60 use a typewriter. These statistics indicate a major unmet need, in our literate world, for typewriter or keyboard training for younger blind people.

Telephones

Telephone ownership among the registered and non-registered is 86 and 67 per cent respectively, compared with 81% among the general population (section 11.2.3.2).

A not-insignificant minority said that the telephone was the 'most' and 'second most' important way of finding things out, 16 and 20 per cent respectively. This suggests that the 28% of visually impaired people without a telephone are at a major disadvantage.

The low income of visually impaired people and the relatively large proportion they spend on a telephone demonstrate its importance.

Relative importance of different sources of information

Personal communication - asking people (85%) and telephoning people (54%) - were the most important sources of information mentioned (Table 11.4). Personal communication divides into informal and formal contacts. The informal category, mentioned about four times as often as the formal, includes 'someone in the household' (32%), 'other relative'(32%) and 'friend or colleague' (21%) (Table 11.6). For younger visually impaired people the dominant source of personal communication is within the household, but moves to someone outside the house for older people.

Social services were the main source of formal information contacts, particularly among the registered. The registered also mentioned voluntary welfare organisations notably more often than the non-registered.

Radio and television were mentioned more often by the younger registered than by other sub-groups. The telephone was mentioned by 12% with little variation across sub-groups.

Chapter 12, Visual impairment and other disabilities

The OPCS study of disability shows that 1,384,000 people in private households have a 'seeing disability'. Our data give a figure of 757,000 registrably visually impaired people. The difference arises because OPCS included about 600,000 people with a seeing disability who could see well enough not to reach the registrable level for partial sight.

The OPCS survey compares the incidence of visual impairment with that of other disabilities. It ranks fifth after locomotion, hearing, personal care and dexterity. Eight other disabilities are less prevalent, including mental handicap and mental illness.

Prevalence rates for registrable visual impairment (i.e. blind and partially sighted) are 3 per 1,000 among those aged 16 - 59; 23 per 1,000, 60 to 74 years; and 152 per 1,000, 75 and over. In other words, 0.3% of the population aged 16-59 is registrably blind and partially sighted; 2.3% of 60 to 74 year-olds; and 15% of those aged 75 and over. The prevalence rate among the 75+ group is startlingly high, and can be assumed to be even higher among people in their 80s.

Vision and hearing are the two senses crucial to communication, one of the most critical functions of humankind. When both vision and hearing are impaired, the individual suffers a truly massive handicap, whose total impact is far greater than the sum of the two individual impairments.

Thirty-five per cent of visually impaired people suffer the additional disadvantage of experiencing difficulties in hearing normal speech in a quiet room, even when wearing a hearing aid. The total increases across the three age groups, 16-59, 60-74 and 75 +, from 22 to 34 and 37 per cent. Our interviewers noted that 45% of those aged 75+ had difficulty hearing the interview.

These figures suggest that people and organisations in contact with very old registrably visually impaired people are justified in assuming that half of the individuals they deal with will be hard of hearing. The communication process adopted by staff will need to be assessed and modified in the light of this finding.

Excluding hearing problems, 67% of visually impaired people have another permanent illness or disability, and 45% say that this illness or disability limits their daily activities (section 12.3.2.2). The illnesses or disabilities most frequently mentioned were arthritis (25%), heart condition (18%), legs/mobility (14%) and diabetes (9%).

These figures represent a major underestimate (section 12.3.2.4). For example, among people aged 75 + hearing impairment averaged 36% by self-report, but rose to 45% as reported by the interviewers.

Chapter 13, Mobility

Orientation and mobility are vital areas of limitation and challenge to visually impaired people, particularly so to blind people. We found that 87% of blind people under 60 had gone out in the week before our interview, although only 51% had gone out alone and on foot. Further analysis of our data and the OPCS survey reveals that the independent mobility of visually impaired people is more restricted than that of the broader disabled population. Only 43% compared with 78% were able to go out on their own (section 13.1.2.2).

Visually impaired people also suffer the added disadvantage of orientation and mobility in unfamiliar surroundings. Seventy-nine and forty-eight per cent expressed confidence in their mobility inside and outside their immediate neighbourhood respectively.

Younger people, partially sighted people, those without other disabilities and the registered are the groups most likely to have gone out alone in the previous week.

Among younger visually impaired people, we found a startling correlation between registration and independent mobility. Among blind people aged 16-59, 70 and 45 per cent of the registered and non- registered respectively had been out alone on foot during the previous week. This is all the more remarkable because the non-registered enjoy slightly better residual vision levels.

There is an expected correlation between mobility training and independent mobility. Among the registered blind aged 16-59, 64% of those who had been trained were independently mobile compared with 45% who had not been trained (section 13.4.1.2).

A comparison with the Gray and Todd survey of 1965 (Gray and Todd, 1968) shows that among young registered blind people the level of independent mobility has not increased over time. This is puzzling given the relative success of mobility training, which was not as widely available in 1965. One hypothesis is that without increased training provision mobility might have declined, perhaps because of actual and perceived increased environmental dangers, e.g. traffic.

Age influences the frequency with which people go out. Across the three age groups, 16 - 59, 60-74 and 75+, 90, 88 and 75 per cent had been out in the previous week. Among the two younger age groups, 58 and 59 per cent had gone out alone, compared with 33% of people aged 75+.

The mobility of older visually impaired people was more restricted than that of elderly people in general. According to Hunt's (1978) study of elderly people, 87% of the general population aged 65+ had been out, while we found that only 42% of blind and partially sighted people aged 60 and over had been out alone in the previous week (section 13.1.2.1). The reasons are both the visual impairment itself and the increased prevalence of other disabilities among visually impaired people.

Visually impaired people are less mobile than disabled people in general (section 13.1.2.2). Even more significant is that 52% of visually impaired people but only 14% of disabled people need help to go out. This finding gives important support to the argument for making visually impaired people eligible for financial help in the form of the mobility allowance.

One vulnerable group identified was blind and partially sighted people living alone. We were shocked to find that 26% (90,000 people) of people living alone say that they are never visited by friends or neighbours and 11% (38,000 people) say that they are never visited by a relative. In addition, blind and partially sighted people living alone were visited no more frequently than people living with a sighted friend or relative. These data say much for the independence of blind and partially sighted people who live alone. They also reveal the apparent absence of an informal support network of a vulnerable sector of society.

In addition, these findings identify elderly blind and partially sighted people living alone as a crucial target group for increased formal and informal support. Lack of such support will hasten an individual's entry into costly residential care.

Mobility training and mobility aids

Use of a white cane or white stick was concentrated heavily among registered (74%) compared with non-registered (8%) people (section 13.4).

Only 5% of visually impaired people overall have received significant mobility training. For registered people aged 16 - 59 the figure rises to 40%, and to 55% for those registered blind.

These findings indicate a drastic lack of mobility training, which is a fundamental requirement for blind and partially sighted people. Given this shortage it is perhaps understandable - but not excusable - that training is offered on an age-related basis. Of blind people in the three age groups, 16-59, 60 -74 and 75+, 33, 18 and 5 per cent had received training.

Thirteen per cent of blind people under 60, and 4% of all blind people, used a guide dog as a specific mobility aid.

The most positive picture to emerge from our study is that an over- whelming majority of blind people under 60 get out and about, and that half are able to do so alone and on foot. This is a reflection not only of youth and determination but also of the greater degree of service offered to this age group.

The most negative picture is of the large number of blind people aged 60 or over and partially sighted people of all ages who receive no significant support in their attempts to be more mobile. These lost opportunities become all the more tragic when set against the relative success of younger blind people. They represent both an indictment of the lack of statutory resourcing and also an underestimate of the capabilities of the people concerned, particularly of the “young elderly” blind. This chapter contains many pointers for service planners and providers.

Chapter 14, Shopping and transport

We explored some basic aspects of shopping and the use of transport. While three-quarters of visually impaired people live within a 15-minute walk of the nearest food shop, 59% rely on others to do their food shopping.

Over half those who do their own shopping reported some difficulty. Old age rather than residual vision was the major variable determining the level of difficulty reported with shopping. The main source of help with shopping was a household member, but as age increased the helper was more likely to come from outside the home.

Blind and partially sighted people use a variety of forms of transport. The main modes are buses and taxis. Among occasional users of transport (i.e. those who did not go out in the last week), the car was most used. In the week before the interview, 59% of respondents had been out by car, 33% by bus, 15% by taxi, 3% by train, 3% by coach and 1%by tube.

Chapter 15, Daily living skills

We asked respondents about three areas of daily living skills: personal care (e.g. getting in and out of bed, washing and bathing, dressing); domestic tasks (e.g. cutting up food, making hot meals, tidying up around the house); and dealing with mail and other tasks (e.g. paper- work including bills and letters, and post and leaflets through the door).

Ninety-one per cent of all blind and partially sighted people experienced difficulty with at least one of these areas. In the three areas, 75, 54 and 59 per cent respectively needed help. For blind people the corresponding totals were 78, 60 and 75 per cent.

We asked who helped in these three areas. As far as personal care tasks were concerned, help came mainly from someone in the house or from the health service. For those aged 16 - 59, someone in the house (78%) was the main source, the health service (25%) the other frequently mentioned source. With increasing age the source shifted to someone outside the home, quite often to someone from one of the statutory welfare services; for respondents aged 75 +, the totals were 26 and 77 per cent respectively (Table 15.3).

Help with domestic tasks showed a similar pattern but with home-helps from social services departments substituting for the health service. However, while 68% of those who needed assistance with personal care were helped by the health service, only 39% of those who needed assistance with domestic tasks were helped by home-helps.

Help with dealing with the mail and other tasks showed a dramatically different pattern, Help from the statutory welfare services was practically non-existent. Someone in the household was the major source of help while other relatives, friends and neighbours filled the subsidiary role occupied by the statutory services in the other two areas.

While the degree of informal support provided by relatives and friends is recognised, the lack of any statutory service alternative is a major gap in provision. The fact that such assistance is required solely by visually impaired people reveals significant, if unwitting, discrimination which should be urgently addressed through a combination of service provision and financial help. (See also Chapter nine.)

Aids and gadgets

Technical aids and gadgets make an important contribution to helping visually impaired people to cope with everyday living. The range and sophistication of these aids varies widely. We examined awareness, ownership and usage of a few of the more popular aids and gadgets available, largely those of interest to blind people and partially sighted people with lower residual vision levels. While awareness of these typical aids was reasonably high among young blind people, it was particularly low among blind people aged 75 +. For example, awareness of special clocks and watches was 75 and 37 per cent among the two groups. Usage of aids runs at a much lower level than awareness. This is to be expected since aids are a personal matter; while some people have no need of them, others are unable to use them.

The impact of registration on awareness and possession of technical aids is remarkable. Taking special clocks and watches as an example, 84% of the registered but only 48% of the non-registered aged 16-59 were aware of them; 31% of the registered but only 2% of the non- registered owned at least one device. These findings provide evidence of the importance of registration as a triggering mechanism.

The overwhelming majority of visually impaired people have difficulty doing everyday tasks. As they age, the combination of the sight problem and other illnesses or disabilities compounds the difficulties they experience. Although aids and gadgets offer only limited help, lack of awareness of them is a failing which needs to be corrected.

Chapter 16, Leisure

Our most notable findings demonstrate that visually impaired people enjoy the same media as the general population. They are, first, that 94% of visually impaired people have a television, and that 90% listen to or watch it, with little variation between blind and partially sighted people. Second, 81% listen to the radio.

The extent of television usage emphasises its significance as a communications medium. It also indicates the importance of encouraging broadcasters not to expand 'vision only' information on programmes (e.g. the use of sub-titles to translate interviews in foreign languages). This also applies to the significant minority of other people who find it difficult or impossible to absorb written or graphic information.

Radio

The radio stations most listened to are local radio (34%), Radio 2 (23%), and Radio 4 (21%), A larger proportion of the two younger age groups listens to local radio (48 and 44 per cent). Proportionately Radio 1 's largest audience was the 16-59 age group (11%).

Television and radio are both vital media through which service-giving organisations reach the visually impaired population. However, BBC Radio 4's In Touch programme, which is designed specifically for visually impaired people, is a highly effective targeted means of communication. Approximately one fifth of all blind and partially sighted people listen to In Touch either occasionally or regularly, and this rises to 75% among those who have heard of the programme. This suggests the need for both the BBC and statutory and voluntary organisations to do much more to promote knowledge of the programme's existence.

Hobbies and leisure activities

Gardening is by far the most popular hobby of visually impaired people. Although it was mentioned by 32%, this rating is in fact lower than among the general population, which suggests that more could be done to promote gardening, especially since it is equally popular among all age groups.

Although knitting would seem an unlikely hobby for blind and partially sighted people, 26%, almost all women, enjoy it. Given the popularity of this hobby it is vital that organisations give this hobby the support that its popularity deserves.

Outdoor sports are widely played by younger visually impaired people. About one-fifth of blind people and one-tenth of partially sighted people under 60 take part in sports such as walking, sailing, skiing and water- skiing, riding, fishing, archery and many others. One reason for the relatively high participation rate is the encouragement provided by schools for blind people and by a wide variety of active specialist sports organisations for blind people. The extent of the success of these organisations, and the fact that a still higher percentage of sighted people participate, suggests that these activities would benefit from further support and encouragement.

Social clubs and centres

Almost half (45%) of blind and partially sighted people go out to clubs, societies, social centres or churches (sections 16.3 and 16.4). Most visited are church or church groups (22%), followed by clubs for the elderly (15%); ordinary social centres/clubs (10%); working men's clubs (7%, men and women); clubs or day centres for visually impaired people (3%); and sports clubs/centres (2% overall, but 17% among young blind people). Frequency of attendance is quite high, over half going at least once a week to all the clubs listed except working men's clubs and blind clubs/centres.

Nevertheless, the 55% who do not visit any club or centre is an unacceptably high figure. A quarter of non-attenders said that they had 'difficulty getting there'. Just over half (56%) said that they were 'not interested'. While this is undoubtedly true in many cases, in a signifi- cant number this explanation may have been given for reasons of self- defence and self-esteem as the individuals concerned lacked ready access to such activities. The challenge facing the organisations involved is to ensure that visually impaired people are able to make a real choice between participating and not participating.

Only 3% of all blind and partially sighted people attend clubs and centres specifically for visually impaired people, although this figure rises to 27% among the registered blind. Once again, registration acts as a passport, although in this case not with a wholly benign effect. This is because we found that, among elderly people, while only 17% of the registered blind went to integrated clubs this rose to 37% among non- registered blind people. We conclude that clubs and centres for visually impaired people should be seen as providing extra opportunities, not as a substitute for attending general clubs.

Social and leisure activities predominate at these separate clubs and centres; 45% of attenders mentioned music and singing; 44%, meeting friends for a chat; 38%, talks; 28%, lunch and lunch clubs; and 23% each, indoor games and handicrafts. However, rehabilitation and training activities were rarely mentioned, even though these might be considered one of the strongest (even the only) argument in favour of separate clubs and centres. We therefore conclude that there is a major opportunity for separate clubs and centres to provide more rehabilita- tion and low-key training activities, especially for elderly people who have recently experienced visual impairment.

Holidays

As many as 38% of visually impaired people have not had a holiday during the last five years. This figure rises to 55% of blind people aged 75+ (Table 16.8), the equivalent of some 113,000 people, mainly women, many of whom live alone. The lack of holidays is not solely age- related, since only 36% of partially sighted people aged 75+ have not had a holiday in the past five years.

Blind people aged 75+ (mostly non-registered) form a key target group for specialised holiday providers.

Overall, 62% of visually impaired people (compared with 40% of the general population) have not taken a holiday in the previous 12 months. This figure includes 68% of those aged 75 + and less than half the 16-59 age group. Only 4% (all registered) said that their most recent holiday was one specially organised for visually impaired people; this figure rises to 16% of registered blind people aged 60 or over. It is older visually impaired people who show the largest preference for hotels catering specially for their needs. This strengthens the case for specialised hotels, which are largely run by voluntary organisations, to attempt to reach the large number of older visually impaired people who have not taken a holiday in the last five years.

Access to leisure services

Visually impaired people follow an exciting variety of leisure and hobby pursuits. However, with the exception of television and radio, there is plenty of room for expansion. Our research also identifies a substantial number of mainly very elderly visually impaired people living alone who never go out for leisure or hobby pursuits and who never go on holiday. Organisations of blind people, and particularly statutory and voluntary service-giving agencies (including those not primarily aimed at visually impaired people) must give these people higher priority.

This group contains a significant number of non-registered blind people. The very act of registration dramatically increases their chances of access to leisure services and activities. All those concerned - ophthalmologists, social service departments and voluntary organisations - must reassess their attitudes towards the registration of older people in the light of the role that registration is shown to play.

Chapter 17, Employment

The OPCS disability survey shows that 31% of disabled people under retirement age are in employment. Our findings reveal that, while the same proportion of partially sighted people are working, far fewer blind people have a paid job (17%). A sighted person is about four times more likely to be employed than a blind person.

Two points should be stressed. First, that 17% of blind people hold a job demonstrates that paid work is feasible for blind people. Second, nearly three-quarters of blind people (72%) who are currently not working have worked in the past, in the vast majority of cases after the onset of visual handicap (Table 17.1).

We discovered one alarming fact about the duration of unemployment. For the general population, short periods of unemployment are interspersed with periods of work. Once out of work, however, visually impaired people find it hard to get another job. Eighty-eight per cent have been out of work for over a year and 55% for more than five years (section 17.3). In addition the last job of 58% of those not working was the one in which their sight failed (section 17.8).

Just over a quarter of visually impaired people lost their last job within two years of onset, and a similar number left their job five years or more after onset.

The data suggest that retention of employment should be a high priority, given the high proportion of visually impaired people in work at the time of onset (section 17.3.1, Table 17.4). At present statutory provision concentrates on finding jobs for unemployed visually impaired people and creating the initial conditions (for example, provision of equipment and training) under which they can take them up.

Our findings suggest that job retention is a neglected area, with support needed to both employers and employees in the crucial period around the onset of the sight problem when the majority of visually impaired people will lose the last job they may ever hold (section 17.3.1).

Statutory and voluntary organisations should devote increased attention and resources to a public education campaign designed to explain to employers, employees and unions the positive steps that can be taken to enable newly visually impaired employees to stay in work. In particular, retraining should be provided free of charge, as already happens with technical aids and the personal reader service (see below).

Occupational structure of visually impaired people

Not only do proportionally fewer visually impaired people work, they also hold fewer professional and managerial jobs and more semi-skilled and unskilled jobs. They are not merely disadvantaged in relation to the general population, but also in relation to disabled ,people in general. For example, 14% of visually impaired workers hold professional jobs, compared with 25 and 34 per cent of the disabled and general populations respectively.

These findings suggest that additional firm positive action is needed to help visually impaired people to obtain and retain work.

Technical aids and other employment services

The survey provides very clear evidence of the importance of special equipment, aids and additional clerical services in helping visually impaired people to find and retain jobs. Working blind and partially sighted people are between three and six times more likely to be using aids and services in their job compared with their out-of-work counter- parts in the job they lost.

This reflects the welcome increased attention and resources provided by the Department of Employment and RNIB. However, their very success suggests that additional efforts to publicise and resource this area are urgently needed. For example, only 23% of working blind people use the additional clerical services including the personal reader service. While the use of special equipment and aids is already high (45%), provision may need to be increased to help blind workers to meet technological change.

Future prospects are not unreasonable for those who manage to stay in employment after onset (Table 17.16). One quarter of people changing jobs gained promotion, one third (32%) moved to a job with similar status and under half (43%) moved to a lower-status job. This is encouraging evidence that, so long as visually impaired people are able to stay in the job market, they can enjoy reasonable expectations and also that employers find their contribution useful.

Chapter 18, Allowances and benefits

Seventy-eight per cent of visually impaired people of working age received some form of state benefit (Table 18.1). Fifty-five per cent of those of retirement age received some form of income maintenance benefit (excluding retirement pension) reflecting their low income level (Table 18.6). Fifty-five percent of those of working age received one or more of the disability-based benefits or allowances. Most strikingly, two- thirds of those not currently in work receive a benefit, which suggests that they are no longer able to work.

In general, visually impaired people depend heavily on state benefits, and a little more so than the disabled population in general.

In view of this heavy dependency, the very low proportion (21%) who have received expert advice on entitlements to benefits is disturbing (Table 18.4). This finding reveals an urgent need to expand benefits advice and support to a group that, besides being vulnerable in them- selves, also has particular difficulty in gaining access to information on benefits and completing claim forms.

Chapter 19, Local authority social services

Awareness of relevant social services

While awareness of 'social services or welfare services' in general was high at 84%, awareness of specific services for visually impaired people was extremely low. One-third of the registered but two-thirds of the non-registered were unaware of the availability of such basic services as white sticks and canes, talking books and local social and day centres.

Once again, registration acts as a trigger, with twice as many registered people knowing about these services. Almost three-quarters of non- registered people (71%) said that they were unaware of the benefits of being registered. Service planners and providers face a substantial and urgent task of increasing awareness of the social services available. If statutory agencies are unable to do this, the voluntary sector should consider taking up this role. In practice, service delivery to the registrable but non-registered must be improved, and registration must be promoted heavily.

Visits by and satisfaction with social services

Overall, only 17% of visually impaired people were visited by their social services department at or shortly after the time of their sight loss. Forty-five per cent of those newly registered said that they had not been visited by social services. Some social services departments may find it difficult to believe these figures. At the very least, we can say that some of those who claim not to have been visited were in fact visited, but the visit made such insignificant impact that they could not remember it.

Another very significant finding is that over 98% of the non-registered (but registrable) were not visited. This is important because a small proportion of social services departments claim that they offer their services equally to the registered and non-registered. While some departments may claim this policy in theory, in practice they are not delivering it.

Forty-five per cent of those registered received a first visit from social services within three months of their examination by an eye specialist. However, 42% were not, or could not remember being, visited (section 19.4.2).

Satisfaction with the first visit was poor. Thirty-four per cent were “very” or “a bit” dissatisfied. This represents a very high dissatisfaction rating (see note 5 to Chapter 19) and ties in with low awareness of services.

Rehabilitation

Four per cent of visually impaired people (35 and 11 per cent of those registered aged 16 - 59 and 60 + respectively) have been offered formal rehabilitation training (section 19.5), although not all offers were necessarily taken up. Only 4% have had a home visit when they were given practical advice and instruction on coping with their sight problem; this increases to 24% among the registered blind aged 16-59. All these are depressingly low numbers.

Since vision loss of registrable severity can take some time to develop, the long interval between initial onset of vision loss and the delivery of practical instruction and advice in the home is worrying. Only 12% received practical instruction within a year, 27% in one to five years, and 42% after 10 years (Table 19.6).

Unsatisfied demand

One-fifth (19%) of the 96% who have not received any practical advice or instruction in the home would like such help. One reason for this relatively low percentage, which reflects a slightly defensive response, is that many respondents, having had to make do on their own, might well have been disinclined to acknowledge their need for help. In absolute terms, however, the 19% represents a massive number of people wanting help.

Fewer than 1% of visually impaired people have received counselling, while a further 23% would have liked it. Demand was greatest among blind people aged under 75 (36%). One in three of this group would have welcomed counselling, but less than one in a hundred received it.

Overall this chapter presents a bleak picture of provision by social services departments. The vast majority of non-registered blind and partially sighted people receive no services, nor do a substantial minority of those registered. Furthermore, client satisfaction with services is low. This evidence combines with other studies of social services departments (Shore 1985, DHSS 1988) to reveal a worrying and unacceptable situation. While good practice certainly exists, it is the exception rather than the norm. The resources available for unmet need appear to be totally inadequate by a factor of three to five. Thus reorganisation or restructuring of services will not provide a solution unless significant additional resources are made available.

Chapter 20, Voluntary organisations involved with visually impaired people

Half our respondents (49%) could not spontaneously name any organisations that help blind people and people with sight problems. Those organisations named by the others included RNIB (22%), St Dunstans (9%), Guide Dogs for the Blind Association (7%) and various local societies for the blind (2%). The figure for RNIB is likely to be inflated because RNIB was mentioned at the start of the interview. A more accurate awareness level would fall between 10 and 22 per cent. (See also note 1 to Chapter 20.)

More registered and younger people named various organisations than non-registered and older people.

Our findings do not confirm the long-standing worry within RNIB that the organisation's title gives the impression that it only helps blind people. The following responses were received to a question about whom RNIB might help: blind people, 93%; partially sighted people, 77%; people who can't see well enough to read, 62%; and anyone who is worried about their sight, 60%.

While understanding of the broad thrust of RNIB's work and the groups it helps is accurate, detailed knowledge is poor. Half were unable to name even one service; this figure varies from 21% of the registered aged 16 - 59 to 60% of the non-registered aged 60 + (Table 20.2).

The best-known RNIB services among the registered aged 16- 59 were: aids and gadgets, 39%; RNIB Talking Books and braille, 24% each; schools 22%; and holidays and hotels, 20%. Nevertheless, RNIB should be concerned that half of all blind and partially sighted people cannot name a single RNIB service. This suggests a need for a major promotional campaign to increase knowledge of RNIB services.

Users of RNIB services

Eighty per cent of those who know about RNIB make use of one or more of its services. This represents 13% of the visually impaired population living in private households, an estimated 100,000 people. Use of services varies. For instance, 72 and 47 per cent among the registered aged 16 - 59 and 60+ use RNIB services compared with 14 and 5 per cent of the non-registered in the same age groups.

Sources of information about RNIB services

Social services workers represent the most important source of information. A quarter (26%) of visually impaired people learned about RNIB from this source. Social workers are thus an important target group if RNIB is to make its services better known. But since they tend to concentrate on registered rather than non-registered people alternative ways of reaching the latter group must be found.

Eleven per cent found out about RNIB via Radio 4's In Touch and other media. These sources offer some scope for development. Opticians may be another key intermediary group. Currently they contribute 4% of introductions. The same applies to doctors (2%).

Although not mentioned above, hospital based 'eye specialists' are in contact with a considerable number of visually impaired people, notably the non-registered (section 5.3). Clubs and centres for elderly people are another possible information source.

Chapter 21, Methodological appendix

This chapter provides detailed technical information about the survey, including a definition of residual vision; the residual vision scale; the questionnaire questions; estimating population numbers from the data; and test.ing for statistically significant differences between percentages.

Part A - Background

1 Introduction

1.1 Objectives of the survey

The purpose of the survey was to assess the needs and views of a nationally representative sample of visually impaired people on a wide range of topics. A number of specific objectives were identified:

  • To provide a national picture of the characteristics of the visually impaired population
  • To examine how the needs of the visually impaired population are being met from whatever source
  • To provide information which will enable RNIB to evaluate, develop and promote its services
  • To give evidence of significant areas of unmet or inadequately met need so that RNIB or other agencies can take steps to ensure that those needs are met
  • To identify problems in obtaining information about services or access to them
  • To identify areas for further investigation
  • To extend and complement the information on severely visually impaired people available from existing data sources, and in particular the OPCS disability survey.

The survey was intended to encompass visually impaired people of all age groups; however, it was felt that the under-16s would require a different questionnaire, so this report concentrates on adults. A survey of children's needs was carried out separately and is the subject of a further report, published as Volume 2.

1.2 Previous major surveys of visually impaired people

There have of course been several previous surveys, the best of which we were able to draw on with considerable advantage in designing our own. The RNIB survey, however, aimed both to collect wide-ranging information on needs and to do so on a nationally representative sample. Previous surveys have achieved one or other of these two aims but never the two together.

Tobin and Hill's (1984) 'pilot' survey of blind people in Birmingham, for example, ranged richly over need topic areas and knowledge of avail- able services. Surveys carried out by local authorities and voluntary societies have been based on much larger samples, and some, like the Hampshire survey (Edge, 1987) have covered a wide range of topic areas, but still on a regional basis.

The surveys that have yielded national statistics, on the other hand, have only done so for a restricted range of topic areas. Hall's (1982) survey covered a large sample at modest cost by drawing from members of the British Talking Book Library. Cullinan's (1977) survey provides useful national data, but it included relatively few visually impaired people who were registered or registrable. The main government sponsored survey of the blind, that by Gray and Todd (1968), in contrast, was limited entirely to registered blind people. The latter survey is still the most thorough study of the mobility and reading habits of blind people, but the coverage was confined to just these two topic areas. Moreover, in what now seems a curious reflection on the welfare priorities of the time, the sample selected for the inquiry had an upper cut off point at 80 years old.

The RNIB survey was timely in that it coincided with the survey of disability undertaken by the Office of Population Censuses and Surveys (OPCS) for the (then) Department of Health and Social Security (Martin et al, 1988a, 1988b, 1989). In the foreseeable future, following its publication, the OPCS survey can be expected to provide the frame of reference for legislation and action on disability. The previous national survey of disabled people took place in 1969 (Harris, 1971). In order to identify a random but representative national sample of people with disabilities both these government surveys involved massive and costly screening operations.

Such screening is well beyond the resources of most organisations outside central government. Because of the wide range of disabilities covered, the amount of information collected on the special needs of visually impaired people is necessarily very limited. If the latest OPCS survey is to be used as a starting point for future action on disability, then more information is desirable on the situation of visually impaired people. We hope our survey, growing as it does out of the OPCS survey, will provide this. Our use of the OPCS survey to provide part of the sampling frame for our own study is described in Chapters 2 and 21, and was possible because of the helpful cooperation and agreement of the DHSS and OPCS.

2 Method

Methodological decisions have a vital impact on the form of results, and for this reason we report fully on these both here and in Chapter 21, the methodological appendix. Those interested primarily in service delivery may wish to omit this chapter, although reading sections 2.4.1,2.4.3.3 and 2.5 will aid interpretation. However, this chapter is crucial for those wishing to reinterpret the data presented here and in the more detailed reports accessible through the Reference Library at RNIB.

2.1 Questionnaire construction

2.1.1 The consultation process

We sought the widest possible consultation on the content of the questionnaire with visually impaired people, their representative organisations and those concerned with their welfare. The consultation process itself went through several steps, which we regarded as an essential part of our research strategy.

2.1.2 The information pack

As a first step, Sally Edge, who had just completed a survey of blind people in Hampshire (Edge, 1987), was commissioned to draw up a list of need headings. The list of 19 headings, produced in the 1986 New Beacon article (Bruce and McKennell, 1986), mostly survived the consultation process and correspond broadly with the chapter headings in this report. The list was circulated for comment to over 30 advisers, each a specialist in one or more of the areas concerned.

On the basis of their comments, we prepared a rough draft of a questionnaire which would be required to do justice to the particular area. These drafts were far too long to be workable, and the next step was to condense them, at the same time producing a short prose rationale of what it was necessary to omit. The shortened, but still overlong, questionnaires, together with our commentary on each need area, were then put together as an information pack. The pack, together with the New Beacon article announcing the proposed survey, was circulated as a consultation document to a further list of organisations and individuals, to New Beacon readers who wrote in to request it, and to the steering com- mittee guiding the research.

2.1.3 Pre-pilot qualitative interviews

Although a standardised interview schedule is essential for a quantitative survey, there is a danger that it can be prematurely standardised around its designers' preconceptions. Although we had taken the experts' views, we believed that we had not sufficiently consulted visually impaired people themselves. Before finalising the pilot schedule, therefore, one of the Survey Directors (AMK) and the Assistant Director (EW) personally carried out conversational interviews with a small but varied sample of 20 visually impaired adults. The 19 topic areas and the experts' views were a guide to issues raised in conversation, but no formal schedule was used. The interviews were non-directive, allowing scope for eliciting from respondents further issues or emphases that seemed important to them. The transcripts of the interviews (which were tape-recorded) were analysed to provide an additional source for the content and phrasing of questions in the largely standardised pilot schedule.

2.1.4 The concept of need

Although the concept of need was central to our enquiry, and to the questionnaire design, it was not possible to proceed from any abstract definition. A literature search (e.g. Bradshaw, 1972; Smith, 1980; Clayton, 1983) shows that there is no single agreed definition of 'real need'. That said, one main distinction does run through the literature, and this can be applied in turn to each of the need areas - defined pragmatically by means of the consultation process. This is the distinction between self-assessed need and comparative assessment of need. To define the former, people are asked directly if they are aware of a need or service, have tried or want to receive the service, or, if already a user, are satisfied with it. Comparative assessments, by contrast, are reached through an evaluation of statistical information on people's circumstances independent of their own perceptions. The questionnaire was designed to allow both types of assessment.

2.2 Sampling

2.2.1 Sources

Names and addresses of visually impaired people who were willing to take part in the survey were obtained from two different sources: the Office of Population Censuses and Surveys (OPCS) (wave 1) and local authority registers (wave 2).

2.2.2 The OPCS first wave sample

The OPCS master sample to which we had access was itself constructed from those who returned a short questionnaire sent (mostly) by post to 100,000 randomly drawn households. Part of the RNIB adult sample was thus a sub-sample of those who identified themselves as having visual difficulties in the OPCS screening. All respondents aged under 60 and half those aged 60 or over who recorded that they had difficulty in recognising a friend across a road, or in reading ordinary newsprint, were visited by the OPCS interviewers and given acuity tests for near and distant vision in their homes as part of a longer interview covering mainly health, social services and income. RNIB was allowed to transfer data from the OPCS questionnaires as they were returned from the field. The transfer sheets covered mainly the sight test results plus some demographic information which allowed RNIB to define its sample. Most of the original OPCS informants had agreed to a further visit by an interviewer at the time of their initial interview, but OPCS decided that they should be given a second chance to opt out by procedures, noted below, that would preserve their anonymity (section 2.2.2.3).

2.2.2.1 Home sight tests

The home sight tests used by OPCS adopted a similar procedure to those used by Cullinan (1977). Distance visual acuity was measured using a standard Snellen card (scaled down for use at 10 feet). For near vision the test type used was the standard 'N' form approved by the Faculty of Ophthalmologists. In each case the card was placed or held 'in such a position that it gets the maximum amount of illumination' (see also section 21.2.1).

2.2.2.2 The RNIB sub-sample boundaries

Only a minority of those reporting difficulties in vision in the OPCS survey are at the low acuity levels that are the concern of RNIB. At a meeting of the advisory group it was decided that the sample selected for RNIB would have a cut-off point at no better than 6/24 for distance vision and N.14 for near vision (the latter being the criterion for membership of RNIB's Talking Book Service).

2.2.2.3 Sub-sampling procedure

The transfer sheets supplied by OPCS contained 2,359 records of individuals, identifiable only by serial number, who reported difficulties with vision. Analysis by RNIB revealed 1,248 respondents who met the residual vision criterion outlined above. These were stratified by residual vision level. We selected all those reporting that they were registered and all the unregistered at the lower residual vision levels but only half those aged 60 or over at higher levels (6/36 Snellen or better).

The serial numbers of these respondents were then given to OPCS. In August 1986 OPCS wrote to these respondents on RNIB's behalf, asking if they were prepared to be re-interviewed. Only a handful refused. The remaining 524 names constituted the sampling frame for wave 1. (The response rate for this first wave fieldwork was 65%, yielding a total of 338 interviews.)

2.2.3 The second wave (top-up) sample

2.2.3.1 The further OPCS segment

The initial intention had been to achieve a target sample of 400 interviews, half aged under 60 and half 60 or over. However, even in the OPCS master sample there were only 160 people aged under 60 within the defined residual vision cut-off points, and after wave 1 fieldwork we were 90 people short in this age group. We therefore decided to 'top up' the sample with a further wave of fieldwork, and at the same time the opportunity was taken to extend the target sample to 600. There were still 67 individuals at registrable residual vision levels available in the OPCS sample, and these were selected for the second wave sampling frame. The remainder of the second wave sampling frame was taken from registers of blind and partially sighted people maintained by local authorities (LAs). This LA sample was mainly drawn with the aim of increasing the number of under-60s registered blind people available for analysis, though there was also some topping up of older registered blind people (see table in section 21.5).

2.2.3.2 The local authority component

A number of local authorities were approached, and these wrote to people registered as blind or partially sighted in their area. A total of 312 blind or partially sighted people agreed to be interviewed, from nine local authority areas - Berkshire, Dudley, Durham, Hampshire, Leeds, Nottingham, Oxford, Northumberland and Waltham Forest. The selection was not totally random, in that all the authorities were 'known' to RNIB, but they did represent a broad cross-section both geographically and in the level of service they were known (from other information) to provide. Although the LA sample cannot be portrayed as a probability sample covering Great Britain of those on the registers, the achieved sample can be re-weighted to obtain a correctly balanced sample by age groups (section 2.4.1). Together with the 'top-up' sample of 67 from the OPCS (all unregistered), the LA sample comprised the sampling frame for the second fieldwork stage. (For further details of the target sample and the response rates see section 21.5.)

2.3 Fieldwork

2.3.1 Timing

The key stages of the fieldwork were as follows:

26 September 1986 first pilot

28 October 1986 second pilot

late November/December 1986 main fieldwork (wave 1)

March/April 1987 main fieldwork (wave 2)

2.3.2 Piloting of the standardised schedule

Following construction of the questionnaire, a standardised schedule was drawn up for the pilot exercise. This, along with the main fieldwork, was carried out under contract by the British Market Research Bureau (BMRB).

Mainly because of the breadth of information to be collected, a two- stage pilot exercise took place. Eight interviews with severely visually impaired volunteers were conducted during each pilot. Care was taken to mix geographical locations and the age and residual vision levels of the interviewees. The small size of the pilot sample enabled each interview to be followed with a degree of attention that more than compensated for the small number. Very experienced BMRB interviewers, mainly fieldwork supervisors, were used and in every case a BMRB executive, or one of the RNIB Survey Directors (AMK) or the Assistant Survey Director (EW), was present. In addition, these BMRB/ RNIB pilot interviews were supplemented by two further interviews conducted independently of BMRB by Sally Edge.

A period of about four weeks was allowed between the first and second pilots, and also between the second pilot and the start of the main field- work. This enabled the experiences gained from the pilot interviewing to be reviewed, and comments from RNIB senior staff who had been sent a copy of the pilot questionnaire to be incorporated. Many questions left open at the pilot stage, for the respondent to answer in their own terms, were closed in the final questionnaire. That is, either coding frames for the interviewer to check or pre-set alternatives for the respondent to choose were incorporated in the final schedule on the basis of replies obtained during the pilot.

Perhaps the most serious problem to arise from the pilot interviewing was the length of the questionnaire. During the first pilot, the interviews lasted more than two hours, which was found to be too taxing for both respondent and interviewer. After each pilot the two RNIB Survey Directors (IB and AMK) and the Assistant Director (EW) considered with BMRB executives the unavoidable deletions and other questionnaire changes. Interview times were eventually trimmed to 95-100 minutes for the main fieldwork stages.

2.3.3 Main fieldwork

All BMRB interviewers on the main fieldwork attended a half-day briefing session, chaired by a BMRB executive. The briefings covered: background to the survey, terminology, interviewing style, contacting procedure and a series of dummy interviews to familiarise interviewers with the questionnaire.

Interviewing on the first stage of fieldwork began in late November 1986, and was completed shortly before Christmas. In total, 338 interviews were carried out. The second stage of fieldwork was carried out in March and April 1987, when a further 257 interviews were conducted, giving a total of 595 interviews. Interviews took place in respondents homes.

Interviewers were instructed to make at least four attempts to contact respondents. Appointments were made by telephone where possible; otherwise interviewers called on respondents personally to make appointments. The overall response rate was 66%. The outcome of all contacts was recorded, and is detailed in section 21.5.

2.3.4 Checking

In total, 52 respondents were re-contacted (either by post or telephone) to check the accuracy of the information collected.

2.4 Analysis

2.4.1 Weighting

Although resources eventually permitted interviews with 595 visually impaired people, it was particularly important that the final sample should contain sufficient numbers of respondents aged under 60 for detailed analysis. A randomly chosen 600, for example, would only have given some 10% in this age group, since most visually impaired people are elderly. The younger age group was therefore deliberately over-represented in selecting the interview sample. To restore the true proportions for tabulation purposes, the numbers of people in each age category have been multiplied by an appropriate weighting factor. More people were available at higher residual vision levels than we needed, so these too were under-sampled and the weights adjusted to restore their true proportions. The weights were finally adjusted by grossing up from the balanced sample numbers to make possible the projection from the sample to population numbers. (See section 21.3 for more detail .)

Table 2.1 illustrates some main effects of weighting. It shows the percentages and actual numbers for the three age groups in the RNIB interviewed sample (A columns), and the corresponding population proportions and projected population numbers resulting from weighting (B columns).

 

A - Age distribution of respondents in the RNIB survey in % (unweighted figures)

A - Age distribution of respondents in the RNIB survey in number (unweighted figures)

B – Population projections from the RNIB survey in % (weighted figures)

B – Population projections from the RNIB survey in number (weighted figures)

Age group

        

16-59

50

(299)

10

77K

60-74

21

(124)

24

180K

75+

29

(172)

66

500K

Total interviewed

100

(595)

    

Weighted population base (K = ‘000s)

    

100

757K

2.4.2 Demarcations

2.4.2.1. Actual and reported registration

The actual registration status is known for the LA sub-sample. At a number of points in the analysis, the OPCS respondents who reported that they were registered blind or partially sighted, and those who reported that they were unregistered, have been classified as if they were reporting their position correctly. The available evidence suggests that errors in classification of registration status through mistaken self- reports are likely to be small in frequency and significance (section 21.9).

Upper limit for registrable partially sighted

We call those sight testing at Snellen >6/24 but unable to read N.12 on the reading test 'N12s' for short. In the OPCS sample there were 167 N12s (see also section 21.2.1). We made a small investment in this group, drawing selectively and achieving 37 among our 595 sample. This is just enough to examine their characteristics further. We then had to decide on the treatment of the N12s with respect to their registrability classification.

Although technically these people fall outside statutory registration limits (in so far as these are determined by Snelien test results), analyses of the original data tape from the OPCS survey showed that some 17% of those reporting that they were registered partially sighted were in fact N12s (Table 21.1 and section 21.2.1). We therefore decided that some N12s should be including our population projections of the registrable but that we would estimate their numbers conservatively. We assumed that 'at the very least' some 5% of the non registered partially sighted would be N12s if these people had had the same opportunity/ willingness to become registered as those who do. The N12s in our sample were weighted accordingly to increase the projected population numbers for the partially sighted by 5%.

2.4.2.3 The dividing line between registrable blind (B) and registrable partially sighted (PS)

The abbreviations B and PS are used in the tables in this report to stand for the registrable blind and the registrable partially sighted. This is the main division by residual vision levels used in the tabulations. The B category combines those actually registered blind and those who are non-registered but whose residual vision is at the statutory levels that render them eligible for registration as blind. The PS category similarly combines the registered and non-registered partially sighted.

For analysis purposes we have to draw a sharp line between the blind and the partially sighted, even though in reality the boundary between them is blurred. This section describes the cutting-points used, and how they were determined.

Figure 2.1 Reported registration status by Snellen categories

bar chart showing reported registration status by Snellen catagories

    Source: OPCS master sample (section 2.2.2)

The general character of the B-PS distinction can be illustrated by the relation between registration and Snellen values. Figure 2.1 charts this relationship for the data from OPCS.

Two main points emerge from Figure 2.1. First, as we would expect, the Snellen category < 3/60 is the one in which the blind predominate. Second, the blind are by no means confined to this level. They are present, albeit in diminishing proportions, at successive Snellen levels. The same holds in reverse for the partially sighted.

While more can be said about the particular set of data in Figure 2.1 (section 21.1), it serves to exemplify the fact that no single criterion other than the actual fact of registration exactly separates the blind and the partially sighted. On any other external criterion we will be dealing with two overlapping distributions. We can expect any body of data relating Snellen levels to registration status to show the same basic pattern -namely, a preponderance of blind at < 3/60 with some overlap into adjacent Snellen categories.

The reason for this result is that a person with visual acuity of < 3/60 is usually regarded as registrably blind. In addition, under the 1948 National Assistance Act a person is defined as registrably blind if he or she is 'so blind as to be unable to perform any work for which eyesight is essential. Thus, over and above visual acuity, the statutory definition of blindness entails considerations of visual field along with vague, less measurable functional criteria.

In the light of the above, we made the following decisions on the criteria for separating the blind from the partially sighted for analysis purposes.

For the LA segment of the sample we used their factual registration status (209 respondents).

For the OPCS sample we used their reported registration status where this was available. The consideration here was that the good approximation (section 2.4.2.1) of reported with factual registration status would render the former a better criterion than any choice of Snellen cut-off values (148 respondents).

For the OPCS segment who reported that they were unregistered we classified those (63 respondents)with Snellen values worse than 6/60 as blind. (For further discussion, see section 2.1.1 .)

The results (including the decisions noted at section 2.4.2.2) in terms of our tabulation is shown in Table 2.2.

 

Sample numbers unweighted figures (B)

Sample numbers unweighted figures (PS)

Sample numbers unweighted figures (Total)

Registered

197

155

352

Non-registered

70

173

243

Total

267

328

595

2.4.3 The choice of classificatory variables

2.4.3.1 Strategy for an initial sift of the data

Based on a questionnaire containing more than 4,000 items of infor- mation, the survey can be considered as a rich mine of potential information. Only a limited amount can be extracted and sifted in this first report. The main strategy adopted for this initial data sift is the choice of a standard classificatory variable based on age and residual vision, against which items in each need area can be broken in one computer run, and the selection for comment of breakdowns that prove diagnostic. The shape of findings in one need area can then be related to other need areas.

2.4.3.2 Breakdowns by blind-partially sighted within three age groups

Age and residual vision were used as stratification variables at the sample design stage with a view to maximising the numbers available for analysis within these categories. Further, we were confident that age and residual vision would prove important in policy and practical considerations. The 'standard head' used for analyses within three age groups and two residual vision categories contains the data shown in Table 2.3.

 

Age (16-59) B

Age (16-59) PS

Age (60-74) B

Age (60-74) PS

Age (75+) B

Age (75+) PS

All ages B

All ages PS

Total

Unweighted

137

162

55

69

75

97

267

328

595

Weighted (K)

30

47

65

115

205

295

300

457

757

The unweighted data are the numbers interviewed and the weighted data are the population projections (K = '000's). For definition of the B and PS categories see section 2.4.2.3

It is possible to make a more refined analysis by age and/or residual vision, but the basis for percentaging becomes rather thin unless we collapse categories for one or other of the variables. For example, we have the capability (see Chapter 6) to sub-divide the B category into those with and those with no light perception (NLP). But in the 60-74 group there are only 55 blind people altogether, and those with and without light perception are 31 and 24 respectively. The latter group is too small reliably to detect any but the most massive differences. Generally we only reported on more refined breakdowns of this type where differences were marked enough to be clearly reliable. Steep gradients between blind and partially sighted sub-groups, within the same age band, usually imply difference at lower levels of residual vision, i.e. between those with no light perception and others in the blind category.

2.4.3.3 Scope of the analysis

Visually impaired people are unique as individuals, and vary importantly in ways relevant to their needs in other dimensions besides age and residual vision level. Prime examples are: onset of visual loss; age (age at onset, duration of loss); presence or absence of other disabilities; living alone or with others; registered or non-registered. Breakdowns have been done on the standard basis for the registered/non-registered variable, and differences are noted accordingly in this report. But in order to complete within a finite timescale we have treated the other possible standard cross-breaks on an inference basis in the same way as for potential cross-breaks between need areas. In other words, we have examined the distributions on the primary variable and drawn inferences for findings on other variables without, as a rule, making the necessary cross-tabulation to check these.

2.5 Presentation of results

The percentages and other proportions in this report are based on weighted figures, unless otherwise stated. That is, they relate to the whole visually impaired population or to some defined section of it. To obtain an estimate of the corresponding population number, therefore, the percentage finding can be multiplied by the population numbers shown as the base figure in the tables.

For simplicity we refer to 'the percentage of respondents', though this should be understood as shorthand for a more accurate but ponderous expression such as 'the numbers of respondents weighted to represent population numbers and percentaged on the weighted population total'. The key point is that 'percentage of respondents' means, unless other- wise stated, our best estimate of the percentage of visually impaired people living in private households in Great Britain with the particular characteristic concerned.

Significance tests (section 21.4) should be based on the actual numbers interviewed (unweighted figures). Both weighted and unweighted base figures are shown in the major tables.

While data have been analysed in terms of the age/residual vision six- category standard head (section 2.4.3.2), not all tabulations show results in terms of these six categories. Separate columns of data are presented only where real differences can be noted and discussed. Adjacent age and/or residual vision categories have accordingly been collapsed where the initial tabulation showed no significant differences (section 21.4).

Most tables show the precise question wording that generated the data. The question number is always quoted, and the precise wording can be found in the questionnaire, a copy of which can be obtained from the RNIB Reference Library.

3 Demographic Characteristics and Registration

3.1 Size of the visually impaired population

Perhaps the most startling conclusion from this study relates to the number of visually impaired people in the population. An earlier report by Shankland Cox (1985), commissioned by RNIB, concluded from desk research that official registration figures underestimated 'true'figures by 30% in the case of blind people and by 20% for partially sighted people.

This study produces, for the first time, reliable estimates, based on fieldwork, of the number of visually impaired people in Great Britain. Official registration figures suggest (section 21.3.2) that there are 94,000 blind and 54,000 partially sighted people aged 16 or over in private households. Our results (Table 3.1) predict 300,000 blind people (319% above official registration figures) and 457,000 partially sighted people (846% above official registration figures) aged 16 or over in private households. When residential institutions are included (section 21.3.3), our estimate for the numbers of blind people aged 16 or over increases to 380,000, 319% higher than the official (1986 DHSS) figure of 119,000; for partially sighted people the increase is to 579,000, 839% higher than the official figure of 69,000.

The entries in Table 3.1 are population projections obtained by applying weighting procedures to the RNIB sample data as outlined in section 2.4.1 (and described more fully in section 21.3). The definitions of registrable, and the demarcation between blind (B) and partially sighted, (PS), are discussed in section 2.4.2. (For a corresponding unweighted table, i.e. showing the distribution for the 595 interviews, see section 21.9.)

The policy implications of this discovery of a massive unrecognised visually impaired population are significant for both service planning and service delivery. Providers may argue, rightly, that services are open to the non-registered. However, results reported later (in Chapters 7 - 18 and, in particular, 19 and 20) show that in fact services only reach a small proportion of non-registered people. If services are to be delivered on the basis of equality of need, resources must be substantially increased to approximately three times the current level. These findings will also radically affect service planning. For example, specialist worker numbers tend to be judged on a ratio basis of the numbers of people registered blind or partially sighted (e.g. one worker to 250 or 400 registered) rather than the actual numbers who may be eligible for registration. The age distribution reported later in this chapter and else- where will also introduce new factors to be taken into account when planning services.

A more detailed analysis of registration status by age and residual vision levels is given in section 3.10.

 

Age (16-59)

Age (60-74)

Age (75+)

Total

*Registered B

18

28

63

109

*Registered PS

12

15

34

61

Total Registered

30

43

97

170

**Non-registered, Registrable B

12

37

142

191

**Non-registered, Registrable PS

35

100

261

396

Total non-registered

47

137

403

587

Total registrable VI

77

180

500

757

(Number interviewed)

(299)

(124)

(172)

(595)

*DHSS published figures reduced by estimate of numbers in residential institutions (see section 21.3.3).

** Estimates derived from OPCS sample applying OPCS weighting procedures and results of home sight tests (section 21.3.2)

3.2 Age distribution

Table 3.2 documents the well-known fact that, in comparison with the general population, the distribution of visually impaired people is enormously skewed towards older age groups. There are no significant differences between residual vision levels. Chapter 12 provides further data comparing the age distribution of visually impaired people with that of people with other disabilities and shows that visual impairment is more age-related than virtually any other disability.

 

Visually impaired population (RNIB survey weighted data) in %

General population in %

16-59

10

74

60-74

24

18

75+

66

8

Total %

100

100

Base (population)

757K

42,903K

(Number interviewed)

(595)

  
3.3 Sex and age

Tables 3.3.a, and 3.3.b, compare the sex distribution of the visually impaired population with that of the general population. In each age group there are more visually impaired women than men; the difference is greater than in the general population, and increases in the older age groups. Even in the 16-59 age group, where women make up half the general population, they number 57% among visually impaired people (the difference is 'statistically significant'). Women comprise 68% of visually impaired people in the 60-74 age group compared with 55% in the general population, and 75% of visually impaired people compared with 66% of the general population among those aged 75+. Thus, among those aged 75+, three out of four visually impaired people are women compared with two out of three in the general population. But because the visually impaired population is so massively skewed towards the very old, the disproportion of females overall resembles that in the oldest group. Thus 72% of the total visually impaired population are women compared with 52% in the population as a whole.

 

Age (16-59) in %

Age (60-74) in %

Age (75+) in %

Total

Males

43

32

25

28

Females

57

68

75

72

Total %

100

100

100

100

Base (population)

77K

179K

501K

757K

(Number interviewed)

(299)

(124)

(172)

(595)

 

Age (16-59) %

Age (60-74) %

Age 75 %

Total

Males

50

45

34

48

Females

50

55

66

52

Total %

100

100

100

100

Base (population)

3,184K

7,797K

3,259K

42,903K

3.4 Marital status

Table 3.4 shows that even in the 16 - 59 age group fewer visually impaired people are married, 56% compared with 74% in the general population. The discrepancy widens in the 60+ age group; only 33% of visually impaired people compared with 59% of the general population are married.

 

Visually impaired population (RNIB survey) Age (16-59) %

Visually impaired population (RNIB survey) Age (60+) %

General population (GHS 1985) Age (16-59) %

General population (GHS 1985) Age (60+) %

Single

26

10

18

8

Married

56

33

74

59

Widowed

9

55

2

30

Divorced

9

2

6

3

Total %

100

100

100

100

Base (population)

77K

680K

    

(Number interviewed)

(299)

(296)

13202

5222

In line with what we know of the age skew of the visually impaired population, widowhood now becomes the main explanatory factor. Some 55% of visually impaired people aged 60 + are widowed compared with only 30% of the general population. (GHS data are for 1985, their Table 3.3; a breakdown for over 60s is not given.)

Further breakdown by age of the data shows that 61% of visually impaired people aged 75 or more are widowed (about 300,000 people). This compares with a figure of about 57% for widows in the general population in this age group (Hunt, 1978). Our figures include both sexes, but, as section 3.2 shows, three out of four visually impaired people in the 75+ age group are women.

Service planning and delivery need to take particular account of the fact that well over half of visually impaired people over 60 years are widowed and therefore lack the support and companionship they previously enjoyed.

3.5 Single person households

Equally, if not more, important than marital status for their informal support network is whether or not visually impaired people live on their own. A remarkable number, 45% or about 346,000, live on their own. Table 3.5 shows that the percentage increases incrementally with age, from 19% for the under 60s to 44% of those aged 60-74. Among those aged 75 and over, who carry the double burden of extreme old age and reduced vision (and in many cases of other handicaps as well - see Chapter 12), 50% (about 250,000) live on their own. However, as discussed further in section 4.1, the ability of many of these elderly visually impaired people to cope may be aided by their continuing to live in accommodation with which they have long been familiar.

 

Age (16-59) %

Age (60-74) %

Age (75+) %

Total

Years lived alone (5 yrs or less)

5

16

8

9

Years lived alone (6-15)

8

14

17

15

Years lived alone (16 0r more)

6

14

25

21

Reason lives alone: Widowed

2

31

42

35

Reason lives alone: Other

17

13

8

10

Total living alone

19

44

50

45

Total living with others

81

56

50

55

Total %

100

100

100

100

Base (population)

77K

180K

500K

757K

(Number interviewed)

(299)

(124)

(172)

(595)

Comparative data suggest that more visually impaired people live on their own than others in similar age groups. Why this is so is not clear. Hunt's (1978) survey suggested that 25% of the general population aged 65-74, and 38% of those aged 75 or over, were living in one person households, compared with the 44 and 50 per cent respectively our survey finds for the same age groups.

We noted in section 3.4 that just over half visually impaired people aged 60 or over report that they are widowed. This is the primary reason people in this age group give for living alone. A comparison of Tables 3.4 and 3.5 suggests that the 17% of the 16 - 59 age group who live alone do so primarily because they have never married, and only secondarily because they are widowed, separated or divorced.

About a third of the 60- 74 age group and half the 75 + age group who live alone say that they have done so for 16 years or more.

We found little relationship between living alone and the level of residual vision. This serves to emphasise the point that blindness is not in itself any reason to prevent a blind person of any age living alone. Far more important are other factors such as mobility (Chapter 13), the level of contact with the welfare services and the strength of the individual's social support network (Chapters 16 and 19), the age of onset of the visual handicap (Chapter 5), and the presence of other disabilities (Chapter 12).

3.6 Employment status

Table 3.6 provides a crude measure of the employment status of those people in the sample aged under 60. Twenty-one per cent of blind people and 29% of partially sighted people are in full-or part-time work. (About 2% of those aged 60 - 74 said that they were working full-time, but no part-time workers were found in this group; 1% of the 75+ group said that they were working part-time.) Perhaps most surprising is the similarity of the status of the blind and partially sighted respondents (the differences do not reach 'statistical significance' with these sample sizes - see section 21.4). The most significant conclusion to be drawn from Table 3.6 is that about 75% of those under 60 are not working.

 

Age and residual vision (16-59) B in %

Age and residual vision (16-59) PS in %

Full time work

16

22

Part-time work

5

7

Not working

79

69

Studying

1

2

Total

100

100

Base (population)

30K

47K

(Number interviewed)

(137)

(162)

    (299 respondents: 296 aged 60+ were excluded)

This is a crude statistic because the category 'not working' includes many people who may not be available for work or who are unable to work. Chapter 17 shows that a large proportion of those 'not working'do in fact wish to work.

Nevertheless, the proportion of visually impaired people not working (approximately 75%) compares very unfavourably with the proportion of people not working in the general population of 31% (CSO, Annual Abstract of Statistics, 1990). The fact that about one quarter of visually impaired people aged under 60 are in work shows clearly that barriers to employment can be overcome. The service-planning and delivery implications in these figures are that more attention needs to be paid to enabling visually impaired people to take up paid employment.

3.7 Income and savings

Table 3.7 shows that nearly three-quarters (72%) of those aged 16-59 lived in households whose net weekly income was less than £139. The average weekly working wage at the time the survey was conducted was about £200. Thus, even visually impaired people of working age live at a very low standard compared with their contemporaries.

 

Age (16-59) in %

Age (60-74) in %

Age (75+) in %

Total

Under £50

16

38

43

39

£50-inder £70

15

11

22

18

£70-under £139

41

46

31

36

£139-under £200

18

4

2

4

£200-under £400

9

2

2

3

£400 or more

2

0

0

#

Total

100

100

100

100

Base (population)

51K

160K

330K

540K

(Number interviewed)

(214)

(99)

(120)

(433)

    (433 respondents: 46 refused, 102 didn’t know, 14 no information)

We should also remember that these are household incomes; we noted (section 3.4) that 81% of younger visually impaired people live with others. Some 29% of the16-59 age group do have incomes above £139 (mostly between £139 and £200) compared with about 5% of those in older groups. The higher household income may be where younger visually impaired people are working or, in a large number of cases, where they are living with others. The numbers living at the extreme poverty level of under £70 per week increase from 31% in the age group 16 -59 to 49 and 65 per cent in the 60-74 and 75 + groups respectively. The increment is 'statistically significant' (section 21.4) for each age step.

Breakdowns by residual vision are reported only where statistically significant differences are encountered (following the procedure in section 2.5). Table 3.8 shows that marginally more partially sighted people than blind people have incomes below £70 per week in both the 16 - 59 (36 and 22 per cent) and 60 + (67 and 49 per cent) age groups; the difference reaches 'statistical significance' (21.4) only in the latter age group.

 

Age and residual vision (16-59) B in %

Age and residual vision (16-59) PS in %

Age and residual vision (60+) B in %

Age and residual vision (60+) PS in %

Total

Under £50

14

17

36

45

39

£50-under £70

8

19

13

22

18

£70-under £139

46

39

45

30

36

£139-under £200

16

19

3

2

4

£200-under £400

16

4

4

1

2

£400 or more

2

2

0

0

0

Total %

100

100

100

100

100

Base (population)

19K

32

186K

327K

565K

(Number interviewed)

(98)

(119)

(90)

(136)

(443)

    (443 respondents: 46 refused to answer, 102 didn't know, 4 no information)

Table 3.9 shows that, of the visually impaired population as a whole, 53% have savings of less than £500, and a further 19% no more than £1,500. Twelve per cent have savings of more than £6,000, among whom are 16% of the 75 + group, compared with 6-7 per cent in the younger groups.

Thus very few visually impaired people have any substantial savings with which to cushion their meagre incomes. Since they will have to meet any extra financial costs arising out of their disability, a picture of extreme financial hardship emerges. This confirms the findings of the OPCS survey of poverty among disabled people in general, and visually impaired people in particular. However, our findings suggest greater hardship among visually impaired people than OPCS found. This gives further support to the widely held view that OPCS methodology under- estimated the extent of poverty and the extra costs which disability brings. Nevertheless both surveys indicate that the vast majority of visually impaired people are poor. This is because their incomes are low and in addition they have to meet extra costs resulting from their visual impairment.

 

Age (16-59) in %

Age (60-74) in %

Age (75+) in %

Total

Up to £500

63

60

46

53

£501-1500

11

11

23

19

£1501-3000

13

9

10

9

£3001-6000

6

14

5

7

£6000 plus

7

6

16

12

Total %

100

100

100

100

Base (population)

54K

130K

343K

526K

(Number interviewed)

(221)

(88)

(117)

(426)

    (426 respondents: 169 respondents did not know or refused to say)

3.8 Education

Table 3.10 shows the effect of raising the school-leaving age to 15 in 1947 and to 16 in 1972. The majority of the 16-59 age group left school at ages 14 to 16, while the majority of those in older groups finished full-time education at 14 years of age or under. As many as 27% of the 16-59 age group have been in full-time education beyond the statutory school leaving age. Among the older age groups there is a smaller, but still substantial, sub-group, amounting to about 12 to 21 per cent, who finished full-time education after the statutory school-leaving age.

 

Age (16-59) in %

Age (60-74) in %

Age (75+) in %

Total

Age finished full-time education (14 or under)

33

74

74

69

Age finished full time education (15)

27

5

7

10

Age finished full-time education (16)

13

8

5

7

Age finished full-time education (17 or over)

25

13

12

14

Still studying

2

0

0

#

Total %

100

100

100

100

Base (population)

77K

179K

501K

757K

(Number interviewed)

(299)

(124)

(172)

(595)

Our sample contained 138 respondents who acquired their visual impairment during or before their school years. This yields a projected figure of about 10% of the visually impaired population, that is 74,000 people (sections 5.2.2 and 5.2.3). Of this sub-group only about one-third said (at GRQ5) that they had attended a special school for the handicapped. In 60% of these cases the school was a special school for the visually handicapped.

Table 3.11 School or college examinations passed

(Comparable data for those not in full-time education aged 25 - 49 are shown for Great Britain)

'Can you tell me about any school or college examinations you have passed - have you passed...?' (GRQ6)

Table 3.11 School or college examinations passed

 

Age (16-59) in %

Age (60-74) in %

Age (75+) in %

All VI in %

GB age** (25-49) in %

CSE

7

-

-

1

12

O level

26

18

10

13

19

A level

10

2

3

4

9

Teaching Diploma

4

-

2

2

Na

Higher education below degree

na

na

na

na

Na

Degree Foreign or other

7

1

2

2

10

Some exam passed

30

19

10

14

65

No exam passed

70

81

90

86

35

Total %

100

100

100

100

100

Base (population)

77K

179K

501K

757K

  

(Number interviewed)

(299)

(124)

(172)

(595)

15,292

    **Highest qualification level of those not in full-time education aged 25 - 49 in Great Britain (OPCS 1986)

    'na' category for comparison not available in both surveys

For the question in Table 3.11, respondents were prompted from a list of 10 types of examination (See GRQ6). In the table, CSE grades 1 and 2 have been combined, and Scottish Low Grade and High Grade certificates have been combined with O and A levels respectively.

Levels of residual vision (B and PS) have been combined, following our routine procedure (see section 2.5), in the above tables because no systematic differences were detectable in the data.

3.9 Social status

Because a mixture of income, occupation and education and family background are involved, social grade, status or class have proved a difficult concept for social researchers to define exactly. After much consideration, BMRB decided (for routine fieldwork practice) to define the family unit's social status by the occupation of the head of the household (that is, the head of the family unit or the senior bread- winner). The social class gradings in Table 3.12 were made by the interviewer on the basis of information collected (at GRQ7) on the occupational details of the head of the household. (The BMRB handbook issued to each interviewer contained detailed instructions for coding the social grade from this information.)

On the BMRB scheme, a household is defined as a group of people who live in the same dwelling and who are catered for by the same person. Every household has a head who must be a member of the household. The head is defined as the member who owns or is responsible for the accommodation occupied by the household. It should be noted that a household does not necessarily consist only of people related by blood or by marriage, and that it can consist of only one person.

Using this classification scheme, BMRB finds that the general population falls into their grades as follows: A (upper middle) 3%, B (middle) 14%, C1 (lower middle) 23%, C2 (skilled working) 26%, D (semi-skilled and unskilled) 16%, and E (pensioners etc) 18%.

 

Age (16-59) in %

Age (60-74) in %

Age (75+) in %

All ages in %

GB* Households in %

A Upper middle

1

1

2

1

3

B Middle

4

2

8

6

14

C1 Lower middle

16

22

18

19

23

C2 Skilled working

21

15

14

15

26

D Semi and unskilled

20

15

7

10

16

E Pensioners, all not working

38

45

51

49

18

Total %

100

100

100

100

100

Base (population)

77K

179K

501K

757K

22,600K

(Number interviewed)

(229)

(124)

(172)

(595)

  

    *Source: BMRB Target group household survey; household social grading

Of primary interest to the present study are the numbers of visually impaired people who fall into grade E. On the BMRB scheme this grade consists of old age pensioners, widows and their families, and those who, because of sickness or unemployment, depend on social security schemes. There are far more visually impaired people in this grade than in the general population at all ages. The extent of representation is quite startling taking account of the age skew, and is because of the large numbers of visually impaired people receiving social security benefits.

However, if the current income and occupation of visually impaired people themselves were the only factor, we know from sections 3.5 and 3.6 that the great majority would be in grade E. Yet more than a half fall into a higher social grade. They do so because of two factors on the BMRB definitional scheme: first, respondents take the social grade of the head of the household, and, second, what counts here for the retired is their previous occupational status. For these two reasons, therefore, the social status of many visually impaired people is at a higher level than would be apparent from their low incomes.

Visually impaired people are not vastly under-represented in the A, B, C1 categories compared with the general population (26% compared with 40%). However, there is a notable under-representation among the C2, D and E categories (25% compared with 55%). This suggests that efforts made to increase the representation of visually impaired people in manual trades over the last five decades, while partially successful, have not succeeded in comparison with work placements requiring more cerebral skills.

3.10 Registration status

3.10.1 Proportion of visually impaired people registered

Table 3.13 shows that, out of the estimated visually impaired population of 757,000 living in private households, only 23% are registered as either blind or partially sighted, and 77% are unregistered. The percent- age registered also declines with increasing age: from 37% of those aged 16 - 59 to 24 and 19 per cent of those aged 60-74 and 75 + respectively.

An important finding of this survey is the role of registration as a catalyst or trigger in the awareness and receipt of services to visually impaired people. While registration itself conveys few benefits, our survey constantly shows that it is registered blind or partially sighted people who are more likely to be aware of or in receipt of these services than the non-registered. Registration brings blind and partially sighted people into the realm of service provision for visually impaired people. Their non-registered, though registrable, counterparts are excluded from, or not made aware of, these services.

 

Age (16-59) in %

Age (60-74) in %

Age (75+) in %

Total

Registered (B or PS)

37

24

19

23

Non-registered (B or PS)

63

76

81

77

Total %

100

100

100

100

Base (population)

77K

180K

500K

757K

(Number interviewed)

(299)

(124)

(172)

(595)

    Data include all visually impaired people at registrable blind or partially sighted levels (section 2.4.2)

3.10.2 Registration status and residual vision

The last two columns of Table 3.14 show that the percentage of partially sighted people registered is lower than that of blind people: 36% of those eligible at blind (B) registrable levels are registered, compared with 13% of those at partially sighted (PS) levels. (B and PS levels are as defined in section 2.4.2.)

 

Age and residual vision (16-59) B in %

Age and residual vision (16-59) PS in %

Age and residual vision (60-74) B in %

Age and residual vision (60-74) PS in %

Age and residual vision (75+) B in %

Age and residual vision (75+) PS in %

All ages B in %

All ages PS in %

Registered

60

25

43

13

30

13

36

13

Non-registered

40

75

57

87

70

87

64

77

Total %

100

100

100

100

100

100

100

100

Base (population)

30K

47K

65K

115K

205K

295K

300K

457K

Number interviewed

(137)

(162)

(55)

(69)

(75)

(97)

(267)

(328)

3.10.3 Registration status, age and residual vision

Table 3.14 shows that in the three age bands (16-59, 60-74 and 75 +) 60, 43, and 30 per cent respectively of those eligible to be registered as blind are actually registered. The corresponding totals for partially sighted people are 25, 13 and 13 per cent respectively.

Thus the chances of being registered vary with both age and residual vision level. Only among registrable blind people aged 16-59 is a majority (60%) actually registered. At the other extreme, of those eligible for registration as partially sighted only 13% of those aged 60 or over actually are registered.

The relationship between age, residual vision level and registration status is discussed further in note 1. It may be noted, however, that there is no correlation between age and residual vision level. Young visually impaired people are no more likely to be at low levels of residual vision than the elderly. The concentration of registration among blind people aged under 60 is the result of two independent tendencies: higher registration among the young and higher registration among people with low residual vision. The coefficients of association fit a causal model in which age and residual vision have independent effects on registration. However, there is no joint effect due to any correlation between age and residual vision; by statistically testing we found that age and residual vision acted separately on the likelihood of being registered rather than together.

Concentration of registration among young people is relative. A young blind person is far more likely to be registered than an old blind person. But, in absolute terms, there are far greater numbers of elderly blind registered people. Because of the skewed nature of the age distribution of visually impaired people (section 3.2) a much smaller percentage registration generates far greater actual numbers of people aged over 60 who are registered. Table 3.1 shows that of the estimated 109,000 registered blind people living in private households, only 18,000 are aged under 60.

3.10.4 Snellen values and registration status

Although the data in Table 3.15 have been assembled from several sources, the estimates it contains can be regarded as approximately correct (see note 2). It is important to distinguish those parts of the B/PS distributions which are merely a consequence of the decisions on cutting-points adopted, as described in section 2.4.2. To recapitulate, the non-registered in our sample with Snellen values worse than 6/60 were classified as registrable blind (as discussed in section 2.4.2.3 and more fully in section 21.1). This was done because analysis showed that a lower cutting-point would have excluded many of the registered blind, and we wished to treat the non-registered on the same basis. (For example 27% of registered blind people have a Snellen acuity of better than 3/60.) The dotted line that marks this cutting-point in Table 3.15 shows that it correctly classifies all but 10% of the registered blind. By the same definition we have done the best job possible of correctly classifying our unregistered but registrable blind by their Snellen values. (As noted in section 21.1, the gains here are at the necessary cost of putting some people into the registrable blind category who would have been classified registrable partially sighted with a lower cutting-point.)

 

Registration status and residual vision R (B in %)

Registration status and residual vision R (PS in %)

Registration status and residual vision NR (B in %)

Registration status and residual vision NR (PS in %)

NLP*<3/60

25

-

-

-

NLP<6/60

48

17

30

-

NLP6/60

17

23

70

-

NLP6/36

5

17

-

10

NLP6/24

3

17

-

40

NLP>6/24<N12

1

9

-

40

Total %

100

100

100

100

Base (population)

109K

61K

192K

395K

(Number interviewed)**

(102)

(120)

(70)

(173)

    *NLP. No light perception (can’t see windows)

    **Table constructed partly from original OPCS master sample.

    See note 2

The difference, 17% of registered and 5% of non-registered (but registrable) partially sighted people respectively falling into the category >6/24 Snellen but less than N12 reading ability (the N12s for short), is a concomitant of our design decisions. Seventeen per cent of registered partially sighted people fall into this category even though it is beyond the statutory limit. As discussed in section 2.4.2.2, given the already very large number of the non-registered partially sighted being estimated, we deliberately aimed at a conservative assessment of the number who might fall into this category outside the statutorily defined limit.

The remaining characteristics of the distributions over Snellen levels in Table 3.15 are independent of our imposed definitions. The zero point in the questionnaire scale, marking out those with no light perception (see section 6.1.1.), can be combined with available Snellen measures to separate levels of residual vision below the < 6160 cut-off point. When this is done, as in Table 3.15, the fact emerges that, while 25% of people registered blind are without light perception, none of the non- registered falling within this boundary for blind registration have sight loss as extreme as this. In other words, those whose sight loss does place them inside the range eligible for blind registration are more likely to be registered if they are at the lower extremes of this range.

Within the partially sighted group, the same relation between registration and residual vision level can be noted. That 40% of registered partially sighted people do fall below 6160 Snellen (i.e. lie above the dotted line) is, as just noted, a concomitant of our choice of a high inclusive cutting-point to cover most registered blind people. But even above this level, the distribution of the partially sighted tends to be skewed towards the higher Snellen values. (The exception - those > 6/24 Snellen but with a reading ability of less than N12 - is another result of our design decisions as discussed above. If anything, therefore, we underestimate the extent to which non-registered partially sighted people are skewed towards higher residual vision levels.)

It is no doubt in the nature of the registration process that the more seriously visually impaired among those eligible will stand the greater chance of registration. To an extent the same process could be at work in producing a greater proportion of registered among eligible blind people compared with the eligible partially sighted people (see Tables 3.14 and 3.15).

Notes to Chapter 3

Note 1 (section 3.10.3)

Relationships between age, residual vision and registration ¯ Dichotomising the three variables as follows:

Dichotomising the three variables as follows:

Age: Y = <60;O = 60+

Residual vision: blind and partially sighted

Registration : registered and non-registered

we have (from the data in Table 3.1) the following three 2x2 tables:

 

(a) Registration within the two age groups Y

(a) Registration within the two age groups O

R

39

20

NR

61

80

Total %

100

100

Base

77K

680K

 

(b) Residual vision within age Y

(b) Residual vision within age O

  

© Residual vision within registration status R

© Residual vision within registration status R

B

39

39

B

32

64

PS

61

61

PS

68

36

Total %

100

100

Total %

100

100

Base

77K

680K

Base

587K

170K

    Date from table 3.1. See also section 21.10 for numbers interviewed

There is no association between age and residual vision (Table b). The relationships between registration and age (Table a) and registration and residual vision (Table c) are statistically significant (Chi Square 12.37, and 53, respectively with ldf. Approximate point correlations would be 0.15 and 0.3 taken on an N of 595).

The coefficients of association fit a causal model in which age and residual vision have independent effects on registration, but there is no effect because of any correlation between age and residual vision.

Note 2 (section 3.10.4)

Production of Table 3.15 'Snellen values and registration status' in the report

This table was constructed as follows, For registered blind and partially sighted people the distributions in Table 21.1 'Snellen categories by reported registration status' in the report were used. Partition of the < 6/60 into NLP, < 3/60 and 3/60 (ie < 6/60) was carried out in terms of a tabulation made at an early stage in the analysis of the OPCS master sample. The tabulation showed a breakdown by Snellen level and registration status for 1,646 (older) OPCS respondents.

The ratio of those at < 6/60 (can't read chart) to those at < 3/60 (LP but can't see chart) was used as a basis for partitioning the < 6/60 in Table 21.6.a. For example there are, among the registered blind, 11 at < 6/60 (strictly 3/60) compared with 32 at <3/60. The 65% registered blind respondents split in the same proportions, giving the result 17 to 48 < 6/60 to < 3/60, respectively. While this should ideally be done on weighted data we know that weighting these Snellen distribution data makes little difference to the distributions (working paper dated March 17, see note to Chapter 21).

The distributions for the non-registered were otherwise obtained from a straightforward breakdown by Snellen values. The numbers of respondents entering into the computations in any column are shown for reference value and the purpose of testing significance; the known population totals are shown for purposes of population projection.

4 Accommodation

4.1 Length of residence

As might be expected, older visually impaired people have lived longer in their present dwelling than younger ones. However, as Table 4.1 shows, the difference is solely between people aged under 60 and 60 +. Twenty-five per cent of the former have lived at their present address for 21 years or more, compared with 40% of the latter.

 

Age (16-59) in %

Age (60-74) in %

Age (75+) in %

Total

5 years and under

27

23

20

22

6-20 years

48

37

39

39

21 or more years

25

40

41

39

Total %

100

100

100

100

Base (population)

77K

180K

500K

757K

(Number interviewed)

(299)

(124)

(172)

(595)

The absence of differences between the two older groups, ages 60 - 74 and 75 +, shows that length of residence does not continue to increase with age. Some people in the older age groups will have moved to residential institutions whose residents are not covered in this survey, others into sheltered accommodation or to live with relatives. Two, 18 and 12 per cent respectively of those aged under 60, 60 - 74 and 75 + (data from YQ3), were living in sheltered accommodation; 6, 4 and 8 per cent respectively of the three age groups were living with friends or relatives (Table 4.2).

For those who do remain in their own home, we can anticipate that familiarity with their home environment and immediate locality, as well as neighbourhood support, will be factors in their adjustment. It was noted in section 3.5 that many elderly visually impaired people live on their own. The data in Table 4.1 suggest that most of them have lived in the same accommodation for a large part of their lives - something that they greatly value. When we asked our sample (at YQ11) if they would like to move if they could, the proportion saying 'yes' fell sharply with increasing age from 33% of the under-60s, through 23% of the 60 - 74s to 15% of those aged 75 or over. The percentage actually thinking of, moving (YQ9) was about half, and again fell sharply with increasing age.

4.2 Type of tenure

Blind and partially sighted people occupied similar forms of accommodation. Age is the most significant influence on tenure, older people being more likely to occupy local authority accommodation and less likely to be owner occupiers, as shown in Table 4.2.

Table 4.2 Tenure within three age groups

“Do you own or are you renting your home?”

IF OWN “Do you own this home outright or are you buying it with a mortgage?”

IF RENTED “Who do you rent this house from?” (YQ2)

 

Age (16-59) in %

Age (60-74) in %

Age (75+) in %

Total

Mortgagees

25

2

2

4

Outright owners

25

30

40

36

Total owner occupiers

50

32

42

40

Local authority tenant

40

58

38

43

Private tenant

1

6

4

5

Housing Association/charity tenant

1

0

5

4

Live with others

4

2

8

6

Other eg tied

4

2

3

3

Total %

100

100

100

100

Base (population)

77K

180K

497K

753K

(Number interviewed)

(299)

(124)

(171)

(594)

    (594) respondents; no data from 1 respondent

Only 4% of visually impaired people, mainly in the under 60 age group, are buying their house on a mortgage. Even in this age group, only 25% have a mortgage and another 25% are outright owners; 68% of the equivalent general population are owner occupiers. Outright owner- ship increases with age to 30 and 40 per cent in the 60-74 and 75+ age groups respectively.

A higher proportion of visually impaired people are local authority tenants than in the general population. Overall, 43% of visually impaired people are local authority tenants, although in the 60 - 74 age group the total rises to 58%. Among the under-60s, 40% of visually impaired people are local authority tenants, compared with just under a quarter of the general population (see Table 4.3). For the 60-74 year-olds, the figures are 58 and 37 per cent respectively, for those aged 75+, 38 and 37 per cent.

 

Age of household head (25-59) %

Age of household head (60-69) %

Age of household head (70+) %

Owner occupiers

68

55

48

Local authority

23

37

37

Other

9

8

15

Total %

100

100

100

Base (sample size)

5918

1677

1891

    Source: GHS 1985 as quoted in Social Trends 18, page 141 (CSO, 1988)

One explanation for this pattern may be found in the generally lower income level of disabled people. While owner occupation is more common among higher income groups, disabled people in general (and visually impaired people among them) may find themselves one of the groups unable to buy their way into the private housing market.

4.3 Amenities

We asked respondents whether they had an inside toilet (YQ4), and some 5%, mainly elderly people, said that they did not. Only 2% reported that they did not have the basic amenities of a separate kitchen and bathroom (YQ5 - YQ8). This is in line with recent data for the general population (OPCS, 1985) and generally marginally better than that reported in Hunt's (1978) survey of elderly people.

5 The Onset of Visual Impairment

5.1 Reported causes of sight problem

Cullinan (1977, page 1) notes that “To the epidemiologist falls the task of reconciling the clinician's model of disease process with the social scientist's interest in the disability it causes. The difficulty lies in getting the balance right.” He adds that 'singularly little is known of the natural history of most degenerative diseases', particularly 'in the field of failing sight'.

Precise medical description was outside the scope of our survey. We simply asked (at YQ13) “What was the cause of your sight problem?” Medical terms were probed for and recorded when known, but were not directly mentioned by the interviewer since respondents were often vague about causes; answer categories given in Table 5.1 necessarily reflect this vagueness.

About 1 in 5 people aged 75 and over mentioned nothing more specific than 'ageing' or 'old age' or, very occasionally, 'macular degeneration'. For the most part, these respondents regarded the slow deterioration of their vision as part of the natural process of growing old. Cataracts was the specific cause mentioned most often by both those 75 and over and those aged 60 - 74.

Younger respondents mentioned a wide variety of specific eye conditions, particularly retinitis pigmentosa but also iritis, nystagmus and several other conditions, which have been grouped as “other eye conditions” (row 5 of Table 5.1). About 1 in 5 of people under 60 fall into this composite category, which then declines sharply in the next two age groups to about 1 in 14 of the young elderly and then to a mere 1 in 50 of the very elderly. The large 'other answers' category covers replies that were too vague to be classified as a “cause”, including non-specific references to “heredity”. (Onset' at birth is examined in section 5.2.2.)

Differences in reported cause by levels of residual vision are not reported here because on the small bases available for percentaging they did not reach 'statistical significance' (section 21.4). The vague- ness of the answer categories may also have been a factor.

 

Age (16-59) %

Age (60-74) %

Age (75+) %

Total

Cataracts

15

35

35

33

Old age

3

2

20

14

Glaucoma

3

10

11

10

General ill health

15

12

6

9

Accident

11

16

6

8

Since birth

20

8

3

6

Sudden occurence

4

2

6

5

Diabetes

4

10

2

4

Blood vessels

3

6

1

3

Detached retina

2

3

2

2

Heart/stroke

1

4

2

2

Illness/disability

9

1

0

1

Other eye conditions

19

7

2

5

Other answers

20

21

17

19

Base (population) = 100%

76K

180K

500K

756K

(Number interviewed)

(297)

(124)

(172)

(593)

    (593 respondents: no information for 2 respondents)

In so far as the categories in Table 5.1 designate disorders with a known natural history, their distribution across the age groupings reflects facts about the onset of visual impairment. We would expect to find cataracts, a disease of slow onset, most prevalent in the oldest age groups. But it is worth noting that cataracts are by no means insignificant even in the youngest age group; about 1 in 7 of those under 60 also mentioned them. The sharp decline with age in the incidence of diseases grouped under “other eye conditions” parallels the decline with age (discussed further below) of the number of people who stated that their sight problem started at birth.

5.2 Time of onset

The length of time over which visually impaired people experience deteriorating eyesight, as well as the age at which they experience it, are both important factors in their ability to adjust and the kind of help outside agencies can provide. We distinguish sudden onset, onset at birth, and loss of sight over an extended period.

5.2.1 Sudden onset

Table 5.1 demonstrates that sudden, traumatic loss of vision (the so- called 'military model'), although featured in some literature (e.g. Carrol, 1961), is in fact the experience of a small minority of visually impaired people. Fewer than 1 in 10 said that their condition was the result of an accident (including 'falling over'), and only 1 in 20 mentioned any other sudden occurrence ('happened suddenly/for no reason at all'). These two combined amount to 13%, but the incidence is no higher among the young than among the young elderly. The combined percentage mentions of this type of sudden onset in each of the three age groups are 15, 18 and 12 respectively.

5.2.2 Onset at birth

Much more typical of the young are people whose sight problems date from birth. They are still a minority even among the young, but they are a very substantial minority, one third. When directly questioned (at YQ14) a somewhat larger percentage (8% overall compared with the 6% unprompted mentions at YQ13) said that their eyesight problems dated from birth. The incidence was 30% among those aged under 60, and declined sharply in successive age groups, to 12% in the 60-74 age group and then to a diminutive 3% among the 75 and overs. The main reason for this is the massive increase in age-related visual impairment; Table 5.2 contains the results to YQ14.

 

Age (16-59) %

Age (60-74) %

Age (75+) %

Total %

From birth

30

12

3

8

Accident

8

7

3

5

Something else

60

80

91

85

Don’t know

2

1

5

4

Total %

100

100

100

100

Base (population)

77K

180K

500K

757K

(Number interviewed)

(299)

(124)

(172)

(595)

Current levels of residual vision made no significant difference to the number of people (8% overall - grossing up to 60,500) mentioning impairment dating from birth (at YQ14). Of those, 73% (about 44,000) said (at YQ15) that their sight had deteriorated since birth, but once again there was no significant difference by current sight level.

5.2.3 Gradual onset

The large majority (86%) of visually impaired people do not undergo a sudden traumatic loss of vision but instead experience a progressive deterioration in their eyesight over a greater or lesser extended period.

Table 5.3 presents data relating to the duration of this period and the stage of life at which it appears.

Those whose sight had deteriorated since birth or was not the result of an accident were asked about the age at which they first realised that their vision was causing them problems in everyday life. Table 5.3 shows the variation in the pattern of onset between the three age groups.

Age of onset

Age (16-59) %

Age (60-74) %

Age (75+) %

Total

16 and under

25

16

4

8

17-39 years

32

13

5

9

40-59 years

40

40

13

22

60-74 years

Na

28

36

30

75+

Na

Na

37

26

Don’t know

3

3

6

5

Total %

100

100

100

100

Base (population)

61K

162K

480K

704K

(Number interviewed)

(226)

(109)

(161)

(496)

    (496 respondents; 99 respondents were not asked this question, onset from birth)

In their daily lives the majority of visually impaired people as a whole do not experience the impact of sight loss until they are at least 60; only 17% experience it before they are 40. Because of the age structure of the visually impaired population, these overall statistics chiefly reflect the onset pattern experienced by very elderly people.

Examined separately, the age groups reveal different patterns. Among visually impaired people of under normal retirement age onset is spread broadly over three periods: 25% during pre-school and school years, 32% during the first half of the working life, and 40% during the second half. Among the two older age groups, onset bunches into shorter periods. Sixty-nine per cent of the young elderly experienced serious loss of vision before they were 60, 40% between 40 and 59 years old. On the other hand, most of the 75 and over group first became aware of a disabling loss of vision after retirement; for just over a third this happened before they were 75, and the same proportion after 75.

These age patterns overshadow any effects of differences in degree of sight loss, for which the data did not throw up any significant patterns.

We also asked 'How old were you when your sight got as bad as it is now?' (YQ17). A simple breakdown by age of the answers added little to the information already obtained from the replies to YQ16. More intensive secondary analysis, comparing ages in YQ17 with ages in YQ16, may throw more light on the extent of the period over which deterioration Of sight is experienced.

5.3 Medical treatment received for sight

Space did not allow an enquiry into the age at which medical treatment for sight problems was first received. However, we did ask briefly (YQ19) about treatments received; Table 5.4 contains the results.

 

Age and residual vision (16-59) B in %

Age and residual vision (16-59) PS in %

Age and residual vision (60+) B in %

Age and residual vision (60+) PS in %

Age and residual vision (All 16+) B in %

Age and residual vision (All 16+) PS in %

Total

Seen eye specialist

87

83

99

76

78

80

81

Hospital in-patient

53

34

55

28

31

29

33

Eye operation

39

26

57

21

28

26

29

Hospital out-patient

67

63

69

69

55

52

58

Medication

57

46

66

49

51

42

49

Base = 100%

30K

47K

65K

115K

205K

295K

757K

(Number interviewed)

(137)

(162)

(55)

(69)

(75)

(97)

(595)

A large majority (81%) of visually impaired people have seen a specialist about their eye problem. A substantial but smaller majority (58%) have also attended hospital as an out-patient, 33% have attended as hospital in-patients, and 49% have received some other form of medication. (These treatment categories and proportions are not mutually exclusive.)

Although treatment varies with age differences, the variation is as great within the level of residual vision. Just over half of blind people under 75 have been hospital in-patients compared with just under a third of partially sighted people in the same age group, while 57% of blind people aged 60 - 74 have undergone an eye operation. In other age groups and among partially sighted people the figure is much lower, generally under 30%.

Our inquiry into specific forms of medical treatment for eyesight was based on evidence gained from preliminary testing of the questionnaire and was designed to cover most of the alternatives in broad terms. About 20% of younger respondents and also of blind people aged 60-74 stated that they had received other forms of (unspecified) medical treatment which did not appear in our check list.

Analysis by registration showed that 96% of registered people compared with 77% of non-registered (but registrable) people had seen an eye specialist. The fact that so many of the latter category had made contact with an eye specialist is important, and these data confirm anecdotal evidence that eye specialists do not always initiate the process of registration for many of their patients who are eligible, i.e. the registrable are not simply unknown to their statutory authorities. Later chapters will show the importance of registration as a trigger or catalyst for service provision, and this evidence suggests that eye specialists could do more to encourage registrable people to register.

6 Residual Vision

6.1 Distance vision

6.1.1 A questionnaire scale

The questionnaire section on residual vision contained eight carefully graded questions (YQ29 to YQ36) in which respondents were asked how much they could see in terms of everyday situations involving distance vision. After analysis of the internal consistency of the replies, six questions were selected to form a graded scale measuring seven levels of residual vision. (For more details and the distribution of interviews over the scale see section 21.8.) The six questions asked were as follows. (An abbreviation of the wording is given here; the questionnaire should be consulted for the precise wording.)

Can you see...
from the light where the windows are? (YQ29)
the shapes of the furniture? (YQ30)

Can you recognise a friend...
if you get close to their face? (YQ31)
at arms length away? (YQ32)
across a room? (YQ33)
across the road? (YQ34)

The six questions function as a scale or ladder on which respondents can be scored according to the point at which they say they can see. Table 6.1 shows the numbers who can see at each level. Those with no light perception (4% overall) receive a score of zero; the remainder (96% overall) can tell by the light where the windows are. The percent- ages fall as each step reaches the next level of difficulty.

The percentages in Table 6.1 should be read in the following manner. Of visually impaired people as a whole, 19, 46, 66 and 77 per cent respectively can recognise a friend across a road, across a room, at arms length and close up; 91% can see the shapes of the furniture in a room and 96% can tell from the light where the windows are, which leaves 4% with no light perception (NLP). (These figures all appear in the right hand column of the table.) Subtracting the entries from 100 gives the percentages who cannot see at each step: thus, the percentage who cannot recognise a friend across a road, across a room, at arms length and close up are 81,54, 34 and 23 respectively, while 9% cannot see the shapes of the furniture in a room.

Scale point

Sees:

Age and residual vision (16-59) B in %

Age and residual vision (16-59) PS in %

Age and residual vision (60+) B in %

Age and residual vision (60+) PS in %

Age and residual vision (All 16+) B in %

Age and residual vision (All 16+) PS in %

Total

0 NLP*

15

-

6

-

6

-

4

1 windows

85

100

94

100

94

100

96

2 furniture

75

100

86

95

82

94

91

Recognises friend: 3 close up

50

94

66

85

65

87

77

4 at arms length

40

85

50

77

49

80

66

5 across room

27

59

32

57

31

58

46

6 across road

8

24

13

23

12

23

19

Base (population) = 100%

30K

47K

270K

410K

300K

457K

757K

(Number interviewed)

(137)

(162)

(130)

(166)

(267)

(328)

(595)

    *NLP = no light perception (i.e. 'no' at YQ29)

Scores on the QRVS7 scale are strongly related to Snellen levels, though not in a one-to-one manner (section 21.8).

It is important to note the small percentage of respondents who had no light perception, 4% overall. These all fall into the blind (B) category, of whom they comprise 15% of people aged 16 - 59 and 6% of people aged 60 +. Analysis by registration (Table 3.15, section 3.10.4) shows that everyone without light perception was registered as blind. Even so, people without light perception only comprised 25% of registered blind people.

Once both lay people and professionals understand that not all registered blind people are totally blind, they ask the following question: 'How many blind people are totally blind?' This survey answers this question for the first time, but initially it is necessary to define the term “totally blind”.

If sighted readers shut their eyes, they will, quite reasonably, think of themselves as temporarily totally blind. However, with shut eyes they can still sense 'from the light where the windows are'. Thus the definition of 'totally blind' includes people who have perception of light but nothing more. On this definition and from our data, we believe that 18% of registrably blind people are totally blind, forming 25% of the under-60s and 14% of those aged 60 and over.

While only a minority (19%) of visually impaired people (12% of blind people and 23% of the partially sighted) can recognise a friend across a road, the majority (77% - 64% of blind people, 86% of the partially sighted) can at least recognise a friend close up. However the significance of distance recognition should not be over-emphasised by sighted readers, who may not realise the extent to which visually impaired people use shape and movement for recognition purposes. In addition many blind people with some distance vision may have severe field loss.

6.1.2 Age differences

While difference in registrability levels (blind or partially sighted, see section 2.4.2) is the paramount factor in Table 6.1, consistent minor differences within age limits are also evident, particularly among blind people. Proportionally more of the younger age group (15% in comparison with 6% of the older age groups) have no light perception, and only 75% compared with 86% can see the shapes of furniture in a room. While in percentage terms a larger proportion of those in the younger age group have NLP, the age bias of the visually impaired population as a whole means that the older age group is larger in numerical terms. Approximately 4,500 people under 60 have NLP, while there are some 16,000 aged 60 and over. The corresponding numbers of people at point 1 of the scale (can tell where the windows are but cannot see the shape of furniture) are 3,000 (10%) and 20,000 (8%) respectively for the younger and older age groups.

6.2 Near vision

6.2.1 Measurements obtained

Two assessments of respondents' near vision capabilities were made, both involving visual reading ability. First, we asked about the ability to read newspapers, and, second, we administered a simplified reading test using a specimen of large print on a test card.

6.2.2 Ability to read newspapers

The ability to read newspaper print was considered a useful general benchmark of print reading ability among visually impaired people. This 'test' was also used in Gray and Todd's survey (1968), and in the OPCS disability survey (Martin et ai, 1988a), therefore allowing some comparison with these two surveys; Table 6.2 shows the results.

A surprisingly large proportion (46% - 27% of blind people, 58% of the partially sighted) claim to be able to read ordinary newspaper print. Including these, as many as 75% (55 and 89 per cent of blind and partially sighted people respectively) claim to be able to read news paper headlines. There is little difference between the age groups although, as with distance vision, in percentage terms there are marginally fewer blind people under 60 because of the proportionately larger percentage of this group with NLP.

Table 6.2 Reading newspaper print

“Can you see well enough to read ordinary newspaper print?” (YQ41)

“And can you see well enough to read newspaper headlines?” (YQ42)

 

Age and residual vision (16-59) B in %

Age and residual vision (16-59) PS in %

Age and residual vision (60+) B in %

Age and residual vision (60+) PS in %

Age and residual vision (All ages) B in %

Age and residual vision (All ages) PS in %

Total

Read newspaper print

22

68

27

58

27

58

46

Read headlines only

30

27

28

31

28

31

29

Total able to read headlines

52

95

55

89

55

89

75

Unable to read headlines

33

5

39

11

39

11

21

NLP*

15

0

6

0

6

0

4

Total unable to read headlines

48

5

45

11

45

11

25

Total %

100

100

100

100

100

100

100

Base (population)

30K

46K

270K

409K

300K

455K

755K

(Number interviewed)

(137)

(162)

(130)

(165)

(267)

(327)

(594)

    (594 respondents: no information for 1 respondent)
    *NLP includes those with no light perception (i.e. 'no' at YQ29), where YQ41 and YQ42 were not asked
    Interviewers were instructed to add, if necessary, 'with whatever you usually use for reading'after asking questions YQ41 and YQ42

6.2.3 The reading test

Below is an actual-size reproduction of the words on the card handed to respondents. The print is 16 point bold, between N14 and N18 on the Snellen print size. Having been shown the card, respondents were asked (YQ43) 'Which of the following phrases best describes how you find reading the card?'. When answering they were requested to use their glasses or whatever else they normally used for reading.

to help you

 

Age and residual vision (16-59) B in %

Age and residual vision (16-59) PS in %

Age and residual vision (60+) B in %

Age and residual vision (60+) PS in %

Age and residual vision (All ages) B in %

Age and residual vision (All ages) PS in %

Total

Can read it comfortably

22

75

36

73

36

75

58

Can read but would find it tiring

7

13

4

5

4

6

5

Have difficulty reading it

13

9

9

8

9

8

9

All able to read card

42

97

49

86

49

89

72

I cannot read it

43

3

45

14

45

11

24

NLP*

15

0

6

0

6

0

4

All unable to read card

58

3

51

14

51

11

28

Total %

100

100

100

100

100

100

100

Base (population)

30K

46K

262K

408K

292K

454K

746K

(Number interviewed)

(136)

(160)

(125)

(164)

(261)

(324)

(585)

    (585 respondents: no information for 10 respondents)
    *NLP = No light perception, YQ43 not asked

Among visually impaired people generally, 72% said that they could read the card. Among blind and partially sighted people the totals are 49 and 89 per cent respectively, ignoring age differences. However, ability to read the card comfortably is probably a better guide to visual capability for sustained reading. Here the totals are 58, 36 and 75 per cent for visually impaired people generally, blind and partially sighted people. One notable age difference was among blind people who said that they could read the card comfortably: 22% of those under 60, 36% of those aged 60 and over, a statistically significant difference.

Claims to be able to read the card were put to the test of reading aloud, and the number of words read correctly was recorded. The results, not reported here, show that almost everyone who claimed to be able to read the card was in fact able to do so.

A key practical question for organisations providing services for visually impaired people is the necessity of producing documents in large print. The traditional argument runs 'since very few blind people can read, it is not necessary'. Our survey suggests otherwise and quantifies the gains of using large print. For example while only 22% of blind people under 60 can read newspaper print, 42% can read 16-point bold type; the equivalent totals for blind people 60 and over are 27 and 49 per cent, while for partially sighted people under 60 the rise is far more dramatic, from 68 to 97 per cent. Reading text of this size is still far more tiring for a visually impaired person than for a sighted person.

Nevertheless, the argument for large print seems to be proved, especially since substantial numbers of blind people are involved.

These results also point to the importance of low vision aids (LVAs) such as hand-held and stand magnifiers as well as closed-circuit television magnifiers (CCTVs). However, Tables 6.6 and 6.7 do suggest under-usage.

6.3 Field of vision

An additional crucial element in defining a person's residual vision is the completeness of his or her field of vision. To measure field of vision is a technically complicated exercise and was not feasible in our inter- views. Interaction of an incomplete field of vision with poor distance vision or near vision, or both, greatly exacerbates visual impairment.

Two examples of field loss are loss of central vision and loss of peripheral vision. Loss of central vision is very common among elderly visually impaired people as a result of macular degeneration, and almost always leads to loss of ability to read or see faces. However, the remaining peripheral vision is extremely useful for mobility.

A much less common example of field loss occurs in more developed stages of retinitis pigmentosa (RP), commonly called tunnel vision. In this situation visual acuity may be good and central vision unimpaired, making reading relatively straightforward. However, the loss of peripheral vision makes mobility extremely hazardous. A person with RP can sit in a train and read a newspaper without difficulty, but on climbing out on to the platform will have to use a white cane to avoid tripping over.

In addition to these two examples of symmetrical field loss, there are many other forms of asymmetric distribution of loss, patchydistribution of loss and haphazard distribution.

6.4 Visual aids

6.4.1 Reported use of glasses or contact lenses

Table 6.4 shows that 85% of visually impaired people with some light perception wear glasses. Even among blind people the totals are high (60 and 80 per cent for the younger and older age groups respectively), while among the partially sighted the totals are 81 and 91 per cent respectively. These figures are percentages of people with light perception; however, they do not fall significantly when recast in terms of the total visually impaired population, since the percentage with NLP is so small. Of the totally visually impaired population (including people with NLP), 82% wear glasses. In numerical terms, 620,000 blind and partially sighted people wear glasses, including 269,000 registrably blind people.

 

Age and residual vision (16-59) B in %

Age and residual vision (16-59) PS in %

Age and residual vision (60+) B in %

Age and residual vision (60+) PS in %

Age and residual vision (All ages) B in %

Age and residual vision (All ages) PS in %

Total

Wear glasses all the time

37

51

50

53

49

53

51

Wear glasses sometime

23

30

30

37

29

36

34

Not al all

40

19

20

10

22

11

15

Total %

100

100

100

100

100

100

100

Base (population)

26K

47K

255K

403K

281K

450K

730K

(Number interviewed)

(108)

(162)

(115)

(162)

(223)

(324)

(547)

    (547 respondents: 48 respondents with no light perception were not asked)

Because glasses are so frequently used by sighted people, it is important to recognise that for blind and partially sighted people glasses area prosthesis with a radically different effect. They provide some amelioration, not a total correction, just as an artificial limb does for a one-legged person.

 

Age and residual vision (16-59) B in %

Age and residual vision (16-59) PS in %

Age and residual vision (60+) B in %

Age and residual vision (60+) PS in %

Age and residual vision (All ages) B in %

Age and residual vision (All ages) PS in %

Total

Reading

29

67

39

72

38

71

58

For close work

27

48

37

59

36

58

50

Distance vision

20

53

29

55

28

54

45

Protection

5

4

18

10

17

9

8

Other users

22

13

14

11

13

11

13

Total wearing glasses

60

81

80

90

78

89

85

Total not wearing glasses

40

19

20

10

22

11

15

Base (population)

26K

47K

255K

403K

281K

450K

730K

(Number interviewed)

(108)

(162)

(115)

(162)

(223)

(324)

(547)

    (547 respondents: 48 respondents with no light perception were not asked)

Table 6.5 shows the variety of uses to which people put their glasses. Reading, close work and distance vision were all mentioned roughly equally by about 50% of respondents. Some 13% said they use glasses for other, unspecified, reasons - this reply was most common (22%) among younger blind people. Eight per cent said spontaneously (respondents were not prompted while answering this question) that they wore their glasses merely for protection, and that their vision was not affected. This reply was most common among elderly blind people. The totals for blind and partially sighted people in the younger and older age groups were 5, 4, 18, and 10 per cent respectively.

6.4.2 Reported use of other low vision aids

Table 6.6 shows that the LVA most used after spectacles is the hand magnifier. Fifty-nine per cent of respondents used a hand magnifier. However, usage is lower among the younger age group (28 and 44 per cent for blind people and partially sighted people respectively) than among older people (60%). Usage of all other LVAs runs at under 5%; the most mentioned (4%) of these was a magnifier used as part of spectacles. However, although these percentages are low, a significant number of people are involved. For example, the 2% who use a stand magnifier amount to some 14,000 people.

 

Age and residual vision (16-59) B in %

Age and residual vision (16-59) PS in %

Age and residual vision (60+) B in %

Age and residual vision (60+) PS in %

Total

Hand magnifier

28

44

60

60

59

Magnifier as part of spectacles

4

4

5

3

4

Stand magnifier

3

2

4

1

2

Field magnifier

0

1

2

#

1

Hand-held telescope

2

5

2

#

1

Other LVA

7

4

5

5

5

Total who have LVAs

34

51

70

63

64

Total without LVAs

66

49

30

37

36

Base (population)

26K

47K

255K

403K

730K

(Number interviewed)

(108)

(162)

(115)

(162)

(547)

    (547 respondents: 48 respondents with no light perception were not asked)

6.4.3 Light fittings

At YQ46 we asked all those with at least light perception “Have you ever had any extra light fittings or stronger light put in your home, because of your eye problems?” Only 20% answered 'yes', and there was little difference between age or residual vision groups. Of those who said 'no', only 5% gave expense as a reason. Other reasons given by those answering 'no' included not thinking it would help (42%) and never having thought about it (34%). Although extra lighting may not help in some cases, these results confirm what many experts have suspected: that visually impaired people are not aware of the generally positive results that may be gained from improved lighting levels. The large percentage (80%) who have done nothing about lighting levels present a public education opportunity to service providers.

6.4.4 Low vision aids used in the reading test

During the reading test, the interviewer was asked to code any LVAs used. The results, given in Table 6.7, confirm that glasses (59%) are the LVA predominantly used for reading, followed by hand magnifiers (13%); other types were used by no more than 2%. Fewer than half the number of blind people aged 16-59 used an LVA for the reading test, compared with two-thirds and three-quarters of the other sub-groups. (Although we noted in section 6.1.2 that there are marginally more younger than older blind people with NLP, this difference is discounted in Table 6.7.) More younger blind people used a hand magnifier, and fewer relied on glasses, than other groups.

 

Age and residual vision (16-59) B in %

Age and residual vision (16-59) PS in %

Age and residual vision (60+) B in %

Age and residual vision (60+) PS in %

Total

Spectacles

31

53

56

63

59

Hand magnifier

23

6

14

13

13

Magnifier as part of spectacles

3

4

3

0

1

Contact lenses

0

1

4

0

1

Field expander

0

0

0

#

#

Stand magnifier

0

0

1

0

#

Other LVA

3

1

3

2

2

All that used LVA

46

65

74

75

73

No LVA used

54

35

26

25

27

Base (population)=100%

26K

47K

255K

403K

730K

(Number interviewed)

(108)

(162)

(115)

(162)

(547)

    (547 respondents: 48 respondents with no light perception were not asked)

These figures give some quantitative indication of the under-usage of LVAs. Table 6.6 showed that 59% of respondents have a hand magnifier, but only 13% used one in the test (Table 6.7). While the test card was printed in 16-point bold type, one can assume that the difference between the proportion of people possessing LVAs and the proportion using them in the reading test is evidence that more respondents might have been able to read the card if they had used their magnifier and if they had been trained and supported in its use.

Part B - Media Reading Habits

7 Large Print

7.1 Sight levels and the use of print

Chapter 7 deals with the amount and kind of print read by visually impaired people; visual ability to read print was discussed in section 6.2. While the sight levels of visually impaired people set the upper limit for the numbers who can read print, the total of those who in reality do read things in print depends on a variety of additional factors.

7.2 Those who normally read print

Our question 'Do you normally read anything at all in print?' (WQ1) was designed to obtain a broad assessment of the number of respondents who, while visually capable of reading print, actually did so. It was asked only of those who had been able to read the test card (section 6.2.3).

 

Age and residual vision (16-59) B in %

Age and residual vision (16-59) PS in %

Age and residual vision (60+) B in %

Age and residual vision (60+) PS in %

Age and residual vision (All ages) B in %

Age and residual vision (All ages) PS in %

Total

NLP*

15

-

6

0

6

0

4

LP but no more*

10

-

8

3

8

3

5

Can see more but could not read card*

33

3

36

9

36

8

19

Can read large print test: does not normally read print

2

13

8

6

7

7

7

Can read large print test: normally reads print

40

84

42

82

43

82

65

Total %

100

100

100

100

100

100

100

Base (population)

30K

46K

262K

408K

292K

454K

746K

(Number interviewed)

(136)

(160)

(125)

(164)

(261)

(324)

(585)

    (585 respondents: no information for 10 respondents)

    *NLP, LP cannot/can see windows, not asked WQ1

Table 7.1 shows that 72% of visually impaired people can read the card (section 6.2.3), and that 65% claim to make use of that ability. In each age and sight band a similar proportion of those who passed our sight test claim to read print.

7.3 What is read in print

Our next question (WQ2) concerned the sort of things respondents read. This question was put first as an open question without prompting for any kind of material. However those who did not spontaneously mention large-print books at WQ2, but said (at WQ3) that they had heard of them, were specifically prompted 'Do you ever read large-print books?' (at YQ4). Table 7.2 shows the prompted and unprompted replies for large-print books, together with the unprompted replies for other items.

 

Age and residual vision (16-59) B in %

Age and residual vision (16-59) PS in %

Age and residual vision (60+) B in %

Age and residual vision (60+) PS in %

Age and residual vision (All ages) B in %

Age and residual vision (All ages) PS in %

Total

Newspapers: ordinary newsprint

12

63

27

50

24

51

42

Newspapers: Headlines

23

60

36

39

35

40

55

Books: ordinary print

17

40

20

27

20

28

25

Books: large-print books

5

17

8

24

8

23

17

Books: large-print books (WQ4)@

0

15

5

5

4

4

6

Total large-print books

5

32

13

29

12

30

23

Letters/bills

17

58

25

48

24

49

39

Other

11

13

3

3

4

4

4

All reading print*

40

84

42

80

42

82

65

Don’t/can’t read print**

40

16

58

20

58

20

35

Base (population) = 100%

30K

46K

262K

408K

292K

454K

746K

(Number interviewed)

(136)

(160)

(125)

(164)

(261)

(324)

(585)

    (585 respondents: no information for 10 people)

    **Not asked WQ2 @After prompting (see Table 7.1)

Reading ordinary newspaper print and headlines was mentioned by 42 and 55 per cent respectively of visually impaired people generally. Among those aged 16 - 59, blind people were far less likely to read either ordinary newsprint or headlines than partially sighted people (12 and 63 per cent and 23 and 60 per cent respectively). Among those aged 60 and over, 27 and 50 per cent of blind and partially sighted people read ordinary newsprint, with similar numbers able to read head- lines (36 and 39 per cent respectively). These percentages run somewhat below those who said that they could see well enough to read these items (section 6.2.2) or were able to read 16-point bold type (section 6.2.3).

Only 17% of respondents said spontaneously that they read large-print books, but a further 6% said so after specific prompting. Some 30% of partially sighted people said that they read large-print books, compared with 5 and 13 per cent respectively of younger and older blind people. The number of people actually reading ordinary and large-print books correlates closely with those who 'comfortably' read our large print test card. (For example, 48% read ordinary or large-print books (Table 7.2), and 58% read the test card comfortably (Table 6.3). Twenty-two per cent of blind people under 60 read ordinary or large-print books.)

From the difference in proportions between those able to read large print and those who do read it, it would seem that leisure large-print reading is not undertaken by those who find it tiring or difficult (Table 6.3). Thus, while large print may reach many more blind and partially sighted people than has previously been recognised, it is only used widely for functional or necessary reasons (e.g. bills, bank statements, recipes). Similarly, ordinary print bills and letters are read by more people than ordinary print books (39 compared with 25 per cent). Indeed, bills and letters were read by virtually half of partially sighted people and 17 and 25 per cent respectively of blind people in the two age groups. (We look at this again in Chapter 15.)

Table 7.3 shows that, although a small sub-group of all visually impaired people, users of large-print books appear to be fairly regular readers. Only 7% of the sub-group said that they had read no large- print books in the last six months, and the totals reading 1 - 3, 4 - 6,

 

Age (16-59) in %

Age (60+) in %

Total in %

No books

25

5

7

1-3 books

43

28

30

4-6 books

10

21

20

7-12 books

11

16

16

13+ books

10

30

28

Total %

100

100

100

Base (population)

16K

150K

166K

(Number interviewed)

(57)

(60)

(117)

    (117 respondents: 478 respondents did not read large-print books)

7 - 12, and 13 or more books were 30, 20, 16 and 28 per cent respectively. People aged 60 and over were by far the more frequent readers. Some 30% of them had read 13 or more books in the last six months, compared with 10% of the readers under 60. A quarter of the latter said that they had read no large-print books in the last six months compared with only 5% of the older group.

7.4 Why large-print books are not read

Among visually impaired people generally, 65% normally read print (Table 7.1), but only 23% read large-print books (Table 7.2). Taking into account people unable to read print at all, this means that only about a third of those able to do so actually read large-print books.

We asked (WQ3) the non-readers of large-print books in this group if they had heard of large-print books. Three-quarters, including almost all the blind people under 60, said that they had. Thus, lack of awareness does not seem to be the main reason for not using large-print books. Those non-readers who had heard of large-print books were then asked directly why they did not read them; the results appear in Table 7.4.

 

All non-readers of large print %

Just not interested

31

Don’t need (yet)

16

Difficult to read/follow

13

Read ordinary print

10

Read other medium

5

Too heavy/bulky

4

Don’t know how to get

4

Popltn numbers (= 100%)

259K

(Number interviewed)

(203)

    (203 respondents able to read test card but who did not read large-print books: 392 respondents were not asked the question)

The small number (4%) who said that they did' not know how to get large-print books is consistent with the finding that lack of awareness is not a major reason for the non-use of large-print books. Lack of interest in reading (31%) is the predominant single reason given. But 13% said that they find large-print books difficult to read. We may infer that these people are among those (Table 6.4) who could read the test card but said that they would not find it comfortable to read print of this size. At the other extreme, 10% of respondents gave as a reason for not reading large-print books that they could read ordinary print.

7.5 Potentially useful large-print items

To try to gauge likely demand for large-print items, respondents were asked (WQ7) if they would find it useful to have a number of items produced in large print. These were bank statements, bills, Radio/TV Times, dictionary, and catalogues. The results are shown in Table 7.5; the percentages are of respondents who had been shown the example of large print and had been able to read it (section 6.2.3).

 

Age (16-59) %

Age (60-74) %

Age (75+) %

Total

Bank statements

55

52

34

41

Bills

60

54

42

47

Radio/TV Times

51

47

39

42

Dictionary

66

45

35

41

Catalogues

52

40

42

43

None useful

25

31

36

33

Base (population) = 100%

58K

136K

349K

543K

(Number interviewed)

(204)

(83)

(105)

(392)

    (392 respondents able to read the test card: 48 NLP, 155 could not read test card)

The general view was that it would be useful to have all the listed items available in large print, with the figures running at 41 to 47 per cent (of those able to read large print). Only 33% said that they would not find any of the items useful in large-print; these are likely to be people who can read ordinary print (see Table 6.3). Rather surprisingly, residual Vision level made no difference to the responses. Taking all the items together respondents under 60 tended to be more receptive by about 10% or so than older people; for individual items the percentage spread was greater, for example 'dictionaries' (66 and 38 per cent), 'bills' (60 and 46 per cent), 'catalogues' (52 and 42 per cent).

7.6 Comparison with Gray and Todd's 1965 results

Comparisons are only possible for a sub-set of our data. When Gray and Todd (1968) carried out the fieldwork for their major study of “Mobility and reading habits of the blind” in 1965, they drew their entire sample from the local authority registers of blind people. Interviews were held with 1,044 people aged 16-64 and 420 aged 65-75. Our survey contains too few registered people in the older age group for valid comparisons. However, comparisons are possible with the 123 of our respondents who are registered blind and aged between 16 and 59. Table 7.6 compares this sub-group of 123 with Gray and Todd's results.

 

Registered blind respondents only, 1986 RNIB survey (16-59) in %

Registered blind respondents only, 1965 Gray/Todd (16-64) in %

NLP*

27

26

LP but no more*

17

17

Can see more but did not read card*

19

33

Read large print test: does not normally read print

2

13

Read large print test: normally reads print

39

11

Total %

100

100

Base (population)

18K

24K

(Number interviewed)

(123)

(1044)

    *NLP, LP cannot/can see windows. Not asked WQ1
    Note that in this table the RNIB sample is not the same as blind people of this age group shown in Table 7.1. These groups are based on registration status rather than on residual vision, hence the somewhat different percentages

The projected population estimates for the RNIB group is 18,000; Gray and Todd suggested 24,000 based on statistics from the (then) Ministry of Health for this age group. Our smaller estimate may be a result of our narrower age range and also of the scaling down of published DHSS statistics to allow for visually impaired people who are institu- tionalised (section 21.3.2). However, the major similarities and differences evident in the table are unlikely to be affected by these minor discrepancies in the variables compared. We took care to retain Gray and Todd's precise question wording, and both reading tests were based on 1/8 inch lower case type. In both surveys respondents were told to use their normal spectacles or other reading aids.

The most striking difference is between the percentages of people able to read print and those who actually do so. While nearly half of the 1965 respondents (11 out of 24 per cent) who could read the large print test said that they normally did read print, in our survey nearly the entire sample (39 out of 41 per cent) who could read the print test said that they read print normally. This indicates an immense shift among young registered blind people over two decades. One cause may be improvements in general education and reading skills. However, more significant is likely to be the increased availability of large print which has proved extremely popular with the 22% of blind people who can read it easily. In 1965 large-print was not common in either libraries or bookshops.

Table 7.6 also suggests that the composition of the younger group of registered blind people may have changed in respect of residual vision levels. The percentages with NLP (who said that they could not see the windows) and those with LP but no more (steps 1 on our questionnaire scale - see section 6.1.1) were the same in each survey (44 and 43 per cent). But in 1986 41% (of the comparable registered blind sub-group) could read the test card compared with 24% in 1965. However, we cannot be certain that this is a real difference as opposed to a different definition of 'reading' here. The RNIB test card contained only three words, and almost everyone (Table 6.4) who said that they could read it read all three words correctly. Gray and Todd's report, however, mentioned that their test card contained a sentence but did not specify either the number of words or the number of words required to be correct to qualify as 'reading'. It is possible that Gray and Todd applied stricter criteria.

8 Tapes and Tape Services

8.1 Introduction

The use of tapes, especially in relation to braille as a reading medium, has long been a matter of debate. There is no doubt that there has been a major increase in the usage of commercial tape-recording and -playing machines; a major rise in the number of members of the RNIB Talking Book Service; and an increase in the number of volunteer and local tape-recording groups putting print material on to tapes at short notice. Given these changes, it is vital to understand current tape usage, for example how many blind and partially sighted people use them, and for what purpose.

Tape services are collectively one of the largest services provided by RNIB. In particular the RNIB Talking Book Service is often cited as RNIB's flagship service, and reaches a larger number of visually impaired people than any other single service. The RNIB Talking Book Service is a membership-based tape library for visually impaired people providing a wide range of fiction and non-fiction books. Other RNIB tape services are more specialised and have far fewer users, e.g. the Express Reading Service which provides a general tape-recording service for visually impaired people. Although we asked questions on most of RNIB's tape services, the design of the survey is most appropriate for comparing users and non-users of talking books and for examining the usage of tape media in general by visually impaired people; it is less suitable for examining services with only a small number of users.

We use the term tape-player in this report as a generic term to include all forms of tape-playing and recording-machines that the respondents may possess. Where it is necessary to distinguish between the RNIB Talking Book machine obtained through the RNIB Talking Book Service and other tape-players, the former is usually specifically named.

8.2 Tape-players in general

8.2.1 Possession of tape-players

Table 8.1 indicates that the main variable influencing possession of tape-players is age. In marketing terminology, the market penetration for tape-players among the under-60s has almost reached saturation- point. Over 80% of this age group have a tape-player, compared with 53% of people aged 60 to 74 and 38% of those aged 75 and over.

 

Age (16-59) %

Age (60-74) %

Age (75+) %

Total

Have tape-player

83

53

38

46

No tape-player

17

47

62

54

Total %

100

100

100

100

Base (population)

77K

180K

499K

755K

(Number interviewed)

(299)

(124)

(137)

(593)

    (593 respondents: no information for 2 respondents)

There is no doubt that the percentage of older people using tape-players is growing. While 38% of those aged 75 + have a tape-player, this increases to 53% for those aged 60 to 74. It is reasonable to assume that this figure will be indicative of future ownership levels for people aged 75 and over, and that the higher ownership levels among younger elderly people will be maintained as they grow older. Nevertheless, this means that well over half of older visually impaired people do not possess a tape-player and suggests the need for a simple player to which they might be introduced in their very elderly years.

Registration status made a difference: 65% of registered blind people compared with 41% of the non-registered possessed a tape-player of some kind. Differences by residual vision level were not statistically significant (section 21.4).

8.2.2 Type of tape-player possessed

Table 8.2 shows that 12% of visually impaired people own an RNIB Talking Book machine, 33% some other type of tape-player, and 54% do not own any kind of tape-player (see note to chapter).

The breakdown of ownership of tape-players other than RNIB Talking Book machines shows that among visually impaired people as a whole, radio cassette players (26%) predominate, followed by ordinary cassette players (15%) and music centres (9%); 'other types' of cassettes (mostly small Walkman players) account for only 1%.

As a whole, younger people are more likely than the older group to possess some type of cassette-player. However, because there are many more blind and partially sighted people aged 60 +, in numerical terms this group possesses many more tape, machines. Among the under-60s residual vision had an impact on ownership. In this age group 32% of blind people and only 5% of partially sighted people own an RNIB Talking Book machine; for ordinary cassette players the figures are 28 and 44 per cent respectively.

 

Age and residual vision (16-59) B in %

Age and residual vision (16-59) PS in %

Age and residual vision (60+) B in %

Age and residual vision (60+) PS in %

Age and residual vision (all ages) B in %

Age and residual vision (all ages) PS in %

Total

Talking book machine

32

5

20

6

21

6

12

Radio cassette player

52

60

30

18

32

19

26

Ordinary cassette

28

44

12

16

14

16

15

Music centre

27

23

10

6

12

6

9

Other

12

4

0

0

1

#

1

All with non-RNIB tape-player

50

78

30

29

32

34

33

Don’t know

0

0

0

2

0

2

1

No tape-player at all

18

17

50

63

47

59

54

Total %

100

100

100

100

100

100

100

Base (population)

30K

47K

270K

410K

301K

546K

757K

(Number interviewed)

(137)

(162)

(130)

(166)

(267)

(328)

(595)

    (595 respondents)

8.3 RNIB Talking Books

Profile of users

Table 8.2 shows that about 12% of visually impaired people possess an RNIB Talking Book machine. The possession-rate is higher among blind than among partially sighted people: 32 and 5 per cent among the under-60s, 20 and 6 per cent among those aged 60 and over. Our data allow us to examine the profile of the users and non-users of RNIB Talking Books simultaneously, and below we provide more detail in relation to age and registration.

The most accurate way of obtaining a user profile would be to analyse the records held on RNIB computers. For more detailed characteristics of membership of the RNIB Talking Book Service the computerised list could be treated as a sampling frame for a questionnaire enquiry. This is what Lucille Hall did in her 1981 postal survey Who Are Britain's blind people? (Hall,1982). It is of interest to compare the age distribution obtained from the present survey with that found in 1981.

8.3.1.1 Age of users

Table 8.3.a. shows that the distribution of people with RNIB Talking Book machines among the three age bands is 15, 31 and 54 per cent respectively. The corresponding totals in Hall's survey, for a random sample of 1,000 people aged 16 and over selected from the complete list of RNIB members, were 21, 29 and 50 per cent respectively.

Some decrease in membership among the 16-59 age band seems to have taken place between the 1981 survey and ours, the fieldwork for which was done in 1986-87. On these sample sizes (section 21.4) the difference between 21 and 15 per cent is just statistically significant.

Membership of the scheme covers only 12% of the registrable visually impaired population. Table 8.3.b shows that membership among the three age groups is roughly level in relative terms, with a decrease from 16 to 10 per cent among the older group. Because people aged 75 and over constitute almost two-thirds of the blind population as a whole, they constitute about half the membership of the RNIB Talking Book Service.

Age group

With TBs %

No TBs %

Total VI %

16-59

15

10

10

60-74

31

22

24

75+

54

68

66

Total

100

100

100

Base (Population)

90K

667K

757K

(Number interviewed)

(132)

(463)

(595)

Age group %

With TBs

No TBs

Total %

Base

(Number interviewed)

16-59

16

84

100

77K

(299)

60-74

16

84

100

180K

(124)

75+

10

90

100

500K

(172)

All ages

12

88

100

757K

(595)

8.3.1.2 Registration status and residual vision levels of users

Table 8.4 gives more fine detail of user characteristics defined by registration sub-groups, sub-divided again by age and residual vision levels.

 

With TBs

No TBs

Total %

Base for %

(Number interviewed)

Registered-Under 60 (B %)

44

56

100

18K

(123)

Registered-Under 60 (PS %)

17

83

100

12

(92)

Registered- 60 and over (B %)

36

64

100

91K

(74)

Registered- 60 and over (PS %)

24

76

100

49K

(63)

Non-registered-Under 60 (B** %)

17

83

100

12K

(14)

Non-registered-Under 60 (PS** %)

3

97

100

35K

(70)

Non-registered-60 and over (B %)

12

88

100

179K

(56)

Non-registered-60 and over (PS %)

3

98

100

361K

(103)

Total %

12

88

100

757K

(595)

**Small number of interviews

Registration is a much more powerful factor than age in influencing the prevalence of Talking Book usage in any of the sub-groups in Table 8.4. Every registered sub-group shows a far higher prevalence rate than the comparable non-registered (age/residual vision) sub-group. For example, among the under-60s, 44% of those registered blind use RNIB Talking Books, compared with 17% of the non-registered at blind residual vision levels (defined in 2.4.2.). Comparing registered people as a whole with all non-registered, we find that 36% of the registered but only 6% of the non-registered use RNIB Talking Books.

8.3.1.3 Information about the RNIB Talking Book Service

Table 8.5 shows that social services were the most mentioned source of information about the RNIB Talking Book Service; 33% of respondents specifically mentioned social workers for the blind, and when other social services workers are included the total increases to 43%. The other statutory service, the health service, was mentioned by 11% of respondents.

 

All Talking Book users %

Social worker for the blind

33

Other relative (not in household)

14

Health service

11

Social welfare worker

9

RNIB

9

Other local associations (not blind)

8

Someone in the household

5

Friend/colleague

4

Local blind association

3

Other social services

1

Others not specified

4

Base (population) = 100%

90K

(Number interviewed)

(133)

    (133 respondents: only asked of current users of RNIB Talking Books)

Someone else finding out about the service on their behalf was reported for 22% of visually impaired people; “other relative”, “someone in the household” and “friend/colleague” were mentioned by 14, 5, and 4 per cent respectively. RNIB itself was mentioned by 9% of respondents.

The majority (61%) of users are registered, and this is the reason why the social services appear as the most important single information source. The various other sources listed in Table 8.5 clearly play an important role in informing the non-registered about the service. As social services workers are such crucial gatekeepers to RNIB Talking Books Service, any attempts to increase membership will require their commitment and co-operation; they are a vital target group of any successful expansion drive.

8.3.1.4 Acquisition of RNIB Talking Book machine and onset of reading difficulty

Table 8.6 shows that about half the users acquired their Talking Book machine as soon as they experienced difficulty reading. The overwhelming reason given by nearly 6 in 10 of those who got one 'much later' was that they were not told about the service at the time. Other reasons mentioned were: 'didn't want one', 'none available and had to wait', 'waited until registered'.

Table 8.6 Time lag between onset of reading difficulty and acquisition of RNIB Talking Book machine - “Did you get one as soon as you had difficulty reading, or was it much later?” (WQ42)

 

All Talking Book users %

Straight away

47

Much later

52

Don’t know

1

Total %

100

Base (population)

90K

(Number interviewed)

(133)

    (133 respondents: only asked of those who were current Talking Book users)

More of the registered than the non-registered reported that they got an RNIB Talking Book machine immediately, but the difference (13%) falls short of statistical significance on the sample numbers available. There is clear scope for providing registered and non-registered people with information about the service at an earlier stage.

8.3.1.5 Numbers of Talking Books read

Table 8.7 shows that 34% of the under-60s read fewer than one book a month, and 20% read four or more books; among those aged 60 and over corresponding totals are 6 and 44 per cent. On average, the under-60s had read 17 books during the previous six months, those aged 60 and over 27 books, the equivalent of about three and five books per month. These figures demonstrate that older members of the service use RNIB Talking Books more heavily.

 

Age (16-59) %

Age (60+) %

All Talking Book users

None

12

2

3

Less than 1 a month

34

6

10

1 a month less than 2

11

17

16

2 a month less than 3

15

15

15

3 a month or more

3

8

7

4 or more (average 4)*

20

44

41

Don’t know

4

9

8

Total %

100

100

100

Base (population)

12K

78K

90K

(Number interviewed)

(71)

(62)

(133)

    (133 respondents: 462 respondents did not have TBM)

    *On average, RNIB despatches four books a month to each member

It is impressive that nearly half those aged 60 and over read four or more books a month, especially since it takes approximately twelve hours to listen to a single book. That so many elderly visually impaired people listen for so long emphasises the importance of the service.

8.3.1.6 Difficulty using the RNIB Talking Book machine

A small proportion (10%) of current users said that they found it difficult to operate the RNIB Talking Book machine (WQ45). The reasons given were "unable to operate the machine' or 'unable to press the buttons'. Perhaps not surprisingly, almost everyone who had difficulty was aged 60 or over (most being in the 75+ age group), and were at the registrably blind residual vision level. Chapter 12 shows that very elderly blind people are more likely to experience other health and disability problems.

8.3.1.7 Announcements on RNIB Talking Book tapes

When we asked (WQ47) whether respondents ever listened to the announcements at the end of the RNIB Talking Book tapes, we found that 73% said that they 'always' or 'sometimes' did. Just under 10% of users said that they did not know about the announcements. Just under 30% of RNIB Talking Book readers said that they could remember announcements they had found particulary useful. These included information on 'sight aids' and 'books by the same author'.

8.3.1.8 Suggestions for improvements in the service

Although about two thirds of RNIB Talking Book readers suggested improvements to the service, these were so diverse that only a few ideas appeared more than once. 'Receiving tapes more frequently'; 'problems with the readers (e.g. reading too slow, not liking their voice)'; 'tapes faulty'; 'more new books' were most frequently mentioned, but in no case by more than 8% of readers.

8.3.1.9 Joint use of RNIB Talking Book machines and other tape- players

Table 8.8 shows that just under a third of RNIB Talking Book users possess only a Talking Book machine and do not have another tape- player. There is a considerable age-related variation: 8% of the under-60s but 35% of elderly people have only the RNIB Talking Book machine.

 

Age (16-59) %

Age (60+) %

All with a Talking Book

TB more

23

44

41

Other tape-player more

40

7

12

Same usage

29

14

16

Only have TB

8

35

31

Total %

100

100

100

Base (population)

12K

78K

90K

(Number interviewed)

(72)

(61)

(133)

    (133 respondents: only asked of current Talking Book users)

As already noted (section 8.2.1), the under-60s are more likely to have some kind of tape-player, and now we see that a substantial number of those who have an RNIB Talking Book machine also have another tape- player. A similar usage pattern emerges among those who possess both an RNIB Talking Book machine and another tape-player. The younger age group uses the non RNIB tape-player more intensively: 40% said that they used their tape-player more often than the RNIB Talking Book machine, compared with only 7% of those in the older age group.

Table 8.8 also demonstrates a remarkable degree of dependence on the RNIB Talking Book machine. Ninety-three per cent of elderly users either possess only an RNIB Talking Book machine or use it as often or more often than an ordinary tape-player. Even among the under-60s, who are more familiar with ordinary tape-players, the figure is 60%.

8.3.2 Lapsed RNIB Talking Book users

8.3.2.1 Profile of lapsed users

All those respondents who either did not initially say that they possessed a tape-player, or who did not mention an RNIB Talking Book machine, were asked (WQ38) if they had ever possessed one. Tables 8.9.a and 8.9.b show that, overall, 4% of visually impaired people previously had an RNIB Talking Book machine. At 12% current users are three times as great; that is, for every three current users there is one lapsed user.

 

Age and residual vision (16-59) B in %

Age and residual vision (16-59) PS in %

Age and residual vision (60+) B in %

Age and residual vision (60+) B in %

Total

Has one now

32

5

20

6

12

Has had but not now

19

5

8

1

4

Has never had one

49

90

72

93

84

Total %

100

100

100

100

100

Base (population)

30K

47K

270K

410K

757K

(Number interviewed)

(136)

(162)

(130)

(166)

(595)

 

Registration status and residual vision – registered B in %

Registration status and residual vision – registered PS in %

Registration status and residual vision – non-registered B in %

Registration status and residual vision – non registered PS in %

Total

Has one now

38

22

12

3

12

Has had but not now

22

9

1

#

4

Has never had one

41

69

87

97

84

Total %

100

100

100

100

100

Base (population)

109K

61K

192K

395K

757K

(Number interviewed)

(197)

(155)

(70)

(173)

(595)

Lapsed users occur with greater relative frequency in the 16-59 age band and also among the registered, where their number approaches two for every three users. Since a majority of the younger age group is registered, both factors are at work. The registered older age group also has a higher than average rate of lapsed users, which indicates that registration in itself is a factor. Among the non-registered, where as we have seen (section 8.3.1.1) the uptake of Talking Books is low in relative terms (even though it amounts to 39% of the total), there are also relatively fewer lapsed users: for every six non-registered users there is only one lapsed user (average of B/PS columns in Table 8.9.b.).

In terms of absolute numbers, those aged 60 and over represent 24,000 of the estimated 32,000 people who have given up the RNIB Talking Book Service. The largest single numerical group is the registrably blind aged 60 and over, of whom 20,000 have given it up; 14,000 of these are 75 or over.

8.3.2.2 Reasons for giving up RNIB Talking Books

We asked those people (some 4% of the visually impaired population) who had given up RNIB Talking Books their reasons. Table 8.10 shows the most frequent reasons given. These cannot be divided into simple independent categories. The single most frequently mentioned reasons were 'could not be bothered', 'did not like the stories' and 'no time/too busy' (22, 18 and 14 per cent respectively). A fair proportion of respondents also mentioned some specific dissatisfaction with an aspect of the service.

“Unreliable or unsatisfactory machines” and 'stories too slow/too long' (which includes having to wait too long for the next tape continuing the text to arrive) scored 9 and 8 per cent respectively. Only 3% of respondents mentioned expense as a reason for giving up their machine, saying that they could not afford the subscriptions or, in one case, that it used up electricity. Other reasons include a variety of answers mentioned by one individual alone: “moved district”, “deaf”, “cannot remember”, “prefer radio”, “couldn't get the hang of it”, “might still have it somewhere”.

 

All lapsed Talking Book readers

Could not be bothered

22

Did not like stories/not a reader

18

No time/too busy/other hobbies

14

Unreliable/unsatisfactory machines

9

Stories too slow/too long to wait

8

Voices bored/made sleepy

5

Can read/sight improved

4

Student, want only non-fiction

3

Can’t afford

3

Easier to use library tape/own equipment

2

Other reasons

15

Base (population) = 100%

32K

(Number interviewed)

(65)

    (65 respondents: 530 respondents either current users, or have never had one)

Many respondents added that they thought that they should send the Talking Book machine back for others to use, or that they had been asked to do so, if they were not using it themselves. This could explain why in relative terms there is both more uptake and more lapsed usage of Talking Books among the registered rather than the unregistered; the registered are more likely to be in touch with social services who actively 'manage' their membership. (Note that the majority of RNIB Talking Book members have their subscriptions met by their local authority social services department.)

8.3.3 Non-users of Talking Books

8.3.3.1 Non-users unaware of the service

Tables 8.11 .a. and 8.11 .b. show that awareness was greatest among younger respondents, of whom only about a quarter had not heard of the service. Registration is an additional factor in the 16-59 age group; 13% of the registered and 34% of the non-registered were unaware of the service. Among the elderly the corresponding totals were 29 and 64 per cent.

 

Age and residual vision (16-59) B in %

Age and residual vision (16-59) PS in %

Age and residual vision (60+) B in %

Age and residual vision (60+) PS in %

Total

Never had a TB: but heard about it

29

58

16

36

30

Never had a TB: but never heard about it

21

31

56

57

54

Have or have had a TB*

51

10

28

7

16

Total %

100

100

100

100

100

Base (population)

30K

47K

270K

410K

757K

(Number interviewed)

(137)

(162)

(130)

(166)

(595)

    * From WQ37 and WQ38, Tables 8.2 and 8.9

 

Age and registration status (16-59) R in %

Age and registration status (16-59) NR in %

Age and registration status (60+) R in %

Age and registration status (60+) NR in %

Total

Never had a TB: but heard about it

33

55

22

29

30

Never had a TB: but never heard about it

13

34

29

64

54

Have or have had a TB*

54

11

49

7

16

Total %

100

100

100

100

100

Base (population)

30K

47K

140K

540K

757K

(Number interviewed)

(215)

(84)

(137)

(159)

(595)

    *From WQ37 and WQ38

The 54% who did not know about RNIB Talking Books were given a brief description (WQ53) and were asked if they would be interested in having one. As Table 8.12 shows, just under one in four expressed an interest.

 

Age (16-59) %

Age (60+) %

Total

Yes, would like one

60

22

23

No, don’t want one

40

79

77

Total %

100

100

100

Base (population)

21K

377K

398K

(Number interviewed)

(67)

(127)

(194)

    (194 respondents: 401 already know about Talking Books)

Answers to hypothetical questions about an unfamiliar service should be treated cautiously as a measure of potential demand. But, on the answers given, Table 8.12 shows that 23% of the 398,000 people unaware of the service would be prepared to use it if it were made accessible. In percentage terms demand is largest (60%) among those unaware of the service in the 16-59 age group. In absolute numbers, however, this amounts only to 12,000 people. The corresponding total (22%) among the older age group indicates a much larger sub-group of some 84,000 potential users.

8.3.3.2 Non-users aware of the service

Of the 30% of visually impaired people who knew about Talking Books but were not current or past users, fewer than 5% had made enquiries about obtaining one (WQ54). This suggests either that there was very little demand from those who knew about the product, or else that they did not know where to enquire.

Table 8.13 throws some further light on the issue. Those who knew about Talking Books but had not enquired about obtaining them, were questioned (WQ58) about whom they would ask.

The range of enquiry points indicates that many people know where to start finding out about the Service. However, four in ten said that they did not know whom they would ask. Others mentioned a variety of people. The most frequently mentioned were 'social/welfare workers'

 

All those who knew about TBs but had not made enquiries about getting one

%

Social/welfare worker

14

Other social services

5

Health service

10

Friend/colleague

10

RNIB

8

Library

6

Local blind association

3

Other relative

3

Someone in the household

2

Don’t know

38

Base (Population) = 100 %

245K

(Number interviewed)

(247)

    (247 respondents: only asked of those who knew about Talking Books but had not made any enquiries about obtaining them)

(14%), “health service” (10%), 'friend/colleague' (10%), RNIB (8%), and the local library (6%). (Note that we were very careful not to indicate that RNIB is the supplier of Talking Books.)

These results indicate that further potential demand exists and can be stimulated by appropriate additional information, even among those who already know about the Talking Book Service.

8.4 Other tape usage

8.4.1 Frequency of use

We noted from Table 8.1 that 46% of visually impaired people possess some kind of a tape-player (including Talking Book machines) and that ownership levels are much higher among the younger age group. This section examines ordinary tape-players and compares their usage with RNIB Talking Book machines.

Interviewers were specially instructed (at WQ37) to code respondents who possessed a Talking Book machine and/or another type of tape- player. Some 42% (population projection 319,000) of the visually impaired population said that they possessed an ordinary tape-player.

Table 8.14 shows that two-thirds of them use it regularly. A third said that they used it most days, a further quarter at least weekly, while nearly a fifth said that they never used it at all. Three-quarters of those at the registrably blind vision level made frequent use of their tape- player, compared with half those at the partially sighted level. A slightly larger proportion of the registered, and of younger respondents, also made more frequent use of it.

 

Residual vision (B in %)

Residual vision (PS in %)

All with a tape player (non TB) %

Most days

44

29

36

At least weekly

31

22

26

Once a month

8

8

8

Less often

6

21

15

Never use the tape

11

21

17

Total %

100

100

100

Base (population)

133K

185K

319K

(Number interviewed)

(187)

(206)

(393)

    (393 respondents: 200 without ordinary tape-player were not asked, no information for 2 respondents)

8.4.2 Use of already taped material

8.4.2.1 Type of material

Table 8.15 shows the material people listen to on tape. Music was most frequently mentioned (76%), and this probably hardly differs from the sighted population. Other than music, the main items mentioned were “local talking newspapers” (20% ), “stories/books” (7%), “national magazines” (4%), “letters” (3%) “religious material” (2%), and “poetry” (1%). Of the diverse items totalling 7%, no individual item reached more than 0.5% (most other replies concerned specially recorded material which was the subject of the next question, WQ63).

Altogether, 45% of the items mentioned concerned the use of tapes for access to verbal or printed material. There was double counting here in that some individuals mentioned more than one type of item. Section 8.4.2.2 examines the count of individuals and compares it with usage of Talking Books.

The main items on which blind and partially sighted respondents differed were 'local talking newspapers' (29% and 14%), “other national magazines” (8% and 2%), and “letters” (6% and 1%).

 

Residual vision (B in %)

Residual vision (PS in %)

All with a tape player (non TB) %

Music

79

74

76

Local talking newspapers

29

14

20

Stories/books

7

7

7

Other national magazines

9

2

4

Letters

6

1

3

Religious material

3

1

2

Poetry

2

1

1

Radio Times

1

1

1

Other

7

7

7

Never use the tape-player*

11

21

17

Base (population) = 100%

135K

186K

321K

(Number interviewed)

(188)

(207)

(395)

    (395) (395 respondents: 200 with no ordinary tape-player were not asked) *Never used player at WQ61

The high use of taped general-interest media, newspapers and magazines possibly illustrates the wider desire for more general interest material, and very likely its wider availability. Other usage would largely depend on the demand for specialist interests.

8.4.2.2 Comparisons with Talking Books

Table 8.16 brings together data on Talking Books and ordinary tape- players. In all, 42% of visually impaired people possess an ordinary tape-player. Even when the 7% who say that they possess one but do not use it are subtracted, the remaining 35% (row f. in Table 8.16) is considerably greater than the 12% who possess a Talking Book machine. Some 34% of all visually impaired people - 68% of those under 60, 31% of those aged 60 or over - have an ordinary tape-player but no Talking Book machine.

However, on the whole ordinary tape-players fulfil a different function from Talking Books. Table 8.16 shows that almost all those who possess an ordinary tape-player use it for listening to music (32% out of 35%). The pattern is similar in every sub-group. For example, although the percentage figure using a tape-player nearly doubles to 74% of the registrable blind in the 16 - 59 age band, 68% (of the total) use it to listen to music.

Nevertheless, some 14% of visually impaired people use their ordinary tape-players for listening to verbal material (e.g. local talking newspapers, other national magazines, letters on tape). At 42%, usage is markedly high among people in the 16-59 age group at blind registrable levels. However, as already noted in section 8.4.2.1 (Table 8.15), there is a wide range of verbal material other than fiction. A count of individuals shows that, while 14% use ordinary tape-players to listen to verbal material, only 3% use them for listening to stories or books (compare the 12% usage of Talking Books). In short, in contrast with Talking Book machines, ordinary tape-players are mostly used for listening to music and only secondarily for 'reading'. Furthermore, most of this 'reading' consists of non-fiction or information material.

 

Age and residual vision (16-59) B in %

Age and residual vision (16-59) PS in %

Age and residual vision (60+) B in %

Age and residual vision (60+) PS in %

Total

Talking books: has only Talking book

1

1

9

1

4

Talking books: Has Talking book and ordinary tape-player

30

4

11

5

8

Talking books: Total with Talking book

31

5

20

6

12

Ordinary tapes: Has ordinary tape player and Talking Book

30

4

11

5

8

Ordinary tapes: Has ordinary tape-player and no talking book

51

79

30

31

34

Ordinary tapes: Total with ordinary tape-player

81

83

41

36

42

Ordinary tapes: Total using ordinary tape player

74

69

36

28

35

No tape-player at all

18

17

50

63

54

Material listened to*: Music

68

63

32

26

32

Material listened to: Verbal material

42

22

17

10

14

Material listened to: Stories or books

7

6

3

3

3

Base (population)

30K

47K

270K

410K

757K

(Number interviewed)

(137)

(162)

(130)

(166)

(595)

    Rows (a) to (e) coded at WQ37

    *Count of respondents at WQ62; see Table 8.15

8.4.3 Recording on tape

About 8% of visually impaired people as a whole, amounting to some 60,000 people, are estimated to use their tape-players for recording materials. Among those aged 16-59 the numbers using tape-players for this purpose reached 43% of blind people and 17% of partially sighted people. The corresponding totals for blind and partially sighted people aged 60 and over were 11% and 2%. Use of tapes for recording purposes is thus particularly prevalent among younger blind people. However, the age bias of the visually impaired population means that the one in ten of older blind people who do use tapes in this way are responsible for half of all tape usage for this purpose.

Table 8.17 contains data on the use of tapes for recording by all owners of ordinary tape-players. The number of interviews was too small to permit a breakdown by sub-groups of the types of material recorded. The various types of materials recorded were: letters, 9%; music, 6%; telephone numbers, 3%; notes for self, 3%; and shopping lists, 1%. The large 'other' category covers diverse items each below 1%; of these radio talks formed a major component (including In Touch, the BBC radio programme for visually impaired people), followed by addresses, recipes, study tapes and notes for meetings. Some 17% of those who owned an ordinary tape-player said that they never used it for either recording or listening.

 

All with a tape player (non TB) %

Letters

9

Music

6

Telephone numbers

3

Notes for self

3

Shopping list

1

Notes for meetings

#

Other

12

Never use the tape-player*

17

Base (population) = 100%

321K

(Number interviewed)

(395)

    (395 respondents; 200 with no ordinary tape-player were not asked)

    *From WQ61, Table 8.14

8.4.4 Difficulties experienced in operating tape-player

About 18% of those who use an ordinary tape,player reported having some difficulty in doing so. This is not very different from the percentage who reported difficulty operating the RNIB Talking Book machine. Similar sorts of reasons were given: 'finding and pressing the right button' and 'seeing how the tape goes in'. Difficulties were as likely to be expressed by younger as by older respondents and by respondents with low as with high residual vision.

8.4.5 Source of tapes

Respondents who used ordinary tape-players were asked (WQ66) where they obtained their tapes. As Table 8.18 shows, the single most frequently mentioned source was “commercial shops” (60%), followed by “friends and relatives” (23%), “local talking newspapers” and “local libraries” (13% each). The predominant use of ordinary tapes for listening to music explains the high usage of commercial shops.

Likewise, the greater use of commercial shops by the non-registered reflects their less specialised use of tapes. In addition, more partially sighted people are not registered, and the tape material they use is likely to be similar to that used by sighted people

Greater usage of specialist tape sources by the registered is not so much an indication of need but rather of a greater awareness of the material available.

 

Registration status (R in %)

Registration status (NR in %)

Total

Shop

46

68

60

Friends/relatives

27

21

23

Local talking newspaper

24

6

13

Local library

24

7

13

Calibre

6

2

4

Local voluntary group

9

1

3

National talking newspaper

4

0

2

RNIB STL

2

0

1

Other

14

5

8

Base (population) = 100 %

95K

171K

266

(Number interviewed)

(256)

(93)

(349)

    (349 respondents: 200 had no ordinary tape machine, 46 did not use their tape-player)

Registered respondents were more likely than non-registered to report that they obtained tapes from either the local library (24 and 7 per cent) or from local talking newspapers (24 and 6 per cent). Registered respondents also obtained more tapes from services for the blind such as Calibre, RNIB Student Tape Library (STL), now the RNIB Cassette Library, and national talking newspapers.

Age also provided some differences. Respondents under 60 were more likely that the older age group to get their tapes from shops (80 and 55 per cent), and less likely to obtain them from the local library (3 and 15 per cent). Slightly more friends and relatives provided tapes for those aged 75 and over, than for younger respondents.

Overall, the RNIB Student Tape Library Service was mentioned by only 1% of respondents. This reflects the general perception (not discouraged by RNIB) at the time the survey was carried out that this was a specialist service for students.

8.5 RNIB compact tape services

While approximately three-quarters of registered blind and partially sighted people had heard of RNIB tape services, just over half (51%) of all respondents either were not currently using an RNIB tape service or said that they had not heard of any of the RNIBtape services offered to visually impaired people.

 

Age and residual vision (16-59) R %

Age and residual vision (16-59) NR %

Age and residual vision (60+) R %

Age and residual vision (60+) NR %

Total

Aware of RNIB tape services

87

65

71

40

49

Not aware of tape services

13

35

29

60

51

Total %

100

100

100

100

100

Base (population)

29K

48K

140K

540K

757K

(number interviewed)

(215)

(84)

(137)

(159)

(595)

Table 8119 brings together all the questions asked about use or knowledge of RNIB tape services. Registration and age are important factors in awareness of the RNIB tape services. Awareness among the registered was 74% compared with 42% among the non-registered, while among the under-60s and the older age groups it was 73 and 46 per cent. Table 8.19 shows that this difference is maintained within the age groups, the registered always being more aware of the services; it should be remembered that younger respondents are more likely to be registered.

Table 8.20 shows the level of awareness and use of the services. Best known was the RNIB Talking Book Service; overall 46% of respondents knew about it, including those who were current or past users. However, nearly two-thirds of those who knew about the service had not used it.

About 4% of all registrable blind and partially sighted people knew about RNIB's Student Tape Library (STL - now called the RNIB Cassette Library) and Express Reading Service (ERS). However, among people who possessed an ordinary tape player, and who could therefore use the service, awareness increased to 12%. Among the key target group of registrable blind people under 60, awareness levels were much higher; STL and ERS were known by approximately 30 and 20 per cent respectively.

Just over 2% of the visually impaired population were actually using STL. Under 1% reported using ERS.

 

Registration status (R) %

Registration status (NR) %

Total

Awareness of tape services: RNIB Talking books

72

38

46

Awareness of tape services: RNIB STL

14

1

4

Awareness of tape services: RNIB ERS

6

4

4

Awareness of tape services: Not aware of any of the tape services

26

58

51

Using/used tape services: RNIB Talking Book

49

6

16

Using/used tape services: RNIB STL

4

0

1

Using/used tape services: RNIB ERS

#

0

#

Not aware of tape service and have tape player

9

17

15

Not aware of tape service and without tape-player

16

41

36

Never use tape-player

4

8

7

Base (population) = 100%

169K

588K

757K

(Number interviewed)

(352)

(243)

(595)

    (595 respondents)

These figures suggest that much could be done to raise the awareness and subsequent use of both RNIB compact tape services. However, demand for ERS may be very limited. When ERS was explained to those who had not heard of it, and they were then asked whether they might use it, fewer than 2% said that they would. Awareness of both services was greater among respondents with low residual vision. This indicates that those with useful residual vision may make more extensive use of printed materials.

Note to section 8.2.2

The 12% ownership of Talking Book machines (section 12.3.1) yields an estimated population projection of about 90,000 on a base of 757,000. There are about 70,000 (9%) known members of the Service. There are several possible reasons for this discrepancy. The 95% confidence interval for a 12% estimate on a sample of 595 is +/-3%. RNIB Talking Books were not specifically mentioned in the question. In addition a response error may have occurred because many respondents may previously have had a Talking Book machine; some of these people may have responded inaccurately, saying that they still had one.

9 Readers

9.1 Visually impaired people who use a reader

9.1.1 Profile

Overall, 40% of visually impaired people said that they use a reader. That is, they obtain information from print by getting a sighted person to read aloud. The percentage varies with age, residual vision and registration status.

Two statistics demonstrate the most extreme form of this variation. Seventy-four per cent of blind people under 60 are read to, while only 28% of partially sighted people over 60 use this method of reading.

As Table 9.1 .a. shows, overall more people with lower levels of residual vision use a reader: 56% of blind people, 30% of partially sighted people. Or, put the other way round, 44 and 70 per cent respectively of blind and partially sighted people do not use a reader.

Younger people are read to more than the elderly: 56 and 38 per cent respectively of those aged under 60 and 60 and over. (There is no difference between the 60-74 and the 75+ age groups.)

Table 9.1.a. also shows that the age difference is independent of differences in sight level. Seventy-four and 54 per cent respectively of young and elderly blind people are read to. Among partially sighted people the corresponding age group totals are 44 and 28 per cent.

Registration is an important factor: 64% of the registered compared with 32% of the non-registered have a reader. Age is related to registration in that more of the young are registered, but most of the registration effect is independent of this correlation. Table 9.1 .b. shows that 74% of the registered aged under 60 have a reader compared with 44% of the non-registered in the same age group. Among those aged 60 and over, the corresponding figures are 62 and 32 per cent.

Table 9.1 .a. shows that just over half of blind people (56%) and just over a quarter of partially sighted people (29%) have someone who reads to them. While the figure for blind people correlates closely with the percentage unable to read our large print card (Table 6.3), the

Table 9.1.a. Use of a reader among visually impaired people by residual vision and age

“Now, I would like to move on to reading. Do you ever have anything read to you? I mean anything at all, not just books or papers?” (WQ72)

9.1.2 Frequency of use

Residual vision is the most important factor in determining the frequency with which respondents were read to. Table 9.2 shows that 44% of blind people and 25% of partially sighted people reported being read to most days. There is a small but statistically significant tendency for people in the 75 + age group to be read to less often than younger people: 30 compared with 45 per cent of those aged 74 and under were read to on most days.

 

Residual vision (B) %

Residual vision (PS) %

All with a personal reader

Most days

44

25

35

At least weekly

27

43

34

Once a month

12

7

10

Less than monthly

17

25

21

Total %

100

100

100

Base (population)

163K

132K

296K

(Number interviewed)

(196)

(136)

(332)

    (332 respondents: 256 not read to; no information for 7 respondents)

9.1.3 Items visually impaired people have read to them

Table 9.3 shows the items respondents listed as having read to them, “Postcards/letters” (88%), “bills” (77%), “official forms” (76%) and “newspapers” (53%) were the items most frequently mentioned. 'Books'and 'magazines' were mentioned by 7 and 19 per cent respectively.

The particular relevance of this list of items becomes clear in Chapter 15, which shows that “bills and paperwork” are among the tasks that visually impaired people find most difficult and challenging.

 

All with a personal reader %

Postcards/letters

88

Bills

77

Official forms

76

Newspapers

53

Magazines

19

Books

7

Recipes

3

Prices/instructions

2

Bible

1

Base (population) = 100%

292K

(number interviewed)

(335)

    (335 respondents: 257 not read to; no information for 3)

The items mentioned scarcely varied in relation to residual vision and age. Books tended to be mentioned more by the under-75s than by those aged 75 or over: 30 and 12 per cent respectively. (There was no difference between the 16-59 and 60-74 age groups.) Magazines, by contrast, were mentioned more often by the under-60s than by the older age groups: 15 and 6 per cent respectively. (Here there was no difference between the 60-74 and the 75+ age groups.)

9.1.4 Items visually impaired people dislike having read to them

Table 9.4 shows that half the respondents did not mention any item which they particularly objected having read to them. The two items most disliked, 'private letters' (42%) and 'bills' (35%) were also among the items most read. Overall, more partially sighted people disliked being read to, 59% compared with 43% of blind people mentioning an item to which they objected being read. For specific items the corresponding percentages were 51 and 36 per cent respectively for 'private letters', and 47 and 27 per cent respectively for 'bills'.

 

Age and residual vision (16-59) B in %

Age and residual vision (16-59) PS in %

Age and residual vision (60+) B in %

Age and residual vision (60+) PS in %

All with a personal reader

Private letters

47

34

35

54

42

Bills

23

20

27

52

35

Newspapers

4

3

8

2

5

Bank statements

1

3

4

7

5

Prices and instructions

0

6

0

4

2

Other items

9

14

15

25

18

No dislikes mentioned

52

57

57

38

50

Base (population) = 100%

22K

21K

145K

113K

300K

(Number interviewed)

(117)

(74)

(84)

(63)

(338)

    (338 respondents: 257 don't have anything read to them)

The major difference revealed by Table 9.4 between elderly partially sighted people and those aged under 60 is that elderly people object more to letters (54 to 34 per cent) and bills (52 to 20 per cent) being read to them. This may be because elderly people, whose visual impairment is more likely to have begun more recently (Chapter 5), find it more difficult to come to terms with being read to. Younger respondents, whose impairment has started earlier, have had a longer time to adjust. Furthermore, since elderly visually impaired people are more likely to depend on 'strangers' to read to them (section 9.1.5), they may object rather more to this intrusion on their privacy.

9.1.5 Identity of readers

Table 9.5 shows that those who read to visually impaired people are, in order of frequency, “someone in the household” (53%), “other relative”(27%), “friend or colleague” (17%), and the “home help” (9%). The pattern of readers reflects differences in the informal support network enjoyed by young and elderly visually impaired people. Among the under-60s “someone in the household” (84%) is followed, a long way behind, by “other relatives” (11%), friend or colleague' (8%) and “home help” (2%). Among elderly people, “someone in the household” (48%) remains the single category most frequently mentioned, but is followed far more closely by “other relative” (30%), “friend or colleague” (19%) and “home help” (10%).

 

Age (16-59) %

Age (60+) %

All with a personal reader

Someone in the household

84

48

53

Other relative

11

30

27

Friend or colleague

8

19

17

Home help

2

10

9

Local blind association

#

#

#

Health service person

2

0

#

Other

#

2

2

Base (population)

43K

252K

2

(Number interviewed)

(191)

(146)

(337)

    (337 respondents: 257 were not read to; no information for 1)

The general pattern is that, as visually impaired people grow older, sources of help move from within to outside the household. Chapter 15 covers this in more detail, examining the way visually impaired people tackle the tasks of daily living, including 'mail' and 'paperwork', for both of which reading ability is essential.

In Section 3.4 we have already learnt that older visually impaired people are more likely to live in single households; thus any print requiring reading must wait for someone outside the household.

Perhaps the most significant point is the frequency with which the 'reading service' is offered (Table 9.2). For example, of the 56% of blind people who are read to, nearly three-quarters (71%) are read to at least once a week, and the majority of them on most days. Of the just over one-quarter (29%) of partially sighted people who need a reader service, two-thirds (68%) are read to at least weekly. Given that a reading service to visually impaired people does not form part of the statutory social services, this represents a considerable, and without doubt necessary, level of informal help.

9.2 Users and non-users of readers

9.2.1 Self-assessed need for more readers

To gauge the existence of an unmet need for more personal reading, respondents were asked whether they would like to be read to or read to more frequently. The overall demand for more reading (8%), shown in Table 9.6.a., masks differences in demand within the individual sub- groups. For example blind people, particularly in the younger age group, want more reader support; 17% of blind respondents under 60 said that they needed more help.

 

Age (16-59) %

Age (60+) %

Residual vision (B) %

Residual vision (PS) %

Total

Yes

17

7

15

7

8

No/don’t know

83

93

85

93

92

Total %

100

100

100

100

100

Base (population)

77K

680K

300K

457K

757K

(Number interviewed)

(137)

(162)

(130)

(166)

(595)

Table 9.6.b. shows that once visually impaired people have experienced the benefits of reader support they are significantly more likely to want more of such help than those who have not experienced it. For example, as many as 20% of visually impaired people under 60 currently using a reader say that they would like to be read to more often.

 

Those with existing readers (16-59) %

Those with existing readers (60+) %

Those with existing readers (All) %

Those without readers (16-59) %

Those without readers (60+) %

Those without readers (All) %

Yes

20

11

12

13

4

4

No

80

89

88

87

96

96

Total %

100

100

100

100

100

100

Base (population)

43K

257K

301K

34K

422K

456K

(Number interviewed)

(191)

(147)

(339)

(107)

(148)

(256)

9.2.2 Reasons for not wanting a reader

Table 9.7 shows that the single most mentioned reason, reported by 37% of respondents, for not wanting to increase the use of readers was simply that people preferred to manage for themselves. The totals, 44 and 26 per cent for partially sighted and blind people respectively, vary with residual vision. Section 9.2.3 examines how far these figures correspond with respondents' actual ability to read print for themselves. The reason that no help was needed as yet also varied with residual vision, being given by 12% of partially sighted and 3% of blind respondents. Fourteen per cent of blind people and 8% of partially sighted people said that they were read to when they needed it. The responses “too old/forgetful” and “too deaf”, amounting to 5% in total, were mentioned solely by those aged 60 or over.

 

Residual vision (B) %

Residual vision (PS) %

Total %

Prefer to manage by myself

26

44

37

Relatives read when needed

14

8

10

Don’t need help yet

3

12

8

Prefer/like radio/television

14

3

7

Don’t like reading

4

5

5

Can’t take things in

3

5

4

Too old/forgetful

8

2

4

Not same as reading for self

4

2

3

Too deaf

2

6

1

Other

42

23

30

Base (Population) = 100%

268K

432K

700K

(Number interviewed)

(228)

(305)

(533)

    (533 respondents: 62 respondents were not asked WQ79)

9.2.3 Use and non-use of readers and print reading

In Chapter 7 it was noted that 65% of visually impaired people could read the large print test and said that they normally do read print (section 7.2.). This overall figure of those able to read print by themselves compares fairly closely with the 60% who do not use a reader (section 9.1.1). About 80% of partially sighted and 40% of blind people read the test and said that they normally read print (section 7.2). Again, this accords fairly well with the 70% of partially sighted and the 44% of blind people who said that they did not use a reader (section 9.1.1).

Forty two per cent said that they could read ordinary newspaper print; 51% of partially sighted people and 25% of blind people (section 7.3). These figures again correspond quite closely with the totals (44 and 26 per cent respectively) noted in section 9.2.2 saying that they could manage for themselves.

From this evidence alone and without more detailed analysis, there does appear to be a broad correspondence between the use and demand for readers and the print-reading ability of visually impaired people.

10 Braille

10.1 Introduction

This chapter examines braille and Moon, the other embossed reading method for visually impaired people. In addition, comparisons in section 10.9 are made with the last major national survey of braille and Moon usage made for the (then) Ministry of Health by Gray and Todd (1968). (The survey was carried out in 1965 and the report published in 1968.) The present survey has been designed primarily to set the role of braille in the wider context of the reading habits of visually impaired people, and is therefore less appropriate for an analysis of the reading habits of braille readers. Caution is necessary in drawing inferences where the percentages quoted are based on a small number of braille readers (section 21.4).

10.2 Establishing braille usage

Respondents who said that they knew what braille was were asked the following question: 'Have you ever had any lessons, or tried to teach yourself to read braille?' (WQ9) Those who answered 'yes' to this question were then asked the following supplementary question: 'Did you become good enough to understand a braille book or magazine?'(we15)

10.3 The braille user group

These two questions, WQ9 and WQ15, were deliberately given the identical wording used by Gray and Todd. Following their example, the two questions together allow visually impaired users and non-users of braille to be placed into one of three categories, as Table 10.1 shows.

We use the term “braille reader” to describe those who have become sufficiently fluent in braille to read a book or magazine. These respondents were later asked a series of questions about their use of braille (sections 10.5, 10.7).

Table 10.1 shows that only 3% (2.51% rounded up) of visually impaired people are braille readers as defined above (84 respondents in our sample). On a base population of 757,000 visually impaired people, our estimate is that there are some 19,000 braille readers. Of these, about 70%, some 13,000 people, are still active readers, and some 10,000 write in braille as well (section10.7).

 

Age (16-59) %

Age (60+) %

Total

Never learned braille (WQ9)*

73

98

95

Learned but not good enough to read (WQ15)

13

1

2

Learned and got good enough to read (WQ15)

14

1

3

Total %

100

100

100

Base (population)

77K

680K

757K

(Number interviewed)

(229)

(296)

(595)

    *includes no/don't know from WQ8

Gray and Todd's survey of braille reading was confined to registered blind people under 80 years old. Before the two surveys' estimates of the number of braille readers can be compared, it is necessary to examine the specific characteristics of braille readers and non-readers.

10.4 Characteristics of braille readers

10.4.1 Age of braille readers

Table 10.1 shows the extreme extent to which braille usage is concentrated among younger visually impaired people. Some 27% of those aged 16 - 59 had learnt some braille, 14% well enough to read a book or a magazine. The corresponding proportion of those aged 60 or over is 1% in each category. It is important to remember that in numerical terms most visually impaired people are aged 60 or over. Thus 1% (1.2% rounded) of elderly braille readers represents a population projection of about 8,000 on a base of 680,000. Fourteen per cent of younger readers represents 11,000 readers on a base of 77,000.

10.4.2 Registration status

Table 10.2.a. shows that 81% of registered blind people under 60 were taught braille. Given that braille is inappropriate for a few people (e.g. some multi-handicapped blind people), this represents a high penetration of braille teaching. However the fact that 30% learnt braille but failed to master it sufficiently to read a magazine or book is of concern.

 

Registered Residual vision B in %

Registered Residual vision PS in %

Non-Registered Residual vision B in %

Non Registered Residual vision PS in %

Total

Never learned Braille

19

66

95

96

73

Learned but not good enough to read

30

25

0

5

13

Learned and not good enough to read

51

9

6

0

14

Total %

100

100

100

100

100

Base (population)

17K

12K

12K

36K

77K

(Number interviewed)

(123)

(92)

(14)

(70)

(299)

 

Registered Residual vision B in %

Registered Residual vision PS in %

Non-Registered Residual vision B in %

Non Registered Residual vision PS in %

Total

Never learned Braille

84

99

98

100

97

Learned but not good enough to read

7

#

2

0

1

Learned and not good enough to read

9

0

0

0

1

Total %

100

100

100

100

100

Base (population)

91K

49K

180K

361K

680K

(Number interviewed)

(74)

(63)

(56)

(103)

(296)

Tables 10.2.a. and 10.2.b. not only confirm the concentration of braille readers among younger visually impaired people but also indicate a further concentration among those people registered as blind. Among registrable blind people aged 16 - 59, 51 and 6 per cent of registered and non-registered respectively are braille readers. Our sample contained only fourteen younger non-registered blind people (section 21.9), and so caution is required when conclusions are made from percentages and population projections on such a small base. Nevertheless, the difference between 51 and 6 per cent far exceeds any possible random sampling error, even on such a small base. Moreover, the findings for those aged 60 +, and for partially sighted people, increase confidence in the conclusion that registration, far more than age and residual vision level, is the crucial factor. Although only 1% of older visually impaired people can read a book or magazine in braille, all these are registered blind, and none at all are unregistered blind or partially sighted. Among the younger respondents, 9% of the registered partially sighted, and none of the non-registered partially sighted, said that they could read braille.

10.4.3 Age of onset of visual impairment

Table 10.3.a. confirms that the ability to read braille is closely related to the age of onset of the visual impairment. People who lost their vision at birth or before the age of 17 are most likely to become braille readers. Thirteen per cent of these did so, compared with 4% of those aged 17-59 and less than 0.5% of those aged 60 or over.

As so many more visually impaired people lose their sight between the ages of 17 and 59 than before the age of 17, the 4% (4.4% rounded) of this group who become braille readers represents, in numerical terms, a substantial part of the total. As Table 10.3.b. shows, almost all of them are registrable blind rather than partially sighted. Population projections indicate that about 8,000 braille readers (4.4% of 182,000) lost their sight in their post-school years, compared with about 10,000 (13% of 78,000) who lost their sight at an earlier age.

Assuming that the age at which braille is learned is closely related to age of onset of vision loss, the data in Table 10.3.a. do not suggest that those who learn braille in childhood are more likely in relative terms to become good enough to read than those who study it between the ages of 17 and 59. Ten per cent of the former group learned braille but did not become good enough to read, while 13% did, which produces a 56% success rate (13/23). Among the older group, the corresponding percentages are 4 and 4, producing a 50% success rate. This difference in success rate is well short of statistical significance.

Given these comparable success rates, and knowing that a significant number of the successful adult learners are at the older end of the age range, two conclusions are suggested. First, more extensive teaching of braille to adults under 60 would be likely to produce a fair degree of success. Second, given that, according to our findings, only 1% of elderly visually impaired people are taught braille, an opportunity exists to develop braille teaching among this age group. One possible argument against expanding braille readership among the over-60s is that Moon may be 'more appropriate' for this age group. However, section 10.6.2 shows that penetration of Moon is extremely low, and so in practice it does not provide an alternative.

 

Age of onset (Birth to 16) %

Age of onset (17-59) %

Age of onset (60+)

Total

Never learned braille

77

92

99

95

Learned but not good enough to read

10

4

#

2

Learned and got good enough to read

13

4

0

3

Total %

100

100

100

100

Base (population)

78K

182K

456K

716K

(Number interviewed)

(151)

(263)

(156)

(570)

    (570 respondents: no age of onset given for 23; no information on the understanding of braille for 2)

    # less than 0.5% (only 1 respondent over 60 reported learning any braille)

 

Age of onset and residual vision (Birth to 16) B in %

Age of onset and residual vision (Birth to 16) PS in %

Age of onset and residual vision (17+) B in %

Age of onset and residual vision (17+) PS in %

Residual vision B in %

Residual vision PS in %

Total

Never learned braille

61

90

95

99

77

98

95

Learned but not good enough to read

12

8

3

#

10

1

2

Learned and got good enough to read

27

2

3

#

13

1

3

Total %

100

100

100

100

100

100

100

Base (population)

36K

42K

251K

386K

78K

638K

716K

(Number interviewed)

(73)

(78)

(184)

(235)

(151)

(419)

(570)

    (570 respondents: no age of onset given for 23; no information on the understanding of braille for 2)

10.4.4 Residual vision level

Table 10.4 shows the extent to which braille reading is related to residual vision levels required for reading print. Three residual vision levels are distinguished: NLP (no light perception), LP (light perception) but unable to read large print, and able to read large print. These three levels correspond to QRVS7 scale point zero, with the remainder divided by the results of the reading test (sections 6.1 and 6.2.3). The total of braille readers in these three categories is 18, 5 and 1 per cent respectively. The corresponding totals in the same three categories of all those who learnt braille, whether or not they got good enough to read, are 26, 10 and 3 per cent.

 

Residual vision (NLP) B in %

Residual vision (Light perception and reading large print*) Not read in %

Residual vision (Light perception and reading large print*) Read in %

Total

Never learned braille

74

90

97

95

Learned but not good enough to read

8

5

2

2

Learned and got good enough to read

18

5

1

3

Total %

100

100

100

100

Base (population)

27K

195K

535K

757K

(Number interviewed)

(48)

(164)

(383)

(595)

    * Large print refers to the sample print respondents were asked to read (section 6.2.3)

Thus Table 10.4 reveals a very strong correlation between braille readership and residual vision, and this may well be produced by more than one factor. The threefold difference between those with NLP and the next category (LP but unable to read large print) is large enough to be statistically significant (despite the small base of 48, see section 21.4). Since neither of these two groups can see well enough to read large print, they can be deemed to have the same incentive to succeed at learning braille. This therefore suggests a difference in the opportunity to learn.

We noted in section 3.9.4 (see also Table 3.14) that those with NLP are all registered blind, while the non-registered but registrable blind, though still less than our 6/60 cut-off point, are skewed towards those with some light perception. The inference is that the very high incidence of braille readership among people with NLP, and so in the extreme residual vision stratum, is an indirect consequence of the increased likelihood that people with NLP will be registered and so form part of the welfare system catering for blind people.

10.5 Learning braille

10.5.1 Lessons and self-tuition

Those who responded positively to WQ9, 'Have you ever had any lessons, or tried to teach yourself to read braille?' (151 respondents, population projection 39,000) were then asked the following supplementary question: 'Is that lessons from other people, self-taught or both?' The responses to these three alternatives, as shown in Table 10.5.a., were 74, 8, and 18 per cent respectively. Thus for most people, learning braille is through formal lessons.

Table 10.5.a. Methods of learning braille

“Have you ever had any lessons, or tried to teach yourself to read braille?” If “Yes”, PROBE: “Is that lessons from other people, self-taught or both?” (WQ9)

 

All who have tried to learn braille

Formal lessons only

74

Self-taught and lessons

18

Self-taught only

8

Total %

100

Base (population)

39K

(Number interviewed)

(151)

    (151 respondents who said that they had tried to learn braille; 444 did not learn braille)

We already know (Table 10.1) that only 3 out of 5 (60%) of those who try to learn braille become good enough to read a braille book or magazine. Table 10.5.b. provides clear evidence that self-tuition is an inadequate basis for learning braille. No one who attempted to learn braille on his or her own, without formal tuition, became good enough to read a book.

 

Able to read book

Not able to read book

All who learnt braille

Formal lessons only

81

65

74

Self-taught with lessons

19

19

19

Self-taught only

0

16

8

Total %

100

100

100

Base (population)

19K

17K

36K

(Number interviewed)

(84)

(65)

(149)

    (149 respondents: no information on level of braille proficiency for 2 respondents; 444 did not learn braille)

10.5.2 Source of braille lessons

Respondents who had received lessons in braille were asked (at WQ13) who provided them. The results, given in Table 10.6, show that the chief sources were welfare services (36%), schools (28%), RNIB (12%), and local blind associations (7%).

 

Age (16-59) %

Age (60+) %

Total

Welfare services*

38

35

36

School

34

24

28

RNIB

23

0

12

Local blind association

2

12

7

Other

3

29

17

Base (population)

19K

17K

36K

(Number interviewed)

(120)

(22)

(142)

    (142 respondents: 9 respondents were self-taught; 444 had not learnt braille) *Includes all services under this broad heading, e.g. mobility officer, social worker for the blind

The composite 'other' category (17%) is almost entirely confined to people aged 60 and over, many of whom could not say who gave them braille lessons. The single category of provider mentioned most often was 'friend or neighbour'. Likewise, mentions of local blind associations were almost entirely confined to elderly people. The welfare agent most frequently named was “social worker for the blind” (by 23% of this age group), the others being mainly “technical officers”.

RNIB is a very significant provider of tuition to the younger age group, where by far the greatest concentration of braille readers lies (Table 10.6). Twenty-three per cent of 16 - 59 year olds, but no one in the older age group, mentioned RNIB directly. Most of this RNIB tuition is likely to have taken place at an RNIB rehabilitation centre, but a number of respondents may have attended an RNIB school. In addition, many respondents answering “school” may have learnt braille at an RNIB school.

Although the other composite categories, school and welfare services, show slightly higher percentages (34 and 38) than RNIB in the younger age group, the small size of the sample should be taken into account. Only 120 respondents in this age band said that they had learnt braille, and on this base the differences between the various categories are not statistically significant.

10.6 Moon

10.6.1 Numbers learning Moon

Moon, which was invented in 1847, eighteen years after braille, is promoted as simpler to learn than braille, and also as requiring less sensitivity in the fingers to read; for these reasons it has largely been considered more suitable for older blind people. However, it has been developed far less than braille, and until recently a Moon writer has not been readily available, which has limited its everyday use.

The series of questions we asked about Moon readership paralleled those asked about braille. However, the low number of respondents made detailed analysis impossible. Our sample contained 37 people who claimed to have learned Moon, but only four of these said that they had become good enough to read a book or magazine, and only one was a current user.

The next section provides detailed evidence of the lack of knowledge of Moon and the low learning success rate. At 11%, this compares very unfavourably with braille success rates. Furthermore, only one person of the four has sustained the reading habit, which also compares very unfavourably with braille.

10.6.2 Awareness

Respondents were asked (WQ24) about their awareness of Moon, in a parallel question to that asked about braille. While braille was widely known, by more than 8 in 10 respondents, fewer than 1 in 10 had heard of Moon (Table 10.7). Unlike braille, awareness of which was spread across age and sight level groups, Moon was mainly known among younger respondents with low residual vision; the highest awareness level (48%) was among registrable blind respondents under 60. Twenty- seven, 13 and 2 per cent respectively of the under-60s, 60 - 74 year olds and those aged 75 + knew what Moon was (Table 10.7).

 

Age and residual vision (16-59) B in %

Age and residual vision (16-59) PS in %

Age and residual vision (60-74) B in %

Age and residual vision (60-74) PS in %

Age and residual vision (75+) B in %

Age and residual vision (75+) PS in %

Total

%

Moon awareness – Know what Moon is

48

13

25

6

4

1

7

Moon awareness – Not know what Moon is

52

87

75

94

96

98

93

Braille awareness – Know what braille is

94

96

86

94

84

83

87

Braille awareness – Not know braille

6

4

14

6

16

17

13

Total %

100

100

100

100

100

100

100

Base (population)

30K

47K

65K

115K

205K

295K

757K

(Number interviewed)

(137)

(162)

(55)

(69)

(75)

(97)

(595)

While 48% of blind people under 60 know of Moon, the figures are only 25% of those aged between 60 and 74 years and 4% of those aged 75 and over. Since one of Moon's benefits is considered to be ease of learning in comparison with braille, particularly for older visually impaired people, this low level of awareness should give cause for concern. Awareness of Moon is concentrated among registered people, in contrast with braille, awareness of which cuts across the registered/ non-registered dichotomy. Perhaps awareness of any “new” product or service for visually impaired people will only be diffused among those who are part of the visually impaired “system”. Those outside the “system” may need to make considerable efforts to find out what is available.

10.7 Use of braille

10.7.1 Current braille users

Those 84 respondents who said that they had become proficient enough to read a book or magazine represent 3% of visually impaired people, giving a population projection of 19,000. When asked an additional question – “Do you ever use braille nowadays?” (WQ16) - approximately 1 in 3 answered in the negative. The 56 individuals who said “yes” constitute the currently active braille readers in our sample, producing a population projection of 13,000. Further questions on the use made of braille were put only to this sub-group of currently active readers in the sample.

10.7.2 Use for reading

10.7.2.1 Material in braille

Table 10.8 shows the replies given by currently active readers of braille to the question “Do you read any of the following in braille?” (WQ19). The first six items - magazines, private letters, books, Radio Times, bank statements and newspapers - were prompted from a check list.

 

Current braille readers %

Magazines

75

Private letters

72

Books

70

Radio Times

42

Bank statements

25

Newspapers

9

Calenders*

2

Technical special books*

1

Knitting/sewing instructions

1

Other things*

27

Base (population)

  

(Number interviewed)

  

    (56 respondents: only asked of braille readers) + Items mentioned without prompting

A wide variety of other items was mentioned spontaneously, but only calendars (2%), technical special books and knitting and sewing instructions amounted individually to more than 1%. The 42% who read the braille Radio Times (produced by RNIB) gives an estimated readership of 5,000. RNIB has 4,000 subscribers which would suggest a larger number of readers. However, the two figures represent good agreement within the limits of sampling error, given that they are projected from a small base of only 56 respondents. About three-quarters of currently active readers said that they read “books”, “magazines” and “private letters” in braille, while “bank statements” were mentioned by a quarter. Nine per cent of respondents mentioned braille newspapers, and other items such as “knitting/sewing patterns”, “crossword puzzles” and “calendars” were mentioned by one or two people.

When asked (at WQ20), only three respondents mentioned an item they would like to read that was currently unavailable in braille.

10.7.2.2 Access to braille and Moon books

The data discussed in this section are based on the 29 out of 56 current active readers who said (at WQ30) that they borrowed books in braille or (one person) Moon. Such low numbers provide only a thin basis for generalisation (section 21.4), and so findings must be interpreted cautiously. Note also that most respondents read braille, not Moon, books. Table 10.9 lists the various sources for borrowing.

 

Those who borrow braille or Moon books in %

National library for the Blind

73

RNIB (general, no special advice)

29

RNIB Braille Library

11

Local blind association

2

Social services

2

Monument Trust

2

Other lenders

12

Base (population) = 100%

6K

(Number interviewed)

(29)

    (29 respondents: only those who borrow braille or Moon books)

Current readers are equally likely to buy or borrow books; only a small number said that they only bought them. The main source for borrowing books was the National Library for the Blind, mentioned by 73% of borrowers. Next most frequently mentioned was RNIB generally (29%), while the RNIB Braille Library was specifically reported by 11%. A number of other sources were named, including local blind associations, social services and the Monument Trust.

Two sources received significant mentions as sources for buying books (WQ32). Thirteen of the 22 respondents who said that they bought books mentioned RNIB, 9 the social services.

Of those respondents who were currently borrowing or buying books, 3 in 10 had not read any or had read 1 to 3 in the previous 6 months, while 4 in 10 had read 4 or more books in the same period (WQ33).

The vast majority of current buyers or borrowers were satisfied with the provision of braille and Moon books.

10.7.3 Use for writing

Braille readers (section 10.3) were asked (at WQ16) whether they used braille for writing. Their replies indicate that about 10,000 do, of whom 7,000 were aged under 60. A negligible fraction of the 7,000 were registered as partially sighted, or registrable as blind. About a third use a writing-frame, over half use a writing-machine, and about 1 in 5 use both. These fractions should be regarded as approximate because of the small base. The most frequently mentioned brand of machine was the Perkins brailler, which was named twice as often as the Stainsby (we18).

10.7.4 Braille and work

We estimate that about 3,000 people use braille at work (WQ21). This represents 10% of blind people of working age, or nearly half the registrable blind people currently at work. When these respondents were asked (at WQ23) if work would be easier if they could use braille more, they all responded negatively. There are several possible reasons for this response. The first is that the finding is completely accurate. The second is that respondents cannot visualise how their working situation might be improved with increased provision of braille. The third reason could be that they do not foresee that their employer would increase the amount of braille and therefore rationalise the situation as making the maximum current use of braille.

Perhaps not surprisingly, all those who reported using braille at work were registered.

10.8 Non-users of braille (or Moon)

10.8.1 Awareness

Overall, a high proportion of respondents (87%) reported awareness of braille (Table 10.7). The percentage was somewhat greater among younger respondents than that reported among elderly people (95 and 86 per cent respectively). Neither residual vision nor registration status had any impact on these figures.

10.8.2 Reasons for not learning braille

While lack of awareness may have something to do with why few people learn Moon, this is clearly not the case with braille. Those respondents who were aware of braille but had not received lessons (a large majority of the sample) were asked “Would you like to learn braille if given the opportunity?” (WQ10). Eleven per cent answered “yes”, with blind and partially sighted respondents represented equally. Age was the main determinant in these responses, 31 and 9 per cent of the younger and older age groups respectively saying that they would like to learn braille.

The 11% who answered “yes” were then asked “Why haven't you tried to learn braille?” (WQ11). The two reasons most frequently given were that they did not think that they needed to yet and that they could manage without it; the latter answer was more common among partially sighted respondents. A small number, running across residual vision levels, said that they were “too old” or “physically not able to”. One-third of respondents gave answers such as 'don't know how to' (13%); 'nobody suggested it' (11%); 'no opportunity' (6%); “never thought of it”(5%).

Those who responded “no”, i.e. they did not want to learn braille if given the opportunity, were asked “Why is that?” (WQ12), with the results shown in Table 10.10. The reasons respondents most frequently gave were that they were too old (31%) or that they could see well enough to read (17%); a further 21% said that they did not need braille or didn't need it yet, which suggests either that they could read print or that they managed in some other way. Only 10% said that braille was too difficult.

 

Residual vision B in %

Residual vision PS in %

Total

Too old

40

26

31

See well enough to read

18

17

17

Don’t need to

6

14

11

Hope sight will improve

6

15

11

Don’t need to yet

9

10

10

Too difficult to learn

12

8

10

May if sight gets worse

2

8

5

Lack of feeling in fingers

4

4

4

Not interested in reading

4

4

4

Base (population) = 100%

198K

348K

546K

(Number interviewed)

(104)

(207)

(311)

    (311 respondents: 151 learnt braille; 56 not aware of braille; 75 want to learn braille; 2 no data)

These replies reveal systematic differences between blind and partially sighted people. Some 40% of blind respondents, but only 26% of partially sighted respondents, gave being 'too old' as their main reason for not wanting to learn braille. No difference between blind and partially sighted respondents was revealed in the answer “see well enough to read”. However, partially sighted respondents consistently produced more replies reflecting their better vision, e.g. “don't need to”, “don't need to yet” and “hope sight will improve”.

10.9 Comparison with Gray and Todd's 1965 survey

Tables 10.11.a. and 10.11 .b. compare the findings on braille readership among registered blind people revealed in the RNIB and the Gray and Todd survey carried out in 1965. Gray and Todd's report does not contain population estimates, but the information provided allows others to do so (their section 2.10).

Although there are some discrepancies in the age bands compared, the broad comparisons that can be made between the two surveys are valid.

 

1986 RNIB survey Age (16-59) %

1986 RNIB survey Age (60+) %

1965, Gray and Todd survey Age (16-64) %

1965, Gray and Todd survey Age (65-79) %

Never learned braille

19

84

33

76

Learned but not good enough to read

30

7

27

13

Learned and got good enough to read

51

9

40

11

Total %

100

100

100

100

Base (population*)

17K

91K

24K

32K

(Number interviewed)

(123)

(74)

(1044)

(420)

    (* Weighted data here applies only to RNIB data)
    Source: Mobility and reading habits of the blind, Gray and Todd (1968)

Table 10.11.a. shows that in 1965, 33% of registered blind people aged 16-14 had never learned braille, compared with only 19% in 1986. This statistically significant difference suggests that during the two decades a notable increase in the teaching of braille to young registered blind people has occurred. From Table 10.11 .b. we can see that in 1986 there were about 16,400 braille readers compared with about 13,000 in 1965. Only one of the 84 braille readers in our sample was over 75, and it is unlikely that Gray and Todd missed many braille readers by excluding people of 80 and over. Thus Table 10.11 .b. implies that most of the growth in braille readers is among people aged about 60 to 74. We estimate that there are about 27,000 registered people in this age band (private households, 1986); the 8,000 braille readers shown in Table 10.11.b. represent about 30%, compared with 11% of the roughly comparable age group in 1965. Since a difference of some 20% is statistically significant, we can be confident that this represents a real change.

 

1986 RNIB survey Age 16-59 (000)

1986 RNIB survey Age 60+ (000)

1965, Gray and Todd survey Age 16-64 (000)

1965, Gray and Todd survey Age 65-79 (000)

Never learned braille

3.4

76.4

7.9

24.3

Learned but not good enough to read

5.4

6.3

6.5

4.2

Learned and got good enough to read

8.2

8.2

9.6

3.5

Base (population*)

17K

91K

24K

32K

    (* Weighted data here applies only to RNIB data)
    Source: Mobility and reading habits of the blind, Gray and Todd (1968)

These two findings - an increase in teaching of braille to the under-60s and over the years an increase in the number of braille readers over 60 - fit together, since cohorts of the former age group have moved into the latter age group.

Gray and Todd's results did not include partially sighted or non- registered braille readers, since these were not sampled. We estimate that there are about 1,000 additional registered partially sighted braille readers, and rather less than a further 1,000 non-registered blind readers in the 16 -59 age group. (See Table 10.3.a., but note that the latter figure is based on only 14 respondents.) However, we also found that only about two-thirds of braille readers, those who learnt braille well enough to read a book or magazine, actually make use of their ability (section 10.7.1, WQ16). Gray and Todd did not ask this question, but both their and our estimates of active braille readers must be reduced accordingly.

We repeated a few of Gray and Todd's many detailed questions on braille readers' choice of material. Their sample of 1,044 and 420 registered respondents aged 16-64 and 65-79 respectively produced some 457 braille-reading respondents for more detailed analysis, while we had only 84. The small numbers in the RNIB sample therefore preclude close comparisons that rely solely on breakdowns confined to the braille reader sub-group.

Our survey estimates that there are 18,000 registered blind people aged 16-59, while Gray and Todd estimated 24,000 aged 16-64. The difference in age band and any real changes over the 20-year interval may not be the only reasons for the discrepancy. Our estimates are for private households, whereas Gray and Todd surveyed all the registered, which includes people living in communal establishments. (We estimated that a surprising proportion, 22%, of people aged 16-59 likely to be registered blind live in communal establishments; see Chapter 21 .) Gray and Todd excluded from their sample anyone classified by the local authority as mentally sub-normal, mentally ill, or deaf, which may have covered many people living in communal establishments.

11. Overview of Reading Habits and Communications Media

11.1 Reading habits

11.1.1 Introduction

Chapters 7- 10 (on large print, tapes, personal readers and braille) provide detailed information on each of these separate reading methods, but do not discuss their use in combination. While most visually impaired people read in more than one way, they generally prefer a particular method. This chapter examines the choice of media and also reviews data collected on writing habits.

11.1.2 The extent of reading

Respondents were asked to consider all the media together in the following terms: “1 would like you" to think about all the different ways in which people can read, whether ordinary print, braille, Moon or tapes or having a sighted person read to you...”.

Following this introduction, respondents were asked: “Would you say that you read now more, or less or about the same amount as before your sight problem began.?” (WQ82) Overall, 9% said that they read more, 21% the same and 69% less. Interestingly the responses were similar across the three age groups, except that 77% of blind people aged over 75 said that they read less. The finding that almost one-third (30%) of blind and partially sighted people read as much or more than before the onset of their vision problems is quite startling. Indeed just over one-third (35%) of blind people under 60 said that they read more than before. While we should not be complacent about the 69% who read less, this increase in reading represents a substantial tribute to the individuals concerned and to the various organisations that supply their needs.

11.1.3 The media used

Following the introductory question (WQ82), respondents were asked (WQ83) about the media they employed most frequently. The results, shown in Table 11.1, reveal that the reading habits of blind people are quite different from those of partially sighted people. Personal readers (33%), ordinary print (29%) and tapes (24%) are the media most frequently used by blind people in each of the three age groups.

Two perhaps surprising aspects of the data are that, for 29% of blind people, ordinary print is the most popular medium, and, second, that individual readers are used so frequently. Statutory and voluntary organisations should note this second conclusion, for this most frequent form of reading receives little or no outside support and encouragement and is almost always left to the individual's initiative. While such initiative should not be discouraged, it would seem important for both the statutory social services and the voluntary sector to expand their work in this area, particularly given the evidence of unmet need among younger blind people (Chapter 9).

 

Residual vision B in %

Residual vision PS in %

Total

Ordinary print

29

60

48

Large print

14

30

24

Personal reader

33

12

21

Tapes (including Talking Books)

24

6

13

Braille

2

0

1

Moon

0

0

0

Don’t know

10

5

7

Nothing reported

#

2

1

Base (population) = 100%

301K

456K

757K

(Number interviewed)

(267)

(328)

(595)

Overall, 2% of registrably blind people used braille most frequently; 12% of under-60s and 3% of 60-74 year-olds did so. There are two reasons why braille cannot be expected to be the most frequently used form, even among younger people. First, as Chapter 10 shows, braille is only used by a minority of blind people; second, insufficient material is produced in braille to make it a dominant reading medium.

As Table 11.1 shows, for partially sighted people ordinary print (60%) is the dominant reading form by far, followed by large print (30%). The popularity of these two media varied very little across the different age groups, although people over 75 showed a greater preference (34%) for large print compared with those aged 16 to 74 (22%). Personal readers and tapes trailed at 12 and 6 per cent respectively.

It is worth noting that so many partially sighted people make use of large print, and that 12% use sighted readers.

11.1.4 Overlap between media

We did not enquire specifically whether respondents used one preferred medium more than others or whether they used two or more equally. However, Table 11.1 provides indirect evidence that most did have a preferred medium. At WQ83 interviewers were instructed to code more than one medium if the respondent was at all uncertain about which was the most frequently used. The amount by which the items listed in Table 11.1 total more than 100% therefore indicates how many respondents mentioned more than one medium. Very few did. The overlap amounted to only 150, and this varies little between sight levels. Even if we assume that the 'don't knows' (7%) include people who could not decide between different media they use equally frequently, the total is still not large.

11.1.5 Customary, temporary and occasional use

Evidence of the occasional use of a particular medium can be obtained by using answers to questions in earlier chapters that focused on any use at all rather than on most frequent use. Table 11.2 brings together the relevant data.

 

Use* %

Use most often %

Ordinary print

-

48

Large print

-

24

Normally reads print

65

-

Braille

2

1

Moon

#

0

Tapes (including Talking Books)

-

13

Talking Books

12

-

Ordinary Tapes

12

-

Personal Reader

40

21

Base (population) (= 100%)

757K

757K

(Number interviewed)

(595)

(595)

    * Data from Chapters 7, 8, 9, 10

Braille The data on braille reveal that while some 2% of respondents (corresponding to 13,000 visually impaired people) said that they currently used braille (section 10.3), only 1% (approximately 7,000 people) used braille most often.

Print According to Table 11.2, 48 and 24 per cent respectively said that they used ordinary print and large print most frequently. (These figures may overlap, since some of the 48% may also have said that they used large print.) This percentage, and the 65% who use print (see section 7.2), make it clear that a large proportion of visually impaired people use print regularly rather than merely occasionally.

Personal readers While 40% of respondents said that they used readers, second only to print, only 21% said that this was their most frequent reading method. Thus, for 19% of visually impaired people, readers provide a vital back-up to other more frequently used media. However, the unique role of an individual reader means that the description 'back-up' probably undervalues this essential contribution. Depending upon circumstances, a reader is Often instantly available to read print material that would take a long time to be transcribed into braille or to be taped by one of the volunteer taping groups. Also, personal readers are preferable for certain kinds of material. For instance, when large quantities of information have to be scanned, but only certain parts need be read carefully, the individual reader can be selective according to the brief given, something that is impossible for taping and transcription services.

Tapes The wording of WQ83 allows no distinction to be made as to whether the respondent was referring to ordinary tapes or to Talking Books. Only 13% mentioned tapes as their most frequent medium in response to this question. In section 8.2, we saw that 12% use Talking Books, and use of ordinary tapes for reading was estimated at approximately the same percentage, though with an emphasis on non- fiction information material (section 8.4.2). If “tapes”, using the term to cover both Talking Books and ordinary tapes, were the most frequently used medium, we would expect mentions of tapes to exceed that of Talking Books alone. That it does not suggests that tapes have an occasional, back-up function, and that many who use tapes rely on other media for regular access to printed material.

Moon As noted, our sample contained only one individual - a registered blind person aged between 16 and 59 - who currently uses Moon, and hence the data do not allow any generalisation about Moon readers as a group. For what it is worth, this one individual not only used Moon but also said that Moon was the most frequently used medium.

11.2 Communications media

11.2.1 Introduction

Large print books, tapes, personal readers and braille (discussed in detail in Chapters 7 to 10 and reviewed collectively in section 11.2) are of course not the only communication channels available to blind and partially sighted people. Writing media and telephones are considered in sections 11.2.2 and 11.2.3. Section 11.3 discusses the relative importance of all these media, together with personal contact and broadcast media, as sources of information for visually impaired people, and in section 11.4 the relationship between information needs and communication media is considered.

11.2.2 Writing media

An estimated 10,000 registered blind people write in braille, of whom nearly 7,000 are aged under 60 (section 10.7.3). These constitute 39% of registered and 23% of registrable blind people under 60, and 1% of the registrable blind aged over 60. (Braille writing and braille reading was almost exclusively confined to people registered blind.)

Ability to use a typewriter is crucial for blind people who cannot write, and also for partially sighted people who need to write formal material and believe that their handwriting is not good enough. At WQ84 we asked 'How often do you use a typewriter nowadays?'

The answers revealed that, while less than 5% (population estimate 32,000) ever use a typewriter, the distribution between age levels is uneven. For example, among the under-60s, 25% of blind people (population estimate 7,000) and 21% of partially sighted people (population estimate 10,000) use one, the majority doing so either “most days” or “at least once a week”. Almost all registered blind people who write in braille also use a typewriter.

Although we did not ask specific questions about writing by hand, we know that 58% of blind people under 60 (Table 6.3) were unable to read our large-print card. This figure suggests an approximate proportion of blind people in this age group who either cannot write at all or who find writing legibly extremely difficult. Since only 25% of the same group use a typewriter, this suggests a major unmet need, in a world so dependent on written communications, for training in keyboard skills.

11.2.3 Telephones

11.2.3.1 Possession of a telephone

According to the 1985 General Household Survey (OPCS, 1985), 81% of private households in Britain possess a telephone. Among visually impaired people overall the figure is 72% (Table 11.3). However, this statistic conceals a significant difference. Eighty-seven per cent of the registered possess a telephone, above the national average, but only 67% of the non-registered. Age makes no difference among the registered. Among the non-registered, 77% of people aged 16 - 59, and 66% of those aged 60 or over, possessed a telephone. GHS found that nationally 66% of households with a gross weekly income of £60 - 80 had a telephone (GHS, 1985, Table 5.29).

For blind and partially sighted people, telephones form an important means of obtaining information. As is shown in section 11.3.1, 16% of respondents said the telephone was the most important way they discovered things they needed to know, and a further 20% listed it as the second most important.

11.2.3.2 Subsidies for telephones

According to the BBC “In Touch” Handbook (Broadcasting Support Services, 1991)

Local authorities tend to follow nationally agreed guidelines to decide whether a telephone is a necessity. The applicant must live alone, or be frequently left alone, or be housebound and be able to show that a telephone is needed for medical and social reasons. Only when all these conditions have been met, and the client has also been assessed as needing financial help, will most local authorities.., consider a telephone to be a necessity, and therefore something that they have a duty to provide. Some local authorities, however, interpret 'need' more generously than this.

The “In Touch” Handbook for 1982 noted that in 1978/79 the amount spent by local authorities on telephone rental and installation in England and Wales ranged from £16 per 1,000 population to£616.

In Touch also discusses help from voluntary sources through the Telephones for the Blind Fund.

This Fund will help meet part of the cost of installation and rental of telephones for blind people of limited means who live alone, or are often alone especially at night, or whose partner is also disabled by infirmity or age. The Fund needs to be satisfied that the applicant has been refused help from his or her local authority under the... Chronically Sick and Disabled Persons Act.

Our data (Table 11.3) indicate that the total contribution of local authorities and the voluntary sector to telephone possession among visually impaired people amounts only to about 11%. Although proportionately small, this corresponds in absolute numbers to about 60,000 telephones. However, some 89% of telephones possessed by visually impaired people (about 475,000) are paid for entirely out of their own incomes. Given the low income of visually impaired people (section 3.6), telephone costs necessarily consume a disproportionately large part of their income compared with the general population, which indicates how essential the telephone is seen to be. Where a subsidy is received, it usually covers the total cost, approximately equal between installation and rental. Only 2% out of the 11% received a partial contribution.

Table 11.3 Telephone possession and assistance with installation and rental costs, by regstration and age

“I’d now like to check with you about how you find out things that affect your daily life. Do you have a telephone of your own?” (CQ37)

“Did anyone help you with the cost of installing your telephone or paying the rental?...did they pay part or all of the cost?” (CQ38)

11.3 Relative importance of different sources of information

11.3.1 Prompted replies

Respondents were read a list of the different media or communication channels and asked to compare their importance. They were asked to say which were important (CQ41); which was most important (CQ42); and which was second most important (CQ43). Tables 11.4, 11.5.a. and 11.5.b. show the precise wording of the questions (see note 1) and the data obtained.

When asked (CQ41) to choose between saying a medium was important or unimportant, respondents gave 'asking people' most votes (85%) for being important; radio received 64%; television 63%; telephoning people 54%; local magazines and newspapers 41%; tapes and Talking Books 13%; talking newspapers 7% and braille books 1%. These figures mean that, for example, 41% of visually impaired people said that they found printed media in the form of local magazines and newspapers an important information source. This percentage did not change drastically among different age groups, or between registered and non-registered people, or between blind and partially sighted people. It is perhaps a surprisingly high figure, but it is not inconsistent with data noted earlier (section 7.2) about the numbers of visually impaired people who can read print. Nor is it surprising when one considers how many visually impaired people have sighted people who can read to them.

The percentage of respondents mentioning other print-substitute media did vary according to registration status. Very few of the non-registered mentioned either Talking Books or talking newspapers (3 and 8 per cent respectively), whereas 23 and 30 per cent respectively of the registered named them. All mentions of braille books came from registered blind people: 25% of the 16 - 59 age group and 4% of those aged 60 and over (data mostly from Table 11.5.a.).

When we asked respondents (at CQ42) to say which of these media were most important, “asking people” predominated at 48%. 'Phoning people' received 16%, radio 11%, television 9%, local magazines and newspapers 7% and talking newspapers 1%. Tapes and Talking Books and braille books did not reach 0.5% overall, and even among registered blind people aged 16 - 59 only received 2% each. The question (CQ43) concerning second most important of the prompted items did not produce any new findings (Table 11.4).

 

Important sources in %

Most important in %

2nd most important in %

Asking people

85

48

18

Telephoning people

54

16

20

Broadcast media: Television

64

9

16

Broadcast media: Radio

63

11

13

Print/print substitutes: Tapes or Talking Books

13

#

2

Print/print substitutes: Braille books

1

#

#

Print/print substitutes: Talking newspapers

7

1

1

Print/print substitutes: Local magazines/newspapers

41

7

7

None mentioned

4

1

8

Don’t know

-

3

5

No information

-

7

9

Base (population) = 100%

757K

757K

757K

(Number interviewed)

(595)

(595)

(595)

    (595 respondents)

The tables do reveal significant differences between blind and partially sighted people, especially among those under 60. In this group, blind people were more likely to rely on asking and telephoning people, and on the radio, Talking Books, talking newspapers, and braille books. While partially sighted people use all these media, they do so to a lesser extent and rely on television and local newspapers more (Table 11.5.b.).

 

Age and residual vision (16-59) B in %

Age and residual vision (16-59) PS in %

Age and residual vision (60+) B in %

Age and residual vision (60+) PS in %

Residual vision (all ages) B in %

Residual vision (60+) PS in %

Age (16-59) in %

Age (60+) in %

Total

Asking people

96

88

86

84

87

84

91

85

85

Telephoning people

83

70

49

54

52

55

75

52

54

Broadcast media: Television

56

67

54

64

54

64

63

60

60

Broadcast media: Radio

83

66

60

61

62

62

73

60

62

Print/print substitutes: Tapes or Talking Books

31

7

24

5

24

5

16

13

13

Print/print substitutes: Braille Books

15

1

1

0

3

#

6

1

1

Print/print substitutes: Talking newspapers

24

4

10

5

11

5

12

7

7

Print/print substitutes: Local magazines and newspapers

39

56

40

40

40

42

50

40

41

Print/print substitutes: None mentioned

1

2

4

4

4

4

1

4

4

Base (population) = 100 %

30K

47K

270K

410K

301K

456K

77K

680K

757K

(Number interviewed)

(137)

(162)

(130)

(166)

(267)

(328)

(299)

(296)

(595)

    (595 respondents)

11.3.2 Unprompted replies

Before presenting respondents (at CQ41, CQ42 and CQ43) with a pre- determined check list of items, we asked them the following open question: 'How do you find out about things you want to know about?'(CQ39) This is an alternative way of capturing relative importance, since a spontaneous mention of an item is an indication of its significance to the respondent rather than to the investigator. However, since our own check list was drawn up as the result of pilot work, we expected that the two approaches would show broad agreement, and the data shown in Table 11.6 confirm this. The open responses to CQ39 have been coded into categories similar to those used for the check list. Again, personal contact (i.e. 'asking people') predominates across the various age and registration categories. The other categories retain their previous importance, with similar differences between sub-groups.

Table 11.6 throws additional light on the detailed content of each category. Personal communication divides into informal and formal contacts, and informal contacts, themselves mentioned about four times as frequently as formal contacts, divide further into “someone in the household” and “other relative” (each 32%) and “friend or colleague”(21%).

Our results confirm those of the major survey (Epstein, 1980) carried out by the Research Institute for Consumer Affairs (RICA) into the information needs of elderly people. Elderly visually impaired people, no less than elderly people in general, largely rely on personal contact sources such as family and friends (the informal care network) for information. In addition, this finding also applies to younger visually impaired people. Within this high level of reliance on informal contacts, marked age-related trends are noticeable. In particular, elderly people rely less on “someone in the household” and more on “other relatives”. Among 16-59 year-olds, 50 and 19 per cent respectively mentioned 'someone in the household' and “other relative”, while among those aged 60 to 74 the corresponding proportions were 36 and 24 per cent, and among old elderly people 28 and 37 per cent (data not shown in the tables).

Among various social services field-workers (the formal care network) mentioned as sources of information were “home help” (9%), “social worker” (5%) and “social worker for the blind” (1%). “Home help” was mentioned by 10% of those aged 60 or over and by 1% of those aged 16-59. Mentions of both types of social worker were more closely related to registration than to age: they were mentioned by 15% of the registered, but by only 4% of the non-registered.

Mentions of the voluntary sector were small (5% overall) and came mostly from registered respondents. Although the differences are too small to reach statistical significance, the data do suggest that local blind societies reach elderly people more often, while RNIB reaches younger registered people. Among registered people aged 16 - 59 and 60 or over, local blind societies were mentioned by 3 and 7 per cent respectively, while RNIB was mentioned by 6 and 2 per cent. Some 2% of the non-registered aged under 60 mentioned RNIB, while none of the non-registered of any age mentioned local blind societies.

 

Registration status and age: Registered (16-59) in %

Registration status and age: Registered (60+) in %

Registration status and age: Non-registered (15-59) in %

Registration status and age: Non-registered (60+) in %

Total

Personal contact: Someone in the household

54

39

47

28

32

Personal contact: Other relative

19

26

20

35

32

Personal contact: Friend or colleague

31

22

20

20

21

Social services: Home help

2

9

1

10

9

Social services: Social worker

9

10

2

4

5

Social services: Social worker for blind

6

4

2

0

1

Social services: Mobility Officer

1

#

0

0

#

Social services: Department of Social Security

3

6

6

4

6

Voluntary sector: Other local association (non-visual handicap)

0

1

2

4

3

Voluntary sector: Local blind society

3

7

0

0

1

Voluntary sector: RNIB

6

2

2

0

1

Broadcast media: Radio

33

13

18

18

18

Broadcast media: Television

24

5

16

19

16

Broadcast media: Health service

2

6

15

4

5

Telephone

15

12

13

12

12

Print/print substitutes: Local magazine/newspaper

10

3

9

8

7

Print/print substitutes: Talking newspapers

6

6

0

0

1

Print/print substitutes: Talking books and cassettes

2

2

1

1

1

Print/print substitutes: Braille books

1

0

0

0

#

Base (population) = 100%

30K

140K

47K

538K

757K

(Number interviewed)

(215)

(137)

(84)

(159)

(595)

Radio and television were mentioned more often by the younger registered than by other sub-groups. The telephone was mentioned by 12% overall, with little variation across sub-groups.

11.4 Communications media and information needs

The information needs of blind and partially sighted people relate to the knowledge and awareness that they have of both services and sources of information about services. The RICA survey found that as a whole elderly people are not knowledgeable about the various services and programmes available, relying largely for information on informal sources such as family and friends. The survey also showed that very few information providers use non-print communications media. Perhaps not surprisingly, elderly visually impaired people were found to be even less well informed than others, including deaf people, without vision problems (Epstein, 1980).

Our results confirm that elderly visually impaired people obtain information largely from these informal sources and also show that this applies to the younger age group as well.

Although no single chapter in this report covers knowledge and information as such, relevant data appear in several different places. As far as possible, we included questions on awareness of services and sources of information on each need area in each section of the interview. The results obtained have been reported in the appropriate section. Thus awareness of braille, Moon, large-print books, tapes and talking book services and of sources of information about them are discussed in Chapters 7 to 10. Chapter 13 deals with mobility, Chapter 15 with household aids and gadgets, and Chapter 18 with benefits and allowances, reporting on awareness of related services and the possibility of obtaining training and advice. Chapter 20 reports on knowledge of voluntary organisations and RNIB in particular. A common feature in all these sections is the higher information level of the registered compared with the non-registered. Chapter 19 deals specifically with knowledge about and attitudes towards being registered and the social services as a whole.

It remains a considerable task for further analysis to bring together all the data on awareness and information spread throughout this report. Factors relating to information needs in specific areas should be distinguished from those factors making for awareness or lack of awareness that are common across all need areas. Correlations can then be sought between awareness and lack of awareness and the use of communication sources. These correlations should be examined both within and across need areas. Differences in circumstances and lifestyles between sub-groups, e.g. blind and partially sighted people will also have to be taken into account. (See note 2 for further dis