Abstract
In April 2020, at the start of the COVID-19 pandemic in Canada, the Canadian Council of the Blind (CCB) surveyed people who are blind, deafblind, or have low vision, to assess the effect that the pandemic was having on their lives (Gordon, 2020).
The following is a summary of the major findings of that study:
The main sources where respondents acquired their information about the pandemic were radio, television, and the Internet. Only one-half of the announcements made by the government about the pandemic were fully accessible to survey respondents. Respondents said they were concerned about maintaining social distancing and having others maintain social distancing from them. About one-half of the deafblind community who responded to the survey indicated that they did not have access to a deafblind interpreter. Respondents reported a very low level of awareness of the locality of COVID-19 testing sites in general and accessible testing sites in particular. Almost one-half of the survey respondents said that they had a need for a sighted guide to assist them when they left home; they said they had not felt safe going outside the home since the shelter in place order was issued by the government. About one-third of respondents said that they were currently shopping in stores for groceries and other essentials themselves, and about one-third of those who did their own shopping in stores said that they were not comfortable interacting with staff members in those stores. A large majority of respondents (86%) were aware that healthcare providers were providing services online. Almost three-quarters of respondents (74%) said that they were worried about being able to see a doctor if they became sick. Almost one-half of the survey respondents were worried about their ability to have someone accompany them to a doctor's office, and they were worried about their ability to obtain transportation to a doctor's office, hospital, or testing site.
by answering questions on this article. For more information, visit: About one-third of respondents said that an important medical appointment had been canceled because of the pandemic. About one-half of the respondents had personal care workers coming into their homes, many of whom were not masked or using the proper personal protective equipment (PPE). Three-quarters of respondents who were still working full-time were working from home, yet more than one-half of the respondents who needed technology to work from home said that their employers would not supply the accessible technologies or devices for them to work from home. Many survey respondents were planning to access government subsidies to help them financially through the pandemic, and there was a high level of concern among respondents about being able to meet their financial commitments. The greatest majority of respondents said that they had the necessary technologies to connect virtually with family and friends. Just over one-half of respondents said that they were concerned that the additional stress from the COVID-19 crisis on their mental health may cause them to be overwhelmed. Asked to identify their current stress level on a scale of 1 to 10, 40% of respondents said they were experiencing more than moderate stress, with 29% rating their stress level at 7 or higher.
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In June 2022, as Canada was undergoing the latter stages of the COVID-19 pandemic, CCB decided to conduct a survey to reassess the situation in order to ascertain whether it had changed since a survey was conducted in 2020 (Gordon, 2020) and whether people living with vision loss were still experiencing issues that needed to be addressed.
Methods
The survey was conducted via the SurveyMonkey online platform. An email message with an explanatory letter, including privacy information, was sent out to the full CCB email list on two occasions. The survey and accompanying letter were also included in the monthly e-newsletter of CBB, the weekly e-newsletter of BALANCE for Blind Adults, the email list of the Alliance for Equality of Blind Canadians, the email distribution list of Fighting Blindness Canada, and the client lists of the Canadian National Institute for the Blind and Vision Loss Rehabilitation Canada. Because of the number of methods of distribution of the survey, we do not know exactly how many recipients received the survey; however, we estimate that approximately 10,000 people received the email letter.
The current survey used many of the same questions that were asked in the 2020 survey in order to be able to make comparisons. In addition, questions were added to the current survey that were specific to this phase of the pandemic.
Results
A robust sample of 572 responses was received over the time period of 6 weeks during which the survey was open for participation. Responses were received from all Canadian provinces and one territory. The results reported here are grouped by subject theme.
Demographics, Degree of Vision Loss, and Living Situation of Respondents
More than one-half (57%) of respondents were over the age of 65 years, with 9.3% being over the age of 85 years. About one-quarter (25.6%) of respondents self-identified as blind, 70.8% as having low vision, and 3.6% as being deafblind. Less than one-half (33.5%) of respondents said that they lived alone. In terms of additional disabilities, 28% of respondents had a disability other than their visual disability—hearing loss was the largest percentage of this subgroup (29%).
Access to Information
Since information about COVID-19 was disseminated from various sources during the pandemic, it is important to understand where respondents acquired their pandemic-related information. The results showed that television, radio, and Internet were still the three main methods by which people gained their information, and 41.0% of respondents said that they had acquired their information from government websites.
One of the features of the pandemic was the frequent provision of COVID-related information by all governments in Canada (federal, provincial, and municipal). In addition to the provision of information via various forms of media, governments provided much of the information on their own websites. The CCB was interested in learning whether people with a visual impairment were accessing this information and whether government announcements were fully accessible to this community. The results of the current survey showed that 78.9% of respondents had accessed a government announcement (up from 69.0% in 2022), with only about 44.0% of respondents indicating that all government websites were fully accessible and 25.3% of respondents saying that only some of the government websites were accessible.
People who are deafblind were asked whether they had access to a deafblind interpreter during the pandemic. About one-quarter (24.4%) of deafblind respondents said that they had access to deafblind interpreters, and 18.7% of respondents said that they only had access to interpreters some of the time. Clearly, many members of the deafblind community seem to have been at risk of not acquiring essential information during the pandemic due to the lack of availability of deafblind interpreters.
Vaccination
Level of Vaccination for COVID-19
The majority (96.6%) of respondents said that they had received at least one vaccination for COVID-19. This number compares very favorably with that of all Canadians. According to the Government of Canada (2022a), 92.7% of Canadians over the age of 18 years had received at least one vaccination. The study's sample had a higher vaccination rate than average Canadians: 95.2% of respondents had received two or more vaccinations (compared with 90.4% for Canadians aged 18 years or older), and 86.3% of respondents had received at least one booster vaccination (compared with 59.3% for Canadians aged 18 years or older). From these data, it appears that the blindness community was well vaccinated.
Accessibility of Vaccination Facility
Respondents were asked whether the vaccination facility where they received their vaccinations was fully accessible. The majority (90.8%) of respondents said that it was, with only 9.2% of respondents saying that the vaccination facility was not accessible.
Transportation to Vaccination Facility
Respondents were asked what transportation they accessed to travel to the vaccination facility. About one in four respondents used a form of public transportation to travel to the vaccination site that made them vulnerable to acquiring COVID-19 (i.e., via public transit, taxi, or ride-hailing application or app). More than one-half (61.0%) of respondents were driven to the vaccination distribution center by a friend or family member, while 19.8% of people walked.
Acquisition of Tests and Testing for COVID-19
Despite high vaccination rates, 21.8% of respondents said that they had tested positive for COVID-19. This number is approximately double that of 10.6% for the Canadian population (Government of Canada, 2022b). A small proportion (1.8%) of respondents said that they had been hospitalized for COVID-19.
Respondents were asked if they were tested for COVID-19 at any time during the pandemic at a testing site outside of their home. Less than one-half (44.9%) of respondents said they had been tested outside their home. A subsequent question asked whether the COVID-19 testing site was accessible. A majority (83.8%) of respondents said that it was. When asked how they traveled to the test facility, 30.2% of respondents said that a friend or family member had driven them there; 10.6% of respondents had traveled to the test facility by public transit, taxi, or ride-hailing app, which made them more vulnerable to contracting COVID-19.
Almost one-half of the respondents (49.3%) said that they had conducted a COVID-19 test at home and 36.0% said that they required help with conducting at-home COVID tests.
Leaving Home
In the current study, there was an increase in the number of people who traveled outside of their homes for various reasons compared with the 2020 survey. The largest increases were those people who left home to acquire prescriptions or other medications and those who left home to visit a doctor. In 2020, only 37.3% of respondents had left home to buy medications. In the current survey, this number had increased to 67.2%. In 2020, 14.2% of respondents had left home to visit a doctor, compared with 71.4% in the current survey.
The survey showed that people were feeling more confident in going outdoors as the pandemic progressed. About one-third of respondents (33.4%) said they needed a sighted guide when leaving home. This number compares with 47.4% of respondents to the 2020 survey who said they needed a sighted guide. Respondents were asked to identify when they first felt safe to go out of their homes. The results showed that more people felt safe as time went on through the pandemic.
Shopping for Groceries and Other Essentials
One-half of the respondents (50.0%) said that they were doing their shopping themselves. This number is higher than the 34.1% of respondents who said they were doing so in the 2020 survey. It appears that people have become more comfortable with going into public spaces as the pandemic has progressed.
At the same time, more people appear to be shopping online than in 2020: 27.2% of respondents said they ordered their groceries online and had them delivered to their home. This number compares with 17.5% of respondents who ordered their groceries online in the 2020 survey.
In 2020, 36.1% of respondents said they were not comfortable interacting with store staff members when shopping. In the current survey, the percentage of respondents who were uncomfortable with interacting with store staff members has dropped to 13.5%. Those respondents who were not comfortable interacting with staff members while shopping were asked to say why they were not comfortable. Many participants reported a lack of accessibility associated with COVID safety measures (such as masks and plexiglass partitions) as the primary reasons for their feelings of discomfort while in stores.
Wearing a Mask When Away From Home
Respondents were asked whether they wore a mask when they were away from home during the pandemic. Only 3.2% of respondents said that they did not wear a mask at least some of the time when they were away from home during the pandemic. The percentage of respondents not currently wearing a mask at all when away from home has climbed to 27.1%. When asked whether they would continue to wear a mask even after the mask mandate has ended, this number increased again, with 30.5% of respondents saying they would not be wearing a mask. Over one-half of the respondents (56.5%) said they were concerned at least some of the time that they could not assess whether those around them were wearing a mask.
Shopping Online for Groceries and Supplies
Respondents were asked whether they started doing their shopping online as a result of the pandemic: 20.9% of respondents said that they started shopping online during the pandemic for the first time. This number compared with 13.3% of respondents who were shopping online for the first time at the start of the pandemic, as reported in the 2020 survey.
Only 29.3% of respondents who were shopping online said that all websites were accessible (compared to 23.2% in the 2020 survey), and 64.3% individuals said that only some websites were accessible. A small proportion (6.3%) of respondents said that no websites were accessible, compared to 15.6% of respondents who found a total lack of accessibility for online shopping in the 2020 survey. It appears that there has been a slight improvement in the accessibility of online shopping websites since the start of the pandemic.
Healthcare Issues
Three-quarters of respondents (75.4%) said that they had met with a healthcare provider either online or by telephone. For this population, telemedicine became a fairly typical method of accessing healthcare during the pandemic.
The healthcare issue that most concerned respondents to the current survey (67.4% of respondents) was that they may not be able to see their doctor if they became sick during the pandemic. Other concerns include 42.2% of respondents who were concerned about being able to access transportation to get to a doctor or hospital, and 40.3% of respondents who were concerned about having someone accompanying them to the doctor or hospital. These fears have not abated with time, since the number of respondents expressing these fears being very similar to that of the 2020 survey. In addition, 26.8% of respondents said that they had had an important medical appointment or surgery canceled due to the pandemic.
In terms of personal support workers (PSWs), 73.9% of respondents who had PSWs come into their homes during the pandemic said that the PSWs were using PPE. This proportion is an improvement from the 60.0% of PSWs in the previous survey who were using PPE.
Employment Issues
Some respondents (13.6%) said that their employment status had changed during the pandemic. When this group was asked what the change in their employment status was, 57.6% said that they had retired, 14.0% of respondents said that they were unable to work, and 6.6% said that they were now working full-time from home. Further, 4.1% of this group were unemployed and 2.0% had been laid off from work.
Respondents who worked from home were asked whether they had the accessible technology they needed if they had to do their job at home during the pandemic. The majority (56.0%) of respondents who work from home said they did have the necessary accessible technology; 24.6% of respondents said they had some, but not all, of the necessary technology; while 19.5% of respondents said they did not have the technology. These results are very similar to those from the 2020 survey, where the numbers were 48.5%, 30.4%, and 21.1%, respectively.
More than one-half of the respondents required to work from home (53.1%) said their employer would not supply the necessary accessible technology they required to work from home. This situation has changed very little since the start of the pandemic: 54 respondents self-funded the accessible technology they needed to work from home. The amounts spent varied: 40.7% of respondents spent between $100 and $999, while 7.4% of respondents spent over $5,000. This situation is very similar to that of 2020.
Financial Issues
One-third of respondents who had experienced a loss of income as a result of the pandemic (33.5%) said they had been able to access government financial assistance. It is unclear why two-thirds of the people who had suffered financial losses did not access government assistance.
Respondents were asked a series of questions as to whether they were concerned at the start of the pandemic that they may not be able to make certain payments. They were then asked whether their concerns were warranted (i.e., did they actually experience difficulty making the payments they were concerned about at the start of the pandemic?). The responses for people who had trouble ranged from 12.2% for people who were concerned about their ability to pay for their utilities to 31.4% for people who were concerned about their ability to maintain their standard of living. In short, approximately one in four respondents who were concerned about their ability to keep up to date with their payments did in fact experience this difficulty.
Connecting With Family and Friends
Nearly all respondents (92.9%) said that they did have the means to connect electronically with their families and friends. This compared with 90.0% of respondents in the 2020 survey.
Stress, Fears and Apprehensions
Respondents were asked whether, at the start of the pandemic, they were concerned that the effect of the added stress on their mental health would cause them to feel overwhelmed. More than one-half (52.0%) of respondents said that they were concerned that they might feel overwhelmed. This number was almost identical to the 52.9% of respondents to the 2020 survey who said they were concerned about feeling overwhelmed at that time.
Respondents who had felt concerned at the start of the pandemic that they might become overwhelmed were asked if they felt that way now: 59.3% of respondents said that they did not feel that way now.
In an open-ended question, respondents were asked what their particular concerns were regarding the COVID-19 pandemic as it related to their vision loss and general health. The responses were grouped into several categories. Despite the number of respondents who articulated no concerns, it is clear that most people were worried about the pandemic and its ongoing effects on their health. In particular, many individuals were concerned about their access to health services, with several identifying an increase in vision loss resulting from delays and barriers to eye care. Respondents were also disappointed by the lack of accessibility related to COVID-related health measures, such as masking and partitions.
Using a 10-point scale, respondents were asked to identify how stressed they felt at the start of the pandemic. In a subsequent question, they were asked to identify how stressed they felt currently. Many respondents (37.5%) said they felt a stress level of 7 or greater at the start of the pandemic. By comparison, only 15.8% of respondents said they were experiencing stress at a level of 7 or greater in the current study. In addition, 46.1% of respondents said that they were experiencing more than a moderate level of stress at the start of the pandemic, while only 22.9% of respondents were feeling more than moderate stress during the current study.
Although there were still a significant number of people with visual impairments who were living with high levels of stress, it was encouraging to note that the levels had decreased over the previous 2 years.
Managing the Emotional Impact of the Pandemic
In a final open-ended question, respondents were asked: “Given the current circumstances and the effect of COVID-19, is there anything that you are doing to manage the emotional impact of the pandemic? Do you feel any positive or negative emotional impacts from the pandemic? (Please explain.)” Responses were grouped into several categories. Importantly, the largest group of respondents used this question as an opportunity to describe negative events and emotional effects during COVID-19. They did not describe any self-care or wellness activities, which may suggest a generalized and severe psychological impact felt by members of the vision loss community. Those who did describe self-care referenced a wide variety of activities, with the largest groups writing about the value of physical and outdoor activity, as well as socialization and the role of family and friends.
Limitations of Survey
Although the survey sample of 572 respondents was a robust sample, we did not make an attempt to assess the extent to which this sample represented the Canadian population of people who are blind, deafblind, or have low vision. The survey group was older than the general population. A comparison of some survey results with those of the general Canadian population is included here for perspective gathering only and is not meant to offer a statistical comparison. Since people self-identified their level of vision loss, we made no attempt to analyze the results by level of vision loss. We did not attempt to assess the results based on whether respondents lived in urban, rural, or remote environments; we did not attempt to assess whether the higher vaccination rates than the general population that we observed among survey respondents may have been related to higher levels of co-morbidities in this group. Since the survey was conducted electronically, questions related to the use and affordability of technology may be biased, as may be questions related to the affordability of technology. People able to utilize technology are probably also better-informed about online communications such as the COVID-19 communications issued by governments, because of their access to technology.
Discussion
Overall, the results of the survey conducted in June 2022 showed that the community living with vision loss was faring much better in June 2022 compared with April 2020, when a previous survey probing the same topics was conducted. More people had acquired information about the pandemic from government websites, and the vision loss community was highly vaccinated, with 96.6% of respondents having had at least one vaccination. In spite of this high vaccination rate, 21.8% of respondents to the survey said they had tested positive to COVID-19, almost twice the number of people who tested positive in the general Canadian population.
One of the more positive results of the June 2022 survey was the revelation that more people were leaving home for a wide variety of reasons, including shopping for food and medicines, visiting doctors, and enjoying outdoor exercise. This increased comfort in going outside was reflected in the decrease in the number of people requiring sighted guides to assist them with social distancing and general wayfinding when they went outside. Almost one-half of the respondents to the June 2022 survey said they were doing their own shopping for groceries, and their survey responses indicated an increase in the level of comfort they felt with respect to interacting with staff members in stores, often through plexiglass partitions. The percentage of people not wearing a mask at all when they were away from home had increased from 3.2%, in the 2020 survey, to 27.1%, in the 2022 survey. The reason for this increase was not explored. More people were shopping online for groceries and supplies and there was a slight increase in the accessibility of online shopping websites reported by 2022 survey respondents.
About three-quarters of respondents had participated in an online visit with a medical practitioner, yet there had been little change in the number of people who were concerned that they may not be able to access medical care if they became sick during the pandemic. About one-quarter of respondents said that they had had an important medical visit canceled during the pandemic. The number of PSW's who wore PPE when entering respondents’ homes during the pandemic increased in 2022 compared to 2020.
There had been a slight increase in the number of people working from home during the pandemic, but it was disturbing to discover that there was essentially no change in the number of employers who provided the accessible technology that was necessary for them to work at home. More than one-half the respondents who were required to work from home said that their employer did not provide the necessary accessible equipment.
Although government grants were available to people who were laid off or experienced a decrease in income due to the pandemic, only about one-third of respondents who had experienced a loss of income had accessed these grants. About one-quarter of respondents who said they had been concerned about the effect that the pandemic might have on their finances did, in fact, experience financial difficulties.
The April 2020 survey had reported that the vision loss community was under severe stress because of the pandemic. The June 2022 survey revealed that stress levels had declined, as did the feelings of loneliness and being overwhelmed. However, there are still a significant number of people with vision loss who are experiencing pandemic-related stress and loss of well-being. Physical and outdoor activities, as well as socializing with family and friends, were the two main methods that people reported using to cope with the stresses associated with the pandemic.
Conclusion
In summary, people with visual impairments, including those with deafblindness, appear to have handled the pandemic quite well, in spite of many of their initial concerns. There is, however, a minority of people who have been adversely affected by the pandemic who remain significantly stressed.
Practitioners need to be aware that a large number of people are still living in loneliness and isolation, due to their reluctance to go out of their homes and their lack of connection with family, friends, or caregivers. It is essential that practitioners connect as often as possible with these clients.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was made possible by unconditional grants from a number of Canada's leading research-based pharmaceutical companies, corporate sponsors, and key members and stakeholders of the vision loss community.
