In mid-2024, I took on the role of co-chair for a working group of expert researchers focused on accessibility testing with people who have cognitive disabilities. This was part of my work at Fable, where I serve as VP of Innovation.
Cognitive disability is a broad term covering conditions that affect how people process information—typically impacting memory, focus, or learning. According to the CDC, 13.9% of the U.S. population lives with a cognitive disability, and a Yale study confirms this number is rising fast.
Our group set four objectives: learn how to recruit and screen participants; define best practices for research with cognitively diverse users; test those methods in a real study; and document everything so others could benefit.
We built a screener that asked people to self-identify if they faced challenges with memory, focus, or learning. Then we reviewed published academic studies involving cognitive testers to gather initial best practices.
Next came a pilot study with 25 testers. We refined our approach iteratively and produced two deliverables: a guide for running user interviews with cognitive participants, and a survey that quantifies their experience with digital products. After that pilot, I suspected that this group would uncover more usability insights than the general population participants I’d worked with before. I decided to test that hunch.
The Cognitive Usability Study
I partnered with the University of California, Irvine—specifically with Syed Fatiul Huq—and Fable researchers Pranav Pidathala, Ali Brown, and Michael Fagan to run a joint study. We generated three websites using an AI prototyping tool, each with a different purpose, design language, and content set to ensure variety in tasks.
| Website | Strong Snacks | Turning Pages | Crown & Comb |
|---|---|---|---|
| Description | A site for three-ingredient high-protein recipes. Recipes can be filtered by category (vegan, muscle building, etc.). Includes blog posts about protein and contact info. | A bookstore site with a curated catalog. Offers filtering by genre, a book swiping feature to build a preference profile, custom book lists, shopping cart, and checkout. | A hair salon site that lets users book appointments and consultations online. Features a VIP program and special packages. |
| Design | Simple, brutalist, bright, heavy on images. | Moody, classic, dark, lots of book cover photos. | Bold, clean, black-and-white with bursts of color. |
| Content | Recipes, blog posts. | Books and book lists. | Services, experience guide, membership info. |
| Key functionality | Category filter, newsletter sign-up. | Shopping cart, book matching, book lists, recommendations. | Appointment booking. |
| Tasks | Find a high-protein snack recipe; read a blog about protein; discover how to get notified about new content. | Find and use the book swiping feature on 10 books; locate the recommended book list; add books from two genres to cart; complete checkout. | Find haircut prices; book a haircut appointment; find the bridal package price. |
We used the same screener—questions about memory, focus, and learning—and split participants into two groups: those who self-identified as having cognitive challenges and those who didn’t. Remember, cognitive disability includes neurodiversity. Neurodivergent is an umbrella term for people whose brains process information and learn differently—commonly associated with learning disabilities (e.g., dyslexia), ADHD, and autism.
We ran 30 user interviews total—10 per website—with an even 5/5 split between cognitive and general-population participants for each site. In every session, a participant completed all tasks for one website during an online interview moderated by a researcher.
At the end of each session, every participant filled out the Accessible Usability Scale (AUS)—a free, Creative Commons-licensed 10-question survey that evaluates website and mobile app usability.
Data Analysis Approach
I reviewed all recordings and transcripts, noting every time a participant raised a concern, voiced confusion, or asked how something worked. I counted all of these as issues. I also noted when a participant missed a task element—even if they didn’t notice it themselves—and recorded every suggestion for improvement.
Examples of issues found:
- “Photo is too tall and requires a lot of scrolling to get to content.” (noted by participant)
- “I get no feedback when I like or dislike a book.” (noted by participant)
- Participant missed the required P.O. Box checkbox the first time. (observed by researcher)
Examples of suggestions:
- “I would like to see a protein comparison in a table.”
- “The ‘More information’ tab should be moved up higher.”
- “I would like more information on how the recommendation list is created.”
Each issue or suggestion was counted only once per participant, even if they repeated the same point.