Dyslexic students’ experiences in using assistive technology to support written language skills: a five-year follow-up

Abstract

Purpose

This study presents several accounts of user experiences with assistive technology (AT). Although previous studies on dyslexic students reported promising results from using audiobooks, text-to-speech (TTS), and speech-to-text (STT), qualitative research is relatively sparse and short-term, and little is known about adolescents’ long-term experiences of using AT in schools. Therefore, this five-year follow-up study aimed to describe dyslexic students’ experiences of AT.

Materials and methods

Nine students with dyslexia were interviewed using a semi-structured framework and a descriptive pattern-based thematic analysis. The students had previously participated in an AT intervention in Sweden.

Results

Three main themes are reported: Contextual factors: facilitators or barriers; Emotional responses in the learning environment; Developing meaningful strategies. The results align with previous research findings that audiobooks are beneficial throughout the school years, while STT is of mixed utility. TTS was mainly used in learning to decode texts. Continued AT use is discussed thematically, concretising experiences connected to schools’ multilevel support.

Conclusions

This study can contribute to the development of AT academic practices enriched by users’ views. The findings reveal factors enabling or hindering students’ continued AT usage. Contextual factors in schools concern organisational elements rather than AT accessibility. Students’ emotional responses (using AT in the classroom) are influenced by dyslexia self-acceptance and AT attitudes. Students’ understanding of how and why to use AT may limit the development of meaningful strategies. Implications and suggested further research are provided to improve dyslexic students’ AT experiences and success in school.

IMPLICATIONS FOR REHABILITATION

• Understanding the organizational factors that enable or hinder continuous assistive technology (AT) use can help teachers support dyslexic students’ development in text-based learning throughout schooling.

• Ongoing attention to the emotional aspects of AT use in the classroom may be a valuable support in conjunction with systematic AT training.

• Listening and text production strategies with AT may need ongoing support to develop both lower-order and higher-order skills.

Keywords:

• Reading and writing disability
• dyslexia
• assistive technology
• experiences
• thematic analysis

Introduction

Dyslexia may affect academic performance because of reading and writing disabilities [1,2]. The severity of the difficulty can also generate experiences of stigma in the social context [3] and negatively impact self-efficacy, defined as students’ beliefs about their ability to regulate and succeed in activities [4–6]. There is a mutual relationship between academic progress and self-efficacy, resulting in a positive or negative spiral [6,7]. For students with dyslexia, there is a greater risk of a downward cycle due to perceived difficulties [7] and using assistive technology (AT) in text-based activities in school might be one way to evade this cycle.

Dyslexia manifests in difficulties in learning to decode and spell words, and thus, students find it challenging to develop reading and writing fluency [8]. Language and speech disabilities are additional causes of fundamental phonological disability in dyslexia [2,9–12]. In addition, other comorbidities, such as attention deficit disorder, appear to be more the rule than the exception [13,14]. Furthermore, dyslexia presents on a continuum (not either-or) [9,14] with persistent difficulties despite intensive training [1,2,7,9,15]. It is also associated with secondary social and emotional consequences, which might also persist and, in some cases, escalate into adulthood [3]. Therefore, individuals with dyslexia have varying levels of needs [13], even if dyslexia occurs in isolation [14].

To aid individuals with reading and writing disabilities or dyslexia, AT may be a support to develop lower- and higher-order skills in text comprehension and text production. In text comprehension, the lower-order skills refer to phonological processes to decode words, which is the basis for higher mental functions [16]. Difficulties in automating lower-order skills can thus hinder developing higher-order skills, such as relating the text to one’s background knowledge and having strategies to monitor one’s understanding [17]. The basis of text comprehension is suggested to be a conscious circular process (predicting – monitoring – re-predicting), which remains the same throughout schooling even as the length and complexity of texts increase [18]. Text production has similar dimensions of lower- and higher-order skills to text comprehension [19]. Students with reading and writing difficulties tend to focus on spelling and sentence order (lower-order skills) when evaluating and revising the quality of their texts, unlike more proficient writers [20]. Therefore, there is a need to support higher-order skills [19] e.g., with AT.

In this study, AT refers to digital applications that can enhance text comprehension and text production, reduce negative consequences [21], and foster engagement of people with reading and writing disabilities or dyslexia [22]. For example, audiobooks and TTS allow one to access and engage with texts by listening, and STT will enable one to dictate thoughts as the tool simultaneously transcribes the speech to written text [23]. The AT definition assumes at least two aspects: AT is aimed at improving functioning and intended for people with disabilities. However, developments in recent years have seen TTS and STS transitioning into mainstream technology which can be accessed on computers, tablets, or mobile phones [23]. Furthermore, Sweden’s education systems have developed to be generally characterised by high access to digital technologies (computers and tablets) [24,25]. Thus, these AT features are widespread nowadays and can be universally applicable in classroom practice [23] compared to five years ago. At the same time, the popularity of audiobooks has also increased [26].

Systematic reviews have demonstrated the positive effect of STT, TTS, or audiobooks on reading and writing ability in students with learning disabilities such as dyslexia [26–28]. Research has also shown that STT and TTS may promote independence and participation in school activities [29–31], increase motivation for overall schoolwork [31], and enhance satisfaction with learning in adolescents and adults if customised to the individual [27]. However, limited research has been reported so far regarding comparing text comprehension between audiobooks and printed text, according to Singh and Alexander [26]. They also argue that more research on learner characteristics (motivation, perception, and attitudes) is needed to gain more knowledge of affective factors impacting text comprehension across media (audiobooks, printed texts).

In the following sections, both quantitative and qualitative research studies are described pertaining to text-to-speech, audiobooks, and speech-to-text.

Text-to-speech and audiobooks

Quantitative research on TTS or human recorded audio concludes that it could assist text comprehension for students with reading difficulties [26,28]. Svensson et al.'s [31] findings suggest TTS can be helpful in bypassing decoding disability and as a remediation function in word decoding (the relationship between letters and sounds and ways to combine them) and word recognition. Therefore, the researchers claim TTS might be one optional way to motivate students’ effort in developing decoding ability, at least for adolescents with severe reading- and writing-disabilities and dyslexia. Furthermore, Singh and Alexander’s [26] systematic review reports that listening to texts has more positive effects when using narrative texts compared to expository texts.

Qualitative research also highlights text comprehension benefits when using TTS or audiobooks for students with learning disabilities [31–33]. Users’ reported experiences suggest that the learning process becomes less strenuous and faster, saving effort and time. Moreover, TTS may enhance feelings of independence in situations like text repetition, such as learning pronunciation in a foreign language, which might increase confidence in expressing oneself in the classroom. Independence is also appreciated because one does not have to ask for help, which might feel embarrassing [32]. Besides, there are technical aspects with pros and cons. The advantages seem to be the adjustable settings of TTS, e.g., speed [32] and ease of use [34]. However, users also describe negative aspects, such as robotic voices, a lack of built-in vocabulary [32], and listening speed, i.e., too high speed, decreasing text comprehension [35].

Speech-to-text

Quantitative research of STT reports benefits in outcomes such as accuracy, text quality, length, and transcription rate [27]. In addition, one recent study indicated that children using STT could dictate text with written language characteristics [36].

Concerning STT users’ experiences, studies by Nelson and Reynolds [37] and Roberts and Stodden [38] also indicate enhanced text quality, which means producing text at the same level as one’s verbal vocabulary because the spelling element, which is an issue in dyslexia, is eliminated. STT might also facilitate the ideation process in text production because one can immediately capture thoughts orally into text before they disappear from the mind. Thus, STT might enable a faster process than keyboarding and support students with attention disabilities. However, there are mixed technical perceptions regarding recognition accuracy, i.e., the technology can misinterpret spoken words, which can lead to an exhausting process of searching for misinterpretations and feelings of frustration, leading to the abandonment of STT in favour of keyboarding [37,38]. These mixed user experiences of STT are also reported in other studies [31,34].

Continuous AT usage in schools

Reading and writing disabilities may not be enough to motivate the continuous use of AT. Instead, other aspects can have an impact, such as personal meanings that interact with contextual conditions [38,39]. First, research suggests that established habits (such as keyboarding) might be difficult to change when AT is introduced during later school years [39]. Second, stigmatising feelings due to dyslexia [3] or AT may lead to students abandoning AT [27]. However, AT may instead minimise feelings of stigmatisation due to increased individual functionality [40] and by using AT on the school’s standard digital tools, such as tablets, instead of earlier traditional AT devices [41]. Thus, AT may be perceived as discreet and not draw unwanted attention from peers when used in a classroom [40].

Teachers’ support may also impact the continuous use of AT. For one, teachers’ positive attitudes towards AT may reduce stigmatisation [40]. Their support in helping the students change behaviour in text-based activities seems necessary, according to Nordström et al. [30], based on the findings of a wide diversity in student AT usage from basic to advanced levels, a few months after an intensive AT intervention [31]. The need to support AT progression is also reported in a systematic review as a favourable condition from the students’ perspective, who want "teachers to be part of the technology-enhanced learning process" [42, p.623]. Finally, the support should be characterised by systematic training [27,31]. Systematic support throughout school can avoid barriers such as students’ shift between devices (tablets to computers) interrupting their AT usage. Another barrier may be reduced regarding unclear responsibility for AT usage between teachers and students, especially when students have several teachers and there is a lack of communication between them [31,39].

The current study

The present study is a five-year qualitative follow-up of participants who previously took part in an AT intervention study in Sweden [31]. The former study investigated the effects of AT on reading or listening to texts and producing texts (STT) and the motivation for schoolwork during 2014–2017 for a group of students with reading and writing disabilities or dyslexia compared to an age-matched control group receiving treatment as usual. The study included 104 students with reading and writing disabilities or dyslexia (cut-off; tenth percentile on decoding) from middle school to the first year of high school. The participants were mainly trained for 24 sessions over six weeks in using audiobooks, TTS, and STT. In total, results from the previous AT intervention were reported in four articles [30,31,39,40].

Overall, the AT research is limited, as demonstrated in the reviewed research literature, especially the qualitative research. Little is known about adolescents’ long-term experiences of AT use in school, which is essential to consider in developing successful academic AT practices [41–45]. The current study will address these limitations. Therefore, the aim was to describe dyslexic students’ experiences with AT, in a five-year follow-up study.

Method

The present study was a five-year follow-up of a former AT intervention study [31]. A qualitative approach was used to describe students’ long-term experiences with AT in school by using the thematic analysis (TA) method [46–48]. The pattern-based TA assumes that recurring ideas across a dataset capture something psychologically or socially meaningful in the context, united by central ideas.

Participants

Nine students (eight adolescents and one adult) with severe reading and writing disabilities or dyslexia were interviewed using a semi-structured framework. The inclusion criteria in Svensson et al. [31] were based on a tenth percentile cut-off of two decoding tests: non-word reading and reading of sight words. All participants had attended a Swedish school from grade one, and students with other diagnoses, such as autism, were excluded. One additional inclusion criterion was used in the current study: the student had to have completed 24 sessions of the former AT intervention [31]. Table 1 illustrates the participants’ background information and present reading ability.

Table 1. Participant background information and reading ability.

Participant	Gender	Grade for AT intervention	Present grade	Sight-word reading^a	Non-word reading^a
1	M	4	9	30	30
2	F	4	8	5	5
3	M	4	9	55	15
4	F	4	9	10	25
5	M	4	7	5	20
6	F	4	8	5	5
7	F	4	8	5	5
8	M	4	9	45	45
9	M	8	3S	–	–

Note: M: male; F: female; S: secondary school.

Some students have spent additional years in the same grade.

^aTwo reading tests were conducted in the present follow-up study. The results are given in percentiles, normed for grade 6: Sight-word reading, A and B: Correctly read aloud words registered, 2 × 45 s. Non-word reading, A and B: Correctly read aloud non-words were registered, 2 × 45 s. The results of A and B in each test were aggregated into a total score per test [49]. Missing value in participant 9.

Based on the above, we aimed to recruit 10–15 participants. Forty-seven students were asked to participate, but only nine students gave written consent to participate. However, the number of participants was considered acceptable in conjunction with the study design [47].

Data collection

A semi-structured interview guide was developed, inspired by the results from the former AT intervention studies by Svensson et al. [31]. A pilot interview was conducted, followed by adjustments in the interview structure according to recommendations to keep the guide in mind [47,50]. The final interview guide focused on the participants’ experiences with AT on different devices (tablet, computer, mobile phone) in reading and writing activities. The manual consisted of open-ended questions covering four topics: the former intervention with AT apps; experiences of the school environment, motivation, and achievement in general; experiences of reading and writing ability; and experiences with AT. Examples of questions covering the four topics: How was your experience of the intervention? How would you describe your ability to read/write (then and now)? How do you use AT in reading and writing activities (then and now)? Is AT beneficial (or not)? Why?; How do you experience using AT in the classroom (then and now)?

The interviewer followed the students’ narratives and asked subsequent questions while covering the different areas of the interview guide. The students were encouraged to demonstrate AT on their devices to help them describe their experiences. They also had access to a tablet with the same applications as the previous intervention to aid their recall. In addition, the participants were told that all responses were of interest. In the end, the students were encouraged to summarise the interview.

The interviews were conducted face-to-face in separate school settings and in different communities in Sweden. However, two were changed to digital (online) Zoom meetings due to the COVID-19 pandemic restrictions on visiting schools. All interviews were audio-recorded on a Zoom H1n professional stereo recorder and transcribed verbatim with some adjustments to written language by the first author (interviewer). Each interview lasted approximately one hour and 30 min, with a short break to keep the student engaged. However, one of the online interviews was divided into two sessions to maintain the student’s attention.

Data analysis

Data were analysed using TA based on Braun and Clarke’s six-stage process [46–48]. The meanings of students’ descriptions of AT experiences were analysed at a semantic level across all interviews in an inductive process. We continuously discussed the process and the findings to strengthen research rigour and develop a rich understanding of the data. The process was flexible and spanned over one year.

First, data familiarisation included repeated listening to audio recordings along with reading transcribed texts. Second, the dataset was coded, interview by interview, organising data extracts into one column of a word document and codes in a column alongside them. Third, the codings were reviewed and organised into potential themes across all interviews in the NVivo programme (released in March 2020). In parallel, mindmaps were developed while searching for themes. Fourth, theme refinement was facilitated by the NVivo programme by reviewing the codes and data extracts. Frequency in data was taken into account, even if the most essential part was to generate meaningful themes. Fifth, the essence of each different theme was described to clarify what was covered without overlapping and how they were connected. Finally, while writing the results, ideas for topics to discuss were noted. Data extracts were selected to illustrate the finding’s key elements, considering anonymity and slight adaptation to written language [50]. The themes were described from various subtheme perspectives, and an overview is given in Table 2.

Table 2. Overview of themes and subthemes.

Theme	Subthemes
1. Contextual factors: facilitators or barriers	(Un)aware access and transitions. Need for environmental adaptations. Continuous or fragmentary support.
2. Emotional responses in the learning environment	Patterns of (non)acceptance of dyslexia and AT. Unwanted attention.
3. Developing meaningful strategies	Adapted listening strategies. Listening strategies cannot be taken for granted. Mixed text production strategies.

Ethical approval

The Ethical review board in Sweden approved this study, and a supplementary ethics application was conducted to increase the number of participants, reference number: 2021-02116.

Results

The analysis generated three main themes relating to students’ AT experiences in reading and writing situations at school. (1) Contextual factors: facilitators or barriers. (2) Emotional responses in the learning environment (3) Developing meaningful strategies.

Theme 1: Contextual factors: facilitators or barriers

This theme demonstrated students’ experiences of factors in the school or classroom that facilitated or hindered the continued use of AT, illustrated by three subthemes: (1) (Un)aware access and transitions. (2) Need for environmental adaptations. (3) Continuous or fragmentary support.

(Un)aware access and transitions

The students described factors at the school level that facilitated or hindered the continued use of AT (the apps) or similar functions on computers. The first factor concerns access. The participants described the availability of curriculum materials with built-in AT features by default, such as TTS and audiobooks. Moreover, they had access to TTS or STT features in Google documents or Microsoft Word. Thus, all students could potentially use them. However, access did not always mean that the students used these features. One barrier was students’ being unaware of access to AT, such as the speech-to-text opportunities in Google documents. Either way, their experiences illustrated the potential usage of AT features for all.

Here (in a digital resource), we have access to most audiobooks. So I can listen, and some others do too. Everyone has access to it (Participant, 4).

Secondly, the students described various schools’ structures for transitions between devices, from tablets to computers, usually in grade 7, which might have been smooth or abrupt. If it was smooth, the students were able to familiarise themselves with the corresponding features on their computers before leaving their tablets, which enabled ongoing AT usage.

When I use STT, I typically use the tablet, but I've started to use the laptop with similar functions. So, I can let go of the tablet more and more (Participant, 9).

Need for environmental adaptations

The most prominent adaptation concerned the auditory environment, especially when using STT to lock out other people’s talk and not accidentally record it. Other reasons were that STT in the classroom might disturb others, or the students did not want their peers to hear what they produced in text. Students solved the problem by going out to the corridor or using a nearby room. Regarding listening to the texts, the students’ experiences varied from working satisfactorily in the classroom to the need for a quiet environment to comprehend the text without disturbing talk in the background, despite using a headset (AirPods).

I can wear headphones and talk into the microphone. People can talk around me as much as they want, because it picks up mostly my voice. If I have no headphones, it can pick up voices around me. I can talk without headphones, but I have to speak close to the mobile phone, so it only picks up my voice. I often whisper into the mic if I send a message because I don’t want others to know what I'm sending (Participant, 6).

Another environmental aspect concerned lesson organisation:

Let’s say I have a 40-minute class. I find it very troublesome to log in and out of the computer to access the audiobooks, so I choose to read most of the time because logging in is a waste of time (Participant, 8).

Thus, the students considered what might be the most time-efficient strategy. Furthermore, audiobooks on mobile phones were perceived as easier to access.

Continuous or fragmentary support

The students’ satisfaction varied regarding the teachers’ support of AT. In general, they felt more confident in using AT these days. However, they also described ongoing formative support to enhance their self-efficacy in using AT:

I'm sure AT strategies have improved, but it’s hard to see these things by yourself (Participant, 7).

Students also described differences regarding the responsibility for introducing AT and when to use it. Consequently, their AT usage during lessons was based on a mutual decision (teachers and students) or placed on the learner. The latter case was perceived as fragmented AT usage and caused feelings of meaninglessness in forming study strategies with AT.

Sometimes you were allowed to use AT, and occasionally you were not. So I felt if I'm not allowed to use it all the time, then what’s the point? (Participant, 9).

Theme 2: Emotional responses in the learning environment

This theme describes students’ emotional responses to dyslexia and AT usage in a classroom. Emotional responses refer to their thoughts, feelings, and behaviour when using or not using AT, illustrated from two perspectives by the following subthemes: Patterns of (non)acceptance of dyslexia and AT and unwanted attention.

Patterns of (non)acceptance of dyslexia and AT

The students described different emotions concerning dyslexia. At first, in early grades, they did not understand the diagnosis. Even before the schools investigated their learning disability, they already perceived that their classmates’ reading abilities were better than theirs. Those who still struggled with the acceptance of dyslexia felt hopelessness, sadness, and frustration about still having difficulties in reading and writing despite their training efforts. Moreover, they described not having passed all their grades in year 6. The situation caused them despair, as they felt different from the others—as a person to laugh at when reading aloud or not as good as their peers.

The students also described reasons for their different emotions towards AT. For example, AT was connected to peers with learning disabilities attending special classes. Therefore, AT was not something to be used in general classrooms. Thus, as soon as they had achieved a decoding level of reading shorter texts, these students abandoned AT, except for occasionally listening to text in learning materials with built-in audio. Instead, they tried to postpone the usage of AT:

It’s your choice, and you don’t have to use it. We (students with dyslexia) will probably delay AT usage as much as possible until we get into trouble and need help (Participant, 3).

Given these experiences, the results indicated a pattern of non-acceptance of dyslexia and non-AT use. However, in the case of accepting dyslexia, the students connected AT to rescuing, facilitating text comprehension, motivating listening to fiction, and producing texts to the same extent as their peers. Moreover, they described AT as a standard feature in digital devices. Consequently, they perceived AT as beneficial for everyone; thus, AT was connected to positive emotions.

I'm not the only one using STT. Many peers in the class do. So it’s not strange. You don’t have to have dyslexia to use STT; everyone can use it. It’s just a help (Participant, 1).

Besides various emotional responses associated with dyslexia and AT, the students’ also perceived classroom norms (in reading and writing) as facilitating or hindering AT use.

Unwanted attention

After the AT intervention, the students were supposed to generalise their learned AT strategies to classroom activities. The students described various classroom contexts, from tablets as a universal learning tool to textbooks as the norm for reading in all subjects. Either way, they described anxiety at the beginning of using AT tools in the classroom. Therefore, when using audiobooks initially, negative emotions arose, such as embarrassment, even if these feelings diminished as time went by:

I don’t care anymore, but in the beginning, it was strange (using audiobooks). I felt a bit left out. At first, I was afraid of being bullied. It never happened, and that’s why I don’t care now. I'm used to it (Participant, 5).

Thus, despite tablets being standard in the classroom, the users might experience unwanted attention, such as classmates staring at them when listening instead of reading a book. Therefore, they adapted to reading norms as much as possible when listening to audiobooks:

I think it’s easier to listen to audiobooks using my mobile phone because you start the app, put the phone in your pocket, plug in the AirPods in your ears, and do not have to mess with the computer, and I prefer having the book in front of me (Participant, 1).

Furthermore, the students described a change in classroom norms concerning listening to texts, which diminished unwanted attention:

In earlier grades, you felt that instead of sitting there with the tablet and everyone else staring at you while you’re doing it, I thought I'd sit down and read instead, but having in-ear AirPods is not weird nowadays. Some might be listening to music or texts. (Participant, 9).

Another aspect of unwanted attention from their peers could be the discomfort about leaving the classroom to use AT in a quiet nearby room and being prioritised by teachers for using these rooms because peers also want access.

When you go to a nearby room to use the AT tools, you must stand up. Then you get attention, both going there and at the end of the lesson, coming back to the classroom. I guess there are comments, too, sometimes (Participant, 7).

However, using a nearby, quiet room was also viewed as an opportunity.

Theme 3: Developing meaningful strategies

This theme describes students’ AT strategies and motives based on their self-assessed ability in reading, writing, and handling technical issues. These aspects are illustrated from three perspectives by the following subthemes: Adapted listening strategies; Listening strategies cannot be taken for granted; and Mixed text production strategies.

Adapted listening strategies

The students described their reading and writing difficulties according to the expected consequences of dyslexia (struggling to decode long words, which they found time-consuming and exhausting). They also described additional challenges that made it even harder, such as problems with speech, attention, and visual perception of the text. Consequently, audiobooks (Legimus) or other curriculum materials with built-in audio were experienced as beneficial during their years in school, e.g., helping them to expand their vocabulary. However, the students also emphasised the importance of teachers’ instruction in listening to texts in the same way as reading.

Their listening strategies were meaningful for text comprehension if adapted to their needs relating to perception, shifting attention, and memory. Thus, some students found it helpful to concentrate on the content when listening without following the text by eye simultaneously:

I close my eyes, listen, and think about the text. Otherwise, I look out of the window and think about other things. I use headphones to block out noise from people talking (Participant, 5).

Another strategy was to listen and try to follow the text by eye simultaneously on a screen or in a textbook. If they were watching the text on a screen, they chose it to be visually colour-marked sentence by sentence, and not word by word, because frequently moved markings were perceived as disturbing attention and memorisation of the content. The colour-marked sentences were also helpful when there were interruptions in the classroom, such as someone asking them a question when they were listening to a text. Then the student had to shift attention to the answer. The colour marks made it easier to find their way back into the text if they forgot to stop the audio. This strategy was also useful in situations when enhancing their vocabulary:

I want to simultaneously see the text on the screen as I hear it. Because if I get hung up on a word, I can pause right away. I might forget what I'm looking for. So, it’s easier if the word is highlighted, and I just look at the screen again (Participant, 2).

Listening strategies cannot be taken for granted

The students were generally positive about listening to text even though they did not use the technology to its full potential, as they were unaware of the search function to find information in the audiobooks (Legimus). Instead, they described a strategy, searching for information from page to page. Furthermore, their descriptions showed that listening to text is not always perceived as easy:

When reading, you can have your own pace, I would say. Then I can vary reading fast or slowly, but it is always the same pace when listening. It is also challenging to stop and go back in the text to listen again compared to reading (Participant, 3).

The point is that a reader’s speed varies; for example, if something is difficult to understand in the text, the reading speed automatically reduces and vice versa, but when listening, there might be too many steps in the audiobook (or TTS) to vary the pace back and forth. In addition, the TTS's prosody sometimes distracts if the emotion expressed does not match the text’s content.

The students’ descriptions also revealed that listening strategies were not easily transferred from one situation to another. First, they experienced that TTS primarily facilitated learning to read, and it was rarely used for reading (listening) to learn. The benefits were perceived as connecting letters and sounds (discovering vowel and consonant confusions) and simultaneously listening to words and sentences when writing on tablets. However, their knowledge of TTS was rarely transferred to situations such as the re-reading and revision of their text production, even though they had access to it and knew re-reading might enhance their text quality. Instead, they described other strategies, such as obtaining feedback from teachers or parents, or they just skipped revising on a text level. Second, in earlier grades, the students had learned to use an optical character recognition (OCR) app on a tablet, scanning printed texts to digital and then listening by TTS. However, the OCR strategy was forgotten later in school, and they did not use it despite their descriptions of a recurring difficult situation: reading printed text booklets. Instead, they handled the situation in other ways: by pretending to read, leaving the classroom in frustration, trying to find a similar audiobook, or reading some part of the text, sometimes in a resigned mood.

Reading booklets never works, so I always search for digital material but usually do not find anything. So I typically do nothing during such lessons (Participant, 7).

Finally, listening to texts could be abandoned if it was not perceived as contributing to the development of their reading ability:

Even if reading is slow and the quality of my work decreases, this is how I learn the best in the long run. So I seldom listen to text (Participant, 8).

Mixed text production strategies

The students described difficulties in spelling and punctuation. Therefore, they appreciated the computer’s spell check when keyboarding, even if the marking of misspelt words can disturb their writing fluency. In addition, the students perceived STT as helpful in spelling and formulating longer texts. Still, their experiences were mixed and characterised by frequent usage to no use.

Positive STT experiences were related to reducing steps in text production and enhancing text quality:

I can write notes on paper or use sentences in a book. Then I say it, and it will appear on the computer screen. It is helpful compared to typing using the keyboard because I don’t have to shift attention between the notes and typing on the keyboard, and I can give more details. So STT is somewhat easier than typing on the keyboard (Participant, 1).

However, in situations such as time-limited tests, the students described formulating their knowledge verbally in a teacher-student condition instead of using STT.

Another benefit of STT might be increased speed. However, their descriptions varied; on the one hand, it meant only the transcription, and on the other hand, it included the revision process. The pace was described as similar to keyboarding when including revision because it takes time to find wrong words, such as homophones like weak – week being mixed up, which could be perceived as tiring.

Nevertheless, those who used STT described various STT strategies: to handle writing conventions, they punctuate the text by saying “period” or using the keyboard. They also synchronise online word-processing programmes between mobile phones and computers. This way, it was possible to produce texts using a mobile phone or computer, and teachers could access them and give feedback. Another strategy, an unusual one, was note-taking with STT while listening to text.

The students who did not use STT mainly described two reasons (except for not being aware of AT access on their computers). First, the technology did not catch their pronunciation of words well enough. However, even when the students described language difficulties, they could strategically use STT, i.e., when words were perceived as easy to pronounce, the STT was used, while for difficult words, the keyboard was used. Secondly, STT was described as unnecessary when the spelling is almost correct:

I'm close to spelling it correctly. So the spell checker understands what word I mean, and then I correct it (Participant, 3).

Discussion

The present study described the long-term experiences with AT of nine students with reading and writing difficulties or dyslexia from middle school to high school in Sweden. Three main themes were identified, with associated sub-themes. The first theme, “Contextual factors: facilitators or barriers”, reflected organisational elements of ongoing AT usage. The second theme, “Emotional responses in the learning environment”, referred to the participants’ pattern of acceptance and aspects of stigmatisation (unwanted attention) in a classroom. Finally, the third theme, “Developing meaningful strategies”, illustrated the participants’ AT strategies and motives (using or not using AT).

Overall, the result aligned with previous research demonstrating academic and emotional benefits for individuals with severe reading and writing difficulties or dyslexia using AT [27,28,31]. In particular, listening to texts might improve text comprehension, pace and independence, and required less effort in text-based activities if customised to suit the individual [27]. In addition, the results were also consistent with previous research regarding experiences of some drawbacks connected to the organisation of support [30,31,38,39], stigmatising feelings [40] and technical issues [32,35,37]. The accumulated research suggests that it is essential to address these drawbacks to make AT interventions sustainable.

In addition, this study added knowledge to long-term AT experiences and the interplay between the environment, the person, and the AT tools’ perceived usefulness in text-based activities [21]. The results are further discussed thematically, concretising the students’ experiences connected to the schools’ multilevel support: organisational prerequisites (theme 1), the classroom experiences (theme 2), and strategies adapted to the individual (theme 3).

Contextual factors

The first theme illustrated high access to digital devices nowadays in Swedish schools [24,25] unlike five years ago (the time of the previous AT intervention). Thus, there is a higher potential use of STT and TTS as they have transitioned into mainstream technology [23,51]. However, the students’ experiences suggested that organisational drawbacks might undermine schools’ investment in digital devices and AT and, thereby, students’ AT benefits in academic outcomes. Thus, the contextual factors were more a matter of the school’s organisational prerequisites in coordination over time [22,31,45] and user participation [45] rather than a financial matter of providing AT.

The organisational prerequisites (aware access, smooth transitions between devices, adaptations in the audio environment, and ongoing support during schooling) may contribute to the students’ mastery experiences and, in turn, promote their self-efficacy [4–6,52] in text-based activities. On the contrary, if there is insufficient coordination over time, these organisational factors may become barriers to students’ attempts to develop and consolidate AT strategies, despite schools’ good intentions in increasing access to digital devices and AT.

In addition, the findings illustrated the need for mutual agreement (teacher-student) in AT usage (when and where) to maintain and develop individual AT strategies during lessons. In line with previous research, user participation in decision-making around AT has been highlighted as an essential factor [39,45,53]. However, there was a considerable variation in how the students described this matter, which may impact predictability and clear expectations in continuous AT usage. Schock and Lee [54] found similar challenges based on young AT users’ experiences in school, such as teacher preparation and being allowed to use AT.

Emotional responses in the learning environment

The second theme illustrated a pattern between individual acceptance of dyslexia and AT and the AT attitudes in the classroom culture, with underlying assumptions taken for granted [55] that may affect the student’s motivation for AT usage.

The participants were aware of the attainment gap in reading and writing ability that they perceived widened considerably in the early school grades [56]. Hence, they expressed more or less anxiety about peer acceptance due to reading and writing difficulties. These feelings of anxiety were linked to real or perceived stigmatisation in relation to dyslexia [3] and AT [27]. However, the stigma (unwanted attention) was present before they started to use AT. This condition, arising from the individual’s feelings about dyslexia, may lead to a negative cycle that can maintain secondary consequences, such as students’ decreasing motivation to perform text-based schoolwork. Therefore, targeting the individuals’ emotions is essential to promote academic performance [3].

Moreover, the students’ descriptions suggested a conflict between academic and social needs depending on how they perceived stigma and AT attitudes in the classroom culture. Consequently, their decision-making regarding the continued use of AT may include considering how to feel the most satisfied in the environment [57], which may lead to perceptions of one need being predominant over another [54]. Thus, consistent with Roberts and Stodden [38], reading and writing difficulties were not always enough to motivate AT use. For example, if the classroom culture signalled one should read and write, but one could add AT if it was difficult, then students might want to prove to others that they could manage without the help of AT. In this case, the learning environment may reflect a poor response to students’ diverse needs [58], which could mean not including AT as a natural part of the classroom practice [30].

Furthermore, the students might try to simultaneously satisfy academic and social needs by adapting to the classroom’s reading and writing norms as much as possible. For example, they described listening to audiobooks using their mobile phones and having a printed book in front of them, following the text by eye like everyone else. However, STT seemed challenging to combine with the norm of writing because the speech was audible to those around, sometimes drawing unwanted attention. This may be one reason the students appreciated listening with AT tools more than STT. At the same time, STT was also described as destigmatising because of its current accessibility to everyone [23,51].

Although students’ stigma was reduced by accessible AT on their mainstream devices [40,41] and by classmates having the same devices (tablets or computers), neither the reduction in stigma nor the potential academic benefits were always enough to motivate AT use. In addition to this, the utility of AT depended on the environment in which they are used. A similar result has also been pointed out in an interview study investigating perceptions of the stigma associated with visual impairment [59] Thus, the perceived attitudes towards AT in the learning environment seem to matter as a step in schools’ inclusion capacity [30,40,60]. This pattern (individual – learning environment) pointed to the students’ needs for feeling autonomy (sense of choice to select strategies), competence (feeling able to complete a task at school), and relatedness (feeling connected to others) in the social context [61,62], as a basis for motivation to use AT.

In the future, AT in text-based activities may be one optional strategy to assimilate (listen and read) and produce texts (STT and writing using a keyboard) [31] rather than something to add if difficult. However, overcoming stigma barriers requires a change in the perspective of AT users, not only in schools but also in developing inclusive work environments [63].

Developing meaningful strategies

The third theme illustrated the students’ AT strategies (listening and text production) and motives to use them in text-based activities.

The participants appreciated audiobooks the most, including materials having built-in read-aloud functions by default, because of their ease of use and high value for text comprehension in schoolwork across subjects throughout schooling, consistent with previous research [31,33].

The result also indicated three essential aspects to consider in training listening strategies: attention, speed, and optimal use of AT features. First, attention may have a moderating effect on listening ability (using TTS) [64]. In the present study, students who described attentional difficulties preferred only listening without simultaneously following the text by eye. In this way, they adapted their listening strategies to individual needs.

Secondly, listening speed may also need training. Even if rare, the present study revealed challenges regarding the matter consistent with Dodge’s research [35]. The rationale for this experience was that in reading, one’s speed varies to understand the text, but when listening, the speed goes on at the same rate, which may interfere with text comprehension. The challenge might reflect a subtype in the Simple View of Reading framework [7,65], i.e., mixed reading difficulties [7], in both decoding and oral language ability (extracting and constructing the meaning of words, sentence syntax, and text as a whole). Therefore, listening to texts may be challenging for text comprehension [7]. The speed perception can also depend on whether the texts are narrative or expository. Previous research has shown that the clear structure of narrative texts can facilitate text comprehension [26]. This result may lead to an increased need to practice listening strategies in expository texts, e.g., one may need to consider adjustable technical aspects such as handling short keyboard commands to adjust the listening speed quickly back and forth.

Thirdly, the optimal use of AT features may also need to be considered when training listening strategies. For example, the participants did not use the (Legimus) audiobook search function, which might be a fundamental help in text comprehension when searching for answers. Thus, they did not use this AT tool to its full potential. A similar result has previously been reported for students’ use of AT features ranging from basic to advanced [30].

In summary, listening strategies cannot be taken for granted [66]. Instead, the training needs to be systematic in using AT [27,31] and adapted to the activity and the individual to help students with dyslexia and added reading difficulties to overcome possible challenges in listening. In addition, Dogan and Delialioglu [42] report that students want their teachers to be part of their progress in using AT; however, the present study found that students have difficulties recognising this progress during the school years.

The results also indicated that motivations for developing listening strategies may depend on students’ understanding of reading. The students’ descriptions sometimes show a limited view that reading is only about decoding. Therefore, they could abandon audiobooks, arguing that reading is only learned by reading (by eye). Similarly, the students appreciated TTS in learning to decode because it was perceived as supporting the ability to associate sounds and letters when typing on a keyboard. However, when students found their decoding acceptable, the goal was reached, and TTS was abandoned. This limited view of reading (only decoding) may become a barrier to developing text comprehension (both listening and reading) and, in the long run, may have consequences for students’ achievement in school. Therefore, it may be beneficial to enhance their knowledge about reading in the broader context of higher-order skills [17,67] and how listening to texts may be relevant to support these skills.

As noted, TTS was appreciated in learning to read: bypassing decoding difficulties and developing decoding ability [31,68]. The experiences reflect the correlation between the two components of the Simple View of Reading, i.e., language comprehension impacts letter/sound recognition and therefore affects word recognition [69]. Svensson et al. [31] describe it as a transfer effect from listening to decoding ability. However, TTS was not easily transferable to other activities, even if some descriptions indicated that TTS was helpful to independently revise their produced texts instead of asking others for help. This re-reading (listening) is essential in helping the writer keep the text coherent [70] and enhance text quality.

As an additional aspect of text production, the participants found STT to have mixed utility in the current study, similar to the previous intervention [30,31] and other studies [34,37,38]. Those who used STT to produce longer texts described benefits that corresponded to previous research: enhanced accuracy, text quality, and length [27]. The students explained reasons for this improvement as STT supported attention and idea generation, confirming previous research [37,38] when bypassing transcription (typing on the keyboard). This finding is important because having ideas is essential for the outcome of text production [71]. When STT supports the cognitive process from ideas to written language in grammatical structures, this bottleneck in writing, limiting fluency [70], is widened. Furthermore, students’ increased ease in text production (written) fluency may positively affect their self-efficacy as writers because one can expect a more positive self-evaluation parallel to the text production [71].

However, regarding STT increasing the speed of text production, the students disagreed because it depended on whether one included the revision process. If included, they described the pace as similar to keyboarding because the revision part of text production may be challenging, as previously reported [37,38]. Thus, it takes time to detect confusing words due to individual pronunciation and how the STT technology interprets the spoken word, e.g., similar words spelt correctly but not right in the context.

The result also indicated that motivation for developing STT strategies may depend on students’ understanding of STT's potential benefits for producing longer texts than keyboarding [27]. Those who use STT to produce longer texts can improve text quality from teachers’ feedback on higher-order skills, such as revising the content and structure of the texts [19,20]. These are critical elements in becoming proficient [72]. However, STT was sometimes described as meaningful only regarding spelling (lower-order writing skills). Thus, a spell-checker was perceived as enough.

Finally, the students described development in various AT strategies based on contextual factors, emotional responses in the learning environment and their motivations for using AT in text-based activities, fulfilling their immediate need for self-efficacy. However, the results indicated diverse AT progress over the years in school, suggesting inequalities in preparation for higher education.

Strengths and limitations

This study included nine participants using AT to various degrees over the last five years. Thus, the responses contributed to positive and negative aspects. The study was conducted in Swedish schools where the national strategy for digitalisation [73] requires adequate digital competence for all students (adequacy refers to digital tools evolving over time and that students’ needs change accordingly). The reader may consider corresponding conditions when transferring the study results to other contexts. Another limitation: two interviews were held online instead of face-to-face due to COVID-19 pandemic restrictions. These interviews are somewhat different because the students could not easily show how they used AT. Instead, the interviewer asked more prompting questions to support the participants’ ability to answer the questions. Nevertheless, the findings may be transferable to other contexts, contributing to enhancing AT provision in schools enriched by the users’ views.

Conclusions

This five-year follow-up study can contribute to the development of appropriate AT academic practices enriched by the users’ views (in this case, students with reading and writing disabilities or dyslexia in middle and high school). The participants’ experiences, described in three main themes, were connected to schools’ multilevel support (contextual factors: facilitators or barriers; emotional responses in the learning environment and developing meaningful strategies). The main findings that enabled or hindered students’ continued AT usage were organisational elements in the context rather than economics and AT accessibility. Moreover, the emotional responses were influenced by the self-acceptance of dyslexia and AT attributes in classroom cultures, meaning the students balanced their academic and social needs to feel comfortable in the learning environment. Finally, the development of meaningful strategies may be limited by insights into AT's optimal functioning, the ability to transfer AT skills between text-based activities, and the knowledge of how AT tools can promote higher-order reading/listening skills as well as text production/writing skills.

Implications

The users’ AT experiences indicate success factors for sustainable interventions: (1) Understanding the organisational factors that enable or hinder continuous AT use can help teachers support dyslexic students’ development in text-based learning throughout schooling. (2) Ongoing attention to the emotional aspects of AT use in the classroom may be a valuable support in conjunction with systematic AT training. (3) Listening and text production strategies with AT may need ongoing support to develop both lower-order and higher-order skills.

Future research stemming from the previous AT intervention [23] and this follow-up study may explore how interventions can be designed to support students’ use of STT in school and its effects on text quality. In addition, what could not be further analysed in this study was how some students managed to achieve the school curriculum goals despite persistent severe reading and writing difficulties and yet had discontinued the use of audiobooks, TTS and STT. What does it mean to have neither adequate reading and writing ability nor AT skills in future higher education?

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Marcus and Amalia Wallenberg Foundation.