Catherine Owens only

Article

Information and communication technology use in daily life among young adults with mild-to-moderate intellectual disability

Camilla Ramsten Mälardalen University, Sweden

Lene Martin Mälardalen University, Sweden

Camilla Ramsten Mälardalen University, Sweden

Lene Martin Mälardalen University, Sweden

Munir Dag Mälardalen University, Sweden

Lena Marmstål Hammar Dalarna University, Sweden

Date accepted: 29 May 2018

Abstract Background: Information and communication technology (ICT) increases participation in life activities, and young adults are frequent users. Young adults with intellectual disability (ID) do not use ICT as much as their peers, and little is known about how ICT is used by young adults with ID. This study describes the use of ICT from the perspective of young adults with mild to moderate ID in a municipal social care context. Method: Semi-structured interviews were used to collect information from 11 young adults with mild-to-moderate ID living in residential care and analysed using a content analysis. Results: ICT was used for family relationships, daily support, interactions based on interests and amusement, and as support for offline activities. Family members were important providers of support for ICT use. Conclusion: Young adults with mild-to-moderate ID use ICT in their daily life. The social care context needs to be further investigated due to its influence on the young adults’ access to ICT and need of support.

Keywords information and communication technology, intellectual disability, social care, young adults

Introduction

Information and communication technology (ICT) tools, such as mobile phones, computers and Internet tablets, have become important in maintaining both purely digital relationships and as an extension of offline relationships (Raghavendra et al., 2013; Shpigelman and Gill, 2014;

Corresponding author: Camilla Ramsten, School of Health, Care and Social Welfare, Mälardalen University, Västerås 72321, Sweden. Email: [email protected]

Journal of Intellectual Disabilities 1–20

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Söderström, 2009a; Stald, 2008). However, young adults with intellectual disability (ID) are not as frequent ICT users as the general population (Government of Sweden, 2003; Scholz et al., 2017), and the organizational support for the use of ICT in municipal social care for adults with ID in Sweden is generally low (Ramsten et al., 2017).

Despite the availability of societal support, people with ID are less frequent participants in social life and are at risk of lower rates of participation in areas such as interpersonal relationships, social inclusion and rights compared with adults without ID (Simões and Santos, 2016; Umb- Carlsson and Sonnander, 2005). People with ID are generally more socially excluded than the overall population (Asselt-Goverts et al., 2015; Simões and Santos, 2016; Umb-Carlsson, 2008; Umb-Carlsson and Sonnander, 2005). Social networks among adults with ID in Sweden are small and consist almost entirely of family, neighbours and care staff (Sorbring et al., 2017; Umb- Carlsson and Sonnander, 2005). Similar patterns have been reported in other countries, such as the Netherlands, where the importance of maintaining or enhancing the existing network is emphasized (Asselt-Goverts et al., 2015). In contemporary society, ICT is used for social purposes – for keeping in touch with friends and family or engaging in areas of interest. Posting updates and photos as well as commenting on others’ posts online has become ways to show a presence and to interact with others (Xinaris, 2016).

Despite the existence of laws requiring opportunities for participation by people with ID, taking part in an actual activity is required for participation to take place (Blomberg, 2006). Participation is defined in the International Classification of Functioning, Disability and Health (ICF) as ‘engagement in a life situation’ and is operationalized according to the activities performed in a social context. Performance comprises the physical, attitudinal and social aspects of the envi- ronment. A situation or activity needs to be accessible for participation to occur. An activity can be accessible in one situation but not in another, depending on differences in the environment (World Health Organization, 2001). The ICF definition has been criticized because participation involves more than the performance of an activity and includes a subjective experience of engagement. Therefore, attendance at a situation is insufficient as a measure of participation (Granlund, 2013; Hemmingsson and Jonsson, 2005). That is, an accessible activity is a precursor for participation by allowing presence, but it does not automatically mean social inclusion or participation (Simplican et al., 2015). Despite the limitations of the ICF definition of the performance of an activity, the ICF provides an accepted definition and measure of participation. Batorowizc and colleagues (2016) make a valuable point that choice of activity is a central part of participation, as is who else is joining the activity.

Technological advances have created new arenas and situations that can offer participation in daily life. The ubiquitous use of ICT has transformed interactional opportunities and conditions for participation and social relationships. The constant availability of digital access means that people are often expected to participate in both physical and digital social arenas simultaneously (Molin et al., 2015; Söderström, 2009a; Stald, 2008; van Dijk and Hacker, 2003). Young adults are more frequent users of social media than older adults (Findahl and Davidsson, 2015; Holt et al., 2013) and use ICT for political, civic (Loader et al., 2014) and social participation (Boulianne, 2015). Thus, being able to use ICT can be important for the participation of young adults (Boulianne, 2015; Loader et al., 2014).

ICT and use of the Internet are less common among adults with ID than in the general popu- lation in Sweden (Findahl and Davidsson, 2015; Swedish Ministry of Health and Social Affairs, 2011) and internationally (Chadwick et al., 2013). In 2015, 93% of the Swedish population aged over 12 years had access to the Internet, and young adults in general were the largest group of daily

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users. In addition, 94% of people in the age group 16–25 years used Facebook and 67% used Instagram. In the age group 26–35 years, the percentages were 84% and 55%, respectively (Findahl and Davidsson, 2015). van Dijk and Hacker (2003) identify four barriers to ICT: (1) lack of digital experience related to lack of interest; (2) lack of material access; (3) lack of skills because of poor user-friendliness and inadequate education or social support; and (4) lack of opportunities for use. Rapid developments in technology can change the barriers experienced by users and may increase material access but there remain differences among a given population – called the ‘digital divide’—which persists because of the differences in access and use of ICT according to social group (Scholtz et al., 2017; van Dijk and Hacker, 2003).

Barriers to access ICT and digital arenas for people with ID are partly related to difficulties with navigation, reading and abstract thinking (Lussier-Desrochers et al., 2017). In a recent Swedish study, parents expressed concerns about the use of ICT among their young adult off- spring because it is difficult for young adults with ID to predict the results of their actions. The written word may be more difficult to understand than the spoken word because of reading difficulties and lack of information normally obtained through body language and facial expression (Molin et al., 2015). In addition, staff and other support people tend to restrict par- ticipation for young adults with ID by mediating and interrupting interactions and activities based on their own ideas about what is appropriate (Bigby and Wiesel, 2015). Staff also tend to have more negative thoughts regarding ICT-use for young adults with ID, than the young adults with ID do themselves (Löfgren-Mårtenson, 2008). These types of lack of support and attitudes can be an additional social environmental barrier to ICT access as a tool for participation by people with ID (van Dijk and Hacker, 2003; World Health Organization, 2001). Participation in activities should be promoted because it can lead to social inclusion, which brings increased self- esteem, well-being and a feeling of contributing to society, and combats social exclusion (Simplican et al., 2015).

Digital arenas are permeated by a risk-thinking approach by others than the persons with ID that limits the opportunities of digital arenas (Caton and Chapman, 2016; Seale, 2014). Simultaneously, the importance of accessibility to ICT and the Internet is acknowledged. Limited access or una- vailability of services may reduce opportunities for participation in the future (Molin et al., 2015). Support is emphasized as a means to overcome the social environmental barriers to ICT among users of social service organizations (Caton and Chapman, 2016; Parsons et al., 2008; Ragha- vendra et al., 2013). Staff members employed in municipal organizations that provide social care are often not supported in their attempts to help people with ID to use ICT, and information about ICT may not be provided to the service user or family (Ramsten et al., 2017). Thus, the use of ICT by young adults in social care is strongly impacted by the social environment, especially as their attitudes towards ICT use can have an impact on service provision (Parsons et al., 2008; Seale and Chadwick, 2017). In addition, Chadwick et al. (2016) reported that, in the United Kingdom, people without ID perceive the benefits of using the Internet to be greater for people with ID than for themselves. In contrast, the social risks, such as being bullied or deceived, are also perceived to be greater for people with ID.

ICT is considered a tool for increasing empowerment and self-determination among young adults with mild to moderate ID (Caton and Chapman, 2016; Darcy et al., 2016; Söderström, 2009b). However, there is a lack of research about the role of ICT in the daily life of young adults with ID and their own description of how they use ICT. Therefore, more information is needed about the nature of ICT use in daily life in a social care context. This knowledge can increase our understanding of what and how support should be organized to enable the use of ICT as a tool for

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activities and participation. Most importantly, this study can assist in amplifying the voices of young adults with mild to moderate ID.

Aim

The aim of this study was to describe the use of ICT from the perspective of young adults with mild-to-moderate ID in a municipal social care context.

Methodology

The study has an inductive, qualitative descriptive approach (Patton, 2014). This allowed us to emphasize and recognize the subjective knowledge of young adults with ID and their descriptions of their ICT use. The descriptive approach maintains a focus on the young adults’ version of reality. For example, they were allowed to describe what they considered important for them in their ICT use, and what was fun and valuable. In this way, the subjective experience of partici- pation could be perceived.

Context

In Sweden, ID is diagnosed according to an administrative definition, and the diagnosis is required for approval of societal support. Adults with ID have the right to social care according to the act concerning support for persons with certain functional impairments (LSS-law) if they have difficulties in daily life that are not met otherwise. The responsibility for social care for people with disabilities in Sweden lies with each of the 290 municipalities (Government of Sweden, 1993: 387). About 1% of the Swedish population has an ID. The relational model of disability is applied in Sweden and in 2014, 64,400 persons received societal support for a disability. The total number of services provided according to the LSS law ascends to 114,800, of which 89% are provided to persons with ID or autism (The National Board of Health and Welfare, 2016). ID can be diagnosed into three levels: mild, moderate or severe (The National Board of Health and Welfare, 2011).

Sample and setting

Participants were recruited through residential homes in municipal social care for people with disabilities in two large cities in the middle of Sweden between September 2015 and May 2016. The first author contacted managers and residential homes in the municipalities and asked for help in recruiting participants to the study. The inclusion criteria were age 18 to about 30 years, capacity to make one’s own decision about informed consent, use of ICT in daily life, being able to read the information letter and sign a consent form, and provision of social care primarily because of mild to moderate ID. The exclusion criteria were major physical impairments or other significant disabilities that influence daily functioning in relation to ICT or incapacity for any reason. In the first municipality, all young adults who met the inclusion criteria were asked for participation. In the second municipality, access was given to three residential homes where all young adults who met the inclusion criteria were asked for participation. In total, three young adults declined participation.

Staff and managers identified individuals with ID who fulfilled the criteria. These individuals with ID who fulfilled the inclusion criterion were described in terms of their daily functioning and need for support rather than a diagnosis. Difficulties in daily life for people with ID are in general

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related to social, conceptual and practical skills (American Psychiatric Association, 2016). The staff at residential care, where potential participants lived, were verbally informed about the study by the first author and asked to inform potential participants about the chance to participate in an interview. Written information aimed to the prospective participants was sent to the staff beforehand to be distributed to participants. A resident interested in participating in an interview together with a staff member agreed on a date and time when the first author would visit and again, formally, to ask about participation in the interview. All participants were informed that partici- pation was voluntary and that they could terminate their participation at any time.

Eleven individuals, six men and five women, aged 22–31 years (median 25 years), agreed to participate in an interview. One participant had additional physical disabilities that did not affect the use of ICT. See Table 1 for participant characteristics.

All lived alone in their own two-room apartment within a municipal residential home. Staff members were available in a nearby apartment, which included an office and common living areas where service users were welcome to spend time.

Data collection

Individual semi-structured interviews were conducted, and their duration ranged from 15 min to 68 min (median 32 min). Participants chose the time and place for the interview. All interviews except two took place in the participant’s home. One of these two participants chose to have a staff member present during the interview. These two interviews were conducted in the staff member’s office–apartment, which meant that the staff member was present in the next room. All interviews were voice recorded.

Questions were asked about how ICT is used in daily life. An interview guide was used and included questions such as ‘Can you tell me about how you used your smartphone/computer/ Internet tablet yesterday?’, ‘Can you tell me about what you use smartphone/computer/Internet tablet for?’, ‘What do you enjoy the most about using a smartphone/computer/Internet tablet?’ and ‘Who do you ask if you need help?’. Follow-up questions focused on specific activities related to activities during leisure time.

Table 1. Participant characteristics and ICT-ownership.

Code Sex Age ICT products at home

Participant #1 Female 30 Smartphone and computer (without Internet connection) Participant #2 Female 25 Smartphone and computer Participant #3 Female 24 Smartphone and Internet tablet Participant #4 Female 26 Smartphone, computer and Internet tablet Participant #5 Male 23 Smartphone and computer Participant #6 Male 24 Smartphone and computer Participant #7 Female 22 Smartphone and computer Participant #8 Male 31 Cellphone and computer Participant #9 Male 31 Cellphone and computer Participant 10 Male 22 Smartphone and computer Participant 11 Male 30 Smartphone, computer and Internet tablet

ICT: Information and communication technology.

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Data analysis

All interviews were transcribed verbatim. The transcripts were analysed using inductive content analysis as described by Elo and Kyngäs (2008), which was considered suitable as it allowed descriptions of content, that is, what ICT was used for. In addition, the descriptive approach was adopted to meet the aim of the study – to describe the young adults’ ICT use. Notes were written in the margin of the transcripts, and meaning units were selected to help manage the amount of text. A meaning unit could be a sentence or a part of the dialogue related to the aim. The meaning units were coded and grouped into subcategories based on similarities and dissimilarities of ICT use. The subcategories were collapsed into higher order categories based on similar ICT use, resulting in two generic categories. These were in turn abstracted into one main category (Table 2). The analysis went back and forth between the transcripts, codes, subcategories and generic categories to confirm the results and to ensure that the categories remained close to the text. Each step of the analysis was discussed by two of the authors (CR and LMH) and presented by the research team at regular meetings until consensus was achieved among all researchers.

Ethics

Ethical approval was provided by the regional ethical vetting board in Uppsala, Sweden (dno. 2015/209). All participants received written and verbal information about the study, consent and their right to cancel the interview at any moment. Participants were observed during the inter- view for signs of wanting to withdraw from the study, and all were asked during the interview if they wanted to end the interview or if there were too many questions. Staff members were requested to talk with potential participants with ID initially about the study and to ask whether they were interested in participating. We felt that the young adults with ID knew the staff and might have felt more comfortable discussing the matter without pressure. We felt that the staff members were familiar with the functional levels of all people at their facility and would, therefore, be able to determine whether a person with ID understands the meaning of the questions. All participants were aware of the topic for the interview and the interview situation when meeting the interviewer (CR).

Table 2. Examples of the analysis showing the abstraction process.

Meaning unit Code Subcategory Generic category

E. (talking about a friend) Yeah, we can write to each other from 7 am to 10 pm! *laughing* So it’s quite long chats we have!

Friendship Interactions based on interests

Social relationships

C. What shall you eat? J. What shall you eat? And so you should prepare everything you need: dishes, food, stuff and other things you need as well. And then you, when you have used, what has been used, made, you tick it so that, therefore…

Food and cooking Support for activity For solitary pastime

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Findings

The use of ICT by the young adults with ID was categorized into one main category, two generic categories and four subcategories as presented in Table 3.

Overall, the young adults with mild-to-moderate ID described using ICT as a tool for com- munication and for performing various types of activities. Additionally, the findings show that ICT is used as a tool to support in the social care organization and for the young adults’ private interests. ICT was described as a natural part of daily life, with several areas of use and a variety of purposes.

To enable leisure-time activities

The main category, To enable leisure-time activities, was created from two generic categories comprising the areas the participants talked about: For social relationships and For solitary pastime. Both generic categories included the successful use of, and the difficulties associated with the use of, ICT and social media. The lack of knowledge about what ICT and social media can be used for was obvious in both the generic categories. This lack of knowledge became apparent during the interviews when some participants could not give examples of what ICT could be used for beyond its current use. In contrast, some participants also gave examples of activities that they knew were available but were not of interest.

For social relationships. The category, Social relationships, refers to the use of ICT as a tool to develop and maintain social relationships. The subcategory, Family relationships and daily sup- port, comprised interactions with family and staff. These were categorized together because both interactions included support and check-ups. The subcategory, Interactions based on interests, comprised friendship and interactions with people who share a common interest. In contrast to Family relationships and daily support, leisure activities and interests were central to this category.

Family relationships and daily support. ICT used for Family relationships and daily support included social relationships that were not self-chosen. ICT was used, primarily the mobile phone, to maintain contact with family members and staff members and to contact their trustee. Most of the regular interactions with family were telephone updates to let the family know that they were all right. ICT enabled more frequent contact with family. One participant had frequent phone contact with his siblings, although only on specific days, which was important to him.

Participants sometimes lacked understanding about how to text message and therefore tele- phoned for updates instead. They received text messages from staff and family members with information even though they did not know how to use text messaging to respond. One participant noted in the conversation with the interviewer: ‘Yeah well, I mostly receive. I haven’t learnt how to send yet’ (#8, male, 31 years). This illustrates that text messages are useful in the young adults’

Table 3. Categories that constitutes the findings.

Main category Generic categories Subcategories

To enable leisure time activities For social relationships Family relationships and daily support Interactions based on interests

For solitary pastime Amusement Support for offline activities

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daily lives despite being a one-way channel of communication. More importantly, text messages are reported to be a positive way of receiving information.

Others had no difficulties with texting and considered calling or texting to be the most appropriate way to communicate. If someone was expected to be at work, for example, texting was considered more appropriate than calling because they were afraid to disturb during working hours. The mobile phone almost entirely replaced the landline phone and was, therefore, needed to ask for and receive support provided by staff in daily life, such as reminders and check-ups. However, participants did not always appreciate being phoned by a staff member and they sometimes chose not to answer. One participant noted:

P: Yeah. I don’t even answer it.

I: Do staff call you on it?

P: Sometimes they do.

I: Do you answer then?

P: No, [I] have no time.

(#9, male, 31 years). This participant reported avoiding answering the phone as he considered that he had other

things to do, or just did not want to talk to the caller at that moment. The interaction with staff was otherwise described as a reciprocal relationship through which

staff members could take the initiative to call and check in but the participant could call to update the staff. The reason to the take the mobile phone outside home was to allow staff to reach them or to be able to call staff to tell them where they were.

Interactions based on interests. This subcategory included the use of ICT and social media (e.g. Facebook) for friendships and to be able to contact unknown people with similar interests. Participants described their use of ICT as a way to maintain existing relationships, to call and text with friends and to develop new relationships. Being reachable during the day was also noted as a positive aspect. Communication via text messages enabled them to maintain social relationships with friends while at work or when involved in activities at home. ICT was also described as enabling contact with friends in other cities who were not seen very often. One woman said: ‘Yeah, we can write to each other from 7 am to 10 pm! *laughing* So it’s quite long chats we have!’ (#7, female, 22 years). This increased the opportunities for social interactions and helped to maintain and deepen relationships with friends.

Experiences of texting with friends ranged from not understanding how to use text messaging to preferring texting rather than talking on the phone. Even though texting was described as problematic because of spelling difficulties, it did not necessarily hinder text communication. One woman explained:

P: It’s good. I try to spell but it’s difficult sometimes.

I: Do you have any help on the phone to spell?

P: No, I try. Those who know me well know what I want to say.

(#1, female, 30 years). For this woman, her spelling difficulties did not hinder her use of text messages to commu-

nicate. Instead, she wrote as well as she could and knew that she would be understood. However,

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use of the mobile phone was sometimes restrained by social environmental barriers. These might be difficulties using the device or when the service provider experienced problems and the telephone network did not work. This hindering of texting and use of social media was expe- rienced as annoying. Other problems related to the product included a broken charger or an unresponsive touchscreen.

P. that the touch screen doesn’t work. Or that it’s uncharged and [I] have to wait.

I. What do you do when the touch screen don’t work?

P. I take out the battery and put it in again, then it works

(#7, female, 22 years). Although help was usually needed, the participants had different strategies for solving simple

technical problems so they could continue to use the mobile phone as they wished. Difficulties occurred in relation to initiating contact with friends because of the cost and

organization of the payment for calling and data. Thus, the use of ICT as a tool for maintaining social relationships depended on others taking the initiative. Participants who used their device frequently and had family support recognized when it was time to change from a prepaid card to a subscription. One participant who did not use his mobile phone noted:

I: Do you have a mobile phone?

P: Yes, I do, [but] it’s locked up.

I: You have it locked up?

P: Yes.

I: When do you use it?

P: I doesn’t work calling because I have no money on it.

(#5, male, 23 years). In this case, no assistance was given to buy a prepaid card, so the participant was not able to use

the mobile phone. Although the participant may not be a frequent user, there was no opportunity to use it.

Social media attracted their attention throughout the day. A common use of social media in everyday life was to chat and stay updated with friends and relatives by following, liking and sometimes commenting on status updates and pictures shared on Facebook or Instagram. One participant noted:

Yes, I do that as soon as I wake up—I check Facebook then when I sit and eat breakfast, I read the news,

check Facebook again, at Instagram. Later, when I get to work, I check Facebook again [to see] if

someone has made an update. (#7, female, 22 years)

This frequency of social media use indicates that it is an important aspect and a natural part of daily life. The frequency of social media use allows the participant to respond quickly to other people’s updates and activities.

Social media also allowed the participants to initiate new social relationships. Facebook was used to explore own interests, which also led to interactions with new people who shared the same

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interest. Facebook provided the opportunity to follow celebrities and idols or to join a group with a specific interest, such as pets. One participant liked to talk about her cat but did not know how to share pictures in the forum and chose to comment on others photos instead.

P. No. But it is because I don’t know how to do (laughs) so it’s no idea but I usually talks about him [the

cat] there. I often, if someone shares a picture of a black cat, then I say that he looks exactly like that

one. But bigger! (#4 female, 26 years)

By commenting on other people’s pictures, she can participate in the forum and share infor- mation about her own cat. By commenting and referring to cats that look like hers, she has found a way to overcome her own shortcomings in ICT use.

Although use of social media was unproblematic for some, others needed support to get started. Lack of social support made the desired use of ICT impossible and created a social environmental barrier.

Participants described their wish to use Facebook as well as a need for help to get started. One woman tried to open her Facebook app but failed and expressed:

P. Noo, I will probably ask someone about how to open it [the app]

I. Who do you ask then?

P. Don’t know. Hard to say . . .

(#2, female, 25 years). The participant wanted to show her Facebook page during the interview but could not do so. In

addition, she did not know who to ask for support, which could mean that neither staff nor family offered ICT support.

Others experienced difficulties opening the application in their mobile phone and did not know who to ask for help or, when asking, sometimes received an evasive answer.

For solitary pastime. The category, For solitary pastime, comprised ICT as a tool to enable activities in the community and for amusement. This subcategory described areas related to leisure and interests, and ways to update topics important to the participant. Unlike “For social relationships”, this category did not necessarily include any interactions with others but did include amusement and access to information that enabled or facilitated participation in offline activities.

Amusement. Participants emphasized their use of ICT for amusement. ICT was described as a part of everyday life throughout the day and as something that could be used with different activities at different times of the day. The mobility of a mobile phone enabled them to play games and to listen to music throughout the entire day. Not everyone had a smartphone, but all participants had a mobile phone and one other device. Playing games was a frequent activity, both to pass the time and as a desired activity. Games did not require interaction with others, but aimed to complete missions and to reach a higher level in the game. Some had tried playing against others but chose to continue playing other games by themselves. Although the games were played individually, this activity created a connection with others in offline relationships. One participant noted:

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No, no, I do have a friend and so, and I usually help her when she asks mostly as ‘Can you help me, I’m

not getting anywhere’ [which I’ll answer], ‘Yeah, I guess I could’. (#6, male, 24 years)

Using ICT for these solitary games facilitated interaction. By helping others and talking about the games, participants find common ground with other people offline.

Some games were described as reflecting what it is to be a young adult in society today with purposes such as meeting a partner and helping young women during pregnancy (e.g. undergoing ultrasound). Other games included aiming to build an entire society and its population.

ICT was also used for company and entertainment. Watching movies or TV series on YouTube was an almost daily activity. They enjoyed being able to watch old TV shows and to search for specific clips on a theme.

One participant said that he often used a mobile phone or computer to avoid feeling lonely and to experience joy. Watching TV episodes or movies while having dinner were the favourite activities

. . . to play music and watch TV-episodes and movies and such. And that is, what I told about the food. It is the most funniest, I’m often not interested in something else. (#6, male, 24 years)

The participant used ICT for company during time at home after work and during dinner. Watching something on the mobile phone while eating made his solitary dinner time less lonely. Later in the evening, the same activity was used to pass the time. ICT was used for listening to music and watching favourite groups on YouTube. Some but not all participants used specific streaming services. Some planned to get these services but needed help and were, therefore, dependent on support to do so. Some did not want to use streaming services, and others did not know about these options.

Another reason for the use of ICT was to obtain information about news sources to access both newspaper and news programs. The paper version of a newspaper was considered preferable, but the online edition was also thought to have benefits. The advantages of the paper edition were the inclusion of comic strips that were lacking in the online edition and the availability at work for some participants. The participants expressed their interest in what was happening in the sur- rounding world and this prompted their engagement in using ICT to access the news. One parti- cipant said:

Yeah, we will have a coffee and talk and, yeah, that we do on Wednesday no, Friday evenings, we

usually talk about the weekend and stuff. We usually read a newspaper called Eight pages that it’s

called. (#8, male, 31 years)

Reading difficulties made many news sites inaccessible, and some participants read news only in a digital newspaper targeting people with ID with support from staff once a week, as described in the quote above.

Not all experienced reading difficulties as a barrier. Some read news daily or even several times a day by themselves on a computer or mobile phone. If reading the newspaper was a frequent habit, the application was downloaded instead of reading the online edition. Reading news using ICT was considered to be a way to save money. Not all participants wanted to read the news. For example, one participant said that she avoided the news as she thinks ‘it’s the same bad things every week, so then I think that I don’t give a shit . . . ’ (#7, female, 22 years). Computers were also identified as a way to watch the news in a way that could be adjusted to be more easily understood. The

Ramsten et al. 11

participants also used the news as a way to keep up their interests in sports because many newspapers have a sports section. Participants with a major interest in sports and in specific teams read only the sports section to keep updated about results and what was happening in specific sport clubs. Another strategy was to visit a sport club’s own web pages to find the latest information about the team and games.

Support for offline activity. ICT was used to obtain recipes and as a support for cooking and finding specific types of food. One specific app was considered to be useful during the entire cooking process. This app organized the cooking process step-by-step and included information about what is needed and when and how to do each part of the process. A checklist made it possible to tick the steps that had been completed. Others used the Internet to find recipes when trying to change their diet. By searching for recipes and sorting by ingredients and pictures, the activity could be per- formed without other support.

Yeah, what do I write. ‘Mud cake’, then it usually comes up, it comes up with suggestions when you

search, so you can click it as well and see how it should look when it’s baked. (#7, female, 22 years)

The pictures on the mud cake, in this case, helped the participant to sort the information and find what she wanted. As she enjoyed baking, searching and finding recipes online facilitated food preparation for her.

However, not everyone succeeded in their search for recipes and ideas when searching without support. One participant said she could not find anything helpful and identified ICT as a support in cooking as useless.

Social media sites were considered to provide inspiration about home makeovers or for finding places to buy things for the home and the cost. ICT was also used to look for other things of interest such as a CD, pet or motorized quadricycle. It was also used as support for crossword puzzles when needing a hint and this allowed the participant to finish the crossword.

P. yes, yes actually if there are questions in the crossword, I take help from Google

I. oh, how do you do then?

P. I search on the question in the crossword

I. You write it in Google?

P. yeah

I. Does it work?

P. Yes, most [questions] I get an answer to

(#11, male, 30 years). By using Google, the participant could persist with the crosswords in the daily newspaper

despite finding them a little too difficult. The participant also recognized that some thought it was cheating, but for him, this was a way to take part in an activity and find a way to complete it.

Offline activities that might not have been performed otherwise could be initiated and completed because of ideas and offers given through email subscriptions and commercials. One person said:

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P: Yeah, it’s good offers and . . . .

I: Have you taken any offer from them at any time?

P: Eh, yes. I have, actually, but then it was with the new boat ‘Viking Grace’, and my former girlfriend,

we went. But it was such a small cabin. But that trip was very good. (#11, male, 30 years)

If the participant had not received the offer to go on a cruise by email, he would not have gone. The information and offer made him book the cruise and he had a good time. Furthermore, ICT enabled the participants to book cinema or bus tickets, although support from a staff member or trustee was needed. Another activity was searching for history about the neighbourhood. One participant and a friend walked around the neighbourhood looking at places while simultaneously using the mobile phone to search for more information about specific places.

ICT was used to learn more about interests and work-related activities. For example, one participant who was interested in children and worked at a kindergarten used ICT to learn more about children and understanding their expressions while at work. Others found applications or recommendations from the rehabilitation centre to be useful for practising different skills.

Discussion

The aim of this study was to describe the use of ICT from the perspective of young adults with mild to moderate ID in the municipal social care context. We found that ICT was used as a tool for several aspects of daily life. ICT enabled social interactions and pastime activities both online and offline. However, the participants experienced difficulties with use of ICT in relation to both the social environment and their ID. Reading difficulties, different types of problems with the device and lack of support limited the use of ICT and restricted some aspects of daily life. On the other hand, when the difficulties could be overcome, ICT seemed to increase independence and par- ticipation in daily life activities and to have an effect on social aspects of life as well as providing support for daily life activities at home. By letting these young adults with ID describe their use of ICT in their own words, an inside perspective on the use of ICT could be revealed.

ICT is used for participation in daily life for people in general which, according to the ICF (World Health Organization, 2001), can be operationalized as performance of an activity in the current environment. The capture of the inside perspective of young adults with ID is strengthened by their reports on their choice of activity, which is also crucial for participation, as underlined by Batorowizc and co-workers (2016). Hence, from a participation perspective, ICT enables the young adults in the study to engage in self-selected activities in their current environment. For example, our study showed that ICT was used in daily life to maintain the social relationships of the participants. It was acknowledged that social media sites enabled them to maintain social interactions with family members and to exchange experiences or interests with new people. Using social media forums such as Facebook and Instagram allowed the participants to maintain contact and be updated about their family and friends. These findings are consistent with those reported by Asselt-Goverts et al. (2015), who found that young adult with IDs wish to enhance their rela- tionships with family members, rather than increasing the number of relationships, which parti- cipants in the current study did by using ICT. Some participants in the current study also took part in discussions on social media sites about their areas of interest. Taking part in online forums by following, discussing and sharing means that participation can take place in several forums simultaneously. Among young adults in general, ICT has been identified as one way to satisfy the

Ramsten et al. 13

social demands to participate in activities both offline and online (Sorbring et al., 2017; Stald, 2008). It is noteworthy that the participants in this study did not report any difficulties in online social interactions. Among young adults with physical disability, ICT has been argued to enable social inclusion without being identified primarily as ‘disabled’ (Söderström, 2009b). Although not explicitly expressed by the participants in this study, it is possible that social media forums provide a positive experience of social interactions as described by Sorbring and co-workers (2017), because it might be easier to interact and be socially included without the ID taking a prominent role. For example, some participants used Facebook to interact with others with the same interest, which helped to keep the focus on the interest rather than the ID. Edgren-Shori (2000) argues that participation in activities facilitates social inclusion in several life spheres. Because ICT has changed the demand for and opened up opportunities for online activities (Boulianne, 2015), being able to engage in interests online can increase social inclusion in important life areas, as shown for love relationships by Löfgren-Mårtenson (2008). However, as young adults with ID are not as active online as the general population of young adults (Chadwick et al., 2013; Swedish Ministry of Health and Social Affairs, 2011), there is a risk of extended social exclusion of young adults with ID.

Participants described their use of ICT to play games, listen to music or watch a video or TV show as common activities when at home alone. Similar findings of ICT-use have been presented by other as well (Sallafranque-St-Louis and Normand, 2017; Sorbring et al., 2017). Although the activities were performed alone without interaction or input from others, they created a platform for participation in offline social relations. Participants in the current study talked to friends offline about games and helped each other to manage the levels and difficulties of the games. Söderström (2009a) and Stald (2008) reported similar findings of a relationship between offline and online behaviours and interactions. The frequent use of ICT in daily life and its prominent role in social relationships have an impact on offline interactions because young adults often talk about online forums even during offline interactions. Therefore, as participants in the current study describe, online games often became a part of an offline friendship.

ICT was used for support provided by staff and for check-ups during the day via a mobile phone using text messages or calling. This provided flexible support for participants who used their mobile phone frequently and outside the home because the communication with staff was not restricted by geography. In addition to recognizing that support from staff sometimes is necessary, ICT may bring independence and the opportunities for people with ID to interact in society alone. Bigby and Wiesel (2015) showed that, when staff members take part in activities in society together with the service user, the staff members tend to interrupt or end interactions between the service user and others. The mobile phone provides the opportunity for a person with ID to call staff for support in different situations and can be an assistive device to help with things such as planning and reminders (Ayres et al., 2013; Carey et al., 2005), but cognitive limitations restrict accessibility (Lussier-Desrochers et al., 2017).

Participants described ICT as a tool for increasing their participation in household tasks, such as cooking, by providing recipes food-preparation tips on the Internet, by increasing engagement in cooking and by choosing what to eat. The Internet and Facebook were also used by the participants to find inspiration for home improvement. The role of ICT as a private device for enjoyment or as an assistive device, which is a product prescribed by the county council to support daily life, becomes unclear in participants description regarding household tasks. Ramsten et al. (2017) stressed that support in the use of ICT in daily life is dependent on staff members’ interest and knowledge because Swedish social care organizations lack a comprehensive plan for support in the

14 Journal of Intellectual Disabilities XX(X)

use of ICT. The ability to use ICT as support for daily life activities at home as desired might be dependent on staff who provide support on a given day and the relation between the young adult and staff (Hasenfeld, 2010a). Therefore, support in the organizational context needs to be taken into account (Seale and Chadwick, 2017). In this study, staff members were described as sup- portive for reading the news online because the participant found it difficult to manage the text amount. Staff members were not described as supportive in other areas of ICT-use. A possible explanation for this is that the relation between staff and the young adults is permeated by an organizational structure that lacks support to staff (Ramsten et al., 2017). Moral assumptions (Hasenfeld, 2010b) about young adults with ID as being incapable of managing social use of ICT can restrict support and thus, the use of ICT.

The use of ICT by the participants seemed to be mainstream, as in the general population (Stald, 2008) but was more limited because cognitive impairment increases the need for support (Chadwick et al., 2013; Lussier-Desrochers et al., 2017). The participants expressed their need for support for reading the news and finding information online. As argued by Chadwick et al. (2013), there is an important difference between knowing about possibilities but choosing not to use them and not knowing about possibilities or activities and therefore not using them. When not knowing about possibilities is the reason for not engaging in an activity online, support may be needed to provide access. As described in the ICF (World Health Organization, 2001), an activity must be available to enable participation. To not know about possibilities is related to unavailability, as shown by the participants’ stories about listening to music on different streaming services. YouTube was a popular choice that participants knew about and used for watching programmes as well. Only a few could mention other streaming services, which suggest they did not know about alternatives. Listening to music was a common ICT activity. Therefore, a specific music appli- cation may be appropriate to facilitate activities such as making music lists. The use of ICT for items that may be unavailable was illustrated by the participants’ mention of finding recipes or items for home improvement. Although some information can be found, difficulties remain in managing the large amount of information (Hemmingsson, 2015; Lussier-Desrochers et al., 2017). Lack of support for overcoming these difficulties is an example of a social environmental barrier that can restrict participation in daily life for young adults with ID if not adequately provided (Lussier-Desrochers et al., 2017; Seale and Chadwick, 2017; World Health Organization, 2001).

Experiences regarding the availability of data and lack of funds on the mobile phone account restricted the participants’ opportunities to initiate contact with others and activities. Participants were dependent on others to initiate activities. Another barrier, which confirmed by prior research (Caton and Chapman, 2016), was the lack of support by family and staff members. For example, participants had asked family members for help but satisfying their request was deferred to another time. This meant that the participants could not use, for example, Facebook, as desired. Lindqvist (2008) described the lack of resources in social care organizations as a barrier because staff must distribute their time between the service users, which meant in this case that the participants could not take part in activities or receive support for activities. However, participants in the current study rarely mentioned support from staff when discussing their problems with ICT. The issue of resources that Lindqvist (2008) highlights is therefore still relevant as municipal social care organizations in Sweden seem to expect staff to be able to provide support for ICT to young adults in daily life when needed without providing further support or resources to staff (Ramsten et al., 2017). Additionally, prior research from the United Kingdom shows that staff members need support from the organization in the form of a stated aim and knowledge to support service users with ICT in daily life (Hegarty and Aspinall, 2006; Parsons et al., 2008). Overall, the findings

Ramsten et al. 15

support and add to the international literature about ICT as a support for participation for young adults with mild to moderate ID (Caton and Chapman, 2016; Löfgren-Mårtenson, 2008; Sallafranque-St-Louis and Normand, 2017). ICT is described as a natural part of daily life, and it was used for several purposes by the participants. These findings are important as they indicate how ICT can be used in daily life. The young adults reported that it facilitates participation and provides knowledge. Thus, the findings may provide a foundation for improving and adapting support for ICT in social services. However, more research is needed on availability in relation to the context and social environment, and organizational aspects should be further investigated.

Several of the participants were laconic in their telling about how they used ICT. Some par- ticipants lost their concentration during the interview, which was then ended. The concentration and ability to tell freely about the use of ICT may be related to the degree of ID, which may also affect the use of ICT. In some interviews, the participant solved the problem by showing instead of telling, but some interviews became quite minimal. The abstraction level of the analysis is, therefore, low. Still, a recurrent pattern arose in the interviews. Despite the laconic telling, a strength of this study is the description of their use of ICT by young adults with ID in their own words and from their own perspective. Difficulties interviewing people with ID is known (Finlay and Lyons, 2002; Sigstad, 2014), but it is important that their voices are heard. The sample of participants was chosen by the staff employed in social care according to the inclusion criteria. The diagnosis of ID was a central inclusion criteria because it entitles societal support such as resi- dential care. The selection of participants was based on their everyday functioning, of which staff often have a valid perception. The differences in power between the staff asking about partici- pation in an interview and the young adults should be acknowledged as a possible limitation. However, all participants were expecting the interviewer and no signs of resistance to the interview were recognized. To the contrary, several participants were excited about the interview.

To increase the trustworthiness of the analysis, to emphasize the young adults’ perspectives and to avoid overlapping categories, the analysis went back and forth between the authors, mainly CR and LMH. The categories were then confirmed by LM and MD for consistency and credibility through the analysis process and cross-checked with the empirical data (Creswell, 2009; Elo and Kyngäs, 2008). This study adds to the body of knowledge of ICT use by young adults with mild-to- moderate ID, and more specific add knowledge about how ICT can enable participation in daily life. Despite contextual differences for availability to ICT between countries, this study mirrors prior international research that has focused in incorporating the voices of young adults with ID. In this respect, the ICT use on the individual level seems to be internationally transferable.

Conclusion

ICT enabled these young adults with mild to moderate ID to participate in activities at home as well as in the community by preparing them for activities, which increased their independence in daily life. The participants experienced difficulties with the devices or aspects related to availability, and these barriers restricted participation when adequate support was not provided. Participation in online forums seems to increase social inclusion in prioritized life spheres. This knowledge is important for developing social care and providing support to enable the use of ICT by young adults with ID. However, more research on the daily use of ICT is needed. Findings from the current study and previous research raise questions about the role of staff members and service providers in relation to the use of ICT in daily life. Participants turned to family members for support rather than to staff. Although attitudes and knowledge about ICT have improved in recent

16 Journal of Intellectual Disabilities XX(X)

years, it is unclear whether attitudes towards the use of ICT by young adults with mild-to-moderate ID have improved. Therefore, more research is needed to understand the contextual aspects for the use of ICT by young adults with ID.

Authors’ note

Lena Marmstål Hammar is also affiliated to Karolinska Institute, Sweden.

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) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Camilla Ramsten http://orcid.org/0000-0002-2929-9902

References

American Psychiatric Association (2016) Diagnostic and Statistical Manual of Mental Disorders. (DSM5). Arlington: American Psychiatic Association.

Asselt-Goverts AE, Embregts PJCM and Hendriks AHC (2015) Social networks of people with mild intel- lectual disabilities: characteristics, satisfaction, wishes and quality of life. Journal of Intellectual Dis- ability Research 59(5): 450–461. DOI:10.1111/jir.12143.

Ayres MK, Mechling L and Sansosti JF (2013) The use of mobile technologies to assist with life skills/ independence of students with moderate/severe intellectual disability and/or autism spectrum disorders: considerations for the future of school psychology. Psychology in the Schools 50(3): 259–271.

Batorowizc B, King G, Mishra L, et al. (2016) An integrated model of social environment and social context for pediatric rehabilitation. Disability and Rehabilitation 38(12): 1204–1215. DOI:10.3109/09638288. 2015.1076070.

Bigby C and Wiesel I (2015) Mediating community participation: practice of support workers in initiating, facilitating or disrupting encounters between people with and without intellectual disability. Journal of Applied Research in Intellectual Disabilities 28(4): 307–318. DOI:10.1111/jar.12140.

Blomberg B (2006) Inklusion En Illusion? Om Delaktighet I Samhället för Vuxna Personer Med Utveck- lingsstörning [In Swedish] [Inclusion an Illusion? About Participation in Society for Adults with Intel-

lectual Disability]. Umeå: Umeå University. Boulianne S (2015) Social media use and participation: a meta-analysis of current research. Information,

Communication & Society 18(5): 524–538. DOI:10.1080/1369118X.2015.1008542. Carey AC, Friedman MG and Bryen DN (2005) Use of electronic technologies by people with intellectual

disabilities. Mental Retardation 43(5): 322–333. Caton S and Chapman L (2016) The use of social media and people with intellectual disability: a systematic

review and thematic analysis. Journal of Intellectual and Developmental Disability 41(2): 125–139. DOI: 10.3109/13668250.2016.1153052.

Chadwick D, Quinn S and Fullwood C (2016) Perceptions of the risks and benefits of internet access and use by people with intellectual disabilities. British Journal of Learning Disabilities. DOI:10.1111/bld.12170.

Chadwick D, Wesson C and Fullwood C (2013) Internet access by people with intellectual disabilities: inequalities and opportunities. Future Internet 5(3): 376.

Creswell WJ (2009) Research Design. Qualitative, Quantitative and Mixed methods Approaches. 3rd ed. Thousand Oaks: Sage.

Ramsten et al. 17

Darcy S, Maxwell H and Green J (2016) Disability citizenship and independence through mobile technology?

A study exploring adoption and use of a mobile technology platform. Disability and Society 31(4):

497–519. DOI:10.1080/09687599.2016.1179172. Edgren-Shori M (2000) Social Exklusion-en Kunskapsöversikt Och Begreppsanalys [In Swedish]. [Social

Exclusion –A Systematic Review and Conceptual Analysis]. Lund: Socialhögskolan, Stockholm: Stock-

holm University. Elo S and Kyngäs H (2008) The qualitative content analysis process. Journal of Advanced Nursing 62(1):

107–115. DOI:10.1111/j.1365-2648.2007.04569.x. Findahl O and Davidsson P (2015) Svenskarna Och Internet. 2015 Års Undersökning Av Svenska Folkets

Internetvanor [In Swedish] [Swedes and the Internet. The 2015 Survey of Swedish People’s Internet

Habits]. Stockholm. Available at: https://www.iis.se/docs/Svenskarna_och_internet_2015.pdf (accessed 5

June 2016). Finlay WML and Lyons E (2002) Acquiescence in interviews with people with mental retardation. Mental

Retardation 40(1): 14–29. DOI:10.1352/0047-6765(2002)040<0014: AIWPW>2.0.CO;2. Government of Sweden (2003) Digitala Klyftor-Förr, Nu Och I Framtiden [In Swedish] [Digital Divide-

s–Past, Present and in the Future]. Stockholm: Government of Sweden. Government of Sweden (1993: 387) The Act Concerning Support for Persons With Certain Functional

Impairments. Stockholm: Government of Sweden. Granlund M (2013) Participation-challenges in conceptualization, measurement and intervention. Child;

Care, Health and Development 39(4): 470–473. DOI:10.1111/cch.12080. Hasenfeld Y (2010a) Worker–client relations. Social policy and practice. In: Hasenfeld Y (ed.) Human

Services as Complex Organizations (2nd ed.). London: Sage, pp. 405–426. Hasenfeld Y. (2010b). Organizational forms as moral practices. The case of welfare departments. In:

Hasenfeld Y (ed.) Human Services as Complex Organizations (2nd ed.). London: Sage, pp. 97–114. Hegarty RJ and Aspinall A (2006) The use of personal computers with adults who have developmental

disability: outcomes of an organization-wide audit. The British Journal of Developmental Disabilities

52(2): 137–154. Hemmingsson H (2015) Trendsetters and followers: disabled young people’s computer use during leisure

time. In: Traustadóttir R, Ytterhus B, Egilsson TS and Berg B (eds) Childhood and Disability in the Nordic

Countries. Being, Becoming, Belonging. London: Palgrave Macmillan UK, pp. 167–178. Hemmingsson H and Jonsson H (2005) An occupational perspective on the concept of participation in the

International Classification of Functioning, Disability and Health—some critical remarks. American

Journal of Occupational Therapy 59: 569–576. Holt K, Shehata A, Strömbäck J, et al. (2013) Age and the effects of news media attention and social media

use on political interest and participation: do social media function as leveller? European Journal of

Communication 28(1): 19–34. DOI:10.1177/0267323112465369. Lindqvist AM (2008) Delaktighet för personer med utvecklingsstörning i en forsknings- och omsorgs-

kontext granskat ur ett medborgarperspektiv [In Swedish] Participation for people with developmental

disorder in a research and care context examined from a citizen’s perspective. Helsingfors: University

of Helsinki. Loader DB, Vromen A and Xenos AM (2014) The networked young citizen: social media, political partic-

ipation and civic engagement. Information, Communication and Society 17(2): 143–150. DOI:10.1080/

1369118X.2013.871571. Löfgren-Mårtenson L (2008) Love in cyberspace: Swedish young people with intellectual disabilities and the

internet. Scandinavian Journal of Disability Research 10(2): 125–138. DOI:10.1080/15017410701758005. Lussier-Desrochers D, Normand LC, Romero Torres A, et al. (2017) Bridging the digital divide for people

with intellectual disability. Cyberpsychology: Journal of Psychosocial Research on Cyberspace 11(1).

DOI:10.5817/CP2017-1-1.

18 Journal of Intellectual Disabilities XX(X)

Molin M, Sorbring E and Löfgren Mårtenson L (2015) Teachers’ and parents’ views on the Internet and social media usage by pupils with intellectual disabilities. Journal of Intellectual Disabilities 19(1): 22–33. DOI:10.1177/1744629514563558.

Parsons S, Daniels H, Porter J, et al. (2008) Resources, staff beliefs and organizational culture: factors in the use of information and communication technology for adults with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities 21: 19–33.

Patton MQ (2014) Qualitative Research and Evaluation Methods. Integrating Theory and Practice, 3rd ed. Thousand Oaks: Sage.

Raghavendra P, Newman L, Grace E, et al. (2013) “I could never do that before”: effectiveness of a tailored Internet support intervention to increase the social participation of youth with disabilities: facilitating social participation using the Internet. Child Care Health and Development 39(4): 552–561.

Ramsten C, Hammar Marmstål L, Martin L, et al. (2017) ICT and intellectual disability: a survey of orga- nizational support at the municipal level in Sweden. Journal of Applied Research in Intellectual Dis- abilities 30(4): 705–713. DOI:10.1111/jar.12265.

Sallafranque-St-Louis F and Normand LC (2017) From solitude to solicitation: how people with intellectual disability or autism spectrum disorder use the internet. Cyberpsychology: Journal of Psychosocial Research on Cyberspace 11(1). DOI:10.5817/CP2017-1-7.

Scholz F, Yalcin B and Priestly M (2017) Internet access for disabled people: understanding socio-relational factors in Europe. Cyberpsychology: Journal of Psychosocial Research on Cyberspace 11(1). DOI:10.5817/CP2017-1-4.

Seale J (2014) The role of supporters in facilitating the use of technologies by adolescents and adults with learning disabilities: a place for positive risk-taking? European Journal of Special Needs Education 29(2): 220–236. DOI:10.1080/08856257.2014.906980.

Seale J and Chadwick D (2017) How does risk mediate the ability of adolescents and adults with intellectual and developmental disabilities to live a normal life by using the Internet? Cyberpsychology: Journal of Psychosocial Research on Cyberspace 11(1). DOI:10.5817/CP2017-1-2.

Shpigelman CN and Gill CJ (2014). How do adults with intellectual disabilities use Facebook? Disability and Society 29(10): 1601–1616.

Sigstad HMH (2014) Characteristic interviews, different strategies: methodological challenges in qualitative interviewing among respondents with mild intellectual disabilities. Journal of Intellectual Disabilities: JOID 18(2): 188–202.

Simões C and Santos S (2016) Comparing the quality of life of adults with and without intellectual disability. Journal of Intellectual Disability Research 60(4): 295–397. DOI:10.1111/jir.12256.

Simplican SC, Leader G, Kosciulek J, et al. (2015) Review article: defining social inclusion of people with intellectual and developmental disabilities: an ecological model of social networks and com- munity participation. Research in Developmental Disabilities 38: 18–29. DOI:10.1016/j.ridd.2014. 10.008.

Söderström S (2009a) Offline social ties and online use of computers: a study of disabled youth and their use of ICT advances. New Media & Society 11(5): 709–727. DOI:10.1177/1461444809105347.

Söderström S (2009b) The significance of ICT in disabled youth’s identity negotiations. Scandinavian Journal of Disability Research 11(2): 131–144. DOI:10.1080/15017410902830587.

Sorbring E, Molin M and Löfgren-Mårtenson L (2017) “I’m a mother, but I’m also a facilitator in her every-day life”: parents’ voices about barriers and support for internet participation among young people with intellectual disabilities. Cyberpsychology: Journal of Psychosocial Research on Cyberspace 11(1). DOI:10.5817/CP2017-1-3.

Stald G (2008) Mobile identity: youth, identity, and mobile communication media. The MIT Press 143–164. DOI:10.1162/dmal.9780262524834.143.

Swedish Ministry of Health and Social Affairs (2011) En Strategi för Genomförande Av Funktion- shinderspolitiken [In Swedish] [A Strategy for Implementation of Disability Policies]. Stockholm: Gov- ernment of Sweden.

Ramsten et al. 19

The National Board of Health and Welfare (2011) International Statistical Classification of Diseases and Related Health Problems-Tenth Revision. Stockholm: The National Board of Health and Welfare.

The National Board of Health and Welfare (2016) Insatser Och Stöd Till Personer Med Funktionsnedsätt- ning-LÄGESRAPPORT 2016 [In Swedish] [Service and support to persons with disabilities –progress

report 2016]. Stockholm: The National Board of Health and Welfare. Umb-Carlsson Õ (2008) Studier Om Hälsa för Personer Med Utvecklingsstörning [In Swedish] Studies on

Health for People with Developmental Disorder. Stockholm: The Public Health Agency of Sweden. Umb-Carlsson Õ and Sonnander K (2005) Comparison of the living conditions of adults with intellectual

disabilities in a Swedish County and in the general population. Journal of Policy and Practice in Intel- lectual Disabilities 2(3-4): 240–248. DOI:10.1111/j.1741-1130.2005.00036.x.

van Dijk J and Hacker K (2003) The digital divide as a complex and dynamic phenomenon. The Information Society: An International Journal 19(4): 315–326. DOI:10.1080/01972240390227895.

World Health Organization (2001) International Classification of Functioning, Disability and Health. Geneva: WHO.

Xinaris C (2016) The individual in an ICT world. European Journal of Communication 31(1): 58–68. DOI:10.1177/0267323115614487.

20 Journal of Intellectual Disabilities XX(X)