COVID-19 and Turkish University Students With Visual Impairments: An In-Depth Inquiry

Abstract

Introduction: The purpose of this study was to investigate the effect of COVID-19 on the academic life, psychological well-being, social relations, and physical health of university students with visual impairments via their personal judgments. Methods: A qualitative research design was utilized with 19 participants studying at 10 Turkish universities located across seven cities. Personal online semi-structured interviews were held in January 2021. The audio-taped qualitative data were analyzed deductively in light of four predetermined themes: academic life, physical health, psychological well-being, and social relations. Results: Findings revealed the negative effects of the lockdown on daily and, specifically, campus life. Most participants claimed their preference for traditional over online education due to certain academic, psychological, and social difficulties, stating also that campus life had many academic and social advantages compared to online education. Physical health issues including access to medical treatments and lack of activity/mobility were also stressed. Discussion: It was interesting to observe that despite the interviews’ focus on daily life, students provided views on the benefits of traditional education and how and why their individual needs should be met by universities, much more than expected. Implications for Practitioners: It may be concluded that several developmental domains of students with visual impairments are affected by attendance at a university and that offices of disability services of higher education institutions and university counseling centers should take thoughtful actions to meet the specific needs of this student population tailored to both online and traditional education.

Following World Health Organization's (WHO) announcement about COVID-19 (WHO, 2019), governments throughout the world immediately employed their action plans for public health (Ryan et al., 2020). These action plans involved minimizing human mobility in order to avoid the spread of the disease (Anderson et al., 2018). Despite differing ratios across nations, one domain of life where human mobility is high is the educational system. Accordingly, 134 nations, including Turkey, locked down schools and transitioned to online education (Karataş, 2020; UNESCO, 2020). Similar cautions were taken for work and social life in Turkey: Many governmental offices and private businesses began working online, the entertainment sector was shut down for long periods of time, and nationwide weekend curfews were announced.

The effect of the lockdown of universities during COVID-19 on the lives of students became a major topic of interest, with numerous studies pointing to various negative academic (Fernandes, 2020; Pacheco et al., 2020), physical, and psychological outcomes (Browning et al., 2021; Husky et al., 2020; Ji et al., 2020; Marelli et al., 2020; McGinty et al., 2020; Tian et al., 2020; Wathelet et al., 2020) for students with typical development. What of the effect on vulnerable populations—in this case, students with special needs? Student and nonstudent adult special needs populations are, even in the absence of COVID-19, known to face more academic, physical, and social barriers in daily and university life compared to their typical peers (Shakespeare et al., 2021). Barriers include access to buildings, housing, study materials, exam accommodations, and maintaining peer relations (Al-Attiyah & Mahasneh, 2018; Dryer et al., 2016; Koca-Atabey et al., 2011; Naami & Hayashi, 2012; Reed et al., 2016; Turkish Council of Higher Education, 2021a).

Following the immediate transition to online education due to the COVID-19 lockdown, special needs students were expected to adjust to the new system (Del Pilar Oviedo-Cáceres et al., 2021; Denisova et al., 2020; Sabatello et al., 2020; Shakespeare et al., 2021; Toquero, 2020) in an absence of the infrastructure necessary for meeting their needs as students (Krishnan et al., 2020; Meleo-Erwin et al., 2021; Toquero, 2020). Reader support, access to online course records and materials, communication with classmates and staff members, exams, project submission dates, and social isolation were among the concerns reported by students (Krishnan et al., 2020). Also, special needs students were found to display more physical health problems, including COVID-19 infections, compared to typical peers (Tummers et al., 2020). Despite such risks, they also faced serious barriers to accessing medical support (Annaswamy et al., 2020).

Visual impairment (i.e., blindness or low vision) itself may create specific concerns in university life including access to course materials and computers, which may increase during times of health threats such as COVID-19 (Rosenblum et al., 2020). Allen and Smith (2020) cautioned that the government-imposed self-isolation strategy carries special physical and psychosocial risks for adults with visual impairments since a significant number of these individuals rely on others for meeting daily needs. In fact, a recent Hungarian study reported that adults with visual impairments experienced difficulties in shopping, leisure activities, working online, and online higher education due to lockdowns (Gombas & Csakvari, 2021). Senjam (2020) claimed that individuals with visual impairments are more likely to be infected by COVID-19 compared to sighted people, perhaps due to their reliance on others, as mentioned by Allen and Smith (2020).

Important as they are, these studies do not or only partially cover samples derived from university student populations. Entering higher education is considered a major transition to adult life (Al-Attiyah & Mahasneh, 2018) that, even in the absence of COVID-19, is stressful for students with disabilities. The compounding effects of this transition during a time of an international pandemic are unknown. Thus, an in-depth understanding of the perceptions of students with visual impairments on the potential factors caused by COVID-19 that may be threatening their life in various domains is needed. Therefore, the major purpose of this study was to investigate the effect of COVID-19 on the lives of university students with visual impairments via their personal judgments. We believed these judgments would provide important clues regarding their quality of life (Dryer et al., 2016; Fayers & Machin, 2015).

Methods

Participants

Using a mixture of purposive and snowball sampling procedures, 19 university students with visual impairments from 10 public universities located across seven Turkish cities joined this qualitative study. The sample demographics are depicted in Table 1. With the exception of Feride (participant 2), who had a comorbid condition (epilepsy), none of the participants had additional disabilities. As for income, all students reported coming from middle-income families.

Table 1.

Sample Demographics (N = 19).

Participant	Age (X = 24.42)	Gender	Marital status	Area of study	Grade level	Learning media
Ayşe	19	Female	Single	Philosophy	2	Braille
Feride	19	Female	Single	English language education	2	Braille
Bengü	22	Female	Single	Psychological counseling and guidance	4	Braille
İdil	22	Female	Single	Special education	2	Braille
Mehmet	21	Male	Single	History education	2	Braille
Berk	20	Male	Single	Turkish musicology	1	Braille
Ceren	29	Female	Single	Religion studies	3	Enlarged print
Elif	22	Female	Single	Special education	1	Enlarged print
Esin	23	Female	Single	Office management and executive assistant training	1	Braille
Bilge	19	Female	Single	Special education and social studies education (double major)	1 (special education), 2 (social studies instruction)	Braille
Pınar	20	Female	Single	Social work	2	Braille
Ayla	27	Female	Single	Psychological counseling and guidance	1	Braille
Zeynep	20	Female	Single	Social studies education	2	Braille
Müge	20	Female	Single	Turkish language and literature	3	Braille
Pelin	39	Female	Married	Social work	1	Braille
Deniz	20	Male	Single	Music education	1	Braille
Devrim	35	Male	Divorced	Social work	2	Braille
Burak	32	Male	Single	Law	3	Braille
Simay	35	Female	Married	Office management	1	Enlarged print

Data Collection

A demographics form and a semi-structured interview form were developed by the authors. For the semi-structured interview form, four major themes were formed in light of the literature on the effects of COVID-19, special needs students, and nonstudent adult populations, and quality of life. These themes were academic life, physical health, psychological well-being, and social relations, and 16 open-ended questions were developed accordingly. Some sample items included “Did you feel any emotional changes in yourself after the onset of COVID-19? (If yes) What were they?” and “Did online education due to COVID-19 lead to changes in your academic life? (If yes) How so?”

The draft form was reviewed by two academics for face and content validity and later pilot-tested on an undergraduate student with visual impairment who was majoring in special education. Following the approval of the Ethics Committee of Dokuz Eylül University (02.18.2021, File: 23708841-640.99-17303), the third author held online interviews through applications based on participant preference (via Zoom, WhatsApp, and Microsoft Teams software) in January 2021. Informed consent for participation and audio recordings were taken from all participants. Next, the recordings were transcribed verbatim, amounting to 91 pages and 3300 lines of raw data. Four randomly chosen interview audiotape recordings and their transcripts were compared by the second author. All interviews were conducted in Turkish, the native tongue of all participants.

Data Analysis

The qualitative data derived from the interviews were analyzed via deductive analysis (Büyüköztürk et al., 2013), in light of the four predetermined themes previously described. Data reduction included all authors’ independently reading and generating codes and categories to be placed under these themes. A total of 52 codes under 13 categories emerged with an 80.94% agreement rate using the number of agreements/number of agreements + number of disagreements × 100 formula (Miles & Huberman, 1994), which may be considered a good rate according to Huberman and Miles (1998). The themes and categories are presented in Table 2.

Table 2.

Themes and Categories.

Final themes	Categories
Physical health	COVID-19 and other health conditions
	Access to clinical treatment
	Nutrition and sleep
	Physical activity/mobility
Psychological health	NA
Social life	Peers
	Family relations
	Leisure activities
	Romantic relationships
Academic life	Academic achievement
	Access to online courses, materials
	Exam and homework accommodations
	Communication with classmates and
	Academic personnel
	Office of Disability Resources (ODS) Support

NA = not applicable.

Finally, all discrepancies were resolved through a two-hour online discussion. Due to scorer disagreements, two categories and four codes were removed from the analysis, leaving 48 codes under 14 categories. These results were further reviewed and verified by two research participants.

Results

COVID-19 and Academic Life

All students commented on the impact of online education on their academic life. One of the most compelling findings was the preference for traditional over online education (n = 15). Students stated the advantages of traditional education as providing sociability, concentration during self-study, higher GPA, benefits from practicum courses, and communication with academic staff members. Berk's statement on having to postpone graduation due to online education is worth mentioning: “My lecturer shows me how to hold the instrument but I can't see. … Now I quit playing. … It's hard to teach the blind to play an instrument, much harder online.” Müge, on the other hand, stated that online education had the benefits of lecture recordings and the obligation of academics to share written course materials, and providing more time for study at home.

Access to online courses and course materials was an important concern for the students. Five stated difficulties with home Internet connections, whereas one claimed problems in keeping up with the flowing PowerPoint presentations. Difficulties in access to online or print course materials or both were emphasized by the students (n = 6). Another four expressed their discouragement at not being able to find sighted readers. Three of these participants stated that they were able to reach volunteer readers before COVID-19, when public libraries were open. Accordingly, four students provided recommendations regarding holding online lectures using alternative programs like WhatsApp and Zoom.

Exams and homework emerged as another critical issue for 15 students. Difficulties concerning exams included time constraints (n = 4), finding a reader or writer (n = 4), and alternative testing arrangements (n = 1). Müge's words on finding a reader are noteworthy:

Before (COVID-19) the staff helped in reading writing during exams, now they go like you’re not at school, you’re on your own. That I would definitely find someone to read for me. But I can't. Even so, the reader has to be familiar with the system.

As for homework, participants reported an increased level of difficulty following COVID-19 (n = 3), problems with access to reading materials (n = 2), a preference for exams over homework (n = 2), and a lack of communication with lecturers (n = 1). With regard to communication, 17 students reported overall satisfaction with staff and classmate communications.

Finally, mixed findings emerged for the support provided by the universities’ office of disability services. Six students mentioned their overall satisfaction with the office of disability services at their schools in providing effective solutions for study materials, homework and exam accommodations, and communication with academics. Five others, on the other hand, reported being left alone by the office of disability services and the lecturers. As Berk stated: “I started school and no one was aware of me. We have to struggle to get noticed. I can say that ODS [office of disability services] doesn't exist in our school.” Bengü complained about the time it took for the office of disability services to handle problems as: “Sometimes issues are taken to the directorate but bureaucratic barriers … things work out slowly, sometimes never do.” In sum, with the exceptions of Internet connection problems and the support of the office of disability services, the difficulties reported by the participants seemed to be specific to students with visual impairments.

COVID-19 and Physical Health

Physical health was the second issue of concern for the students. Four students claimed that they could not access medical treatment and had to postpone their treatments due to fear of infection in clinical settings. As Feride stated, the timing of some of those treatments was critical: “I have epilepsy. … If I could’ve gone to my doctor maybe she was gonna cut my medication or increase the dose.”

Another category mentioned as a major complicating factor was decreased physical activity and mobility (n = 12). Burak stated: “I used to be physically active … I could climb stairs, up and down, five, ten times a day, now it leaves me breathless.” Three participants expressed the advantage of traveling to school during traditional education because it had given them “a reason to move.” Note Feride's related words: “At least I could go to the campus … there was some physical activity in my life.” Two participants, on the other hand, claimed that they spent much of their time at home both before and during COVID-19, and, thus, their physical activity level was low in general.

Sleep and eating habits were also emphasized as health-threatening factors following the lockdown (n = 11). Increased or disordered eating and frequent fast-food consumption resulting in weight gain were the most mentioned changes in eating habits. Three students also spoke of excessive and disordered sleep patterns following COVID-19.

COVID-19 and Psychological Well-Being

Seventeen students expressed some form of psychological effect following COVID-19; 14 of these were negative. Among these were anxiety (n = 2), anger (n = 2), loneliness (n = 1), lack of joy (n = 2), depressive mood (n = 1), fear of infection (n = 2), and emotionality or emotional fluctuations (n = 3). Elif mentioned the effects as follows: “I get up, look around, attend online lectures. I don't know whether I’m a student or not. Did I quit school, no. I really don't know how I feel.” Pınar expressed her feelings in harsher terms: “I feel I’m locked up in a hospital.” An interesting response by Pelin involved her general view of the emotional life of individuals with visual impairments:

We are emotional. We, the blind, carry a dreamer personality. A sighted person, when she goes out, can be attracted by the color of a car …, since we can't, we create a broader fantasy world. … Yes we are emotional, and the pandemic might have heightened this.

Three students mentioned the psychological benefits of traditional education due to the opportunities it provides for socializing. Bengü explained her feelings of loneliness caused by the lack of social relations following COVID-19 as: “I was forming very good connections at school. I could get help … it was good to spend time with friends. … Sometimes I feel lonelier.” Three other students believed that COVID-19 brought no psychological problems since spending nearly all their time at home was their all-time routine prior to the COVID-19 lockdown.

COVID-19 and Social Relations

The negative effect of COVID-19 on social life was reported by 13 students. Among the reasons reported were school lockdown, their negative psychological state, and lack of face-to-face interaction. Bilge briefly explained the importance of traditional education in social life as:

I was always on campus so I think my social relationships have been disrupted. One feels a little cut down. University not only means academic life but is rather a place for socializing but you feel its absence. You can only text friends and that's not enough.

In addition, as was found for psychological health, two respondents claimed no difference in peer relations following COVID-19 due to their home-at-all-times routine (i.e., their social life was already very limited before COVID-19).

The impact of COVID-19 on family relations was also frequently mentioned by the participants. For nine participants, the effect was negative, for two it was positive, and three claimed no noticeable effects. The reasons put forward for the negative consequences were excessive physical proximity with parents or spouses (n = 4), having to face quarrels more often (n = 3), parental constraints (n = 1), and lack of outdoor leisure activities with family members (n = 1). Müge expressed the effects of intense physical proximity as: “We did have issues but with this situation [COVID-19] … you have shown much patience … but when you’re always home … it becomes more devastating.”

Discussion

COVID-19 entered our lives so suddenly and, as Rosenblum et al. (2020) put it, a lot of work will be needed in the field of visual impairment regarding COVID-19 before we may come up with a deeper understanding of how a pandemic affects these individuals and develop action plans accordingly. We believe our study was a small, but important, contribution to understanding those dynamics in that it gave us a chance to hear in detail what really is going on with students with visual impairments, from the individuals themselves.

Findings generally showed that the immediate and unplanned transition to online education following COVID-19 seemed to impact the academic, psychological, physical, and social life of students with visual impairments in certain aspects. Perhaps the most important finding was participants’ preference for traditional over online education, in that most claimed campus life to have enhanced physical and social well-being together with academic achievement. Finding readers, taking exams, completing homework, and access to study materials were the most frequently reported academic problems, and, with the exception of finding a sighted reader, these issues were found to be the major concerns of students with differing disabilities in other countries (Krishnan et al., 2020; Meleo-Erwin et al., 2021; Shakespeare et al., 2021; Toquero, 2020). Finding a reader may thus be considered a critical situation that specifically affects people with visual impairments and, as many participants stated, when readers are not available, academic achievement can be hindered to an important extent. Thus, this finding may lead us to question the compatibility of the present educational system with its users with visual impairments.

Another issue on academic achievement rose from Müge's statement on being “left alone” by the office of disability services. Following the announcement of Disability Counselling and Coordination Regulations (National Gazette of Republic of Turkey, 2006), universities are obliged to establish an office of disability services to provide physical, social, and academic accessibility for special needs students via universal design (Çimen, 2021) and universal design for learning principles (Edyburn, 2019). Academic support has to provide study materials and exam accommodations including the testing environment, content, and time. It arises from our findings that some universities actually have chosen not to comply with the legal requirements. As a matter of fact, a recent report revealed that offices of disability services were found at only 88% of Turkish universities (Turkish Council of Higher Education, 2021a). The same report also added that these offices provided special needs students with online course materials whereas social facilities were remarkably limited. Taken together, priority should be given to informing special needs students about their legal rights in order to help them advocate for themselves during their undergraduate and graduate studies.

Psychological well-being was another domain frequently reported by the participants. Results did not enable associating a specific psychological symptom with the lockdown. However, the high percentage of participants reporting some form of negative psychological state tells us that students with visual impairments may be at risk for varying emotional problems. Similar findings exist for samples derived from various age and special needs categories showing that COVID-19 has become a psychological risk factor for everyone (Husky et al., 2020; Ji et al., 2020; Marelli et al., 2020; McGinty et al., 2020; Tian et al., 2020; Wathelet et al., 2020).

The important point to be considered here is perhaps the developmental stage of the individual coupled with a visual impairment. Most university students are at the emerging adulthood stage of development, which is characterized by identity formation, emotional instability, and self-centeredness. It is a time when individuals gradually begin to separate from their families and are expected to independently orient to new and, in most cases, unfamiliar environments with new challenging responsibilities (Arnett, 2007). Therefore, they already carry psychological risks in the absence of any large-scale health threat. Couple these risks with the problems reported by students in this study, and it might be that COVID-19 has added to the psychological problems of students with visual impairments and that counseling and guidance services might have to work harder to reach this group of individuals.

Findings on social relationships were similar to research on other student populations, pointing generally to negative effects on peer relations (Beichi et al., 2021). One interesting finding, however, was that some participants’ reported a lack of social relations prior to the lockdown. Therefore, the social lives of, at least a portion of, students with visual impairments may be at stake regardless of the consequences of COVID-19. Recall that many participants also stated that campus life had offered them social opportunities. Thus, it may be wise for future studies to validate our findings regarding universities as holding good potential for forming social relationships for students with visual impairments.

It is known that compared to others, individuals with visual impairments carry higher risks for infections (Senjam, 2020) and additional disabilities (ICEVI, 2021) which at times require medical treatments, a critical component in maintaining physical health. Our findings have confirmed that access to medical treatments was challenging for some participants, similar to the findings reported by Annaswamy et al. (2020). In spite of the fact that physical health is an important component of quality of life affecting all other domains of life (Magallares & Schomerus, 2015), the provision of alternate services that are accessible by individuals with visual impairments would be an effective way to support the needs of this population, including those students enrolled in universities.

According to our findings, a second important issue on physical health involved the effect of the lockdown on physical activity and mobility. First, five participants mentioned that a decrease in physical activity affected their health in general. Second, it may also be inferred from the results that decreased physical activity during the lockdown was coupled with decreased face-to-face peer relations, which, as the participants have claimed, increased their feelings of loneliness and depressive thoughts as well. Third, participants’ mention of campus life as having a buffering effect on physical activity and mobility makes us question the effects of online education on students with visual impairments once again. This study was conducted during the COVID-19 lockdown, and a lack of mobility and physical activity may be considered a natural consequence to a certain degree since some of the participants claimed to be very mobile prior to the lockdown. However, some claim that individuals with visual impairments face limitations in physical activity and mobility in general (Jiang, 2015; Ong et al., 2018). Apart from the effects of COVID-19, the possible barriers to physical activity and mobility for individuals with visual impairments may be tested in future studies.

Implications for Practitioners

According to Krishnan et al. (2020), a person's disability should not be considered the sole reason for one's lack of understanding and meeting societal expectations and independence. Rather, action must be taken to remove environmental and social barriers faced by those individuals. As Shakespeare et al. (2021) state, fixing these barriers may require the identification of specific student needs and concerns directly through the voices of those individuals, followed by designing and implementing individualized programs. Although limited, due to the research design, this study may be important for the field of visual impairment in the sense that it provided students the opportunity to directly express their own needs and concerns regarding the effect of COVID-19 on their lived experiences, which may be useful in determining a road map for communities, counseling centers, and the office of disability services of universities.

In this study, the participants considered campus life as a valuable environment for meeting academic and social needs. Thus, we ask: Which steps should be taken by offices of disability services to meet such needs? The needs and concerns reported by the study participants varied a great deal, which tells us that offices of disability services may have to base all their work on an individual differences approach as recognized by the inclusive philosophy (Borthwick-Duffy et al., 1996). It is obvious that such a philosophy will require a lot of effort, especially for offices of disability services of universities with large populations, however, it seems plausible to stress the adage, “No one said it would be easy.” After all, meeting needs at the individual level forms the basic core of support services for special needs populations in inclusive settings (Tanrıverdi & Sarıca, 2021). Based on this philosophy, offices of disability services should be encouraged to offer numerous supports for students to choose from and, based on the results of this study, these supports should cover social and psychological services as well as academic accommodations.

In the 2021–2022 academic year, university education in Turkey began to apply a hybrid model, with a 40/60% ratio of online and face-to-face education (Turkish Council of Higher Education, 2021b). Thus, it may be claimed that online education has begun to be an important part of university life and that access to such a form of education may be a critical concern for offices of disability services. Parallel to our findings, offices of disability services will have to find ways to help students with visual impairments keep up with online and on-campus education offered synchronously. The specific issues to consider at that point will have to include access to course materials, computers and other technological devices, and sighted readers for courses offered both online and on-campus. Offices of disability services will also have to motivate those students to attend school social activities. As reported previously, the participants went through various negative psychological states during the pandemic. Although on-campus education makes way for socializing, COVID-19, followed by school lockdowns, may again limit our lives. Therefore, the provision of psychological services should be a priority for offices of disability services.

The results indirectly showed that there were differences in the service provision of offices of disability services across universities. We believe that any student in any university should have the right to receive effective services. Therefore, Turkish universities need to create a set of standards for providing disability services to their students with special needs. Also, knowing that 12% of the universities do not currently have offices of disability services, the Council of Higher Education is advised to deal with such a critical issue as soon as possible.

Last, this study was conducted in a culture that is blended with Eastern and Western norms and values. However, our findings seem to overlap to an important extent with international studies (Allen & Smith, 2020; Del Pilar Oviedo-Cáceres et al., 2021; Gombas & Csakvari, 2021; Rosenblum et al., 2020; Senjam, 2020), letting us, to a certain degree, infer that university students with visual impairments across various cultures go through similar experiences before and following a global health threat, in this case, COVID-19.