An Investigation of the Experiences of Orientation and Mobility Trainers in India

O&M training for trainers has become more abundant in India since the 1970s, starting with the development of extended training programs at the National Centre for the Blind [30]. More recent offerings by private institutes, as well as non-profit organizations provide greater access to the area. Training in O&M has become an established part of courses for special education intended for individuals with visual impairments [30]. The National Association for the Blind (NAB) Karnataka [28] offers various training programs designed to empower individuals with visual impairments and support them integrating into mainstream society. Programs offered include a foundational course, the Train the Trainer program, and the community-based rehabilitation program. For example, the Train the Trainer program offered through NAB Karnataka [28] has been designed to develop skilled trainers who can effectively teach and support individuals with visual impairments. O&M training is typically offered in six-week blocks, covering the rules of walking in public using a cane, negotiating the limits of a confined space, navigating steps and escalators, commuting using public transportation, and learning techniques to map and memorize routes and layouts in both rural and urban areas [28].

Researchers suggest that in India, there is a paucity of O&M trainers who support youth with visual impairments in mainstream schools [24]. This can limit levels of independence among youth, who are forced to look elsewhere to obtain the support that is needed. Furthermore, rural India has been described as lagging behind in basic infrastructural development indicators for public services and facilities such as education, health, livelihood, and social protection [10], which in turn reduces the opportunities for persons with disabilities living in these areas because they are faced with additional disability-specific barriers, such as negative attitudes and inaccessibility of the environment [13].

O&M skills training can be obtained through the support of both governmental and non-governmental organizations (NGOs). Organizations operating in India providing O&M training include VisionAid [43], the National Association for the Blind (NAB) [27], and the National Institute for the Empowerment of Persons with Visual Disabilities (NIVH) [39], among others. Charities, such as the Blind Organization of India [6] and Mitra Jyoti [22], also offer assistance to individuals with visual impairments, by supporting the development of skills and providing education, including O&M training and daily living skills for individuals with visual disabilities, including both congenital and adventitious impairments.

India has been described as making leaps in supporting individuals with visual impairments with O&M [24]; however, more can be done to cater to the large population, especially those resident in rural areas where services and training may be lacking compared to those in urban areas.

The experiences of O&M trainers have been examined by a range of researchers (e.g., [4, 9, 11]). In their study, Griffin-Shirley et al. [11] inquired about teaching techniques and resources used to provide O&M services to individuals with visual impairments. Findings revealed the importance of immersion training and developing problem-solving skills. The inquiry with trainers conducted by Dove et al. [9] revealed the accelerated interest in remote O&M instruction and assessment, while the widespread adoption of smartphones with accessibility support is thought to have driven interest in assistive apps (e.g., mapping tools). Dove et al. [9] also found that most trainers are introducing them into their practice with some of their clients, and a few are regularly teaching clients how to use a variety of apps. The researchers offered suggestions that satellite and street views offered by mapping tools could be used to support instructors in first identifying travel routes with their clients and then rehearsing how they might be completed. Finally, issues of self-efficacy and how this could be developed through O&M training were examined in the study by Bandukda et al. [4].

The studies described above have offered interesting insights into the perceptions of trainers. However, these have been conducted in locations where access to services, technologies, and strong levels of infrastructure are taken for granted. Our study described in this paper examines experiences in LMICs where access may differ considerably.

Research has shown that the proliferation of technologies to enhance O&M and navigational skills offers considerable promise to individuals with visual impairments [31, 4]. These include adaptive software technologies in mobile devices, enabling better navigation and social interaction in environments where accessibility remains a significant challenge [31]. Deverell et al. [8] describe the ways in which technology can serve O&M professionals. These include the use of more specialized devices like electronic travel aids (e.g., Miniguide [21], Ultracane [42]), accessible maps with audio/haptic options, Braille and tactile graphics, electronic magnifiers, and virtual reality systems for simulating O&M experiences [8].

Findings from these prior studies highlight a limited awareness of client-used apps, the expense associated with devices, and inadequate technology training as barriers. It emphasizes the need for comprehensive O&M training in LMICs and technology training to meet the evolving needs of clients with low vision or blindness.

Researchers suggest technology facilitates not just communication but also broader social and economic participation for individuals with visual impairments [31]. However, challenges like language barriers and Internet access persist and can impact the ability to participate, which in turn can pose difficulties, particularly for those in low-income settings [40, 41].

Technology, however, does not always solve problems in LMICs. The difficulties in understanding the language of audio output from screen readers, inaccessible features of existing social media platforms, and lack of training lead many individuals with visual impairments to either not explore or abandon these platforms [40]. Interviews and observations have identified technical, societal, and economic barriers that impede low-income blind students' access to social media platforms. Challenges like the unavailability of screen reader software, and difficulties in grasping the concepts of social media interactions were noted, with many participants expressing the need for continued training and usage to overcome these barriers [40].

In a more recent study with individuals with visual impairments in India conducted by Nagraj et al. [25], findings highlighted the limited use of technologies for navigation, in part attributed to the lack of trust in coverage outside of urban areas. Preferences were identified for obtaining human assistance when navigating in certain scenarios where technology was not perceived to work. Technology was also found to be impractical given the situational and environmental context. For example, using earphones when interacting with a navigational app on a mobile device would pose challenges, as auditory cues could mask environmental cues.

In this paper, we investigate the experiences of O&M trainers when working with individuals with visual impairments. Our findings offer an insight into how training is facilitated, differences between training in urban vs rural settings, and how to train others to be safe.

This study set out to explore the experiences of O&M trainers in India, including their experiences when being trained for the role and when supporting individuals with visual impairments. Due to the limited number of these experts and the difficulty of reaching them, participants from different organizations and states within India were invited to participate. The participants were recruited through direct contact with organizations working with individuals with visual impairments (e.g., [28, 32]) and through snowball sampling.

We used a semi-structured interview format, which has the flexibility of being able to ask follow-up questions and go deeper into interesting subtopics that may arise during the interview. We initially asked participants about their training and professional preparation. Then, we inquired about ways they instruct others to navigate crowded environments, areas with heavy traffic, and settings where infrastructure may be limited (i.e., lack of sidewalks, presence of hazards such as gutters, potholes, etc.). We asked about differences in training, support, and resources in both urban and rural environments, how technology was used to support O&M training and for professional development, and the impact of social stigmatization on individuals with visual impairments seeking O&M training. Participants were invited to describe ways in which O&M instruction and resources could be modified in the future, and ways that they perceived O&M training to differ outside of India.

All interviews lasted between 30-60 minutes and were conducted remotely by phone or through videoconferencing software. Interviews were conducted in English, Hindi, and other regional/state languages (e.g., Kannada) depending on the preferences of participants. In certain cases, participants would utilize a mixture of English with Indian languages to help express themselves more coherently. A translator was needed to support the multilingual first author for speakers of regional/state languages.

Each interview was recorded and automatically transcribed (and, if needed, translated into English by a translator) for purposes of analysis. All notes and transcripts taken were made available to all other researchers on the team for interview analysis.

After each interview was completed, the first author completed an inductive thematic analysis of each interview transcript and recording. The recording was used to manually correct errors in the automatically generated transcript and identify potentially relevant quotes. As the interview analysis continued, several recurring themes and challenges were identified. These were discussed with a second researcher who had also reviewed the transcripts to gain consensus on these themes. Once themes were refined, they were shared with the rest of the authors in the team, who provided feedback and helped to further refine the themes. Data was collected until theoretical saturation was achieved.

The first author led the research, conducting interviews and analyzing data. Having grown up and lived in India for over 30 years, the first author has knowledge of the culture and people across various states; an experience that has been instrumental in the careful selection of participants from different regions for this study. This unique positionality affords an insider's perspective on the rich traditions, varied languages, and complex social dynamics intrinsic to the daily life of its people.

A total of twelve participants were recruited for this study. Participants had between 2 to over 40 years of experience working as an O&M trainer, and all worked for Non-Governmental Organizations (NGOs) in India. These included institutes, charities, and a private university. While 3 participants solely focused on conducting training in rural environments, 9 participants who predominantly worked in urban environments also had experience of traveling for short periods of time to work as O&M trainers in rural settings. Only one of the participants identified with a visual impairment. A more detailed demographic breakdown appears in Table 1.

Participants described their journeys moving toward becoming O&M trainers. While the majority had worked towards a degree in Special Education, where O&M was covered as one of the modules studied, others had studied other subjects prior to undertaking a specialized certification in O&M training through the National Association for the Blind (NAB) [27] (P2) or the Train the Trainer program offered through [28] (P6, P9). Factors influencing decisions to move into the field included experiences with friends and family with visual impairments who had gained independence through O&M training (P4, P5), or knowledge of special educators who supported disabled communities and a desire to follow suit (P8). P9 who had prior training in banking and finance, started an internship at an NGO and discovered a pathway to being a trainer from there, which they found to be more meaningful than their previous career.

When asked about training provided to them, the majority highlighted that they had been blindfolded over extended periods of time as a method intended to support understanding of the experiences of individuals with visual impairments. P5 described how they were asked to conduct daily living tasks while blindfolded, including navigating around the city, catching a bus, moving around a market, seeking help from the sighted individual, going to the shops, and purchasing items. These would be similar tasks to those which would be presented to trainees with visual impairments after qualifying. Others described sitting for periods of time wearing a blindfold to empathize with the loneliness felt by individuals with visual impairments. Most of the practices described by our participants used blindfolds as a low-cost, accessible way to help trainers exercise O&M skills over an extended period of time to gain facility and mastery. However, some had the goal of creating empathy, which can be problematic.

The participants shared that their decision to persist in the role of an O&M trainer stems from their enjoyment of the job and the substantial goodwill received from trainees grateful for acquiring essential O&M skills. Participants observed that the acquisition of these skills empowers trainees to lead independent lives, fostering newfound confidence. During the interview, P5 expressed appreciation by sharing a compliment they received from one of their trainees, who stated, "Your instruction enabled us to achieve independence, motivating me to remain dedicated and continue my work."

Most interviewed trainers described that in addition to their work instructing O&M skills, they consistently fulfilled other roles, including special educator and trainer of independent living skills. While all participants trained individuals with visual impairments, some participants also trained (sighted) special education teachers or field workers who would be going out to work as O&M trainers in the future. Others described the role of playing counselor for both individuals with visual impairments and their families, whose expectations regarding what could be achieved as an individual with visual impairments differed.

This multiplicity of roles was supported and expected by NGOs that hired the participants. These organizations expect trainers to perform a range of tasks related to daily living skills rather than solely focusing on O&M. Participants found the experience of working on multiple skills positive in nature. For example, P2 said, “I like working in NGOs as I have independence and can teach other skills to visually impaired people with O&M training.” Overall, participants found NGOs to offer valuable services to individuals with visual impairments and appropriate remuneration to trainers, in contrast to governmental organizations, some of which were tough to enter.

An important role played by trainers was that of providing advocacy for their trainees by counseling their families about the importance of independence and acquiring life skills. Participants described how they often faced issues of social stigmatization in both rural and urban contexts. While this was more prevalent in rural areas (Section 5.5), it was still present in urban areas. P2, P4, and P5 mentioned that they had counseled families of individuals with visual impairments in urban areas to build confidence and strength to send their children to gain O&M training. P4 described an incident where a student with a visual impairment convinced their mother to send them to an O&M trainer. The student's mother used to accompany them to college, and help navigate on-campus. This led to feelings of embarrassment and impacted self-esteem. Gaining training with a long cane was thought to offer a pathway to independence at college. The student brought their mother to the training center where P4 was working. P4 was able to explain the benefits afforded by being independent, and the importance of not overprotecting offspring with visual impairments.

Participants described the ways in which O&M training was structured for trainees with visual impairments. Generally, a six-week intervention was thought to offer the skills needed to use a long cane effectively and to practice orienting positions and navigating in a range of different environments. These included wayfinding through urban and suburban neighborhoods, locating bus stops, and mounting and deboarding from buses. In addition to learning the ‘shorelining technique¹’, participants were asked to practice different techniques to help negotiate their environment. Once instruction was provided, the trainee would then be tested on the skill developed (i.e., using the cane to identify landmarks or to navigate to a particular location). After completion of the task or after a specific cutoff time, the trainers would provide feedback. If successful, they would work on developing other skills or using these skills in different environments. If unsuccessful, further training in that area would be provided until a minimal threshold was met. Tasks would begin in controlled settings, such as an indoor environment, prior to moving to less-controlled settings.

Participants were upfront about the challenges faced in older cities in India, where infrastructure may vary from newly planned cities and include narrow and uneven sidewalks, as well as negotiating construction on roads, and a lack of pedestrian crossings with accessible signals [25]. Additionally, participants shared that during training, they accounted for potential hazards that may cause risks to safety, such as falls. Participants also described how they used mistakes as a teaching tool to support learning. For example, if a trainee did not identify an obstacle, the trainers would let them bump into the obstacle and believed that the actual experience of bumping would help the student learn what cues to look out for to avoid this happening again. P5 used the example of slipping into shallow potholes on the road as an example of mistakes that would be valuable for trainees to experience first-hand and learn to avoid in the future.

Participants described that in situations with safety concerns, they would train trainees to ask for help from sighted individuals. These included instances when navigating crowded environments, such as busy thoroughfares or navigating streets with heavy traffic. In these cases, participants highlighted that individuals with visual impairments should try to make themselves more ‘visible’ (i.e., by making their long cane more prominent) so that they can better locate help. When asked about the impact of asking for help from sighted users on the trainees' dependence, participants expressed that they would prioritize safety over autonomy. In cases where safety could be compromised, participants would provide training on locating pedestrians nearby, asking for help, appropriately holding on to a sighted pedestrian (by continuously touching their arm or shoulder), and ways to assess the safety of the interaction. In other cases with increased danger, participants recommended that their trainees avoid non-essential individual travel. These included traveling at nighttime and during inclement weather, especially during heavy rainfall in the monsoon season. For example, P4 said, “If a sighted person does not go out of their house during heavy rains, how can a visually impaired person go out in such a situation?”

When asked about how training was made more culturally relevant to an Indian audience, a major observation by the participants was that in India, training with the cane was preferred to using service animals. None of our participants reported supporting training O&M skills with the aid of service animals, and described service animals as rarely encountered in India. This was thought to be attributed in part to concerns over the large amount of training needed and costs to maintain the animals. P5 was concerned that using a service animal may create further risks for an individual with visual impairments in India. They described that in areas where stray street dogs are abundant, a person with visual impairment who uses a service animal may encounter difficulties with their dog barking at other dogs or even being attacked by them.

Another interesting cultural consideration described by one of the participants included using the cane with the left hand and freeing the right hand for other uses, such as signaling and greeting, among others. Training was also provided to use the left hand to help block lower limbs from encountering obstacles. As a rule of thumb, participants described training individuals with visual impairments to walk on the left-side of a sidewalk, where there may often be a wall or rail to help navigate. However, due to the volume of pedestrians in urban areas, walking adjacent to a wall was not always possible. In terms of cultural considerations, the right hand is generally considered cleaner in many Indian subcultures, thereby limiting the use of the left hand for specific tasks.

When asked about how O&M training had changed over time, participants described that they had made many modifications in interventions over the time that they had been training others. Participants suggested that if things were working, there was little point in changing them.

Finally, participants described that while O&M training is generally free of cost for individuals with visual impairments in urban and rural areas, most organizations have limited O&M experts (e.g., one or two trainers across a major area), which limits access to training for a broader audience.

Given the proliferation of interactive technology used to support orientation and mobility (described in the Related Work section), we were interested in understanding what role, if any, do interactive technologies play when training individuals with visual impairments in India. Participants highlighted that none of their former trainees with visual impairments had inquired about using tools such as Google Maps [17] or Lazarillo [23] to help support navigation.

When unpacked in more detail, participants highlighted many reasons for being hesitant to use interactive technologies in their training. These included the prohibitive cost of these technologies, including the cost of Internet-enabled mobile devices needed to access them. Additionally, they mentioned that intermittent Internet connectivity would cause practical issues, making such systems unreliable. With respect to maps, some of the participants were also concerned about their usability and accuracy for users with visual impairments. For example, P4 said, “maps often confuse visually impaired people as they are not precise and accurate while walking and shifting directions.”

Participants also highlighted issues with using mobile devices and canes at the same time. For example, they had concerns about how their trainees would navigate with a cane in one hand while encumbered with a phone in the other hand. Furthermore, they expressed safety concerns about using a device that could be easily dropped or stolen in busier environments. When asked about using visual assistant tools such as Aira [1], participants expressed concerns about the usability of such services in busy urban environments in India and potential difficulties with the service providers being able to read or interpret signage in local characters.

Interestingly, smart canes such as the device developed by Saksham [36], were known to almost all of our 12 participants. These devices were often showcased by independent researchers visiting programs where participants were teaching. Most of our participants suggested that smart canes were rarely used by individuals with visual impairments in India, as availability, cost, and concerns about powering the device if on-the-go for an extended period of time could cause concerns. Factors such as cost were beginning to be addressed, as some devices like the SmartCane from Saksham [36] could be procured through the Assistance to Disabled Persons scheme (ADIP) [3]. The scheme aims to equip persons with disabilities with assistive devices essential for their social, economic and vocational rehabilitation [36]. P9 highlighted that smart canes work best in less busy environments where fewer obstacles are present. However, in busy environments (such as cities in India), the smart cane would be continuously buzzing in response to detecting obstacles and people, which could cause considerable confusion to users.

Participants described lacking interest in using interactive technology to support training other trainers, or even for supporting their own professional development. For example, none of our participants reported keeping their knowledge of current developments in O&M training up-to-date through using websites, videos, or online professional networks. However, this proved to be an area that was difficult to talk about. When asked how they continued professional development, participants described asking for support in-person from their former places of training or when attending in-person conferences and workshops in India related to visual impairment and O&M training.

As described in Section 2.1, all participants had some experience conducting six-week O&M training interventions in rural areas. Participants shared that the NGOs organize these interventions as outreach camps in rural areas where individuals with visual impairments and their family members living in proximity to the camp would be invited to participate. These interventions would be similar to the ones described in Section 5.1. However, daily living skills seemed to be a more prominent feature contained within the training in rural areas. In particular, skills such as self-care and advocating for oneself were also taught. When questioned about providing daily living skills in the training conducted in rural areas, participants highlighted that the lack of opportunities for specialized education for individuals with visual impairments, combined with social stigmatization regarding disability, created a complex situation.

When describing the types of O&M training provided in rural areas, participants shared that they encouraged trainees with greater levels of support to use a cane (or a makeshift cane using bamboo) to help navigate their environment. In some cases, participants described creative strategies they had observed in rural areas that are appropriate for that context. For example, P5 described how a trainee (the child of a farmer) would navigate home by holding the tail of a buffalo which had been taken out to graze. A sense of security was maintained, as he knew that the animal would not fall or move towards unsafe areas (e.g., gutters by the side of the road). While following the buffalo, the trainee could spend time mentally mapping the environment.

Participants shared that in their experience, individuals with visual impairments in rural areas are often told to be cautious and avoid dangerous situations (e.g., going out when dark or in inclement weather) or just to avoid going out at all. In these cases, participants described how they would provide counseling to trainees during the training process, encouraging them to try new things and increase their mobility, with the longer-term aim that they could then work on modifying attitudes regarding disability among their own families. In other cases, where families were more resistant to their visually impaired family members gaining help from NGOs, participants had to work harder to also educate the family members on the potential that individuals with visual impairments could offer to society. This could prove to be a challenge due to language barriers with participants, as many regional languages are spoken in rural areas in India.

Recruitment and retention for rural camp attendees were found to be influenced by families’ attitudes or concerns. Participants described speaking with some families who were under the impression that an NGO may take their children with disabilities away from them, either temporarily (i.e., to provide additional O&M training at an urban site), or even permanently. There were more serious concerns about bad actors taking advantage of their children being away to exploit or kidnap them. The latter concern was driven by stories regarding vulnerable populations from rural India being exploited or trafficked in urban areas where their support systems are limited, sometimes leading to severe and enduring consequences [7]. Children with disabilities, in particular, are thought to be an easy catch for traffickers [34]. Specific examples of concern mentioned by families included human trafficking for purposes of illegal organ removal and trade [20]. Other families expressed concern that if their child did not learn all the skills needed within the six-week intervention, they might need to go to the city where the NGO was located for further training and be away from their families for an extended period of time. It was feared that the child would behave differently once they experienced life in an urban environment and possibly lose touch with their roots, or even be misguided or abused.

To counter the families’ concerns and issues raised by misinformation, NGOs recruited local field workers from the areas where the camp would run. These field workers would then visit villages in person and develop a relationship with families and community members. They could then highlight the benefits of O&M and other skill training. Participants believed that these trust-building activities facilitated by local field workers were effective at engaging visually impaired individuals to participate in O&M and other skills training, as well as getting their families on-board, and assisting in the logistics of the training process.

Participants discussed prospects for trained trainees with visual impairments. P9, who described training 200 trainees over the past 7 years, felt that their former trainees were not all independent or even gainfully employed. P9 described how, after going through a difficult job search process, a few of their blind trainees who were not economically stable started begging on the streets for survival. P9 described this as an unfortunate reality. For example, P9 said, “It is sad to see that a visually impaired person begs after being capable of doing a desk job. The companies should consider and have some sort of vacancies for people who are having visual disabilities.”

When questioned regarding ways to aid the situation for visually impaired youth in India, particularly those in more impoverished circumstances, participants identified several areas of possible improvement, including increased access to training and strengthening the infrastructure. Although participants were largely hesitant to utilizing emerging technologies (e.g., smart canes and smart glasses), a few of our participants highlighted as long as these could provide measurable gain, and factors such as cost, availability and concerns regarding efficacy for obstacle detection were addressed, adoption could increase. Interestingly, no participants placed any blame on the lack of government funding for O&M training. However, it was evident that the majority of the camps and interventions that participants were aware of were organized through NGOs, rather than through government-sponsored initiatives.

In terms of supporting their own needs, O&M trainers mentioned that they thought that outside of LMICs, training and professional development for trainers themselves are more abundant. They stated that trainers in countries with more resources have stronger connections to their professional community, where they can meet and share what they have learned with each other. Also, conferences outside of India happen on a regular basis where trainers can visit and learn more about best practices. They expressed a desire to have more connections with others in their professional community, including the international community. For example, P9 said, “If given an opportunity, I would like to know the experiences and methods by discussing with other trainers around the world by visiting the conferences and getting in touch with the trainers.”

Our study highlighted issues caused by prevalent stigma, including patronizing and overly protective attitudes towards people with visual impairments that sometimes resulted in them not participating in O&M training programs. We found that participants took on many roles, such as being counselors, rights experts, advocates, and community contacts, in addition to O&M trainers, to overcome these issues and not only train individuals with visual impairments with skills but also educate their families and community members about the importance of independence and individuation.

The importance of including family members and caregivers in efforts to increase accessibility is recognized in prior research [15, 37]. Furthermore, studies have shown that experiencing stigma can have a negative impact on the development of an individual's sense of self [38]. In LMICs, such as India issues related to stigma may be reinforced by its highly structured, hierarchical social systems, including the caste system [19]. Furthermore, these may be amplified by the large number of people with O&M needs, the limited resources and training delivered in the context of a lack of resources and specialist equipment, and the general low priority assigned to disability issues [24]. In line with previous research that has recommended considering intersectional issues that can exacerbate or alleviate stigmatization associated with disability, and hence diversify people's experiences in this context [19], we also found that trainers adopted culturally sensitive methods such as working with local field workers, and promoting awareness of the importance of dispelling misinformation regarding the role that individuals with visual impairments can play in society.

Our findings revealed a lack of integration of interactive technology with training. Furthermore, participants expressed hesitation and resistance toward technologies that are created elsewhere and might not be appropriate for their particular setting. Generally, participants did not think of digital technology as adding additional value to O&M interactions in India, and it appeared that trainees with visual impairments were also not asking for support with digital navigation technologies. While hesitation about the relevance and sustainability of interactive assistive technologies is reported in LMICs [14, 40], this contrasts with findings from research in high income countries (HICs), such as those described by Dove et al. [9] who found that all of their participating O&M trainers were familiar with the GPS tools in Apple Maps [2] and Google Maps [17], and that many work with trainees who are keen to use them.

Furthermore, our findings revealed that in contrast to the strong emphasis on prioritizing independence, sometimes with the extensive use of interactive technologies, in HICs, the trainers sometimes taught their trainees to ask for help from sighted individuals to prioritize, or to make themselves more visible through waving their long canes to attract help. This was motivated in part due to challenges with infrastructure, which is recognized to be lacking in some rural areas in India [13]. Outside of LMICs, research indicates the value of conducting tasks independently. However, this may be easier to conduct in scenarios where limited infrastructure is not a concern.

Findings from our study revealed the lack of localized resources to support O&M trainers for purposes of professional development. While some who were based in urban areas were able to attend conferences or make contact with their former instructors who may have worked in closer proximity to them, those who were residents in rural locations did not appear to have had the same opportunities afforded to them. This was due to a combination of a smaller support network, a lack of resources to cover costs for attending venues to ask for help, and language barriers encountered. Furthermore, additional time was often spent by trainers in rural areas to build trust with families to support the recruitment and retention of individuals with visual impairments and to help address the negative impact of feelings relating to self-perception of visual impairments [38]. As tools and techniques for O&M training advance, it is important that trainers are able to keep up with trends and innovations in the field. As an example, participants described their own training where blindfolds were donned to gain awareness of ways to navigate without sight (described in Section 5.1). However, research has shown that using disability simulation exercises, such as using blindfolds to simulate blindness among sighted people, is harmful as they can amplify existing stereotypes about people with disabilities and lead to a false sense of empathy [5, 26]. Providing access to events to translate and communicate recent innovations and research-informed practices locally could offer considerable promise for trainers in rural areas.