Whether it’s scheduling a dentist appointment, buying tickets to a concert, or reading the news, we use the internet on a daily — if not an hourly — basis. And if you don’t have a disability, it’s easy to take being able to do these things online for granted.
But for the 61 million American adults who have some form of disability, what many people consider “simple” online tasks can be challenging, frustrating, and sometimes even downright impossible.
That’s where website accessibility regulations come in.
The Americans with Disabilities Act (ADA) requires any US business that falls under ADA Titles I and III to have websites that offer “reasonable accessibility” to people with disabilities:
- Title I: Businesses that employ 15 or more full-time employees each working day, for at least 20 calendar weeks in the year
- Title III: Businesses considered “public accommodations,” such as healthcare providers, hotels, banks, and accountant offices
While the World Wide Web Consortium (W3C) did produce guidelines that have been accepted as standards for website accessibility, there technically aren’t any regulations that clearly spell out what makes a website accessible. But in general, an accessible website is one that takes into account the needs of those with hearing, visual, physical, and cognitive impairments.
Crystal is CareContent’s resident website accessibility whiz, and she’s here to share her insight.
What are the risks of having an inaccessible website?
Crystal: An inaccessible website can alienate your audience and make your organization appear tone-deaf, especially if you serve patients with disabilities.
It also means missing opportunities to engage with your audience. You could lose patients and consumers, and decrease conversion (such as patients not making appointments after visiting your site).
This ultimately goes against your goal of improving health and wellness. And from a business standpoint, it can mean revenue loss.
There are also legal repercussions, correct?
Crystal: Yes, there can be. A user can file a lawsuit for discrimination or other claims against the organization if they are a Title I or Title III business and fail to provide adequate accommodations on their website for people with disabilities.
For example, Tenet Healthcare, which operates several healthcare facilities, was sued on behalf of Americans with visual impairments because Tenet organizations’ websites were not accessible via screen-readers.
Lawsuits are more on the extreme end, but they are increasing. ADA-related digital lawsuits in 2020 increased 23% over 2019. In December 2020, there was a nearly 100% rise over January 2020.
Has COVID-19 been a factor in that increase?
Crystal: Definitely. Quarantine has caused a significant increase in computer and internet usage, and with people spending more time online, they’re finding more accessibility issues.
On the subject of COVID-19 — accessibility issues on vaccine registration sites have impacted the ability of people with disabilities to get vaccinated.
The organization WebAIM found that in February 2021, only 13 of 94 state and DC vaccine websites had no accessibility issues.
Inaccessibility has resulted in instances where the visually impaired haven’t been able to register for vaccines without help from others. But with such few appointments available, and with them filling up the second they’re posted, relying on others can slow down the process. Many blind people use the schedule-by-phone option instead, but that comes with its own set of problems, like extremely long hold times.
Crystal’s Recipe for Redesigning an Accessible Website
Combine equal parts:
- Dedicated project resources for reviewing the website for ADA compliance
- Competent web developer to address issues found in ADA compliance review
- Consideration in the project timeline for the ADA review
What factors often get overlooked in terms of navigation and functionality?
Crystal: A lot of sites overlook people whose physical disabilities affect their fine motor skills, and can’t use a mouse.
Everything should be easy to navigate with just the keyboard. This includes menus that are easy to navigate with the tab key and a clear keyboard focus (a box around the section being tabbed through). When there are audio, visual, or carousel components, users need to be able to play, pause, replay, and advance with just their keyboard.
Every form field should have a descriptive label that doesn’t disappear as a user types, and error messages need to specify the exact error.
Also, use proper header hierarchy. Put the headers — the H1, H2, H3 tags — in logical order, which means that an H3 tag shouldn’t be used if there’s no H2 tag before it, etc. And always use these tags instead of separating sections with bold text. Devices like screen readers often scan text for the header tag elements in order to navigate through the page.
And what about in terms of the content itself?
Crystal: Pay attention to the needs of people with cognitive disabilities. Don’t use technical jargon, spell out acronyms, and define complex words. This is actually really helpful for all readers, regardless of whether or not they have a cognitive disability.
The National Institutes of Health (NIH) recommend that any online health materials be written at a 6th to 7th grade reading level. But even the top consumer health websites, like Mayo Clinic and NIH itself, tend to be grade 10+.
There are a few ways to check your content’s grade reading level, like the “Readability Analyzer” from data·yze.
Just remember — the tool might see a jargon-y word and automatically calculate that as a higher reading level, without taking into account that you explain what that word means. In medical content, you’re almost always going to have some of these technical words. So you do have to take the scores with a grain of salt, but they are a great starting point.
If you’re struggling, the Centers for Disease Control and Prevention (CDC) has a really helpful guide for creating easily understandable materials.
What are some overlooked media elements that designers need to keep in mind?
Crystal: Remember to always add alt text tags for images so that screen readers for visually impaired users can read the image. Also, add captioning for any video or audio media for people with hearing or visual impairments. Additionally, use color contrasting for text overlays on background or images so that they’re easier to see.
You may also want to avoid videos or interactive graphics that have flickering lights, since these can trigger seizures or migraines in people with certain neurological conditions. TikTok actually just created a feature where the user can skip any of this content.
Any last thoughts?
Crystal: At the end of the day, there isn’t a 100% guaranteed formula for an accessible website. There’s plenty of guidance available. You just have to put yourself in the shoes of users with disabilities and design and develop your website to include their needs. You know your audience best. You’re equipped to make your site the best that it can be for them.
