Key Post Highlights
> What are the different web accessibility regulations — and who do they apply to?
> How are web accessibility laws enforced?
> What’s next for web accessibility?
We like to think we live in a world where most of the barriers people with disabilities face in accessing healthcare have been knocked down (think handicapped parking spaces, ramps leading into buildings, doors that open automatically).
The data, however, paints a much harsher reality:
Here are 5 questions to ask yourself while building your vision:
- 1 in 4 adults in the US have some kind of disability.
- 1 in 4 adults with disabilities between the ages of 18 and 44 do not have a regular healthcare provider.
- 1 in 4 adults with disabilities between the ages of 45 and 64 did not have a routine check up in the last year.
While there are many barriers to access that people with disabilities face when seeking healthcare, the inability to navigate your organization’s website should not be one of them. In fact, your healthcare organization may be legally required to provide everyone — including people with disabilities — equal access to your website. But if anything, the pandemic has brought into harsh focus just how far we have to go in this area.
If making your website accessible has usually been an afterthought — if it’s even been thought of at all — it’s time to shift your mindset. Regardless of whether you’re familiar with regulations like the Americans with Disabilities Act (ADA) or Section 508, your organization may be required to comply with certain accessibility standards.
Here’s what you should know about web accessibility regulations and enforcement in the US — including what they mean for healthcare organizations, and what may be coming in the future.
What Are The Different Web Accessibility Regulations — And Who Do They Apply To?
In the US, there are currently two main rules that may apply to your healthcare organization’s website: the Americans with Disabilities Act (ADA) and Section 508 of The Rehabilitation Act (Section 508). This depends on whether you are a business open to the public or a government business (or government contractor).
The Americans With Disabilities Act of 1990 (ADA)
Title III of the ADA requires businesses that are open to the public to provide people with disabilities “full and equal enjoyment of their goods, services, facilities, privileges, advantages, or accommodations” to prevent discrimination. This includes having an accessible website. The ADA website specifically lists “hospitals and medical offices” as an example of a “business open to the public.”
Other examples of businesses that fall under Title III include:
- Retail stores
- Sports arenas
While the ADA does not have its own web accessibility guidelines outlined in the law, the Department of Justice (DOJ) has recently suggested in accessibility-related cases (more on that below) that Web Content Accessibility Guidelines (WCAG), Version 2.1, Level AA is the gold standard it is looking for websites to reach in order to be considered accessible.
The Web Content Accessibility Guidelines (WCAG) is a set of recommendations developed by the Web Accessibility Initiative to make web content more accessible across devices — like computers and mobile phones — for people with a wide range of disabilities (such as blindness, low vision, deafness, hearing loss, limited movement, speech disabilities, and photosensitivity).
There are 3 levels of WCAG conformance: A (lowest), AA (what most organizations aim for), and AAA (highest).
Following WCAG usually makes your website more usable for everyone.
Section 508 of The Rehabilitation Act (Section 508)
Section 508 requires information and communication technology (ICT) — which includes websites — that is “developed, procured, maintained, or used by federal agencies” to be accessible for “people with physical, sensory, or cognitive disabilities.”
Unlike the ADA, which uses the most recent WCAG 2.1 standards, Section 508 requires websites to meet level AA from the earlier WCAG 2.0.
With the exception of government websites or government contractors’ websites, most hospital and healthcare organizations do not have to meet Section 508 requirements. But the good news is, if your website is meeting the WCAG 2.1 AA standards as recommended by the ADA, you’re already meeting Section 508 standards as well. This is because 2.1 standards are built upon 2.0 standards.
How Are Web Accessibility Laws Enforced?
The ADA is usually enforced for web accessibility violations in one of two ways: by private citizens filing lawsuits against companies with inaccessible websites, or by the Department of Justice (DOJ) investigating violations.
The DOJ usually gets involved if a violation is serious and has a profound effect on people with disabilities. For instance, in November 2021, the DOJ reached a settlement with Rite Aid, whose online COVID-19 Vaccine Registration Portal was not fully accessible.
In particular, the DOJ noted that “the calendar on Rite Aid’s website used for scheduling vaccine appointments did not show screen reader users any available appointment times, and people who use the tab key instead of a mouse could not make a choice on a consent form that they needed to fill out before scheduling their appointment.” This made the website inaccessible to people who use screen readers as well as people who use a keyboard rather than a mouse to navigate websites.
With people spending more time online during the pandemic, accessibility has come into the spotlight. And the Rite Aid case is just one example of how the COVID pandemic has brought an increased focus on web accessibility — and with it, an increase in accessibility lawsuits.
Section 508 Enforcement
Government websites have also come under the spotlight thanks to the increased need for accessible online services brought on by the pandemic. A 2021 report by the Information Technology & Innovation Foundation found that nearly 1/3 of the homepages for federal government websites — including the Food and Drug Administration and the National Cancer Institute — did not pass an accessibility test compared with benchmark nongovernmental websites.
And, as with the ADA, Section 508 can also be enforced through lawsuits brought on by consumer complaints. Even though Section 508 guidelines apply to government websites, anyone who uses them can sue for noncompliance, whether they are a government employee or a private citizen.
What’s Next For Web Accessibility?
So now what? With no clear, uniform standards — but a clear need to clean up the virtual house — where does this leave the state of web accessibility? And what does any of this mean for your healthcare organization?
In September 2022, Senator Tammy Duckworth and Representative John Sarbanes introduced the “Websites and Software Applications Accessibility Act” which, like the ADA, would require places of public accommodation to have accessible websites. What sets this proposed legislation apart, however, is that it states, “The Department of Justice (DOJ) must issue standards of accessibility for applicable entities to meet this requirement.”
In other words: web accessibility compliance would no longer be a matter of guesswork. You won’t have to wonder, “Which standards do I think my organization should be following?” Instead, it will only be a matter of implementation.
Admittedly, that may seem like no easy feat at first. But you may be a lot further along than you think. Interested in finding out where your website currently stands? CareContent’s comprehensive web accessibility audits have you covered.
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.