Readily available but how accessible?

An analysis of the web accessibility of healthcare-related resources

Authors

DOI:

https://doi.org/10.17411/jacces.v13i2.421

Abstract

With advances in technology, more health information is readily available to the public. Individuals with disabilities rely on online healthcare-related resources to access educational information and promote informed decision-making in their care. The Web Content Accessibility Guidelines (WCAG) were created to provide universal web practices which complement the needs of all individuals, such as those with low vision or screen readers users. However, many websites and the resources within them (e.g., PDFs) do not prioritise WCAG, leaving individuals with disabilities at a disadvantage in terms of their autonomy and health literacy. The objective of this study is to investigate and describe the common web accessibility errors present on international occupational therapy and pediatric websites and the resources within them. This mixed methods study evaluates compliance to WCAG success criteria using automatic web accessibility evaluation tools, specifically WAVE and AChecker, and manual checks to capture the human element. Descriptive statistics were used to examine the frequency of errors across several success criteria within the sample websites and PDFs. A subsequent thematic analysis was used to further examine how and why these errors violate the WCAG success criteria. Through automatic evaluation tools, many websites and resources did not comply with numerous WCAG 2.0 success criteria. Through manual checks of the web pages and resources within them, 5 themes were identified: inaccessible images, challenges accessing additional resources, poor structural formatting, lack of tagging in PDFs, and minimal colour contrast. The results of this study can inform web developers and contributors (e.g., Occupational Therapists) on how to successfully produce accessible websites and PDFs to provide equal access to health information. In conclusion, this study adds to the current understanding that many public-facing websites and the resources within them (e.g., PDFs) are not accessible, including healthcare-related websites meant to support informed decision-making among individuals with disabilities.

References

Acosta-Vargas, P., Hidalgo, P., Acosta-Vargas, G., Gonzalez, M., Guaña-Moya, J., & Salvador-Acosta, B. (2020). Challenges and Improvements in Website Accessibility for Health Services. Intelligent Human Systems Integration. (pp. 875–881). Springer International Publishing. https://doi.org/10.1007/978-3-030-39512-4_134

AChecker Web Accessibility Checker. (2018). AChecker. Retrieved from https://achecker.achecks.ca/checker/index.php

Alajarmeh, N. (2021). Evaluating the accessibility of public health websites: An exploratory cross-country study. Universal Access in the Information Society, 1–19. https://doi.org/10.1007/s10209-020-00788-7

Braun, & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

Henry, S. (2019). Introduction to Web Accessibility. Web Accessibility Initiative.https://www.w3.org/WAI/fundamentals/accessibility-intro/

Mackenzie, L., Coppola, S., Alvarez, L., Cibule, L., Maltsev, S., Loh, S. Y., Mlambo, T.,Ikiugu, M. N., Pihlar, Z., Sriphetcharawut, S.,Baptiste, S., & Ledgerd, R. (2017). International Occupational Therapy Research Priorities: A Delphi Study. OTJR (Thorofare, N.J.), 37(2), 72–81. https://doi.org/ 10.1177/1539449216687528

Mason, A. M., Compton, J., & Bhati, S. (2021). Disabilities and the digital divide: Assessing web accessibility, readability, and mobility of popular health websites. Journal of Health Communication, 26(10), 667–674. https://doi.org/10.1080/10810730.2021.1987591

Mueller, M. Jolly, R. Eggert, E. (2018). Web Accessibility Laws & Policies. Web Accessibility Initiative. https://www.w3.org/WAI/policies/

Nganji, J. (2015). The Portable Document Format (PDF) accessibility practice of four journal publishers. Library & Information Science Research, 37(3), 254–262. https://doi.org/10.1016/j.lisr.2015.02.002

Schmutz, S., Sonderegger, A., & Sauer, J. (2016). Implementing Recommendations From Web Accessibility Guidelines: Would They Also Provide Benefits to Nondisabled Users. Human Factors, 58(4), 611–629. https://doi.org/10.1177/0018720816640962

Sik-Lanyi, C., & Orbán-Mihálykó, É. (2019). Accessibility testing of European health-related websites. Arabian Journal for Science and Engineering, 44(11), 9171–9190. https://doi.org/10.1007/s13369-019-04017-z

UsableNet. (2021). We do it for you. https://usablenet.com/technology/assistive-technology-services

Vigo, M., Brown, J., & Conway, V. (2013). Benchmarking web accessibility evaluation tools: measuring the harm of sole reliance on automated tests. Proceedings of the 10th International Cross-Disciplinary Conference on Web Accessibility, 1–10. https://doi.org/10.1145/2461121.2461124

W3C (2023a) What We're Working On https://www.w3.org/WAI/update/

W3C. (2023b). Understanding success criterion 1.4.4: Resize text. https://www.w3.org/WAI/WCAG21/Understanding/resize-text.html

W3C. (2018). How to Meet WCAG (Quick Reference). Web Accessibility Initiative. https://www.w3.org/WAI/WCAG21/quickref/#abbreviations

W3C. (2021). Evaluating Web Accessibility Overview. https://www.w3.org/WAI/test-evaluate/

Wagner, L. (2021). Disabled People in the World in 2019: Facts and Figures. InclusiveCity Maker. https://www.inclusivecitymaker.com/disabled-people-in-the-world-in-2021-facts-and-figures/

WebAIM. (2023). WAVE Web Accessibility Evaluation Tool. https://wave.webaim.org/

Wordpress.com Support, (n.d.). Accessibility. Retrieved from https://wordpress.com/support/accessibility

Yi, Y. J. (2018). Web accessibility of healthcare websites of Korean government and Public Agencies: A user test for persons with visual impairment. Universal Access in the Information Society, 19(1), 41–56. https://doi.org/10.1007/s10209-018-0625-5

cover

Downloads

Published

2023-11-30

How to Cite

Fernandes, K., Paramananthan, S., Cockburn, L., & Nganji, J. (2023). Readily available but how accessible? : An analysis of the web accessibility of healthcare-related resources. Journal of Accessibility and Design for All, 13(2), 188–215. https://doi.org/10.17411/jacces.v13i2.421