Have you ever thought about how a visually impaired person visits a website? They don’t have someone read it for them. Instead, they use screen readers or magnifiers. Programs like ZoomText enlarge the screen for people with low vision and can also apply specific colour schemes to make the content clearer. However, these accessibility tools can't function well if the website lacks certain accessibility features, which is why WCAG exists.
The Web Content Accessibility Guidelines (WCAG) are designed to make web content more accessible. This blog post will explore the importance of WCAG in healthcare, its core principles, levels of conformance, specific considerations for healthcare settings, legal requirements in Australia & the U.S., practical steps for implementation, and the benefits beyond compliance.
What are the WCAG Principles? (The POUR Principles)
WCAG is built on four core principles encapsulated by the acronym POUR: Perceivable, Operable, Understandable, and Robust. These principles ensure that web content is accessible to all users.
Perceivable
Information and user interface components must be presentable to users in ways they can perceive.
Why? When screen readers read through the screen, they read the alt text or captions for media. If such text is not described properly, visually impaired users will have difficulty understanding the image. Here are the top three guidelines that play the most important role.
Alt text for images
Ensures that screen readers can describe images to visually impaired users.
When applying an alt text to images, try to be as descriptive as you can. For example, this image’s alt can be: A person wearing a white cap and white T-shirt doing a kickflip (a skateboard trick where the board flips 360 degrees in the air) at a skateboard park during twilight.
Captions for videos:
Offer text descriptions for audio content and detail the visuals of the video. Here’s an example of a good video caption of a chef demonstrating making an omelette. The chef's speech was transcribed, and each visual step was described explicitly.
[Music playing softly in the background]
00:00:00:00 --> 00:02:00:00 [Chef smiles] Hi everyone, today we're making a basic omelette.
00:02:00:00 --> 00:05:00:00 First, crack two eggs into a bowl. [Chef cracks eggs into the bowl]
00:05:00:00 --> 00:08:00:00 Add a pinch of salt and pepper. [Chef adds salt and pepper]
00:08:00:00 --> 00:11:00:00 Whisk them together until they're light and frothy. [Chef whisks eggs]
00:11:00:00 --> 00:15:00:00 Heat a little butter in a pan over medium heat. [Chef puts butter in a pan and turns on the stove]
00:15:00:00 --> 00:18:00:00 Pour the egg mixture into the pan. [Chef pours eggs into pan]
00:18:00:00 --> 00:22:00:00 Let it cook for a few minutes until the edges start to set. [Chef watches omelet cooking]
00:22:00:00 --> 00:25:00:00 Gently push the cooked edges towards the centre. [Chef demonstrates]
00:25:00:00 --> 00:28:00:00 Fold the omelette in half. [Chef folds the omelette]
00:28:00:00 --> 00:30:00:00 And there you have it! A delicious omelette. [Chef plates the omelette]
[Music fades out]
Sufficient colour contrast:
WCAG 2.2 has updated its guidelines on object contrast. Content colour contrast refers to how readable text or objects are against their background colours.
You can find online colour contrast tests that compare foreground and background colors to provide a contrast ratio. The higher the ratio, the easier it is to read.
This is crucial for both accessibility users and regular users, as good colour contrast makes content easier to read and can boost engagement.
[Read the complete perceivable guideline on WCAG 2.2 here.] (https://www.w3.org/TR/WCAG22/#perceivable)
Operable
User interface components and navigation must be operable by all users by any means.
Why? Some accessibility features need keyboard navigation and screen readers to read aloud. If websites don't support keyboard use or give enough time for screen readers, users may struggle to understand your content.
Keyboard navigation
Users should be able to navigate websites through a keyboard interface without requiring specific timings for individual keystrokes, except where the underlying function requires input that depends on the path of the user’s movement and not just the endpoints.
To help users navigate the website easily, there are a few things we always aim to avoid for better accessibility:
- Time-based animation and contents: It avoids rushing users and accessibility software, which may need more interpretation time.
- Seizure triggers: Ensures content does not cause seizures through flashing or flickering elements.
- Drag and drop element: Most keyboard navigation does not support drag and drop. Even if it does, interacting with it can be complicated. Always allow alternate interaction methods if drag and drop is unavoidable.
[Read the complete operable guideline on WCAG 2.2 here.] (https://www.w3. org/TR/WCAG22/#operable)
Understandable
The user interface should be easy to understand and use. Here are some tips for creating a user-friendly website.
- Clear language: Use simple language that is easy to understand.
- Consistent navigation: Keeps navigation predictable across pages.
- Avoiding complex layouts: This simplifies user interaction with straightforward designs.
[Read the complete understandable guideline on WCAG 2.2 here.] (https://www.w3. org/TR/WCAG22/#understandable)
Robust
Last of the POURs, Robust means content should be strong enough to function well with both current and future user agents, including assistive technologies. For example,
- Valid HTML: Ensures proper structure so assistive technologies can interpret it correctly.
- Proper use of ARIA attributes: Enhances accessibility by providing additional context about UI elements.
[Read the complete understandable guideline on WCAG 2.2 here.] (https://www.w3. org/TR/WCAG22/#robust)
WCAG 2.2 for the Healthcare Industry: Ensuring Accessibility for All
Understanding web accessibility can feel like navigating a complex landscape, but thankfully, established standards like the Web Content Accessibility Guidelines (WCAG) provide a framework.
WCAG offers a set of recommendations for making web content more accessible to people with disabilities. This is particularly crucial in the healthcare industry, where accessible digital platforms can significantly impact patient care and well-being. These guidelines are organised into different levels of conformance, each building upon the previous one to offer progressively more robust accessibility. They create a standard that helps make the online experience more inclusive for patients, providers, and staff.
WCAG Conformance Levels: A Foundation for Inclusive Healthcare
WCAG's three conformance levels—A, AA, and AAA—provide a tiered approach to web accessibility. While all levels are important, Level AA is generally considered the target for most web page, including those in healthcare.
Level A: The Essential Starting Point for Healthcare Accessibility
Level A represents the minimum accessibility requirements. Meeting these criteria ensures that web content is perceivable, operable, understandable, and robust (POUR) for some people with disabilities. In healthcare, this foundation is crucial for basic access to information and services.
Key Features: This level addresses the most fundamental accessibility issues. Examples relevant to healthcare include:
- Providing text alternatives for non-text content (images of medical equipment, charts, videos explaining procedures).
- Ensuring content is presentable in different ways without losing information or structure (e.g., screen readers for patients with visual impairments, different font sizes for users with low vision).
- Making all functionality operable through a keyboard (essential for patients with motor impairments).
- Providing users enough time to read and use content (important for users with cognitive disabilities or those using assistive technologies).
Limitations: While crucial, Level A by itself doesn't address many common barriers faced by people with disabilities in accessing healthcare information. It's a starting point, not the end goal.
Level AA: The Recommended Standard for Healthcare Websites
Focus: Level AA builds upon Level A and addresses a wider range of accessibility needs. It's the generally accepted target for most websites, and particularly vital for healthcare, as it aims to make content accessible to a broader range of users with disabilities.
Key Features: Level AA includes all Level A criteria plus additional requirements, such as:
- Providing alternatives for time-based media (captions and transcripts for videos about treatments or health conditions).
- Ensuring sufficient colour contrast between text and background (crucial for users with low vision or colour blindness).
- Making content adaptable (e.g., responsive design for different screen sizes, allowing patients to access information on various devices).
- Providing clear navigation mechanisms (essential for patients trying to find specific information or services).
- Avoiding content that triggers seizures (important for patients with photosensitive epilepsy).
Importance: Level AA significantly improves accessibility and is considered the benchmark for creating inclusive healthcare experiences. It's the level most healthcare organisations should strive for to ensure equitable access to care.
Level AAA: Going Above and Beyond in Healthcare (With Considerations)
Level AAA represents the highest level of accessibility. It includes all Level A and AA criteria plus even more stringent requirements. While it offers the most comprehensive accessibility, it's often not feasible or necessary for all websites due to practical limitations.
Key Features:
- Level AAA adds requirements like:Providing sign language interpretation for audio content (beneficial for deaf patients).
- Requiring even higher levels of colour contrast (can be challenging to implement while maintaining design aesthetics).
- Offering more detailed descriptions for complex visuals (valuable for patients with visual impairments).
- Ensuring full cognitive accessibility (can be complex and require specialised expertise).
Challenges: Meeting Level AAA can be challenging and expensive. Some criteria may be difficult to implement or could impact the design and functionality of a website. It's often reserved for specialised healthcare websites or those with a specific focus on serving users with different disabilities.
WCAG 2.2 and the Future of Healthcare Accessibility
WCAG 2.2, the most common followed version of the guidelines, builds upon previous versions and introduces new success criteria to address evolving accessibility needs, particularly in areas like cognitive accessibility and mobile accessibility.
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