Accessibility Guidelines that Healthcare Marketers Overlook

Content Authors: Ongoing Maintenance

Accessibility compliance requires diligence from your content authors as they maintain and update your site. I’ve seen many sites fail to provide adequate alternative text, video captions, and transcripts for audio files. I’ve also seen many sites rely on the use of color alone to differentiate elements.

Text Alternatives for Images – WCAG 2.0 1.1

While many healthcare marketers know that an image needs alt text, deciding on what to put in it gets tricky. Remember that you’re primarily describing the image to someone who cannot see the image as clearly as you can. Image alt text should be an accurate and equivalent representation of the image.

Images generally fit into a few categories:

  • Decoration. The only time an image alt tag can be left empty is when the image is purely decoration or used for visual formatting. Most images used today do not fall into this category as we try to speed up our sites and reduce the number of unnecessary images.
  • Complex. Complex images include graphs, charts, maps, diagrams, and infographics. These images often include a lot of text and information that is more difficult to accurately describe using the alt tag alone. Make sure there is adjacent text on the page that describes what is represented visually.
  • Text. An image that includes text should have alt text that exactly matches the text in the image. There is no need to include the words “logo of” or “image of” as the screen readers already announce the content is an image. When text is included in a large banner image, be mindful of how it will scale. If the same image is used for mobile devices, the text often becomes very small and difficult to read. If someone with low vision zooms in to make the text larger, the scaled image text will become pixelated. WCAG 2.0 1.4.9 Level AAA even recommends no text in images at all except for decoration or logos.
  • Photo. Photos bring color and emotion to a page. They are a point of interest that helps people relate to your content. When someone cannot see the image, or see it very clearly, they appreciate being included in the conversation by having access to descriptive alt text for the photos. Just because a person can’t see that cute baby photo on your maternity page today, doesn’t mean they have never seen a baby in the past. Describe the photo for them, how the baby looks, the expression on their face, their surroundings, and what the baby is doing to paint a picture in their minds. Use tactile descriptions that mention color.

In addition, images that are the only thing inside a link must have alt text that clarifies where the link goes. Without that text, someone using a screen reader will just hear “link,” which gives no information where the link will take them. If you’re still unsure about what to include in the image alt text, refer to the Alt Decision Tree for guidance.

Alternatives for Media – WCAG 2.0 1.2

Like images, all media files need a text alternative. You need transcripts for audio and video, and captions for video that has audio. This is obviously necessary for people who are Deaf or hard of hearing, but really everyone benefits from this often-overlooked accessibility requirement. People with learning disabilities or who have another native language find it helpful, as well as people who are unable to play the audio due to technological or environmental constraints. The text alternatives also provide the only way for search engines to index your media content.

In addition, people who are blind need their videos audio-described so they can follow along with anything that may be happening visually. Audio descriptions are important for videos that show text, non-verbal gestures or cues, and scene changes. Some videos may not have these elements, such as stationary headshot videos for physicians, and therefore do not require an audio description.

PDFs

PDFs are another form of media that are often neglected. PDFs and other external media files you provide must also meet WCAG criteria. This includes things like adding a document title, image alt text, and ensuring proper linear reading order with a screen reader.

Use of Color – WCAG 2.0 1.4.1

If you use color to distinguish elements on a page, the color has to meet a contrast ratio of 3:1 to be compliant. If you’re using colors that don’t meet that ratio, you must use other formatting to distinguish the elements.

For example, you may think the underline beneath links looks dated, but it serves an important role. If you remove the underline, the text color is the only distinguishing factor. That means it must meet the proper ratio against the other text and against your background color.

Meeting ratios for both is difficult. If you don’t like the underline beneath links, try moving the underline lower, making a dashed line, adding a border, or highlighting the link. As long as you visually distinguish the links with some formatting element, you’ll be compliant and make it easier for people with low vision to navigate your site.

For graphs, charts, and image, make sure you’re using more than color to show differences. For example, a line graph with multiple lines of different colors won’t make sense to someone who’s colorblind. Distinguish the lines some other way, such as with symbols. For bar and pie charts, adding texture is effective.

Developers: Implementation & Design

Attention from your content authors is key, but it’s not enough to fully comply. Here are some things designers and developers need to implement.

Moving Banner Sliders and Video Backgrounds – WCAG 2.0 2.2.2

Content sliders and video backgrounds are increasingly popular on healthcare websites. But these common features can make your site unusable for visitors who have motion sickness, low vision, or cognitive impairments.

People with vision impairments or reading disabilities need more time to read and understand content. When content is in slides that are continuously moving with no obvious way to pause them, they will be impossible to read. People with motion sickness or vertigo could even feel ill from the motion, which is the last thing you want to make potential patients feel when coming to your healthcare site.

To help these people, always provide a user control to let them stop or pause any animations to give them the time they need to read the content (see image).

Avera eCARE's home page, which has a video background. A "pause" button is at the bottom right corner of the video.

Keyboard Accessibility – WCAG 2.0 2.1

Everything on your website needs to be accessible by the keyboard. There are many reasons a person may not be able to use a mouse like arthritis, Parkinson’s disease, or any number of other motor skill disabilities. People with blindness that use screen readers also use keyboard only.

Visible Focus – WCAG 2.0 2.4.7

When you use a mouse, you watch the pointer to know where you are on the page. To see where you are with a keyboard, your site needs to provide a clear focus state for clickable elements, such as an outline or highlight (see image).

St. Vincent Healthcare's home page, which uses a box with an orange outline for visible focus. The focus is on the "Choose a Doctor" link in the navigation.

Bypass Blocks – WCAG 2.0 2.4.1

Bypass blocks make navigating a page faster for people that use keyboard only and screen readers by giving them ways to skip over repetitive content blocks like your site header.

One way to provide a bypass block is to include a “skip to content” jump link as the first link on the page. The link should be visible when it receives focus so sighted people using the keyboard will be able to make use of it to bypass the navigation and skip straight to the main content.

Another method is to use semantic HTML5 elements and ARIA landmark roles to separate content into meaningful sections. Screen reader users will be able to use these named sections to skip to the part of the page content they need like the navigation, search, or main content.

Dropdown menus and other hidden content

Some pages include content that’s initially hidden and reveals itself when a visitor clicks a button or hovers over something. Some examples include drop-down menus, photo sliders, accordions, tabs, and light boxes.

Without the proper ARIA roles, screen readers can’t identify what these types of elements are doing. Your code must notify screen readers when hidden content appears to let visitors fully interact with your site.

Best practices and technology have changed in the past couple years, so make sure your site adheres to the latest guidelines. A couple years ago, ARIA had very little browser support. Now it is becoming more popular, changing the standards for creating equal access to site content.

Depending on how old your site is, these changes may warrant a partial or complete redesign.

Conclusion

Full compliance with Section 508 and the ADA requires effort from everyone who contributes to your website. Make sure your designers, developers, and content authors follow the WCAG to keep your site in compliance.

While this post gives an overview of some commonly missed guidelines, achieving full legal compliance requires attention to many more details. You can get a complete picture of your current compliance by talking with an accessibility expert at an agency like Geonetric. Contact us if you’re interested in learning more.

Take Control with Digital Governance

In this video, Jill Jensen explains why digital governance matters to healthcare marketers.

You’ll learn:

  • Four components of governance and how they work together
  • How to improve the governance process you’ve started, or where to start if you haven’t yet
  • The benefits of creating a core strategy statement
  • When to use governance tools – like a content matrix – and why

Website Redesign: How Gundersen Health System Unified Its Digital Brand

With hundreds of locations and multiple microsites, Gundersen Health System was looking to redesign on a content management system (CMS) that would give the growing organization the flexibility and functionality it needed. Attend this webinar and hear from Gundersen Health on how they created a new, responsive main site, complete with provider ratings and reviews, and 11 responsive microsites that complement the overarching system brand – all built on one, flexible CMS.

You will learn:

  • What to look for in a CMS that will support an integrated system (hint: scalability, flexibility, and the ability to control your branding across the system)
  • The benefits of creating a user-focused content strategy that merges multiple sites under one digital brand
  • How to build custom, physician profiles that connect with site visitors and help them convert, complete with ratings and review

Beneath the Surface: How Web Design Impacts Your Site’s Health

How do you find and fix these trouble spots? In this webinar, we’ll reveal the invisible layers and hidden corners of your site’s design. We’ll share how to identify and triage the problems you’re likely to find.

You will learn:

  • How your site’s design can impact SEO, social media, accessibility, mobile user experience, site maintenance, and online conversions
  • Tools and techniques for testing web pages to uncover problems and opportunities
  • Which problems are critical to fix today, and which areas you should keep an eye on for the future

SEO for Healthcare: 10 Ways to Reach Healthcare Consumers Through Search

You’ll learn how everything from security to user experience can impact SEO, and how to:

  • Make your site secure
  • Get to know your users
  • Target your content appropriately
  • Provide a good user experience
  • And more…

If your organization is looking to improve rankings, focusing on these 10 key areas will help your team make the most of your optimization efforts.

 

Download our eBook


Eight Ways Your CMS Could Be Holding Back Your Healthcare SEO

Your external efforts to improve SEO can only have so much impact if your CMS isn’t doing its job. This white paper details the eight things to look for in your CMS, including:

  • Schema.org
  • Sitemap
  • Canonical URLs
  • Customizable metadata
  • And more…

Be sure to check if your current CMS, or the platform you’re evaluating, has the built-in functionality that’s needed to enhance your search rankings.

 

Download our White Paper


SEO for Healthcare: Reaching Healthcare Consumers Through Search

SEO is essential to ensuring it’s your information they find, whether that’s a clinic location, physician, or service offering.

You will learn:

  • The exploding variety of ways healthcare consumers are searching for information, and how to be the answer they find
  • What you should be doing today to ensure your SEO success continues, and where to begin if you’re not feeling successful yet
  • The concepts and buzzwords you must understand — schema.org, entity optimization, mobile-first indexing, AMP — to stay on top

Questions to Ask Your Potential SEO Agency

This white paper will help you find the right SEO agency for your healthcare organization. Download it today, and learn what you should be looking for, including:

  • Specialization in healthcare consumer behavior
  • Specific web writing experience
  • Expertise with schema
  • Experience with local optimization
  • Knowledge of web content management systems
  • Certification as a Google Partner

Partnering with an expert agency is more important than ever. Know what you want out of your potential partner, and don’t take a chance on an agency without asking the tough questions.

 

Download our White Paper


Lawsuits Put Web Accessibility On The Agenda For Healthcare

Legal actions against big brands has been a common tactic to raise awareness of the challenges of website accessibility and to encourage organizations to prioritize the costs and trade-offs of improved web accessibility. As far back as 2009, Target Corporation was sued for web inaccessibility. In more recent years, Universities such as Harvard and MIT have come under fire followed by online retailers such as Patagonia, Ace Hardware, Aéropostale and Bed Bath & Beyond. Healthcare has simply become the next industry to come under scrutiny at a time when the number of legal actions and threatened legal actions is rising dramatically.

What is Web Accessibility?

The Americans with Disabilities Act (ADA) prohibits discrimination on the basis of disability in places of public accommodation. ADA covers a long list of common disabilities including vision, hearing, cognitive, and motor skill impairments.

The ADA doesn’t specifically mention the digital world but, following the Target lawsuit, it has generally been considered to apply. Proposed changes in the ADA formalize the requirement for web accessibility.

It’s not always easy to see how these disabilities might impact a visitor’s experience with your website particularly for those not familiar with the functioning of assistive technologies. For example:

  • Hearing impaired visitors can’t follow video assets without closed captioning or transcription
  • Blind visitors using screen readers rely on a range of technical elements such as form tags to communicate important information about the page
  • A visitor with Parkinson’s disease may have difficulty with some tasks requiring use of a mouse if they cannot be performed with a keyboard
  • Text placed on top of images or patterned backgrounds may not be legible for colorblind visitors

What can organizations do to comply?

Lawsuits are happening today and all signs point to an increase in such actions over the next few years. With literally hundreds of possible accommodation options available, healthcare organizations should work with agencies with Accessibility professionals on staff, such as Geonetric, at least for an initial audit of your current level of accessibility compliance.

It’s also a good idea to familiarize yourself with the Web Content Accessibility Group (WCAG) 2.0 requirements.

Compliance programs typically have several phases.

  • An initial audit to assess the current state of compliance and baseline against which to measure progress
  • Recommended actions to improve the current accessibility compliance of the organization’s digital properties
  • A work plan which prioritizes the recommendations and assigns ownership and timelines for completion
  • An ongoing management plan which often includes training of content contributors to reduce the risk of introducing new accessibility issues in the future and annual reviews to assess progress and identify new compliance challenges and issues

Final Thoughts

Website accessibility has hit the front burner for many healthcare organizations because of these lawsuits. As we look at embracing accessibility for your organization, it’s important to remember that the reasons for treading this path go beyond risk management. Ultimately, making your web properties available to all visitors is the right thing for your organization to do, particularly for healthcare organizations. The organizations that we serve are driven in no small part by a mission to serve our patients and the community and this is an important part of that mandate.

Selecting a Web Content Management System for Your Health System

Whether you’re in the selection process, or wondering if you should be, this webinar will provide the information you need to make an educated choice.

You will learn:

  • Signs your CMS isn’t working for you (and how to know if the problem is really something else)
  • To maneuver the landscape of approaches and options for managing web content from both a technical and organizational perspective
  • Healthcare-specific considerations — including functionality, governance, and security — for selecting a web CMS