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How tech’s brightest stars are putting accessibility first

  • min read
    • Today, tech firms are starting to realize it's good for business if their technology is accessible to all users, whether disabled or non-disabled. But knowing that accessibility matters – and making it a core business priority in actions as well as words – are different things. I've been speaking with two companies celebrated for putting accessibility first in product design – fast-growing accounting software business Xero and accessible app and software designers Axess Lab. I also spoke with Siteimprove – a company making software that helps businesses catch and fix website accessibility problems. "Accessibility is important because customers are at the center of everything we do," says Laila Coulton, Head of Digital Accessibility at Xero. "Our culture values diversity and inclusion. We want to make a difference by championing these values within our sector and the broader community. As a large tech company, we believe it's our obligation." Hampus Sethfors, Co-founder and Accessibility and User Experience Specialist at Axess Lab, thinks similarly. "I see it as being on the right side of history. People with disabilities have been excluded and discriminated against. It's time humankind stepped up. Making the digital space inclusive is a huge part of that." Sethfors believes improved accessibility for disabled people benefits all users. "I've got a baby at home and constantly find myself one-handed, lacking time and lacking sleep. Building products that work for people with impairments is a way to build awesome products for everyone." How common are accessibility problems? Axess Lab examined digital products like banking apps, online shopping sites and food delivery apps to find out if disabled users can complete routine tasks. They've found problems so widespread that, more often than not, web users with disabilities simply can't use them. Sethfors thinks one of the main reasons behind this is that software engineering and web designer education rarely includes practical accessibility skills or knowledge. "Too few tech professionals have accessibility training. If you're trained, accessibility is little or no extra effort. Picking colors with enough contrast doesn't take longer than picking colors that contrast poorly – you just need to know how." Accessibility, usability or both? Some use terms like accessibility and usability interchangeably. But are they the same thing? Coulton of Xero says, "The two are intertwined. I challenge my teams to start with usability rather than ticking off accessibility compliance criteria. The focus should always be on the user experience. Accessibility is making sure as many people as possible enjoy those usable experiences." Sethfors points out, "If your product is only usable for some, it should be called Some User's Experience, or SUX, as Ubisoft accessibility specialist Billy Gregory tweeted. Usability is more than accessibility, but a product can't be usable unless it's accessible." Accessibility can mesh well with security and affordability too. Take, for example, Motorica, who work with prosthesis users to create high-tech, secure and affordable artificial limbs. Kaspersky helps Motorica make sure its prostheses are safe from cyber-intrusion. Focus on making things work for users Coulton says Xero reviews designs using the Perceivable, Operable, Understandable and Robust (POUR) framework from the Web Content Accessibility Guidelines (WCAG). The World Wide Web Consortium created it in consultation with disabled web users to give standards for making digital products accessible. "We review and test code, including automated and manual testing against the WCAG success criteria. We do functional testing using screen readers such as VoiceOver, NVDA and TalkBack. We also test and research with users with disabilities." Sethfors says sometimes businesses get too hung up on the guidelines. "They're long and complex, but accessibility is super interesting, fun and engaging. Instead, focus on making things work for users." Jennifer Chadwick, Senior Accessibility Consultant at Siteimprove, agrees. "Using a checklist to comply with WCAG is an excellent practice to introduce teams to implementing accessibility. Companies should also run regular usability testing with people with disabilities. Sites can comply with WCAG but not be optimal for users, so using the guidelines and conducting user testing is best." Where accessibility work fits When is the right time in development to think about accessibility? Coulton says, "Across the whole cycle. We start with inclusive research and setting the accessibility scope. Designers and Front End Developers must ensure accessibility is part of their definition of 'done.' We validate with user testing and the WCAG success criteria." Sethfors thinks you can never start too soon. "I'd start before the development cycle and build accessibility into current business habits. If you acceptance-test regularly, add accessibility criteria. If you user-test every other month, recruit one or two diverse users for each test. Take small steps, everywhere, all the time. It's more effective and fun, and less costly." Tobias Christian Jensen, Siteimprove Digital Accessibility Specialist, says it's crucial to be proactive. "Fixing accessibility retroactively is like adding plumbing after building a house. Accessibility should be a part of every step." Jensen recommends adopting a practice of Shifting Left, described by Siteimprove's Chadwick as, "Moving efforts around designing and testing for accessibility issues as far back in the workflow as you can. Everyone – from UX and graphic designers; to content writers; to developers – must consider the needs and preferences of people with disabilities as early as possible." Finding testers with disabilities So at some point (ideally, many points,) you'll need to find people with a range of disabilities to test your products. These include physical impairments, like motor impairment and using prosthesis, low vision, Deaf or hard of hearing, but also invisible impairments, like memory loss and inability to focus. Then there's neurodivergence such as autism, ADHD and learning difficulties, and much more. Sethfors suggests, "Find and partner with disability organizations in your area. Make sure you have a way to pay users to take part. If you need help recruiting, Fable specializes in recruiting diverse test users for larger organizations." Siteimprove has a rewarding partnership with Fable. "Our software monitors your efforts to meet WCAG conformance and best practice for code. We combine this with usability assessments for the most complex and high-traffic webpages by Fable's testers. Both provide valuable reports on barriers to remove." Starting your accessibility journey Coulton points to Sheri Byrne-Haber's words in her handbook for designers, Giving a Damn About Accessibility. "To avoid the peaks and valleys of the accessibility emotional roller coaster, people just getting started on their accessibility journey need to accept the following statement at face value: Your first effort at accessibility is unlikely to be outstanding. Don't use this as an excuse." Sethfors adds, "If you approach accessibility in the right way, you'll have a blast, make your team proud and create a better product for everyone."
making technology accessible

How healthcare businesses can make their tech more accessible

  • min read
    • Tech advances in healthcare have benefited millions. From online doctor appointments to remote diagnosis aides like the digital stethoscope, digitalized medicine and telehealth has increased health access for many. But some groups are locked out of healthcare despite the digital healthcare revolution. Hospitals and clinics, and medical device developers and suppliers must be more aware that a good portion of the population can't use some new services, because their needs weren't considered in the design. I'm talking about the 15 percent of the global population with a disability – from learning disability to visual impairment to motor impairments and many other conditions. If people with disabilities can use these new technologies, they could benefit more than any other group. Accessible health tech doesn't happen by accident Imagine you're blind and have a chronic health condition, so you need ongoing doctor appointments. You'll be expected to organize much of this online, including registering on the clinic's portal, booking appointments and paying bills. If your appointment is in person, you may need to check in using an automated kiosk or speak to your doctor online using video conferencing. While these tasks are effortless for many people, they can be a barrier for those with disabilities. Cutting-edge technology too often leaves the most vulnerable behind. Medical devices should be tested with customers with a range of disabilities to make sure they can use them. Still, studies show patients with disabilities report many problems using medical devices and equipment. When accessibility is considered, it's often an afterthought rather than a requirement. Around the world, many countries have laws safeguarding the rights of people with disabilities. Ignoring these regulations is a risk for business and public institutions alike. Digital accessibility lawsuits are fast increasing. Examples of accessibility barriers in health tech Blood glucose meters Blood glucose meters or glucometers help people with diabetes track blood sugar levels to ensure they stay within a healthy range, usually by the user placing a drop of blood on a testing strip and reading the blood sugar level from a screen. That's easy unless you have, say, a tremor, lack of dexterity or low vision. Diabetes can cause sight loss, making impaired vision more common among people with the condition. Inaccessible equipment may force some diabetics to rely on others to help keep their conditions in check. This loss of independence can be frustrating: Relying on others may mean scheduling your life around them or extra costs for rides or aides. Pregnancy tests For many, a pregnancy test result is something they want to share with a partner or other people, but not always. What if you couldn't see the result and had to ask someone to read it for you? UK charity supporting those with sight loss RNIB has developed a prototype for a tactile pregnancy test which may one day be a mainstream product. Appointment check-in kiosks Nowadays, institutions and businesses offer digital kiosks for many tasks, like checking in for flights and ordering food. In healthcare, kiosks are especially popular for appointment check-ins. Protecting patient privacy is critical. More accessible kiosks would help people with disabilities maintain privacy while providing information a healthcare institution might need. Laura Miller, former co-chair of the kiosk accessibility committee for the Kiosk Manufacturers Association, says, "Without access to medical information, autonomy in viewing and updating personal healthcare facts and the right to medical record privacy, people with disabilities can't securely navigate their medical journey without help. Critical to an accessible healthcare experience is being able to privately listen thanks to a headphone jack and screen reader and being able to navigate and communicate information." Website and app accessibility A visually impaired patient may need to use different websites and online portals for healthcare-related tasks, like using review sites to research doctors or using online portals to get medical records. If these websites are not accessible, they would have to ask someone for help. Keyboard-only users (not everyone can use a mouse) may find it impossible to fill out a form or reveal roll-over content. A cognitively impaired person may be overwhelmed by huge blocks of text not broken up by headers. Someone with low vision or color blindness may not be able to see buttons or read text that contrasts poorly with background color. There are guidelines to follow to make websites, apps and PDF forms accessible. The World Wide Web Consortium (W3C) – an international organization seeking universal web access – developed the Web Content Accessibility Guidelines (WCAG) in consultation with disabled web users. These guidelines give technical criteria that make the web easier to use for people with many impairments. For example, using descriptive link text ensures those using a screen reader can understand where a link will lead them. Making calls to action and navigation links larger helps someone with reduced dexterity more easily use them. Although many of these guidelines are easy to follow when you know how, most websites don't follow basic web content accessibility guidelines. Online medical appointments Online appointments, sometimes called telehealth, skyrocketed during the pandemic. Though it won't replace in-person doctor visits, it's convenient and cost-effective, and many have chosen to keep using the service. It's even more important that people with disabilities can access online appointments because some face barriers leaving their homes, making in-person appointments hard. But if the remote appointment app or website doesn't work with screen readers, visually impaired people may not be able to use it without help. Telehealth is off the table for patients with a hearing impairment unless there are on-screen captions (subtitles.) How to start your accessibility journey What every company or organization must do to improve accessibility for patients, customers and clients is different, but here are some ways to get started. Automated accessibility testing A fast way to understand your digital content's accessibility is to run an automated scan for machine-detectable accessibility errors using a tool like ARC Monitoring. Google Lighthouse also has accessibility assessments among its features. Automated scanning identifies less than half of the barriers a person with disabilities may encounter online. You must manually audit to make sure you catch all problems. Manual accessibility auditing An accessibility audit is a manual review by an expert that finds WCAG failures only a human can identify. While any trained accessibility auditor should know the difference between accessibility 'box-ticking' and true accessibility, organizations like TPGi and Australia's Disability Accessibility Centre have auditors with the disabilities they're checking for barriers around, so could give you a more reliable and thorough picture. Ask for feedback While it's best to get feedback on a product or digital application during design and build, it's never too late to find out what users think. Ask for feedback from people with disabilities on where they're finding barriers, for example, by providing an accessible online form, email address or phone number for reporting an access barrier. Focus on the most crucial user journeys – the main things your users need your service to do. Observing users trying to get through these journeys, either in person or remotely, can be hugely informative. Bear in mind, voluntary feedback isn't enough to ensure a product is accessible. Not all customers want to or have time to tell you about barriers they face. Once your tech is accessible, maintain it Once your organization is at the point where its tech is reasonably accessible, you need to maintain the accessibility. Here's how. Decide accessibility is a must for every project Buy-in from stakeholders matters. Projects may need longer timelines for more quality assurance, developers may need training and it may cost more to ensure you're doing it right. Buy-in from senior leadership affects everything the organization does, from the culture to choosing vendors to your results. Build accessibility into product and service design The earlier in the design process you consider accessibility, the better. Your website is probably the biggest product you control, so if you're planning a redesign or adding something new, bake in accessibility considerations. You'll save time on a smoother launch and fewer remediations down the line. Monitor accessibility Digital assets are always changing. As you update websites and add new content, monitor for accessibility issues. Train employees in accessibility When you train employees in all divisions, not just developers, on what accessibility is and why it matters, it creates an inclusive culture. People start adding accessible features, code and tactics to projects, meaning better results and fewer fixes later. It may seem daunting to start an accessibility journey, but the rewards outweigh the obstacles. People with disabilities could gain much from healthcare's digital transformation, but tech designers must make sure we understand and commit to accessibility. There'll always be more to learn, but with forethought, we can design healthcare tech that meets more people's needs.
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