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Healthcare providers, both private and public, are required by the Americans with Disabilities Act (ADA) to offer equal access to healthcare services and facilities, including websites and other digital information. To ensure that you are complying with the provisions of the act, ADA compliance testing is, to say the least, “recommended.”

With healthcare costs for people with disabilities reported to comprise 26.7% of all healthcare costs in the country, totaling approximately $400 billion per year, doing so makes sense from both a business and regulatory standpoint—And not doing so clearly impacts an enormous portion of patients who need healthcare services.

Given that not all websites have taken the steps necessary to make them accessible to people with disabilities, making their website ADA compliant offers healthcare providers the opportunity to differentiate themselves from their competitors.

Barriers to Access

There has been significant publicity, in recent years, relating to the need to comply with Title III of the ADA, which states that places offering public accommodation must remove “access barriers” that would prevent a person with disabilities from accessing an organization’s services or products.

What constitutes a barrier to access?

One example would be if an individual who is blind is unable to use screen-reading technology because a website hasn’t been designed to accommodate such software. Another would be if a person with a hearing disorder had to watch an instructional video with no closed captioning provided.

Those don’t seem like user-friendly experiences, do they?

Similarly, a patient with manual dexterity challenges is likely to become frustrated using a website that doesn’t accommodate assistive technology.

Enhancing the Patient Experience with ADA Compliance Testing

If your website has barriers that prevent people with disabilities from easily accessing it, performing ADA compliance testing can help improve the patient experience. Following are four ways in which ADA compliance testing to make sure a website is compliant with WCAG 2.0 (Website Content Accessibility Guidelines):

• Making sure your website can be navigated solely by keyboard. People whose physical disabilities prevent them from using a mouse will find your website difficult to use unless you have tested it to ensure that users can access all functionality (browsing, purchasing, accessing links, etc.) with just the keyboard.  
• Selecting a proper contrast ratio between your site’s text and its background. Patients with visual impairments can find it difficult to make out the text on your site if you haven’t tested the contrast ratio to ensure it meets minimum visibility standards.
• Testing your website’s text-scaling capability. To ensure maximum accessibility for readers, test your website to verify that it can process text scaling to as high as 200% without this causing horizontal scrolling or other layout problems that make it hard to read your site’s content.
• Verify that your site works with screen reader software. This type of software converts the text on your website into a form (such as text-to-speech) that can be understood by people with visual impairments. Testing your site to make sure that it can accommodate such software is crucial to staying in compliance with the ADA’s accessibility requirements.

Testing all of the above aspects of your website’s functionality enables you to make improvements where necessary, so it is easier for people with disabilities to use your site. This, in turn, can significantly improve the patient experience for those users.

Benefits of Improving the Patient Experience for People with Disabilities

There are a number of benefits you can derive from testing your site to make sure it is accessible to people with disabilities. These include:

• Reduce any potential legal liability: There have been a number of instances of patients or patient groups suing healthcare providers who failed to comply with the ADA. By testing your site to ensure that it is in compliance with the ADA, you can reduce the likelihood of being sued for noncompliance.  
• Boost your potential customer base: There are over 50 million people in the U.S. with disabilities, according to the United States Census Bureau. By making sure your website is easy for them to use, you instantly increase the number of patients you can serve.
• Improve patient loyalty: Patients with disabilities who already work with your organization are likely to
  appreciate your efforts to make sure they can easily access information related to their care online. Doing so can enhance patient loyalty, helping you keep patients happy (and less likely to look elsewhere to meet their healthcare needs).
• Enhance search engine optimization (SEO) efforts: When patients search for your category of healthcare, the higher
  your organization’s name is on the list, the more likely it is that web searchers will contact you.

Search engines gauge a site’s accessibility to users, among other factors, when determining how high a site rates in their rankings. By taking the necessary steps to make your website easily accessible by people with disabilities, you can also boost your site’s ranking with the search engines, helping you attract more business.

Start Your Website Compliance Check

Not sure if your website’s compliant with ADA? User1st takes the first step towards compliance for you by analyzing your website to identify accessibility issues. Find out how accessible your website is today.

What You Need to Know to Protect Your Business

After years of court battles, the legal precedent has been set. Companies and organizations can be penalized if individuals with disabilities cannot access their online content.

As the Internet becomes an ever-growing part of our everyday lives, numerous pieces of Federal and State legislation are now focusing on web accessibility. To avoid costly fines, businesses need to start incorporating web accessibility into their website design and development cycle. In addition to protecting themselves from litigation, doing so will also help them attract and retain customers with disabilities as well as build goodwill with the public at large.

What are Common Reasons for Web Accessibility Complaints?

Causes for web accessibility complaints are wide-ranging and in many cases depend on a particular person’s disability. Although no business can account for all forms of disability, the World Wide Web Consortium (W3C), the main international standards organization for the Internet, has published a set of guidelines to help make online content accessible to individuals with disabilities, called the Web Content Accessibility Guidelines (WCAG). WCAG 2.0, the second iteration of the guidelines, focuses on four principles that are necessary for web content to be considered accessible:

• Perceivability: Information and user interface components must be presentable to users with disabilities in ways they can understand it; content needs to be transformable from one format (e.g., sight, sound) into another (e.g., alternative text). Form fields also must have labels so screen readers can read them to users. Headings, link groups, and paragraphs must be structured appropriately so screen reader users can identify and navigate to them easily.
• Operability: User interface components and navigation must be usable through various input methods (e.g., using a mouse, keyboard, voice input)
• Understandability: Information and the operation of user interface must be comprehensible. This includes writing content in plain language, explaining jargon and acronyms, and intuitive and consistent navigation
• Robustness: Content must be robust enough that it can be interpreted reliably by a wide variety of user agents—including assistive technologies—and across operating systems, browsers and mobile devices

While there are certainly unique cases and circumstances that require further accommodations, following these guidelines will not only address the majority of potential complaints and ensure consumption by users with disabilities but also protect a business from legal liability.

How to Address Web Accessibility Complaints

Receiving a web accessibility complaint does not inherently mean a loss of customers. Handled properly, responding to a complaint can show your customers and users that you care about their concerns and can even help them build a stronger relationship with your brand. Here are some steps to turn a web accessibility into a positive situation.

• Quick Response

Responding quickly to a complaint and acknowledging the existence of a problem is always the best course of action. Addressing the specifics of the complaint may take some time, but all organizations must make clear that they are working swiftly to address the concern.

• Assessing the Issue

The organization must then review the complaint to see whether it is an isolated occurrence, such as an outside glitch, or whether it is a perpetual issue.

• Planning a Course of Action

If the issue is perpetual (ex: a webpage whose content cannot be read by a screen reader), a plan to remedy the issue must be devised. In many cases, this involves restructuring a web page or recoding the site, which may require the expertise of an accessibility specialist.

• Correcting the Issue and Reviewing

Once a plan is set in motion, the actual remediation must occur. This is followed by a review and test phase to ensure that the complaint has been resolved. This normally involves end users testing the site, and it may include the initial person who filed the issue to ensure that their complaint has been addressed to their satisfaction.

How to Avoid Future Web Accessibility Complaints

Ensuring that your web pages are accessible to individuals with disabilities seems like a daunting task; it requires a significant monetary and time commitment that may not be seen as worth the effort. This approach is misguided as the costs associated with being inaccessible can have far greater consequences than the costs required to achieve accessibility in the first place. Besides the legal fines, not having accessible content also means missing out on a significant number of potential customers.

The best way to avoid future web accessibility complaints is to make it a top priority during the development phase. Finding out how to incorporate web accessibility early on can save time and money down the road. Likewise, continuous monitoring of your site’s compliance with the WCAG will ensure that your site is shielded against legal action.

Nevertheless, the reality is that the sheer volume of content and information an organization produces on a daily basis makes achieving (and maintaining) web accessibility a challenge. New web accessibility techniques exist today that automatically update web pages to WCAG standards and offer continuous monitoring to ensure your web pages are always accessible.

The future of web accessibility is in automation. Automated systems provide both a cost- and a time-effective solution to web accessibility. Automation reduces cost by not requiring a dedicated web accessibility specialist and reduces time to achieve compliance by not requiring manual recoding. Likewise, it increases overall company efficiency by keeping your development efforts focused on your business rather than on web accessibility compliance.

Thirty years ago, the landmark legislation of the Americans with Disabilities Act (ADA), opened the doors of opportunity for people with disabilities to have equal access to jobs, services (such as healthcare), and consumer goods and services (shopping, banking, homebuying). In today’s digital economy, access has moved online and the need for equitable access couldn’t be greater. Online accessibility is the safest accommodation for people with disabilities to obtain the essential services they need in this COVID environment.

In 1990, the first website was just being developed. Since then, the majority of websites were not developed to be compatible with assistive technologies such as screen readers. We have a lot of catching up to do, but with cloud technology, businesses and organizations have several options to implement web accessibility quickly and in a cost-effective manner.

Although ADA accessibility lawsuits were already pushing more businesses and services toward web accessibility, COVID-19 accelerated the need for accessible online access to goods, services, and information. As we look toward economic recovery, web accessibility can be a force multiplier—a way to drive more digital business and realize cost savings–while providing people with disabilities the access to essential goods and services they need.

Before organizations can fix their websites, they need to know their site’s accessibility posture – if their website meets current guidelines and if not, what are the errors and how many need to be fixed.

Choosing the Best Web Accessibility Testing Tool for Your Needs

Website accessibility testing is a top trending topic among the web development community, and businesses and organizations are looking to integrate accessibility testing to mitigate their legal risk and improve their SEO. The increase in ADA website accessibility lawsuits as well as the increase online use due to the coronavirus has thrust web accessibility to the forefront of web design.

Much of the focus has been on automated testing, however, this only tells part of the story. Automated accessibility testing can only detect approximately 40% of accessibility errors plus/minus 5 points depending on which expert you talk to. Promises of “full accessibility” without manual accessibility testing fall short of meeting accessibility compliance requirements. While automation and AI has the promise of reducing the work required for accessibility, these 100% guarantees fail manual, human accessibility testing in most cases, leaving your organization vulnerable to a lawsuit. Automation and AI is intended to support, but not replace, the human effort for the highest levels of usability and compliance

Web accessibility testing supports quality assurance goals of providing an inclusive customer service, mitigate legal risks, and improve website performance. Good accessibility testing allows you to detect and remove barriers that a person with disabilities may encounter so your site provides the same service to all customers. As defined by the World Wide Web Consortium (W3C), “Web accessibility testing is a subset of usability testing where the users under consideration have disabilities that affect how they use the web.”

It is always best practice to test during development and content creation of your website. No matter if you are testing during development or after, accessibility user experience testing should include manual testing with screen readers in addition to automated to ensure full compliance with W3C Web Content Accessibility Guidelines (WCAG) 2.1 and protect your brand.

Manual Accessibility Testing 

There are tools you can use to test your own site if you have the in-house capabilities. If you work with a vendor for testing, you should also be aware of the assistive technologies they use for quality assurance.

There are few assistive technologies that most widely used depending on geographic location.

• For desktop testing: Jobs Access with Speech or JAWS has been very popular especially in North America. Internationally, Non-Visual Desktop Access or NVDA has the most usage, but recently this open source screen-reader has grown in popularity in North America.
• Apple’s screen-reader VoiceOver is a distant third in usage on desktop. For mobile testing: In North America VoiceOver on iOS devices has dominated usage statistics with some surveys saying as high as 80%. TalkBack, Android’s mobile screen-reader makes up most of the rest of the market and usage.

The right accessibility testing approach and what assistive technology to use depends on a number of factors unique to your organization, its current accessibility posture and compliance goals. For more information regarding manual and automated testing, contact a User1st accessibility specialist.

Automated Accessibility Testing

As many organizations look for efficiency, automated testing help you catch and fix errors quickly and guide your manual testing efforts leading. The best practice is to combine the two in a repeatable process that allows you to prevent regression and keep pushing the accessibility arrows up.

With so many automated tools on the market, how do you evaluate which is best for your organization? First, you should define your needs.

Here are the 5 factors to consider when selecting accessibility testing tools:

1. Scope: Are you going to test a few pages only, or are you going to check the entire website or web application?
2. Number of participants: Do you have few or many employees in your organization that will utilize the testing platform?
3. Stage in the development cycle: Are you interested to connect the tool you have to your development CI/CD dev cycle or have the platform validate the code and content that is already in production? For those with an advanced CI/CD integration, you will be able to identify patterns quickly with the right platform.
4. Quality over time: Accessibility testing in general and maintenance of UI components, can be challenging if there are constant design changes or communication challenges between the development and marketing teams. You’ll want to maintain consistency in your testing process and handling of results.
5. Quality: Level of accuracy you are seeking in your tests based on your compliance goals.

After assessing your needs, know the Pros and Cons of the 4 types of Testing Tools Available. 

1. Browser plug-ins  Cons: Plug-ins will not allow you to scan many pages at once. It will not also allow you to connect the tools to your Dev environment and will not provide ways to compare scans you may do before, during, and after remediation. If you have many people using the plugin, each person may also come away with different results.
   • Pros: Free and easy to implement.
2. Automated APIs
   • Cons: Will require an integration into your internal systems, which can be costly. May scan the pages over a browser-less docker, which may lead to low quality of tests due to limited validation capabilities. Some of the available accessibility testing tool options on the market will not have integration abilities into your CI/CD process while some will. Some will not have interface for developers and testers, and the process can only be done over a ticketing system or Jira.
   • Pros: Cheapest on the market
3. Online applications
   • Cons: Can provide the service probably only on the last stage of the Dev cycle. Will not include tools to capture user experience flows.
   • Pros: Cheap and will not require an integration into your internal systems.
4. Onsite installations (CI/CD)
   • Cons; Most expensive
   • Pros: Will require integration into your internal systems, and the use of docker.

User1st Combines All 4 Testing Tools in One Affordable and Enterprise Grade Testing Platform.

Check1st™ is a robust automated accessibility testing tool, that has all the above: browser plugin, API and Jenkins integration, user experience flow and simulation and recording abilities, online solution and interface, and onsite Docker installation.

Check1st’s abilities can help you indicate keyboard focus and mouse activity simulation, executing over 90 accessibility validation engines that scans the DOM elements over a real browser. With these capabilities you will be able to integrate with your Dev cycle, with your unit testing of UI libraries, be provided with interface for its regression results of different scans in different point in time, and include unlimited pages to be tested.

By combining Check1st™ capabilities with User1st manual accessibility testing services, your will be able to generate code quality base line, and potentially prevent regressions from deploying to production.