Abstract

BackgroundDespite the introduction of the Web Content Accessibility Guidelines and legislations, many websites remain poorly accessible to users with disability, especially those with visual impairment, as the internet has become a more visually complex environment. With increasing reliance on the internet and almost 2 million people in the United Kingdom being affected by vision loss, it is important that they are not overlooked when developing web-based materials. A significant proportion of those affected have irreversible vision loss due to rare genetic eye disorders, and many of them use the internet as a primary source of information for their conditions. However, access to high-quality web-based health information with an inclusive design remains a challenge for many. We have developed a new web-based resource for genetic eye disorders called Gene.Vision that aims to provide a holistic guide for patients, relatives, and health care professionals.ObjectiveThrough a usability testing session of our website prototype, this study aims to identify key web-based accessibility features for internet users with vision impairment and to explore whether the contents provided in Gene.Vision are relevant and comprehensible.MethodsA face-to-face testing session with 8 participants (5 patients, 2 family members, and 1 member of the public) and 8 facilitators was conducted on a prototype website. Remote testing was performed with another patient due to COVID-19 restrictions. Home page design, navigation, content layout and quality, language, and readability were explored through direct observation and task completion using the think-aloud method. A patient focus group was organized to elicit further feedback. Qualitative data were gathered and analyzed to identify core themes through open and axial coding.ResultsAll participants had good computer literacy; 6 patients with visual impairment used visual aid software including iOS VoiceOver and Speak Screen, iOS Classic Invert, ZoomText 2020, Job Access With Speech, and Nonvisual Desktop Access. The features identified by the participants that will enhance accessibility and usability for users with visual impairment were a consistent website layout, a structured information hierarchy with a clear description of links, good chromatic and luminance contrast, a simple home page with predictable and easy navigation, adaptability to various assistive software, and readable and relevant content. They reported that dynamic content (such as carousels) and large empty spaces reduced accessibility. Information on research, support available, practical advice, and links to charities were incentives for repeated website visits.ConclusionsWe demonstrated the importance of developing a website with a user-based approach. Through end user testing, we identified several key web-based accessibility features for people with visual impairment. Target end users should always be involved early and throughout the design process to ensure their needs are met. Many of these steps can be implemented easily and will aid in search engine optimization.

Highlights

  • BackgroundPeople with disabilities have been recognized to experience inequalities in multiple aspects of their lives from education and employment to health care, finances, and leisure [1], with the internet being a key accessibility feature in all areas

  • The features identified by the participants that will enhance accessibility and usability for users with visual impairment were a consistent website layout, a structured information hierarchy with a clear description of links, good chromatic and luminance contrast, a simple home page with predictable and easy navigation, adaptability to various assistive software, and readable and relevant content

  • We identified several key web-based accessibility features for people with visual impairment

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Summary

Introduction

BackgroundPeople with disabilities have been recognized to experience inequalities in multiple aspects of their lives from education and employment to health care, finances, and leisure [1], with the internet being a key accessibility feature in all areas. With an increasing reliance on the internet and almost 2 million people in the United Kingdom being affected by vision loss, of which 360,000 are registered with visual impairment or severe visual impairment (blind), it is important that they are not overlooked when developing web-based materials lest they risk being socially excluded altogether [5,6]. To make the internet more accessible, the World Wide Web Consortium first introduced the Web Content Accessibility Guidelines (WCAG) in 1999; its current iteration (WCAG 2.1), published in 2018, serves as an update rather than as a replacement of WCAG 2.0 (introduced in 2008) It contains 13 guidelines based on 4 main principles: perceivable, operable, understandable, and robust, with each guideline having 3 levels of testable success criteria—A (lowest level of accessibility) and AA and AAA (highest level of accessibility) [7]. We have developed a new web-based resource for genetic eye disorders called Gene.Vision that aims to provide a holistic guide for patients, relatives, and health care professionals

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