Health Literacy

Making Sure Your Web Site Is Accessible

Article from the Boston Globe’s On Call Magazine, April 2003

By Helen Osborne, MEd, OTR/L
President of Health Literacy Consulting

The World Wide Web is an important resource for many people. Its use goes far beyond simply communicating with friends or being entertained. For some, it’s a source of education, a way to find work, and a portal to healthcare information they need. But for people with disabilities, either temporary or permanent, the Web can be difficult to use, even frustrating. Unless you invest the effort to ensure your site is accessible, its useful content might never get to the people it’s intended to reach.

Jane just had eye surgery. Consequently, she cannot read the words or see the buttons on some Web sites she wants to access. When she tries to enlarge the font size to suit her needs, she finds most sites won’t let her do that. And when she installs a voice reader to hear text she cannot see, she hears the words “click here” far more often than any useful instructions. Or consider Sam, who has a progressive neurologic disorder. Sam lacks the fine-motor skills needed to control a mouse, so he navigates using only the keyboard. Consequently, he is frequently frustrated when he comes to a Web site and cannot get to the information because the keys aren’t adequate.

People like Jane and Sam need Web sites that are accessible and easy to use. Some need ways to increase font size or change colors to make the site easier to see. Others need alternative text that describes graphics such as maps, illustrations, or photos. Still others need to be able to operate buttons, navigation bars, and hyperlinks only by using keys on the keyboard such as “Tab,” “Enter,” up and down arrows, and page up and page down keys.

Shawn Henry is the Web Accessibility Initiative (WAI) outreach coordinator for the World Wide Web Consortium (W3C). She says that accessible Web sites benefit everyone, not just people with disabilities. She cites alternative text as an example. People who are blind or have low vision can use voice reading software with alternative text to understand the graphics they cannot see. That same “alt text” also helps people without disabilities who use hand held devices or have slow Internet connections. When they turn off the images so they can access Web pages faster, alt text lets them read what these images are supposed to be.

If you want to improve the accessibility of your own organizations Web site, start by asking your patients about the challenges they face. Next, test the site for potential access problems. Then share what you learn with colleagues, administrators, Web developers, and IT specialists to help improve your Web site’s accessibility. Here are some ways Henry suggests you can start.

Test your Web site without a mouse. Many people have difficulty with the computer mouse. This includes people who use mouth sticks or head sticks, or those with hand tremors or other fine-motor difficulties who cannot click or double-click the mouse. It also includes those who have trouble learning. “The mouse is not intuitive,” says Henry. “It’s hard for many people to connect what they see with what they need to do.”

Henry recommends that you try navigating the Web site without a mouse. See how easy or hard it is to get from one page to another using only the keyboard. For example, try using the Tab key to move to links and the Enter key to select a link. Once you identify problem areas, talk with your organization’s Web developer or IT specialist about ways to make these tasks easier.

Test your Web site with a voice browser or screen reader. Screen readers and voice browsers are two kinds of software that read aloud information displayed on computer screens. Screen readers are more powerful than voice browsers and can read most computer applications including word processing, spread sheets, e-mail, and Web information. Screen readers, however, are expensive and many people find them hard to learn. Alternatively, voice browsers cost less (some offer free 30-day trials), are easier to use, but only read information found on the Web.

Henry suggests you familiarize yourself with this kind of software. Download one of the products and listen to what Web sites sound like when read by synthesized speech. You then can talk knowledgably with patients about this type of software and also see more readily what needs to be improved on your organization’s site.

Test your Web site with an accessibility evaluation tool. After you’ve tested your site with a Web browser and without a mouse, you might also want to try an automated accessibility evaluation tool. The Health Literacy Consulting Web site ( for example, uses the “Bobby” evaluation tool. While tools like this pinpoint specific problems, Henry cautions that their detailed reports may at first seem overwhelming. She recommends you add a dose of common sense and writes about this in an online article, Web Accessibility Evaluation Tools Need People.”

Educate Others About the Need for Accessible Web Sites

  • Talk with patients and families about the challenges they face navigating the Web. Ask about the software they use to make this task easier and offer to help them find additional resources as needed.
  • Talk with Web developers and IT specialists about the challenges patients face and about your testing experience. Even though accessibility guidelines have been in place for many years, some technical specialists are unaware of what they need to do. Let them know about valuable resources like WAI that provide technical information and tools to improve accessibility.
  • Talk with colleagues and administrators. Share the news about accessibility with people who develop, design, and pay for your organization’s Web site. Let them know that even the most attractive and informative Web site is of little value when it cannot be accessed and used.

How to Find Out More

Shawn Henry is the Web Accessibility Outreach Coordinator at WAI. She is also the Web master and developer of UIAcess (, an online resource about universal interface design and Web accessibility. You can reach Henry by e-mail at

  • WAI, in coordination with organizations around the world, pursues accessibility of the Web. To read more and find links to resources, go to
  • “Evaluating Web Sites for Accessibility” is an online resource that describes approaches for evaluating Web site accessibility. You will find it at
  • “Bobby” is an automated tool to help web page authors identify and repair barriers to access by individuals with disabilities. To learn more, go to

Article reprinted with permission from On Call magazine and published by a division of Boston Globe Media.