Accessibility in HealthTech – How to Design Apps That "Speak" to Everyone?

If you believe digital accessibility is not a significant issue, attempt to access a website on your laptop using a screen reader. If it's your initial attempt, you will likely struggle without searching online for instructions. Even after managing to enable it, you'll likely encounter difficulties in obtaining the correct information.

Consider the frustration experienced by approximately 15% of the global population who regularly encounter accessibility challenges when reading or navigating through an online application.

Having limited health literacy can pose challenges for individuals to derive benefits from apps that offer health education or enable doctors to gather health information.

Similarly, limitations in general literacy act as significant barriers to utilizing anything beyond the most straightforward applications. Insufficient technological literacy, which can particularly affect older individuals and users who lack regular access to computers and smartphones, further contributes to the inaccessibility of healthcare apps.

Accessibility is frequently disregarded by product designers, programmers, and business owners under the misconception that individuals with disabilities do not utilize their products. However, this belief is a myth. It is impossible to determine the exact number of disabled users who access or attempt to access a website. This is primarily because the assistive technologies employed by these users cannot be tracked using standard analytics tools.

Regardless of the available data, digital accessibility should not be considered a luxury. Just as physical spaces are designed to facilitate easy navigation for people, we must also design digital applications that cater to those who wish to access them. When we deny accessibility to users based on their impairments and disabilities, we erect a barrier between them and the rest of the world.

The Growing Need for Accessibility in Digital Health Apps

The issue of accessibility in healthcare products is particularly significant. Healthcare applications are intended to improve health outcomes and enhance the efficiency of healthcare services. However, if these applications are inaccessible, how can users with color blindness, cognitive and learning disabilities, or hearing difficulties benefit from them?

When examining disabilities, it becomes apparent that they encompass a diverse range. Disabilities generally fall into four primary categories: visual impairments, physical disabilities, hearing impairments, and cognitive challenges.

Imagine a situation where a visually impaired person wants to use a popular application. Insufficient contrast between the background color and text color in an application can make it difficult for her to distinguish elements such as icons and placeholder text.

Frequently, placeholder text in form fields is presented in a light gray color, which can be challenging for users to perceive easily. Consequently, users may need help to see the example text and comprehend what information they are expected to enter. Color blindness, affecting approximately 1 in 12 men and 1 in 200 women, can also significantly impact user interactions with a health app. While using red to indicate errors is common, individuals with color blindness may be unable to perceive this color.

A significant number of apps are not designed to be compatible with keyboard navigation, causing difficulties for users who are unable to use a mouse, such as individuals with visual impairments or dexterity challenges.

Presenting information without a clear visual hierarchy poses difficulties for most users when trying to scan through it. This can significantly hinder older individuals and those with limited health or general literacy. Similarly, health and wellness apps that aim to educate will fail in their purpose if the content includes excessive jargon or assumes a high level of literacy or health literacy. Additionally, overly complex forms can create barriers for users. Many medical practices attempt to streamline paperwork by providing electronic forms to patients before their appointments. However, users with various disabilities and literacy challenges can feel discouraged by lengthy onboarding questionnaires and forms that are hard to understand and complete.

‍

‍

WCAG: The Gold Standard for Digital Accessibility in HealthTech

Designers and developers can ensure the accessibility of apps by adhering to the Web Content Accessibility Guidelines (WCAG) established by the World Wide Web Consortium, which have gained international adoption.

While the WCAG consists of over 60 guidelines, they can be categorized into four main areas: perceivability, operability, understandability, and robustness. By following these guidelines, designers, and developers can take significant steps toward creating accessible apps.

WCAG defines three levels of accessibility: A, AA, and AAA, with AAA being the most rigorous standard. While A-level is often considered the minimum requirement, depending on the target users and their needs, it may be necessary to implement the AA or AAA standards for higher levels of accessibility.

For instance, Google's Material Design guidelines highlight the importance of clear, robust, and specific accessible design. Apple also prioritizes simplicity and perceivability as crucial elements, recommending that developers support personalization and conduct audits with accessibility features enabled to ensure compliance with WCAG standards.

Best Practices for Developing Accessible Healthcare Apps

The first point is to understand whom we are designing for - it is valuable to research the potential target audience, explore their needs and usage patterns, learn more about their habits, things that hinder them, and what they would like to see in digital solutions.

The issue lies in our tendency to rely on assumptions and lack of awareness. Many designers assume that individuals with disabilities do not use the internet, which is simply not true. Therefore, it is crucial to shift our focus towards understanding the experiences of people with disabilities - why they use a particular product or service, what motivates them, and how it impacts their daily lives. By prioritizing the individual, we can accurately capture their true motivations.

When creating designs for users with visual disabilities, it is essential to consider the contrast ratio and avoid over-reliance on color for conveying crucial information. For instance, in a mental health app that enables users to color-code a calendar to track mood changes over time, it is essential to acknowledge that color blindness and low vision can hinder color perception or interpretation. Therefore, designers may opt to incorporate alternative visual elements, such as emojis or distinct patterns, to represent different color options.

Designers should collaborate closely with developers to ensure that elements like tables and headings are compatible with assistive technologies. This is especially important for screens that present test results or other health-related data. Tables must be correctly coded to ensure that users of screen readers can always understand the association of each item with its respective column and row.

To cater to users who are deaf or hard of hearing, it is crucial to provide captions and transcriptions for video and audio content that are generated by a human rather than artificial intelligence. This helps minimize transcription errors, which can be particularly harmful in medical contexts. For users with dexterity challenges, it is vital to consider the size and spacing of user interface (UI) elements such as buttons, fields, and checkboxes. Touch targets should be adequately sized to accommodate these elements. It is worth noting that these considerations benefit not only individuals with dexterity challenges but also those with visual impairments, as larger icons and sufficient spacing make apps easier to use for them as well.

Information should be well-organized and aligned with common reading patterns, highlighting the most crucial information for easy scanning. This is essential because individuals with low health literacy may find it challenging to comprehend and follow their treatment plans.

We should also remember that accessibility issues are not limited to disabled individuals and the elderly. In fact, at some point, anyone can find themselves in a situation where they face limitations. For example, how would you navigate the subway with a broken leg? Or how would you orient yourself in a foreign country where you don't speak the language? The point is that accessibility benefits everyone, regardless of their abilities or temporary circumstances. Designing with accessibility in mind ensures that the needs of a diverse range of users are met. It allows for greater inclusion and empowers individuals to navigate and engage with various environments and technologies, regardless of their limitations.

An important aspect is testing solutions with end users. Will a visually impaired person be able to read the content in the app without any issues? Will they be able to easily enlarge the text and navigate the app in a way that remains understandable?

To what extent is the app accessible for individuals with hearing impairments or those with speech or communication-related impairments? How user-friendly is it for individuals with physical impairments or limitations?

A Developer's Perspective on Building Accessible HealthTech Apps

Okay, you already understand the challenges a designer faces while "drawing" an application. However, besides the appearance, the application must also respond well to the user's needs. Particular attention should be paid to mobile applications, which are nearly impossible to use without these features.

One example of adapting apps to the needs of people with impairments is to enable the use of "Dynamic Type" functionality which allows users to adjust the system font size according to their preferences. By supporting Dynamic Type, your app will automatically adjust its text size to maintain legibility, benefiting users with visual impairments.

It is also worth remembering that when using images in an application, descriptive alternative text (alternative text) should be provided. This text should convey the meaning and purpose of the image to users using screen readers. This way, they can understand the context even if they can't see the image.

Interactive elements are a very important part of an application, without which none can function. Therefore, make sure that buttons and links have sufficient target size. This makes it easier for users with mobility impairments or who use alternative input methods (e.g., stylus, adaptive switches) to accurately select the desired item without unintentional touches.

It's a good idea to tailor the app to the platform you want it to be available on, especially since it may be useful for users with visual impairments wanting to use iOS's VoiceOver or Android's, TalkBack to provide audio feedback and assist in navigating your app.

If your app includes multimedia content like videos or audio, provide closed captions or transcripts. Closed captions enable users who are deaf or hard of hearing to follow along with the spoken content. At the same time, transcripts provide a textual version of the information, making it accessible to all users.

It is also essential that in addition to implementing the above functionalities, they should be tested appropriately. I'm not just talking about different devices and resolutions, where you'll test that every user on every device can access these facilities. Still, it's also a good idea to involve people with disabilities who could potentially use the app to make sure that the functionalities you've introduced work.

Designing for People with Disabilities = Designing for Everyone

The issue with a user interface (UI) that neglects accessibility is that it prevents a significant portion of users from accessing a website, product, or service. These barriers not only cause frustration but also impede users from accomplishing their goals efficiently. They can be particularly bothersome for individuals with disabilities, who may have to find alternative, less optimal ways to interact with the interface. As designers, we are responsible for eliminating these barriers and ensuring equal access for all users. We must treat individuals with disabilities with the same respect and consideration as we do for other users. It is our duty to prioritize inclusivity and dedicate the necessary time and effort to make our designs accessible to everyone.