Customer/Patient Experience Special Feature 2021: … and access for all

… and access for all

One important step in developing online customer experiences is making sure that all customers – including those with disabilities – can experience them.

By Joshua Slatko • [email protected] 

It would seem self-evident that customer experiences aren’t worth much if the customer can’t experience them. But making digital properties accessible to users with disabilities is a challenge only beginning to be faced by brands, and certainly by brands in the pharma space. According to the 2021 WebAIM Million report, an annual accessibility analysis of the top million home pages on the web, 97.4 percent of pages had detectable Web Content Accessibility Guidelines (WCAG) failures, with health and fitness-related sites doing only slightly better than average by number of errors per page. And a number of major brands in the broader consumer space have already been at the wrong end of lawsuits and major settlements regarding online accessibility. So it would seem that pharma brand managers have some catching up to do.

“Many sites do include features such as font resizing or color/contrast adjusters, but the majority of pharma or life sciences brands are not fully accessible,” says Amy Toft, group UX director at Intouch Group. “This can be due to unfamiliarity to the accessibility discipline or unawareness to the accommodation needs of their audiences. Of course, time and budget can play a factor too – oftentimes updating an existing digital property can be time- or labor-intensive and internal timelines do not allow it.”

Toft’s own agency, Intouch, has built a handful of accessible websites recently, but she still believes that fully accessible websites are far from the norm in pharma, and are limited to brands already focused on disabilities. “I would say the pharma sites that provide more accessibility accommodation are those that treat a specific disease that affects vision or movement, since their very audience needs accessibility measures in place in order to access the content,” she told Med Ad News.

Why have brands been so slow to adapt? Pharma surely doesn’t lack interest in the needs of disabled patients; but the industry surely does have a long history of slow adoption of new technologies.

“I believe it’s not so much that healthcare brands are not in tune with customers, but more so that healthcare in general is a bit slower to adopt newer technologies or functionalities with regard to digital,” says Chris Seda, executive VP, director of experience design for the FCB Health Network. “This is mostly due to the importance of ensuring that anything new that’s used for digital in healthcare is very much tried-and-true and will never lead to a technology issue with something as important as, say, safety. I know that may seem counterintuitive, but getting a digital property compliant requires a whole other level of expertise in design, development, and quality assurance.”

That said, brand managers may have to start suppressing their usual conservative approach to new tech, because the legal landscape around ADA access to digital tools is shifting rapidly towards greater compliance. In October 2019 the U.S. Supreme Court declined to hear an appeal of a decision by the 9th Circuit Court of Appeals holding that the ADA protects access to the digital properties of restaurants and stores just as it does for their physical locations. A blind customer, Guillermo Robles, had sued Domino’s when he found that the company’s website didn’t have the capability to allow him to order a pizza online. In response Domino’s argued – unsuccessfully – that the ADA applied to its physical stores but not its website. “The ADA mandates that places of public accommodation, like Domino’s, provide auxiliary aids and services to make visual materials available to individuals who are blind,” the appeals court had ruled in January 2019. “This requirement applies to Domino’s website and app, even though customers predominantly access them away from the physical restaurant.” The Domino’s case isn’t alone, either; according to the digital accessibility company UsableNet, 3,550 lawsuits related to digital ADA accessibility were filed in the United States in 2020, 23 percent more than the previous year and nearly five times the number filed in 2017. Some big names have been defendants, too, including Target (agreed to a settlement including $6 million in damages), Netflix (added captioning to all video content), and Beyoncé. 

While pharma brands may not be “public accommodations,” the parallel is surely too close for the industry’s comfort. In an op-ed published in the December issue of Med Ad News, Seda wrote, “Is it only a matter of time before we start hearing about the class-action lawsuits? Remember all the stories of Patent Trolls snatching up nebulous patents to take advantage of? How long before the inevitable scourge of ‘Accessibility Trolls’ ascend from the depths of the Web hunting for vulnerable companies and organizations they can exploit?”

So whether motivated by expanding a brand’s audience or reducing the potential for lawsuits, teams ought to be baking ADA compliance into their digital efforts from the very beginning. Seda views this approach as simply another part of developing great customer experiences. “In a perfect world, it should be less about ADA compliance and more about providing content, features, and functionality to all users equally, regardless of their abilities,” he told Med Ad News. “As a user-centered design practitioner, I look at it as: meet the needs of all users, and the rest will fall into place. So, by following that principle, you should meet the criteria of WCAG and ADA, by default.”

Toft of Intouch believes that brand managers are already becoming aware of the need for ADA and WCAG compliance, and that many are moving in the right direction. “I would say awareness is moderate with most brand managers,” she says. “More and more frequently, I hear from brand teams that they received an unsolicited letter regarding the inaccessibility of their website … essentially, the sender is trying to sell a service. But in my experience, once they are made more aware of compliance, they ask questions and truly want to know more. They start thinking of the comorbidities their customers may have and want to make sure what is being built will accommodate their needs. Overall, the response we have had when we discuss accessible design has been positive.”

The goodwill that comes with being accessible is a key factor in deciding to update a site or build with accessibility in mind from the start, Toft notes. But being or becoming accessible isn’t like flipping a switch. “A plan should be created, and features and functionality can be done in phases,” she told Med Ad News. “I think the phased approach makes it more palatable, especially if there are many issues that require correction.”

It’s also important to be open and transparent about that plan. “Post it on the brand website (or the product in question),” Seda suggests. “Let people know where the brand stands on digital inclusion and digital equity by having a statement available for all to read. Give them access to the backlog so they know what’s going to be addressed and be sure to also give them a way to reach the site owner if they come across an accessibility issue of their own that the brand may not be aware of.”

What should that plan include? “Any brand looking to get it done right needs to consider how to provide provisions and tools to enable users of varying abilities, but they should also consider if those abilities are permanent, temporary, or situational,” Seda says. “They need to be aware that the end user of their digital property may not be the same person their strategy team identified as their target customer. I try to remind people that there could be an edge case where someone with a disability is looking up certain content on behalf of that target customer.”

Toft recommends answering three key questions. “First, I would decide what level of compliance I want to meet. The WCAG has three levels of compliance – I would recommend Level AA as it meets the majority of compliance issues and covers a wide range of disabilities.

“Second, I would review who my audience is and determine their unmet needs. The best way to do that is ask them. Run a usability test on a site or concept with actual representatives of the audience – be as inclusive as possible in the recruiting to get the most impactful findings.

“Finally, I’d determine what is the budget I am willing to spend, as accessibility is an investment.”

After that, Toft recommends finding a partner that can audit any current digital property, to learn where you may be compliant already and determine the roadmap for future updates – including the timeline.

“If building a new site, I would find a partner that can help educate your team on the nuances of accessibility and what to consider while building,” she says. “This includes all steps of the process – discovery, design, development and testing.”

Ideally, each brand should have an internal champion for accessibility on the team to serve as the coach, mentor, and reviewer to ensure the new site is meeting the required compliance level. “There would hopefully be a growing team of experts of various abilities that can use assistive technology to ensure the site is meeting everyone’s needs,” Toft told Med Ad News.

The rapidly growing capabilities of voice-powered tech are one area brand teams ought to explore as they consider how to make their digital properties more accessible. “There are a ton of opportunities with conversational interfaces and voice assistants like Alexa, Google Assistant, et al,” Seda says. “To that end, FCB’s team of experience designers and creative engineers are already building prototypes that allow a user to ask Alexa to navigate a screen, have the screen read back to them, and other really exciting interactions using just your voice.”

It might also be wise to take a hard look at other brands who’ve been successful at opening their digital spaces and devices to customers with disabilities. Apple may be the most prominent example, but there are others. “I have it on excellent authority – from a friend who uses assistive devices to access the Web – that a few companies getting it right are American Express and American Airlines,” Seda told Med Ad News. “In the healthcare space, 98point6 is a great example. This is because, in addition to making their digital properties accessible, they are making an effort to build digital inclusion and digital equity into their corporate cultures and development processes.” 

 

Web Content Accessibility Guidelines

The Web Content Accessibility Guidelines, or WCAG, are a series of recommendations published by the Web Accessibility Initiative of the World Wide Web Consortium in order to make Web content more accessible, particularly for people with disabilities. The “At a glance” overview of the most recent version of WCAG, version 2.1, includes the following:

Perceivable

• Provide text alternatives for non-text content.

• Provide captions and other alternatives for multimedia.

• Create content that can be presented in different ways, including by assistive 

   technologies, without losing meaning.

• Make it easier for users to see and hear content.

Operable

• Make all functionality available from a keyboard.

• Give users enough time to read and use content.

• Do not use content that causes seizures or physical reactions.

• Help users navigate and find content.

• Make it easier to use inputs other than keyboard.

Understandable

• Make text readable and understandable.

• Make content appear and operate in predictable ways.

• Help users avoid and correct mistakes.

Robust

• Maximize compatibility with current and future user tools.

More information about WCAG can be found at https://www.w3.org/WAI/standards-guidelines/wcag/.