WordPress powers over 25 million sites with more than 14 billion pages viewed each month, making it one of the most popular web publishing platforms. Imagine if every one of those sites was accessible.
Joe O’Connor has been a leader in making that happen, through the WordPress accessibility team which works from the inside to make WordPress into a web publishing platform for everyone.
Joe joins Whitney Quesenbery for this episode of A Podcast for Everyone to talk about what it takes to make an open source platform that can help authors make their sites accessible. They talked about:
- How can you make your WordPress accessible?
- What are the best accessible-ready WordPress themes?
- What tools can help you keep your content accessible for everyone?
Joseph Karr O’Connor lives in Santa Monica, California. When Section 508 came into effect in 1999 he began leading Accessible UX teams creating accessible web environments. Joe has been using WordPress in support of non-profits, research, and university news since 2005. Now leading Cities, a world-wide effort to build free accessible WordPress themes, Joe also contributes to Make WordPress Accessible and asks you to get involved. He’s known on Twitter as AccessibleJoe.
Resources mentioned in this podcast
- WordPress Guidelines: Accessibility
- Accessibility-Ready WordPress Themes
- Making WordPress Accessible
- WP Accessibility plugin by Joe Dolson
- The Cities project
- Accessibility checking tools
Accessible WordPress themes that Joe recommends:
Whitney Quesenbery: Hi, I’m Whitney Quesenbery, I’m co-author with Sarah Horton of “A Web For Everyone.” Today, I’m talking to Joe O’Connor, known to his friends on Twitter as “accessible Joe.”
Joe’s been using WordPress for almost 10 years. That’s a really long time in Internet years. Hi, Joe. Thanks so much for joining us.
Joe O’Connor: Hi, Whitney. Thanks for having me.
Whitney: I’ve been thinking about WordPress a lot. You probably know this, but maybe everybody in the audience doesn’t, that WordPress is one of the largest web-publishing platforms in the world?
The stats I looked up said that there are over 25 million sites and more than 14 billion pages viewed each month. That’s gigantic.
These sites range from little, tiny personal blogs but also big, corporate sites, like CNN, UPS, CBS, TED. That, it seems to me, is a really large target for accessibility. That’s a really large target for accessibility.
Joe: Yes, some of the other stats that I’ve seen, say that WordPress runs about 20 percent of the Internet. When I found those statistics I was astounded, but indeed it makes it a really large target for accessibility.
Any change that we make in the admin, in the back-end, any seams that come out that are accessible, are used by millions of people, and so it’s an important segment of accessibility work.
Whitney: I’ve noticed that it’s still a little hard to figure out where to start. When we built the user experience magazine site, we knew we wanted it to be accessible, but we finally decided we had to start from an accessible theme, and it was hard to figure it out.
I noticed recently that 2014, the brand new default WordPress theme, is now tagged “accessibility ready.” Can you tell us what that means?
Joe: I’m the Accessibility Team Lead for WordPress, and on the team we have many, many talented people. We set out to make a tag for accessibility, and we thought things through, and concluded that though there are those things a theme developer can do to make sure a theme is accessible.
Unless the content people use accessible methods, it will no longer be an accessible site. I’ve personally had content authors steadfastly refuse to write alternative texts for graphics.
Claiming that their work road was already too much to handle. Did I mention that I spent many years in higher education?
Whitney: Yes, hard to get people to change, isn’t it?
Joe: After some deliberation, we acknowledged this fact with a tag that signals that this theme is accessibility-ready as in, ready to add accessible content.
Whitney: For someone like me, who’s in-between. I’m not really a developer, and I’m not just a content developer. That means that if I use that theme, and I don’t mess it up, and I then put my content in the Web with good accessibility principles, then I’m OK.
Joe: Yes. You still have to check your work, and I have some recommendations for tools to do that, which will appear on the page with this podcast, the links. Accessible themes are still very few. We’re reaching out to more developers than ever before.
It’s been a lot of action this year in WordPress accessibility. A lot of mainstream WordPress venues, like WP Bacon, and some other podcasting operations have done features on us.
And we’re awed by the response from the developer community. Nonetheless, there are still very few accessible themes.
Whitney: You find those themes by going to the WordPress.org site, and going to the themes, and searching for the tag “accessibility-ready”?
Joe: There’s a hitch with that! We recently negotiated our way through getting the “accessibility-ready” tag to stick. Some themes mention the word accessibility in their tags, and a few of them have used the “accessibility-ready” tag.
Until recently, we had no way of coming back to them and saying, “You’ve used accessibility-ready.” Did you mean this? Did you copy the tag from another theme? Do you mean it’s accessible because it’s accessible on the Web?
Whitney: Right, truth in advertising, and making sure that we really mean accessibility in the sense we’re using it.
Joe: We’re now able to come back to theme developers and say, “OK. You’ve used the accessibility-ready tag. We’re going to assess your theme for accessibility.
If it fails we will come back to you and tell you what failed, help you make some changes, If you fail to make those changes with 10 days, the tag will be removed.
Whitney: You’ve got some teeth in it, but you’re also helping people out?
Joe: Yes, we’re extending, scaffolding all the way to everyone. We tell everyone we talk to that we’re ready to help, we’re able to help, and we’d love to help.
Yet, there are still very few accessible themes. The accessible themes that I use or recommend, one of my blogs uses Blaskan, B-L-A-S-K-A-N. That’s by Per Sandstrom.
The link will be on the page with the podcast. There’s a new theme, Simone, by Morton Rand-Hendrickson. He works at lynda.com. He does the WordPress videos there, many of them, and he’s a really great guy. He’s stepped up with a team recently called Simone.
One of the themes that ships with WordPress, when you download WordPress and install it in a site, you’re going to get Twenty Fourteen. Twenty Fourteen is accessibility ready, and it has that tag because the accessibility team worked on Twenty Fourteen to help make it accessible.
It has skip links. It has a number of different things that make a theme accessible. If you’re building a theme, I suggest starting with underscores. That’s not spelled underscores, its _s. But we call it underscores, which has recently been accessibility enhanced by Morton Rand-Hendrickson.
“_s” is a blank theme that developers can use to quickly prototype and build themes. It has some accessibility enhancements now, which will go a long way to helping them.
Whitney: That’s great. Are there other tools that someone developing a site could use? Are there good plugins and things?
Joe: Well, there’s a plugin by Joe Dolson, who is a mainstay of the WordPress Accessibility Team. Joe has a plugin called WP Accessibility. It’s for everyone. It’s not so much to help developers. I’ll take that back. If developers would take a look at WP Accessibility, and look at what it does.
It will help you install skip links, for instance. All you have to do is click it, and it’ll go there. It’ll happen, and your site can have visible or invisible click links. A skip link becomes usable when the user tabs into the site.
Whitney: This is pretty interesting because it sounds to me like the accessibility team at WordPress has really built, let’s use the word “scaffolding,” and I really like that because you’ve got guidelines, you’ve got a tag so you have a way to check sites and help developers get there.
You’ve got some plugins to help them, but the thing that seems to be really revolutionary is that you’re working on the WordPress Team. You’re not just coming in afterwards and saying, “This works. This doesn’t work,”
But you’re building the tools to help people build accessible tools. That seems like a real shift in the emphasis from being outsiders asking for things to be made accessible to being insiders helping build the plumbing that makes it possible to have accessible sites.
Joe: The beauty of WordPress as with other open source projects is, indeed, that it’s open source, and everyone’s invited to work on it. Anyone can work on it, and are encouraged to work on it.
Some of the older members of the team have been working on it for years. We focus on core, that’s called trunk. We’re working on live code to remediate accessibility situations that come up when people who don’t use accessible routines, contribute to core.
Whitney: You’re working on the team that’s building the core code that underlies WordPress, is that what I’m hearing?
Whitney: Very exciting. You had an example of how the team has worked to make sure that what goes out in WordPress is accessible.
Joe: For instance, right now, we’re working on focus indication in the left navigation bar. The left navigation bar has some focus indication right now. Dark grey turns to black when you select one of the main menu items.
Then, as you move over into the submenus, the titles of the submenus change from a light grey to a dark blue. For those of us in accessibility, we understand that you can’t have color as the only means of signaling something.
We’ve added a visual indicator by drawing a white or a black box around the selected item. There are eight different color schemes to admin, and so some of them do better with white, some of them do better with black.
The idea is to make a contrasting color box appear around the selected item so that now there are two visual focus indicators.
Whitney: Like choosing that you want to edit pages or you want to edit posts.
Joe: Right, so when you go to the post’s main heading, you’ll see that the focus indicator is dark grey turning to black, plus there’s a white box around it.
Whitney: You’re not talking about making the sites that are built with WordPress accessible. You’re talking about making WordPress itself accessible. So that someone who’s using assistive technology or who has low vision can use WordPress to write their own blogs and to develop their own blogs.
Joe: Right, accessibility is required on both ends.
Whitney: That’s pretty revolutionary. [laughs] I say that with complimentary aim. We do often focus on the end users and making sure that we can build something accessible.
But I know more and more people who are developers who are also assistive technology users, and it’s great to hear that WordPress is accessible to them as developers.
Joe: I’ve been doing accessible UX since 1999, and in 1999, we thought, “Wow, all the websites are going to be accessible,” so maybe not revolutionary, but evolutionary. We’re developing tickets. We’re helping people write solutions for the tickets.
Some of us can write code. Others can’t write code. Some of us are better at documentation. We’re doing everything we can to help the WordPress developers with the back end, with core.
Then we’re doing outreach at Word Camps and at meet-ups to theme developers, to help them understand that we have resources for them to use to make their themes accessible.
Whitney: Now let’s move forward to an actual blogger, someone who’s maybe developed their own site theme, maybe they had someone else develop it.
Now they’ve got their site set up and they’re adding new content all the time, new blog posts. What are the most important things that they should do to make sure that the content they add to their site is accessible?
Joe: At this year’s Access U in Austin, Texas, presented by Knowbility, I did a class about adding accessible content to WordPress sites. You can download the Word Doc on my site at AccessibleJoe.com/tools. The link will be on the list of resources on the podcast page.
In it, I do mention some of the ins and outs of WordPress itself, so how to use some of the dialog boxes and where you put the alt text for images and all that.
There are some things that anyone can pay attention to in any web page, such as adding alternative text descriptions to media, using headings and lists, use simple language, if you can. Certainly if it’s aimed at physicists, you’ll have to use your judgment.
Whitney: If you’re talking to physicists, talk in physics, but if you’re talking to everyone, the mythical everyone, speak a language they know.
Joe: Ensure that the link text makes sense out of context. Screen readers can separate out lists of things. They can separate out a list of links.
If you used the default in WordPress, which is read more, or read more of this story, what they’ll hear is a list of links that say read more, read more, read more, read more.
Which one would you choose? I don’t know. Make sure that the link text makes sense. The plugin WP Accessibility will change that for you and append the story name to read more and the story name. Your links can be expanded to make sense.
Use some extra text there. Don’t rely on visual or audio cues. Don’t say, “Below, I’ve posted this,” or, “In the green box, you’ll see this.” Use of contrasting colors is good. Make sure that your color contrast is sufficient to meet the thresholds.
Pay attention to complex tables. If you have to make a table, make it accessible. There are all sorts of resources on the web for making accessible tables. Also, pay attention to creating accessible documents.
Whitney: If you post a PDF file that people can download, make sure that’s accessible?
Whitney: These all sound like really basic content tips, applied to WordPress, nothing particularly special here. In fact, I do authoring in WordPress, and I’m not a coder, and I’ve found it pretty easy to do everything except tables.
I have to say, the table editor doesn’t help me all that much, even with tables, at all. Certainly the alternative text is right there in the media files and headings and lists, all the themes that I’ve ever worked with come with heading and list code built into it.
And link text and language, of course, is your own writing. For me, the only thing that I still find hard to do is tables.
Joe: I’ve been around for a while, and the only thing we had was a text editor in the beginning.
Whitney: That’s right…. We do have to go into that text editor and edit and put the table heading codes in.
Joe: I code my own tables. I don’t rely on the wysiwyg editor Tiny MCE. Tiny MCE, by the way, has been upgraded and updated for accessibility greatly in the last iteration. In 3.9, there are more accessibility routines built into Tiny MCE.
Whitney: That’s the basic post-editor?
Joe: Yes, that’s the wysiwyg editor.
Whitney: If I could paraphrase what we’ve been talking about, it’s start with an accessible theme to build an accessible theme. Follow the basic rules for accessible content.
Make sure that anything you add, whether that’s a form, or a media, or a document, that you’re uploading is accessible. It doesn’t really sound that hard. Got any final words of advice?
Joe: It’s a matter of civil rights, and you’ll hear this from every accessibility person on earth. With the blind experiencing 70 percent unemployment, partly because of lack of access to information, with disabled people all over experiencing high levels of unemployment.
We owe it to our fellow human beings to make things accessible. Really, it is easy once you get the routines down. It’s like any other workflow item. Adding all texts does not take that much. I’ve been told otherwise, [laughs] simple routines can help a lot.
Whitney: Good advice. Thank you so much for joining us today, Joe. We’ve been talking to Joe O’Connor, known on Twitter as AccessibleJoe.
If you’re interested in learning more about how to make your WordPress site accessible, we’ll have a list of resources available up on the podcast page along with the transcript.
Thank you so much! Thanks to all of you for listening in, and a special thanks to our sponsors, UIE, Rosenfeld Media, The Paciello Group, and O’Reilly for making this series happen. Be sure to follow us at A Web for Everyone on Twitter for information about future podcasts.
Medical records are moving online. That means they have to be accessible, but it’s also an opportunity to improve them – especially personal health records intended for patients to use to monitor their own heath. Dean Karavite explains how a project to design a personal health record for people with disabilities led to some innovative ideas that could make them more useful for everyone.
Dean joins Whitney Quesenbery for this episode of A Podcast for Everyone to talk about the work he’s been doing in a project to create usable and accessible health records.
- What are personal health records?
- Why are they important for people with disabilities?
- What have they learned about the accessibility of electronic health records?
- What can you learn about any product by testing it with people with disabilities?
- How does the design of the Cuisinart connect people with disabilities and the Mac?
Dean Karavite is a Human Computer Interaction Specialist for The Children’s Hospital of Philadelphia (CHOP). He has fifteen years experience in clinical informatics, was a usability specialist at IBM, and has experience developing assistive technology solutions for people with disabilities. He got his masters degree in HCI from the University of Michigan, School of Information. About the project collaborators.
Resources mentioned in this podcast
- Project website: Accessible Designs for Personal Health Records
- Project Research Report
- Useful Personal Health Records: Designing for Accessibility (User Experience Magazine)
- Book: Just Ask by Shawn Henry
- The Surgeon General’s Call to Action to Improve the Health and Wellness of Persons with Disabilities
- Marc Harrison
- CBMi and the Children’s Hospital of Philadelphia
- Inglis Foundation
- National Center for Accessible Media at WGBH
- NIDRR – National Institute on Disability, Rehabilitation, and Research
- Liberty Resources
- IDEO and OpenIDEO
- Dragon speech recognition software
- Book: Design for Care: Innovating Healthcare Experience by Peter Jones
Whitney Quesenbery: Hi, I’m Whitney Quesenbery. I’m co-author with Sarah Horton of “A Web For Everyone.” Today, I’m talking to Dean Karavite from the Children’s Hospital of Philadelphia, where he’s a human interactions specialist in clinical informatics.
That sounds like a mouthful, but it really just means that he works on making medical information usable for both patients and health professionals. One of his current projects is designing personal health records that are useful for people with disabilities. Hi, Dean. Thanks so much for joining us.
Dean Karavite: Hello, Whitney. Thank you so much for inviting me to talk about our work.
Whitney: Let’s start by talking about what you mean by a personal health record for people with disabilities. What kind of problems are you trying to solve?
Dean: First, I think we can start with some definitions. They’re actually important for a number of reasons. If you were to go to the healthit.gov website, there’s a page that provides precise definitions for different systems used in health information technology.
What’s interesting about these definitions is they’re largely based on system interoperability.
What that means is the ability for these systems, or the lack of ability, for these systems to share information between different healthcare providers or organizations, as well as to patients.
Whitney: This is all technical. This is “Can one computer talk to another?”
Dean: Yes, in effect. If I could go through some definitions, and then I can explain to you why it’s important to people with disabilities. First, we have the electronic medical record, or the EMR.
This is defined as the electronic version of a patient chart, but exists only within a single healthcare organization. For example, Children’s Hospital of Philadelphia or another hospital in town, or even your doctor’s office around the corner.
Corresponding to that on the patient side is what’s often referred to as the patient portal. This allows patients or family members to log in, access some of the record, and perform some basic tasks, like prescription renewals, lab results, things like that.
Again, like the EMR, they are confined or limited to a single healthcare organization. You might be receiving care from different providers, and each might have their own EMR, and therefore, you might have multiple patient portal accounts, none of which are connected.
Whitney: That doesn’t sound very good.
Dean: No, it’s a big problem, and there are many people working on this. Next, we have another definition. The EHR, or electronic health record. This refers to, again, a clinician system, but unlike the EMR, this has information about the patient from any and every provider they’ve ever seen.
Whitney: Now we’re getting a little more patient-centered.
Dean: Yes, but the problem with the EHR is that, at least in the United States, and at a practical level, it really doesn’t exist yet.
Then, we have the PHR, or personal health record. This is defined as a system that is managed by patients, where they can collect, compile, organize all of their information from multiple healthcare providers in one place, but the problem there is it’s not easily connected to healthcare providers.
Whitney: We have a mythical EHR, the thing that’s going to pull all of our data together, and then we have to make up for it, something patients can use on their own systems.
Whitney: We have a mythical EHR that will pull everything together, but doesn’t quite yet. Is it filling a gap to say we have a Personal Health Record, which the patient can manage to solve that gap?
Dean: Yes, it allows them to manage their own information, but it doesn’t allow them to easily share that information with new or existing healthcare providers.
Whitney: Another gap appears.
Dean: Yes, but in our project we decided to use the term PHR somewhat generically, and imagine hopefully a near future state where interoperability is solved.
Whitney: This sounds like a pretty big generic problem, and I’m sure you’re right. There are probably thousands of people in the US working on it, if not more, around the world. Tell me where this connects to accessibility.
Dean: As part of our project exploring accessible Personal Health Records, one of the methods we have applied was performing a survey with 150 people with different disabilities. In that survey, we had our participants’ rate over 20 health topics in two ways.
First, in terms of how important the particular topic was to their health and healthcare, and second, their current level of satisfaction with a particular issue or topic.
The number one, most highly rated issue in terms of importance was the ability to share medical information between different providers’ offices, and hospitals.
Whitney: This isn’t just technical…you’re just looking at a chart, and saying here’s a gap, let’s fill it. This is actually coming from people. Are you talking about people with various kinds of disabilities, here?
Dean: It certainly applies to people with severe disabilities, but also anyone who’s a complex patient and receives care from multiple healthcare providers, because the real underlying issue here isn’t just the transfer of data, but care coordination, which is the collaboration in not just communication, but collaboration between multiple healthcare providers.
Whitney: When we were talking before, you said something that I thought was really important, and I want to make sure we bring it out early, which is that disability doesn’t necessarily mean poor health.
Dean: Right. The source of that idea and that concept, which I think is really a very valuable resource that your listeners might be interested in, is the Surgeon General’s Call to Action to improve the health and wellness of persons with disabilities.
It’s really available online. I’m sure you’ll be providing a link to that on your website.
Whitney: We sure will.
Dean: In the report, which was published in 2005, it doesn’t really cover healthcare technology, but it does a wonderful job, I think, of describing the overall landscape, you could say, of people, disabilities, and health, and healthcare. The authors make a number of important points.
First, and foremost, is that people with disabilities can live a meaningful and fulfilling life, but the key is health and wellness. However, they go on to present a number of studies and data demonstrating that people with disabilities encounter myriad disparities with almost every aspect of health and the healthcare system.
Whitney: Give me some examples of things that might challenge them in managing their health.
Dean: The report cites a number of measures, for example, higher risks, poor outcomes, access, really almost you can think of. What’s, I think, important about that is now we know people with disabilities are underserved by technology that’s not accessible, but they’re also underserved by the healthcare system.
Whitney: Tell me about some of the kinds of health issues, in specific, someone with a disability might need to manage.
Dean: This is a pretty large topic, and there’s different ways to think about this. As you stated before, we should not equate disability with poor health, and not think of disability as an illness.
One thing that the Surgeon General’s report stresses is that we should treat not the disability, but the whole person. This was reflected with many of the participants in our study.
For example, we met plenty of people who were disabled, but their disability wasn’t necessarily a health issue, meaning it didn’t require ongoing care or any type of treatment, nor did these people think of their disability as a health issue.
At the next level, there are people who have a disability, and while their disability isn’t necessarily an ongoing health issue, there are secondary issues related to their disability that need to be managed.
I have a few examples. For example, a person who’s blind, they might have to take some eye drops to maintain their tear ducts. Or, it could be a person who’s deaf and has a baby, and undergoes genetic testing to determine whether or not their baby has a particular variant for hearing loss.
Then, there might be a person who has a spinal cord injury and is using a wheelchair, and with that, comes a number of secondary issues. For example, first, we need to prevent pressure sores or bed sores. There are special cushions that can do that, as well as checking and maintaining skin integrity.
They also might have a urinary catheter. Along with that, we have to prevent infection, and also measure daily fluid intake and output.
At the next level, we met plenty of people where their disability was the result of an illness that required ongoing treatment, for example, multiple sclerosis or spina bifida.
Then, you had other people who had these types of issues along with other more common chronic illnesses, for example, diabetes, heart disease, high cholesterol, etc.
What we found is that we’ve learned a lot from, of course, all of our participants, but from these more complex patients, they often provided us with the most detailed, sophisticated, and even innovative ideas on what an accessible PHR should do.
Whitney: It’s interesting. Shawn Henry, who wrote the book “Just Ask” about doing usability testing with people with disabilities, has been talking about, questioning whether, we ought to be thinking about people with disabilities as extreme users.
That is people who might be particularly stressed by websites that are written to code or by information that isn’t very clear or by information that doesn’t appeal to all their senses, so that if they’re relying one sense more than other senses, they’re more likely to find a problem.
That’s a pretty interesting idea. I think what you’re saying is very much the same.
That people with disabilities use the healthcare system a lot and in many different ways, both as the people with many different chronic health problems to people for whom their health isn’t really an issue at all to people who need some monitoring of things like what you said about monitoring infections and fluid intake and outtake.
That suggests that you have a population that represents, in a very small group of people, a wide range of what a good personal health record needs to do.
Dean: Absolutely, I actually had a chance to talk to Shawn on the telephone about a month ago about our project, and she was fantastic. I agree with this. I think that many people who promote this idea of the extreme user. I have two sources where I’ve learned about this method or this concept, you might say.
First, I met a gentleman from IDEO a number of years ago. He told me that this was a foundation of their approach to design in many ways. Maybe not specifically to people with disabilities, but any extreme user who represents the tail end of the normal curve. They’re more interesting, and we can learn more from them.
Another great example of this method in practice was the industrial designer, Marc Harrison. He was both a teacher and designer at the Rhode Island School of Design. Way back in the mid-70s, he applied this approach specifically by thinking about people with disabilities in the design of the Cuisinart food processor.
Whitney: Way before the Good Grips, huh?
Dean: Yes, some people say that Harrison’s work and teaching actually influenced people who went on to design all these wonderful kitchen devices.
He actually influenced technology, too. I have an interesting little story here that I love to tell.
If you read the Steve Job’s biography by Walter Isaacson, there are two references to the Cuisinart, where Steve Jobs told the original designers of the first Mac to go out and buy Cuisinart. “It’s great. You have to see this thing.”
If you put the original Mac in 1984 side-by-side with an early ’80s Cuisinart, the influence on the physical design of the Mac is immediately obvious. Not only is the Mac designed with software for accessibility and more universal design, but its physical design had this perhaps unknown influence as well.
Whitney: This goes along with the idea I’m hearing a lot in design circles which is that, the broader your influence is, get out of your little box and look for inspiration all over the place.
In fact, IDEO’s OpenIDEO project really espouses that, because they start with inspirations as their first step where people are encouraged to go out and get as broad and crazy, as many ideas as they can, and bring them into the group.
Can you give me a story about how one of your extreme users helped you see something interesting that you wrapped into the project? I think we’ve been talking a little theoretically, and I’d love to bring it down and ground it in some of your research.
Dean: I have many interesting stories, but there’s one in particular I’d like to share with you. One of our participants was a woman who, a number of years ago, was in a horrible accident. She was a pedestrian hit by a drunk driver.
This left her paralyzed from the neck down, paraplegic. Not only did she survive her injury, but she insisted on staying at home, though confined to a bed or wheelchair, with home health aides, in order to raise, I think, her three or four children to adulthood.
Once her children were fully grown and out of the house, she had more time to pursue her own interests. One thing she did, for example, she’s always interested in art. So, she had learned to paint both realistic portraits and landscapes by essentially holding the paintbrush in her teeth. That’s pretty amazing.
She also had never used a computer, but wanted to learn. With help from one of our project partners, Inglis Foundation here in Philadelphia, and their assistive technology experts, she had learned to use a computer, but the only way she could interact with a computer was using speech recognition, Dragon Systems.
She had to learn both a PC and navigating a PC and all the different applications while simultaneously learning how to use Dragon systems. She told me a story that brought together both healthcare and technology.
A little while back, she had seen her physician who, I believe, specialized in people with spinal cord injuries. They did some lab work, and there was some particular level, I’m sorry, I don’t remember what the level was, that was low.
The doctor prescribed her some supplements to bring this level up. I believe she went home and she thought about this, and she wasn’t happy about this prescription for at least two reasons. First, like a lot of people with disabilities, she has a very fixed, limited income.
This represented an additional cost that she really couldn’t afford. Second, she just didn’t like the idea of taking a pill. She went online and did some research and identified a number of foods that could help increase this blood level.
On her own, she changed her diet and then created a spreadsheet where she tracked, not only her diet, but these different blood levels over time. When she finally reached the desired level, she went to her doctor and said, we’ve met the level.
Here’s what I did and here’s my data. The doctor was so impressed that she not only agreed with this treatment course. She now prescribes the same dietary changes to other patients who have the same issue.
Whitney: I think what I love about that story is not the personal overcoming of difficulties, but how she used essentially a very small PHR, she created her own little PHR, to manage this. She was able to use data to solve her own health issues, but also to suggest things that could be used for other people.
Dean: What this really demonstrates, what I think is really interesting about it, is it demonstrates some of the work we’re doing at Children’s Hospital in research on shared decision making, using patient portals and different systems to support decision making and collaboration between patients and providers.
One of our research assistants’ focus, his name is Dr. Alex Fiks. What I’ve learned from Alex is that decision making is really founded on, first, defining and communicating a person’s preferences and goals.
Then you come up with a plan to meet those goals, and then you develop some measure that can be used to track the progress of meeting that goal over time.
This woman’s story perfectly represents a shared decision making model, and everything’s there except for a PHR that can support the collection and communication of this information.
Whitney: We’ve been talking about this project for a long time, and we haven’t given you a chance to talk about who’s involved and how you brought together the team. I understand it’s three organizations, the Children’s Hospital of Philadelphia, the Inglis Foundation, and NCAM at WGBH.
Why don’t you just tell me a little bit about who’s involved and how the collaboration comes together.
Dean: The project is led by WGBH and the National Center for Accessible Media. They received the grant from the Department of Education National Institute on Disability, Rehabilitation, and Research, NIDRR.
Both Inglis and I and my boss, Dr. Grundmeier, are collaborators on the project with WGBH. The grant is referred to as a field-initiated project, so unlike a more traditional research project, its real goal is to demonstrate some process towards improving the life or every aspect of people with severe disabilities.
Whitney: It’s like what we would call a pilot.
Dean: Exactly. Now we couldn’t build an actual PHR, but the project was designed to demonstrate the application of both usability and accessibility methods, including subjects of people with disabilities, and essentially going through a whole series of usability methods towards the final product of interactive prototypes that we user-tested.
Whitney: At the end of this, NIDRR, which is a federal agency, will end up with not just a bunch of concepts, but some good, user-centered design supporting the results and hopefully take it further. Is that the goal?
Dean: Right, and all of our methods, results, and even the prototypes are freely available to EMR, EHR vendors, developers, anyone in the community.
Whitney: That’s really great. I know that you have a website. I think it’s HealthITAccess.wgbh.org.
Dean: WGBH is managing that, yes.
Whitney: We will, of course, as always, have links and all the other names and links that we’ve been mentioning on the website. I know that a couple of your collaborators asked if they could be on this podcast, but we think it’s an easier conversation when we can’t see each other to do it one-on-one.
I’d like to just give them a nod and hope that you have represented them well.
Dean: I hope so.
Whitney: What else have you learned? Has there been anything that’s surprising? Actually, my favorite ideas are ideas that seem obvious once you’ve seen them happen in the research. Anything that’s come out that really jumped out for you?
Dean: Yes. Beyond all the data and the results and the analysis, there’s something that I actually learned a long time ago but continued to relearn, and I think it’s very important. You referred to this many times.
In technology, UX, many people are striving to create accessible technology, and then other people are striving to create innovative technology. Unfortunately, there are still people, though not in the UX community, who feel that accessibility can be a barrier or somehow inhibit innovation.
I believe the exact opposite is the case. People with disabilities can be the source of many innovative ideas. Going back to the mid-90s when I started working with people with disabilities and assistive technology, I remember a few things.
First, I was forced to learn about and apply very rigorous usability methods. There was really no way around that, so it’s a great environment for that. At the same time, I was extremely selfish and thinking, repeatedly, “Boy, this stuff is so computer, I wish I had this on my computer.”
For example, touch screens, on-screen keyboards with word prediction, zoomable displays, speech recognition, text-to-speech. Think about it. It took about 10 to 15 years, and now we all have it on our computers, our phones and other devices, and we absolutely love it.
Whitney: That’s a really, really great example. Sometimes, it takes awhile to figure out. We start with a new technology.
For a while, there’s the technology looking for a problem. Often, extreme cases are the problem they solve. Then, it slowly migrates into general technology.
Dean: I had the same thoughts in this project. By taking all these different participants and their experiences and their stories and their ideas, and creating these PHR prototypes, I found myself thinking repeatedly, “Boy, this is a pretty cool PHR. I wish I had one, not only for myself, but my family, friends, and, of course, all the physicians and patients we work with.”
Whitney: I want to touch on one thing that relates to methods. If people are interested in what you did, there are great write-ups of all of your surveys and your prototyping and your usability testing.
I don’t want to take time to go through them here because they’re much more comprehensive on the Web than we could cover. But one of the things that a lot of people find as a challenge is finding people with disabilities who they can work with, and setting up usability tests to be able to include people in their research.
Can you talk a little bit about how that worked for you?
Dean: We had a distinct advantage in that our project partner, Inglis Foundation, manages the care of hundreds of people with disabilities. Not only were they a collaborative in the project, they were a source of many of our participants.
However, they specialize mainly in people with severe physical disabilities. We also found another organization, here in Philadelphia, Liberty Resources, who helps people with all types of disabilities live independently. They provided us with other participants, too. They were a great help.
There are certainly a lot of people out there with disabilities and all they seem very appreciative and enjoy being part of the project. Another resource might be your local university.
Most have some type of assistive technology and lab and/or faculty and students who are interested in accessibility. That might be a good resource, too.
Whitney: It sounds like one of the pieces of advice I heard was to not wait until you are ready to do your first usability test to get to know people. Don’t put out a call and announce that you’re ready for the doors to open, but actually do a little bit of outreach in advance.
Start making those connections early. Find out who’s in your community, what organization are there, what schools are there, so that you’re building those relationships before you ask people for their help.
Whitney: I want to end with one other thing, which I was reading the website, and it said one of the things you did was an audit of three personal health record websites. Of those three, one only met half of the basic accessibility guidelines.
That sounds really terrible, but the other two only met two of the 12 guidelines, but then it goes on to talk about an inverse relationship between accessible and functional. Can you tell me about that?
Dean: Yes, it was really an interesting experiment. We reviewed these three different systems for both usability, accessibility, and also functionality.
I really felt like I was in the “Goldilocks” scenario. Though, of course, it wasn’t one that was ‘just right.’
For example, the first system, they seemed to have made an honest effort at meeting accessibility guidelines. Yet, the system functionality was really very limited, and usability was also a problem. There was very complex navigation, very confusing.
The other system that did the worst in terms of accessibility actually had the most functionality, and a lot of very sophisticated functionality matching some of the ideas from our participants.
The third system was somewhere in between. It was a PHR type system. It was pretty good in accessibility except for one particular issue. It relied on patient entered data, and with every piece of patient entered data, you had to enter a date. Well, the date widget was neither accessible for screen readers or keyboard only. I thought it was interesting representing this one little problem that could be such a huge barrier.
But, overall, I think what we learned from that exercise is that if you were to put these three systems together, you’d have a pretty great PHR. I think what’s fundamental here and interesting is that the technology isn’t the problem. There are no constraints.
There’s no issue with making an accessible PHR. It can be done. The real issue here with these systems really comes down to good requirements gathering, and then the application of a solid set of both usability and accessibility methods.
Whitney: Was the focus of your work really about understanding what a PHR needed to do because you already knew how to make things accessible and usable?
Dean: Yeah, we actually talked about that quite a bit. WGBH, people like yourself, many are promoting all types of accessibility methods. There’s plenty of that out there.
We didn’t feel like we could add too much to the excellent works that already available. Instead, we wanted to go in a different tack, and think about, or demonstrate in effect, “What if we designed a PHR specifically for people with disabilities? What would that be like? Would it be usable? Would it be accessible? Would it be functional?”
I think we answered that. I hope we answered that. That no only would be accessible and usable, but also highly functional and more innovative than existing systems.
Precisely because it’s based on people who face a lot of challenges, both with their health, but also access, mobility, finance, everything, and as a result, have many more interesting and detailed ideas of how we can better engage with the healthcare system.
Whitney: I think that’s an awesome place to wrap up at actually. Dean, this has been fascinating.
I think we could talk for hours, but I’ll say again that there’s lots more information and some great research stories up on the Health IT Access site.
Tell me a little bit about some of the people who really helped make this project sing.
Dean: At WGBH, we had a number of people. Larry Goldberg who was the PI of the project, who’s the Director of NCAM. Madeleine Rothberg who’s Project Manager. Geoff Freed who’s their Accessibility Expert.
At Inglis Foundation, their CEO Gavin Kerr, who is fantastic. Lea Frontino who’s their VP of Health IT and Innovation. Don Waller, who’s the Head of their Assistive Technology Lab and did a lot of work in not only connecting us with participants, but building test stations that we could use for the participants we tested at Inglis.
At CHOP, myself and my boss, Dr. Grundmeier who was one of our most amazing researchers, physicians, developers, analysts, statisticians.
Whitney: That’s a really big team. That’s kind of cool. I’m used to hearing more about projects that are a couple of people, in a skunkworks project, but this sounds much more well rounded.
Dean: Yes. And…I forgot one person. I’m sorry, Jason Withrow who’s a developer. He’s a contractor, and he also has a degree in HCI and experience with accessibility.
Whitney: We’ll give a shout out on the website, and I’ll get some papers from you that might be interesting for people who want to dig a little more deeply in the research. To wrap up, if you’re interested in learning more, the project website is, again, healthitaccess.wgbh.org.
To find the podcast page on rosenfieldmedia.com, look for the page for “A Web for Everyone.” That’s our book and follow that link to A Podcast for Everyone.
Thanks so much to you for listening in, and a special thanks for our sponsors, UIE, Rosenfield Media, The Pacielo Group, and O’Reilly for making this series happen. Be sure to follow us at @awebforeveryone on Twitter for information about future podcasts.
CBMi and The Children’s Hospital of Philadelphia. The Children’s Hospital of Philadelphia was founded in 1855 as the nation’s first pediatric hospital. The Center for Biomedical Informatics (CBMi) at The Children’s Hospital of Philadelphia is the home for the development of innovative solutions to healthcare’s immediate and long-term informatics needs. CBMi provides informatics-focused services, applications, and educational programs to Children’s Hospital clinicians and researchers.
The Inglis Foundation is a community-based foundation that is committed to using technology and healthcare information to empower people with severe physical disabilities to live life to the fullest. Inglis maintains a skilled-nursing care facility and independent-living facilities as well as care management, adult day and employment services for people with disabilities living in their own homes.
NCAM and WGBH (Project Leader). WGBH Boston is America’s public broadcasting powerhouse—PBS’ largest producer of TV and Web content. The Carl and Ruth Shapiro Family National Center for Accessible Media at WGBH is a research and development organization that works to make existing and emerging technologies accessible to all audiences. NCAM is part of the Media Access Group at WGBH, which has been providing captioning and video description services for people with disabilities since 1972.
I always like it when worlds collide, showing that we can start from different goals, but end up with similar guidelines. One of those happy collisions is plain language and accessibility. If you are looking for one thing you can focus on to improve your web site content, plain language is a good place to start. Making information clear helps everyone because:
- People read with different degrees of literacy. Clearly written information helps those who don’t read well.
- They do not always read carefully. Even skilled readers may be scanning a page quickly.
- They may have a cognitive, language, or learning disability. Understandable vocabulary is an important part of making information clear.
- Visual disabilities can affect reading, so presenting text well helps, too.
- They may not know (or read) the language well. In a global web, readers may be from anywhere in the world.
I’ll be teaching a class on writing in plain language at AccessU, in Austin on May 12-13, 2014. But if you can’t join us at this great conference, my slides are available online on Slideshare.net (where you can download an accessible Powerpoint file).
For the accessibility side of this collision, plain language is part of the WCAG 2.0 accessibility guidelines, especially “3.1 Readable: Make text content readable and understandable.” But well-written content is also helpful for meeting other guidelines, by making sure that:
- Headings and field labels organize the content in a descriptive way that supports readers. (WCAG 2.4.6 and 2.4.10)
- Users can understand what will happen when they click on a link because the link is written clearly and presented in a clear context. (WCAG 2.4.4 and 2.4.9)
- Instructions and help are available, especially for interactive features and forms. (WCAG 3.3.2 and 3.3.5)
- Unusual words that the audience may not know and abbreviations are explained. (WCAG 3.1.3, 3.1.4, 3.1.6)
The plain language advocates also point out the understanding information can be a civil right. This is especially true when the information comes from your government, or affects your rights and benefits as a citizen. But it can be just as important in reading contracts, terms of service, or instructions for using a product. At TEDxO’Porto a few years ago, Sandra Fisher-Martins, of Português Claro, gave one of the best presentations ever on this perspective.
- The Right To Understand
(YouTube Video from TEDxO’Porto, 2011)
It’s in Portuguese, with English subtitles so I’ve posted the transcript here.
Transcript: The Right To Understand, Sandra Fisher-Martins
The story I’d like to tell you started in 1996, when I was studying in England.
One day, I was looking through my bank statement, even though there wasn’t much to look at and, in the top corner, I noticed a symbol which said that this document had been written in plain language, so I could understand it.
I thought this idea interesting, so did a bit of research and found out there was a campaign for language simplification. I thought it a fabulous idea, and then forgot about it.
When I returned to Portugal, I was confronted with several documents, for example, my work contract, the mortgage agreement, the power bill documents which reminded me of that symbol [ the Crystal Mark ] not because they were clear and simple, but because they were the exact opposite. Because, only after a second or third reading, I could begin to understand them.
So the little seed that had been sown in ’96 started to grow. And, one day, I found myself walking into the boss’ office and quitting my job so I could dedicate myself to this.
Right from the start, I realized the problem was a lot more serious than I thought. Not only were these documents complex and annoying, but literacy, which is the ability to understand written documents, was very low in Portugal.
Here’s a graphic about literacy in Portugal. There’s still about 10% of Portuguese who can’t read or write at all. This graphic shows us the ones who can – or claim they can – read and write.
So, there we have the red group which represents those who are on the lowest literacy level, Level 1. They’re those who can join up letters to make words, but can’t actually understand what they read. For example, if they need to read a medicine leaflet to figure out the correct dose to give their child, they can’t. They can’t understand the information. That’s 50% of the Portuguese.
Then we have another 30%, the guys in yellow. These are the ones who can get by, as long as they don’t have to read anything new or different. So, for example, if they work in a factory and a new machine arrives and they have to read the manual to operate it, they can’t.
And that’s already 80% of the Portuguese.
Then there’s a few who can handle documents as long as they’re not too complex. And there’s 5% of the population who can understand truly complex documents.
And just so you don’t think this is the norm, that other graphic shows literacy in Sweden. While we have 20% of people with a literacy level considered essential for daily living, Sweden has 75%.
And looking at this graphic, I realized we live in an information apartheid. I realized there’s a small minority who can access information and use it for their benefit and a huge majority who can’t. And because they can’t, they’re excluded and at a disadvantage.
I’ll give you an example. That’s Mr. Domingos. He’s our building’s janitor. He started reading when he was 27. He’s in the yellow group we saw earlier. Once in a while, he comes to me and says “Miss Sandra, I got this little letter…” Whenever Mr. Domingos or someone in his family gets a letter they don’t understand he brings it to me and I help translate it. So, that time he said, “I was about to throw this in the bin, but could you just check if it’s something important?” It was. Mr. Domingos had been waiting for some time to have knee surgery and it was he letter that contained a “Surgery Voucher.” When someone has been waiting a long time for surgery, they’re sent this voucher that can be used at a private clinic. And Mr. Domingo’s letter almost went in the bin.
Later, I found out that, in that same year, only 20% of those vouchers had been used. I find it hard to believe the other 80% just got better while they waited. They probably did what Mr. Domingos was about to do: “What’s this? Don’t get it. It’s rubbish.” They missed the opportunity to have the surgery they needed.
When people don’t understand, it has serious consequences, not only for themselves, but also for the whole country. If I don’t know my rights or the benefits I’m entitled to, I probably don’t know my responsibilities either and I’m not an active and participating citizen.
And now, maybe you’re sitting there thinking “Poor Domingos, that’s tough.” “Me? I’m a green one. I’m pretty sure I’m a green. I was invited to come to TEDx.” But let me read you a few things I’ve got here and we’ll see what color you are when I’m done.
This one is from a car insurance policy. It says:
“Unless otherwise stipulated, upon demise of the insured person, the insured capital is provided, in case of predeceasement of the beneficiary relative to the insured person, to the latter’s heirs. In case of commorientes of the insured and it’s beneficiary, to the later’s heirs.”
Next, I’ve got a medicine leaflet, “Beware. Erytheme, edema, vesiculation, keratites and urtication can still occur.” Got that?
This one is really good. Is signed the new office’s tenancy agreement on Friday and it said: “I, the guarantor, assume the tempestive payment of the lease, waiving the benefits of division and previous exclusion.” When I read “tempestive payment” I pictured myself barging into the landlord’s office, slamming the door and shouting “HERE’S THE MONEY!” But that’s not what it means. It’s not.
When we move away from our area of expertise, and we don’t’ have to go very far, it doesn’t have to be string theory, when we move away from our area of expertise, we’re as much in the dark as Mr. Domingos. And these are not documents written by experts for experts like the string theory ones. These are documents written for me. These are public documents. Documents I need to understand to get by daily. To live my life. The tenancy agreements, the medicine leaflets, the power bills. All these should be clear, so we can understand them. Because, what happens if they’re not?
I’ll give you an example of mistakes, bad decisions, due to misunderstandings of bad documents. You remember the “subprime crisis” in the United States? People were signing agreements without truly understanding what they were agreeing to. If they knew, they would have realized as soon as interest rates went up, their mortgage payments would shoot through the roof. Do you think that, if the financial sector had a culture … captions missing…
This huge gap between the average literacy level, and the complexity of public documents, all the way… captions missing …
Well, the most obvious solution, given that literacy is .. captions missing… Let’s teach people. It’s obvious. Of course we must teach people. But it’s hard, and it’s slow. I don’t even want to imagine how many generations it will take for us to reach Sweden’s level. But it’s not just because it’s slow. There is another reason. If the documents’ language isn’t simpler, we already see that even people with high literacy, people like you guys, struggle to understand a document if the language is complex. Yes, we must improve literacy, but right now, it’s much more important to reduce public documents’ complexity and simplify language.
I’ll give you an example. this is what I mean by “simplify language.” This is an extract from an insurance contract: “It’s agreed the insurer blah blah blah…” Compare the before and after versions. This is what I mean by “simplifying language.” It’s communicating in a simple and clear way so that our reader understanding it the first time. Which one do you prefer? Pretty obvious, isn’t it?
So, how can we get the government and businesses to communicate with citizens in a language they can easily understand? There are several ways. Some countries have take the legislative route. Last year, the U.S. and Sweden passed laws which require the State to communicate with people in a language they can understand.
You might think: “But that’s normal. Sweden and the U.S. are more advanced than us.”
“It would be nice if we also had these laws, wouldn’t it?”
It would. And you know what? We do. Since 1999. The administrative modernization law says the communication between State and the people must be simple, clear, concise, meaningful, without acronyms, etc. etc… But no one complies with this law. The legislation route only works in countries where laws are made to be applied.
But there is another way. The marketing way. And how does it work? Private companies simplify tier language, they make a big song and dance about it, consumers love it, sales go up. Works a treat. But it works just for the private sector.
And there is a third way, which for me is the most important. It’s through civic movements, which are based on a change of mindset.
In those countries where this succeeded – remember the English symbol of the Plain English Campaign? it’s often based on consumers’ movements.
And how do you star a civic movement? We need to understand two very important things. First, wanting to understand public documents, it’s not a whim, its not intellectual curiosity. t’s a daily need and, most of all, it’s a right. It’s everyone’s right.
So, understanding is a right. But there’s something else. Those who write, must write to be understood. How do we make this work? First, we need to become more demanding consumers and citizens. Think about it. Next time someone hands you a document you just can’t understand don’t just let it go and pretend you get it. No, demand to understand. Ask questions. I know it’s not easy to ask the guy in the suit: “This bit here in the contract, what does it mean?” It’s not easy at all. Maybe even a bit embarrassing. But don’t worry. It’s actually a sign of intelligence. What do you teach your child to do when they have a question at school? “Be really quiet, pretend you know and make a clever face.” That’s not it, is it? You say: “When you don’t know, stick your hand up and ask until you get it.”
And that’s exactly what we need to do as consumes and citizens. Next time you’re handed a document you don’t get, demand to understand. Put pride to one side for a bit and ask until it’s all clear.
Then there’s another side. Those bad documents don’t just fall from the sky. Someone wrote them. In such a large audience, there are probably some lawyers, public servants…Don’t worry, I’m not asking you to stand up. But I do ask you to think about it. How many times do you write documents for the public, for those who don’t share your language, and you do it in a way that only you will understand? And you’ll say: “But there’s a reason for it.”
My friends, I’ve heard them all. There are thousands of them: “It’s the way we’ve always done it,” “my boss…” “the judge…” “what if it goes to court?” “You want to destroy language,” “We have to educate people,” “We can’t lower the standard.” Blah blah blah. I’ve heard them all. They’re all excuses.
Someone mentioned Einstein before. He said once: “If you can’t explain it simply, you don’t understand it well enough.” For Einstein.
So… (arggh running out of time!) If you know what you want to say, you just need to believe it is possible to write it in a clear way. And how do you do it? It’s very easy. You write for your Grandmother. I’ll show you Grandma. You write with respect and without patronizing her. And you use these three techniques.
First of all, you start with what’s most important. Grandma is busy. She’s not going to read three full pages just to get to the main idea. Start with what’s most important.
Second, use short sentences. Because Grandma, like any of us, if the sentences are too long, by the time she gets to the end, she won’t remember the beginning.
And finally, the third: use simple words. Those that Grandma already knows. OK? It’s easy.
Before I leave, I’d like to tell you about Claro. It’s a social responsibility project with the aim of changing the way public communication is made. What do we do?
We’ll start this year with a collection of Clear Guides. We’re going to take very complex subjects and boil them down to the essentials. We’ll start with the Clear Guide of the Justice System, which, I think, will be very useful.
Another thing we’ll do is give prizes to the best and worst documents. Because there are people out there trying to communicate clearly and should be rewarded. And there’s some lazy ones who don’t even try and should be humiliated. So, we’ll award the best and worst. I’m counting on you to help out. The campaign will be launched through Claro’s Facebook page. So become friends and you’ll be up to date.
But finally, most of all, what does Claro want? We want to put two ideas in your heads.
First demand to understand.
Second, write to be understood.
Write for Grandma. But if you don’t have a Grandma, write for Mr. Domingos. He’ll appreciate it.
If you work in user experience or accessibility, you probably spend part of your time on advocacy–making the case for a new design idea or a new way of working. Lawsuits are the ultimate way to get two sides to come to an agreement, but it’s also an extremely confrontational style of advocacy.
A more collaborative process might be a better way to reach your goal with an agreement that is a win for everyone.
Lainey Feingold is a disability rights lawyer with an extraordinary record of landmark cases, including settlements with some big companies that have made their sites more accessible. She’s done all this using Structured Negotiations, a process that lets a group of people work together to find a solution to a problem. It takes active patience, flexibility, grounded optimism, confidence, trust, and a empathy to be successful at Structured Negotiations.
Lainey joins Whitney Quesenbery for this episode of A Podcast for Everyone to answer questions about this new way of reaching agreements.
- What are Structured Negotiations?
- Why are they more effective than lawsuits?
- How can you used the concepts in structured negotiations for UX advocacy?
- What are the characteristics of a good negotiator?
Lainey Feingold is a disability rights lawyer who works primarily with the blind and visually impaired community on technology and information access issues. She is nationally recognized for negotiating landmark accessibility agreements and for pioneering the collaborative advocacy and dispute resolution method known as Structured Negotiations.
Resources mentioned in this podcast
- Law Office of Lainey Feingold
- About Structured Negotiations
- Examples of Web Accessibility Settlements
Whitney Quesenbery: Hi. I’m Whitney Quesenbery, and I’m co-author with Sarah Horton of “A Web for Everyone for Rosenfeld Media.”
Today, I’m talking to Lainey Feingold. Lainey is a disability rights lawyer with an extraordinary record of landmark cases. She’s also a California Lawyer of the Year for 2014, and recognition of her work that includes settlements with companies like Walmart, Bank of America, Weight Watchers, Major League Baseball, and the Safeway grocery chain, all of which have made their sites more accessible for people with disabilities.
Hi, Lainey. Thanks so much for joining us.
Lainey Feingold: Hi, Whitney. Thanks for asking me.
Whitney: I love your work so much. I’ve heard summaries of the kind of work you do focusing on the settlements that you’ve reached, but it seems to me that a lot of the UX work we do includes what I might call internal advocacy that is when we’re working to convince other people on our teams or in our companies, that a new design idea will work.
We always seem to be looking for better ways to make the case. Before I met you, I always thought lawyers meant lawsuits, but you’re doing something quite different, using structured negotiation as an alternative. Can you start by telling us what structured negotiations are? Maybe a quick example of how it works?
Lainey: Sure. Structured negotiation refers to a way to resolve legal claims without litigation. Most of your listeners are probably familiar with lawsuits or mediation or arbitration. Those all involve third parties helping the people at the dispute make a decision or come to a conclusion.
Structured negotiation is a way to resolve claims working directly with all the stakeholders. The way it works is we get a call from most often a blind person that’s usually our client base, but the method would work for other claims as well.
We get a call and, say, we recently did a settlement with Weight Watchers. The person was a blind woman who’s a Weight Watchers member and she wasn’t able to access the tools on the Weight Watchers site. They have an amazing set of digital tools to help people lose weight. She wasn’t able to reach the right people in the company to make it work.
She called the lawyer and we did a little research and found that this was really a health issue that impacted a lot of people in the community. We wrote to Weight Watchers. We said, “This is a claim. You really need to make your website accessible for people with disabilities, usable by people with disabilities.
Rather than file a lawsuit, let’s sit down and see if we can make it work, talking with each other.” That’s how we do it.
Whitney: Do people respond to that? Why would a company be willing to work with you?
Lainey: Whitney, that is a very good question. At the beginning, I first started doing a lot in this way 20 years ago. We had been approached by a blind lawyer who was an expert in tax issues and finance issues. He had written a book, yet he couldn’t use a basic technology to finance industry, which was, and still is, the ATM.
We got this situation. Blind people can’t use ATMs, but the ADA was new. There were no accessible ATMs in the United States. We thought, “Maybe we should a couple of banks and see if we can work with them on a solution.” It worked. I used to think it was luck, but now, I’ve been doing it for 20 years. We have some of the biggest institutions in the United States.
I think that it’s a viable method, and it works because when approached in the right way on these kinds of issues, large institutions can say, “Hey, I didn’t really think about that. With occasions extremely expensive for all sides, let’s see if this thing can work.”
Whitney: You said something at the beginning about how instead of having a third party making the decisions, you got to work directly together. Does that mean that everybody gets to sit around the table together and work? Because I’ve been an expert on some legal advocacy work, and it was really frustrating that I wasn’t allowed to be in the room.
Lainey: It’s funny you mentioned that, because I think the way that structured negotiation brings expertise to the table is one of its strongest qualities. Too often in legal claims, the basic idea of litigation is people are opposed to each other. There’s one side and the other side. Both sides usually need expertise.
Each side has to hire their own expert and that expert has a very defined role when they can speak, what they can write, what are the circumstances when they communicate their expertise.
In structured negotiations, we really try to always think of it as a round table. For web consultants, for example, we really think it’s important for a company to feel comfortable with the consultant that they hire, because every corporate culture is different. There are a lot of great consultants out there, but they wouldn’t all work well with every company.
In our process, we try. The best cases, it works this way
We bring our expertise and the client’s expertise by saying, “Here are these experts. Why don’t you see who will work best with your company?”
Whitney: You’re not just coming to a decision about how to solve a problem. You’re actually helping them get the skills they need, the experts they need to help them solve that problem?
Lainey: With the ATMs, when we started, there were no talking ATMs in the United States. The blind team, a spokesperson really helped the companies understand what makes something usable for a blind person. The developers and the technology people were thrilled to have that input. That’s been my experience throughout.
The people who are doing the work, they want the web to be available for everyone. They want the ATMs to work. Having, especially the usability side of it from the blind users was completely critical. With the websites, we use WCAG 2.0 Level AA as a standard. We know, going in, that that is what we think the companies need to do.
There are many situations where we can have WCAG 2.0 AA compliance, but you still need the user feedback. We did negotiations with the major credit reporting companies in the United States to make sure that blind people could get their credit reports in accessible formats. They had a very unique catch at the time.
We had 19 different blind people testing it on a whole variety of configurations. The process allows for that kind of involvement of the people directly affected
Whitney: That’s really great. It’s a little like participatory design where we go from where designers and we know what you can do to where usability experts and we’ve worked with enough users to be able to represent them to actually letting the users be part of the process.
Lainey: Yes, as much as possible. That just seem so many “Aha!” moments or light bulbs going off when the developers, the designers, the content writers actually get to meet the consumers who are using their site in different ways.
Whitney: It sounds like early usability when we would make what we call highlight reels. We can make videotapes of pieces of the usability sessions for the “Aha!” moments, just to try to bring it home. I knew that we’d tipped over a corner once when I was working with a team. We had done some recording and I said, “What would you like to do?” They said, “Could we just sit and watch?”
They said, “What you said is great, but we’re learning even more by being able to see it directly.” I thought that was a big moment for me in my work, thinking about how we bring people together. It sounds like you’re both trying to solve a problem but also creating relationships. Maybe not with those individuals forever but between a development team and a company and the people they work for.
Lainey: Relationship building is really a critical part of it. In some ways, you could say, “It’s not really fair for any one blind person or one deaf person to be a stand-in for all blind people and all deaf people.” In fact, a lot of people have never met people who need or use a computer without using a mouse or can’t listen to the video unless it’s captioned. They just never had the experience.
Whitney: Does your relationship with the company go on past the settlement?
Lainey: Yes. We write the letter. When all works according to how we would like it to work, we have meetings and then there’s language drafting exchange, we have a settlement agreement. That agreement, at the end of the day, looks very much like an agreement as if we had filed the lawsuit. It’s just we skipped all that procedural nuttiness.
Then like a litigation settlement agreement, eventually, they do expire but we do continue the relationship. We’re working with very big companies with a lot of digital content and sometimes is backsliding, but we have the relationship there to do a quick correct if something goes wrong afterwards.
Whitney: It sounds great. Do you find that solving one problem actually opens the door to their being able to not cause so many problems in the first place? We always have this idea of, “Do the pilot project. That will show them how to do better usability or better accessibility.” Sometimes, we get to see whether that works. Sometimes, we don’t.
Lainey: I am a complete believer in the pilot project, or we call it baby steps. I would say probably 50 percent of our cases, we have had to take small steps first to get the company comfortable with doing the work and to dissolve the fear factor, which is very present in a lot of these issues. They don’t know, “If we offer large print, how many people? Is it going to be too expensive?”
We recently announced agreements with major pharmacy chains for talking prescription information. What might happen if we do this? There are a lot of unknowns. That’s OK. We can take it slowly. That’s another good thing about this process. We can take the first step.
A good example of that is Major League Baseball. We did a deal with them. They’ve been great negotiating partners. We’re representing the blind community, and the focus of the first level of work they did was their website issues, mostly affecting blind people.
We did a second agreement with them, extended that first one as a mobile app, became more popular. Now, they have a very good mobile app. Then this year, really directly unrelated to us but I like to think having something to do with us, they have announced a great captioning program, because they just got asked about accessibility and they’re just really doing a great job.
Whitney: It sounds like it takes a combination of patience and persistence. What skills or qualities do you need to be successful in this style of working?
Lainey: It’s funny you say patience and persistence, because if structured negotiations had a mascot, it would be the stone lions that sit outside the 42nd Street Library in New York, whose names are Patience and Persistence. They were named that during the depression by the mayor who felt those are qualities that New Yorkers should have. I think they’re qualities that negotiators should have.
In terms of the patience, a lot of lawyers feel patience is weakness and if you give extra time or you’re not insistent on holding the deadline, somehow, you’re not protecting your clients’ rights.
I put an adjective in front of patience and call it active patience for that reason, which really just means you’re not waiting around, tweeting your thumbs, hoping the person will do the right thing, but you’re recognizing that in a large institution, and even in a not-so-large institution, change takes time and there’s a lot of cultural factors that you just can’t come in and say OK overnight, snap your fingers, and usability is going to be a principle of this institution. Active patience is key.
Whitney: Your website talks about two other words that I really love. One is grounded optimism, and the other is confidence and trust.
Lainey: Grounded optimism, I actually stole it from someone I know named Gil Friend, who’s a sustainable business guy. He wrote a piece on grounded optimism, and I asked him, “Can I take that for structured negotiations?” Basically, that’s the same thing in terms of putting adjective active in front of patience.
It’s not being optimistic like, “Oh, everything is rosy. If we just wait long enough, everything is going to work out.” It’s grounded in strategy and that if you take the right steps, you can trust and here’s where trust comes in, one way. That’s going to work out.
I believe in negotiations. If you didn’t, it’s not all smooth sailing from the first time we write the letter. Even the companies we have best relationships with didn’t start out, “Oh, thank you so much for writing to us. We’re really glad to have a lawyer on board.” No. If you believe in the process, then you can weather the inevitable downturns that are going to come along.
Whitney: I love that you’re taking such a long view, because it’s really nice to see someone who can see this not as a day-by-day win but something that happens over months and maybe years. I really think that’s a quality that we need more of in UX, which is being willing to say, “Just because it isn’t perfect today, doesn’t mean that we can’t take baby steps that are accumulating.”
I think the thing we worry about is that they’ll be baby steps today and then they’ll be backsliding. It takes 15 more baby steps to get back to where you were.
Lainey: The key is to hold onto the big goal. I was actually talking to my husband about this, because he writes about activism. I was talking about this whole baby step thing and that it’s somehow falling short because another piece that I think has really helped structured negotiations is this idea of appreciation and appreciating the baby steps.
Because when we first worked on the talking ATMs with the banks, Bank of America had 15, Citibank had 5, Wells Fargo had 10. We did these press releases. Congratulations. That was out of their whole fleet. Now, every single one of those banks has every single ATM that’s accessible to blind people.
I think as long as you hold onto the far goal and don’t quit until you get there, the baby steps is a good strategy.
Whitney: You mentioned appreciation. Laura Packer, who is a storyteller and the wife of my co-author — I’m talking about Storytelling for User Experience — talks about appreciations. One of the things that she gets people to do when they’re working on stories is she’ll get one person to tell a story to another. Instead of critiquing it, that person has to give that person telling the story an appreciation of it, what did they like in it, what did it move them to feel.
I loved that because it let us turn off that little critic that sits on our shoulder and yaps in our ear and just let us sit back and think, “What’s good here?” Because her point is that a storyteller with a brand new story they’re working on, or anybody with something brand new they’re creating, doesn’t really need someone to critique them. They need someone to tell them what’s working well so they can build on it.
Lainey: I like that, because I think, as you know, I’m trying to write a book about all of this. It is a whole new thing. As I get feedback from people, I’m like, “Wow, you have to be confident that you’ll get to the end.”
Whitney: Dare I ask when the book will be done or you, like the rest of the authors on “I don’t know, I’m working as fast as I can” plan.
Lainey: Actually, I’m trying to say I’m staying in the present. Right now, in the present, I’m writing the book. That’s about as far as I can go with that.
Whitney: We’ll have to come back to you when it’s further along and see where you are in a future present. I just want to ask you one other thing, which is that when we are thinking about doing advocacy in our own work, just in any other kind of design work, do you have any tips for us that you can think of on how we could apply the principles of structured negotiations to just the day-to-day work of designing a product?
Lainey: Sure. Because I think advocacy skills and strategy are pretty much the same in whatever venue they’re being applied to. I think a lot of these traits that we’ve talked about come into play when you’re negotiating with your own side and your own team. I think that, this is one thing writing a book has taught me when I can take the long view and look at all the cases, usually, when people aren’t readily doing something that you want them to do, there’s a reason for that.
I like structured negotiations because it allows us to tease out that reason. When you sue somebody, the other side has to defend and say what they’re doing is right. There’s really no chance for a conversation about, “I’d like to do it different, but I’m afraid of this.” I think they would apply in any situation to just try to open up the communication to understand what is the issue that’s blocking us from going further.
Whitney: It sounds like we need to understand the motivation on our teams and partners, the stakeholders just as much as we need to understand the motivations for users.
Lainey: I think so, because there could be people are thinking, “How many people are really going to use it this way? Do we really have to work?” There are certain things, and if people are willing to express it, then it can be addressed.
We had a problem with the ATMs at the beginning, because everybody was counting the precise number of users at each ATM. Where are the users?
They didn’t take into account the fact that when ATMs themselves were first introduced in the United States in 1969, the industry had to do a huge amount of work with users to get them comfortable trusting a cash machine with their cash. But there wasn’t that same kind of user hand-holding when they first came online for blind people.
Whitney: Yeah, I’m working with a company on their website. It’s a news site. We suddenly realized that it wasn’t just about saying, “Oh, this is accessible,” or “This is usable,” or “This is a better app,” because if you’re already someone that reads news or gets cash or goes to the baseball game, you’ve found a way to do it already. Maybe it’s not a perfect way.
We have to actually convince you not just that it’s good enough but that it’s better than what you’ve got — that it’s an improvement and that it will actually be easier for you. It’ll improve your life in some way to try this now-improved website.
Lainey: That is so true for the disability community, because people are so used to having to create workarounds. For the talking prescription issues — the things that people do to figure out one rubber band is this prescription and two rubber bands is that — in this day and age there’s just no excuse for that, but people have gotten used to doing it.
Whitney: We’re trying to help people give up complicated, old ways of doing things in favor of nicer, newer ways.
Lainey: Yeah, it takes education on all sides.
Whitney: That is a lovely view for the future, I think, which is the idea that we could actually collaborate instead of just fighting our way through every problem that we come to. I love the idea about learning from how people solve problems that are similar, but in different fields and building on it, because we’re all people.
Lainey: Absolutely. I’ve learned so much listening to you, Whitney, in conferences and presentations and how usability works and how the whole field works. I think I’ve tried to bring some of those learnings into our relationships with our clients. When they’re meeting with the companies and trying to encourage the companies about not to think of accessibility off in some corner, but do you already have usability people, and let’s integrate these issues into something we already have.
Whitney: Yeah. Boy, that sounds like a better win, doesn’t it?
Whitney: I see that we’ve been talking for a while, so I wanted to say thank you so much, Lainey, for joining us. If you folks who are listening are interested in following Lainey’s work or in learning more about structured negotiations, we have links on our website, but you can follow her. She’s @lflegal on Twitter. Her website is lflegal.com.
There are wonderful summaries of the settlements that she’s worked on, but also some great descriptions of how she works and what kind of work she does.
Thanks to all of you for listening in, and also a special thanks to our sponsors, UIE, Rosenfeld Media, and the Paciello Group for making this series happen. Be sure to follow us at a web for everyone at Twitter. That’s @awebforeveryone — all run together as one word. Thanks so much.
Kevin Brooks is the co-author of Storytelling for User Experience, a friend, and most of all, an amazing storyteller.
In January, Kevin was diagnosed with pancreatic cancer.
If Kevin’s work has touched you – through his storytelling, workshops, or the book – let him know you are thinking about him.
Laura Packer, his wife and another great storyteller, is keeping a journal on CaringBridge, to let his extended families stay in touch. Silly pictures, random thoughts and any words are welcome: a photo of his first hospital room showed a wall covered with reminders that they are not alone in this fight.
If you’ve never heard Kevin tell stories, listen to one of them. I particularly love Roller Coaster. It’s the first long-form story I ever heard him tell. It’s about his love of roller coasters, and the story of one particular ride. If you’ve ever dragged someone along on your obsessions, if you’ve ever tried to get someone (or a group of people) to see why something can be scary and exhilarating all at once, it’s 11:21 minutes well spent.
Kevin always throws himself into his work with invention and verve. Who else would hold a surprise wedding. His own. His story Tomato Paste, recorded at the MassMouth Story Slam, is another example of putting a little bit of yourself into everything you do.
Update Friday March 28. Laura wrote to say, “It is with immense sorrow and overwhelming gratitude that I tell you that Kevin Brooks has moved onto his next adventure. Prior to his death, Kevin had many sweet hours holding hands, hugging and kissing those who love him. His passage was peaceful. He was surrounded by family and close friends who sang him into the next world.” Read the rest of Laura’s message.
Kevin M. Brooks, we will miss you.
I spent last week in San Diego at the amazing CSUN Conference on Disabilities, absorbing the presentations and even better hallway conversations. And, I gave three presentations on UX and accessibility.
It was very encouraging to see how much focus there is on moving beyond checklist compliance and towards making user experiences that are delightful for everyone.
Many presentations from internal accessibility groups talked about efforts to work more closely with product and UX teams from the start. And when I asked the audience in one session how many of them had run or observed usability testing, most of the hands went up. Breaking down the silos is a good place to start.
My three presentations are all on my Slideshare page.
Accessibility note: You can read the presentation online as a series of images, or download an accessible Powerpoint file. There’s also a transcript of the text in the presentation at the end of the page.
Where usability meets accessibility
Jayne Schurick and I looked at the intersection of usability and accessibility in the user experience:
- How usability problems can be more severe when there are also accessibility barriers.
- When accessibility problems can amplify usability issues and make them more noticeable.
- Looking beyond the noise for the problems that have the most impact on the user experience.
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Need a little usability? What you can learn from usability testing
Every study starts with a question. This session started by examining the questions that usability testing can answer and then matching them to different approaches and methods. It will help you know what you can (and can’t) learn from working with real people as they try to use a web site or other product.
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Accessibility as innovation: Creating accessible user experiences
Accessibility can be a “wicked” problem – one that is difficult to solve because the requirements are incomplete, contradictory, or changing. It’s especially hard to keep advances in technology, standards or regulations, attitudes, work processes, and personal habits all in line.
But, if we take diverse participation in the design process seriously, we might find that we change the question and end up with even more innovative products.
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If you’ve just been put in charge of making a site or app works for everyone, the most daunting step might just be the first one. Sure, there are standards, but sometimes they raise more questions than they answer.
What you need is an easy way to get started. And Easy Checks may be just what you need.
Sharron Rush heads the Easy Checks project at the Web Accessibility Initiative. These simple steps help you get an idea of whether a site meets some of the basics for good accessibility, without any special technology or tools. She joins Whitney Quesenbery for this episode of A Podcast for Everyone to answer some of these questions.
- What are the Easy Checks, and why are they needed?
- Can anyone use the Easy Checks? Is there special equipment needed?
- What’s the best way for a project team to get started with accessibility?
- How do usability and accessibility fit together when you are evaluating a web site?
Sharron Rush has been an advocate, a learner, and a teacher of accessible technology for 15 years. She is Executive Director of Knowbility and an Invited Expert to the W3C Web Accessibility Initiative where she co-chairs the Education and Outreach Working Group, which wrote the Easy Checks.
Resources mentioned in this podcast
- Easy Checks – A First Review of Web Accessibility
- Access U (May 12-14, 2014 in Austin)
- Web Accessibility Initiative
Whitney Quesenbery: Hi everyone. Welcome to this episode of “A Podcast for Everyone.”
Whether you are in charge of the user experience, the development or the strategy for a website, our goal is to help you make your site accessible, without sacrificing design or innovation. I’m Whitney Quesenbery. I’m the co-author with Sarah Horton of a new book from Rosenfeld Media, “A Web for Everyone.”
Today, I’m talking to the extraordinary Sharron Rush. Sharron is the Director of Knowbility, home to projects like the Accessibility Internet Rally, AccessWorks, they do projects to help companies make their sites accessible, and they run the annual AccessU conference. We’ll talk about that at the end.
She’s also a part of the Education and Outreach group at the web accessibility initiative at the WC3. She joins us today to talk about Easy Checks, and how they can help you get your site on the road to part of being a web for everyone. Welcome, Sharon.
Sharron Rush: Thanks Whitney. It’s great to be here.
Whitney: Great to have you. Before we dive in, I want to just mention the URL, so we make sure we get it in the tape, that URL for Easy Checks is www.w3.org/WAI/eval/preliminary, and the full title of this page is “Easy Checks – A First Review of Web Accessibility.” You know, Sharon, that sounds almost practical, and this is from a standards organization.
Sharron: [laughs] Are you surprised? You sound like you’re very surprised at that. That was our goal, in fact. We wanted something that was practical, and that really truly was easy.
Whitney: Yes. It sounds like we all know what we need to do, what we don’t know is where to start. It’s great to see some material out there that will help. Tell me about who created the Easy Checks and how you worked on it.
Sharron: You mentioned a minute ago that I was part of the W3C’s Education and Outreach Working Group for the Web Accessibility Initiative. That’s a group of volunteers and invited experts who take all of those fabulous very technical documents that are developed around HTML5, CSS, and all the accessibility standards, the Web Content Accessibility Guidelines, all of those things.
What we try to do is digest them, and do outreach that will help lay people use them, understand what they are, and be able to really use them in a practical way. One of the things that we kept hearing was that…I just feel overwhelmed when I come to the W3C. I’m interested in accessibility, but I really can’t even begin to know how to apply those Web Content Accessibility Guidelines (WCAG). What we decided was, why don’t we make a really easy way for people who aren’t technical, who don’t necessarily have automated testing tools or any of that, but just to get an idea of what does accessibility mean and how do I know if I’m even in the Ballpark.
Whitney: Cool. So, you see why I was a little surprised about something called the easy connectable standards, but it’s really great to hear that kind of project. I have a really big question with just how did you decide what you should include. I assume that Easy Check are things that are really important, but how did you decide what to include?
Sharron: That is a good question. That part wasn’t an easy thing to do because there are some things that create great barriers for accessibility but that aren’t really easy to check. We start by developing a framework that says, here are the requirements in order to be an Easy Check. It has to be all these things, but paramount was, it has to be easy to make a decision, it has to be easy to make a call on whether or not it passes or fails.
We weren’t always successful, and I think you’ll find, if you look at the Easy Checks, that we say, “Here’s what you can do. You can take this step and you can do this, but, even if you get a green light on this, you’ll probably want to go further. If you get a red light on this, at least you know that you have a problem. It’s not all black and white either, through the Easy Checks.
Whitney: Two things. They have to be things that we could do, like someone like me who’s not very technical could just look at the site and be able to pretty easily tell…maybe not if it met the guidelines, but it certainly could tell if it fails.
Sharron: That is correct.
Whitney: Also, these are things that are important to get started with accessibility, so if it fails these, then maybe some of the deeper things don’t matter them much because you haven’t even gotten the door open.
Sharron: That is exactly correct, too.
Whitney: So, let’s pick one of them apart, and talk about how it works and why it’s important. The first one on the list is ‘Page Title.’ It seems pretty basic, doesn’t it?
Sharron: One of the reasons that we put that as the first one is because it’s relatively easy to check, and it’s the first thing that you often encounter when you come to a website. We thought, “We’ll start with the page title. Does it have a page title, does it not”? And also relatively easy to understand the importance of, because people who are listening to the Web need that for orientation, to understand where they are, “Am I on the right page? Am I where I thought I was going to be”? If the page title is announced and it’s clear, and gives that information, then they have success.
Whitney: Are you talking about the title that’s up in the title bar or the title that might be a big display title on the page.
Sharron: The title that is shown in the window title bar.
Whitney: If you’re listening to the Web with a screen reader that gets read to you as you enter a page?
Sharron: It does, yes. That’s the first thing that you hear.
Whitney: So, you know that if you clicked on a link, you’ve got to the place you wanted it to be.
Sharron: That is correct.
Whitney: The second one is ‘Headings.’ Again, that doesn’t sound like a really technical thing.
Sharron: No. Checking for headings, but now what you have to do there is to make sure that you’re not just looking at the page to see if there’s big, bold text. In this case, you have to actually do a little bit more investigation and see, has it been marked up as a heading? So, before people get really scared about, “My Gosh! I have to know code,” we do also introduce in the Easy Checks some easy tools that you can just put in your browser and use to help you find those things.
Whitney: Cool. So, I don’t have to have a web editor or a technical development environment.
Sharron: Right. And you don’t have to open a source code and start digging through the source code. You can download some of these tools and, that’s one of the first things we take you through, how do you chose the tools that will work, that will be easy to use, and the results of which you can understand also very easily.
Whitney: This sounds like you’re really addressing something that I hear a lot when I talk to project teams, which is that they say, “We want to do it but the whole thing seems daunting,” and they don’t know where to start. You’ve told us that someone who isn’t that technical could use Easy Checks. Here’s my real question, if you fixed the things that were in Easy Checks…let’s say you found out that you didn’t have good headings or good page titles and you actually fixed them, how much of a difference does that make?
Sharron: It makes a huge difference because those are the ways that people even orient to the information on the page, to begin with. You used the phrase earlier about opening the door. You definitely are, then, opening the door so that people know where they are, know how to get among the different sections, where they’ve landed, and they just have a really useful way to interact with the information that they’ve come upon.
Whitney: I noticed that the page actually breaks this into a couple of parts. There’s this page title, and then there are some things that are really about the text. I don’t think we often think about the content of the page when we think about accessibility, and a lot of people jump right into worrying about, “Is it Java script, and does it do things in complicated ways that are easy”? This sounds like it’s stuff that would apply to even a very basic website.
Sharron: Yes, Absolutely. That was our goal, to make sure that anyone…and also regardless of the tools, if you are using WordPress, Drupal or some content management system, these Easy Checks still apply and you can use them really sequentially or you can jump around and see what…”Well, I just added some multimedia. I just want to check that out.”
Whitney: If you’ve just added something new…
Sharron: If you’ve just added something new to your site and you just want to check on that particular part of it…
Whitney: You said something really interesting which is, this isn’t a sequence, so it’s not a process, it’s a series of checks that you can use. Tell me how you would decide when to check something.
Sharron: Certainly, you’re welcome to…and people have used this sequentially, just gone one ride after the other and done all the checks. In some cases you may have just added a new feature, and you’re not sure if you can reach that or activate that with a keyboard. So, you might use a keyboard access check, all by itself.
If you’ve added a new sidebar and you say, “I wonder if that text contrast meets the requirement for people who have color blindness or low vision,” and you just want to check that one thing. Then, you can really segment this out and check whatever it is that’s of concern or maybe that you have responsibility for, if it’s media or some other aspect.
Whitney: That’s nice because I think often…I know there are sites where one person does everything, but a lot of times I would think that the people in charge of multimedia might be different that the people in charge of, say, writing forms. So, this lets you get the right check to the right person.
Sharron: Exactly. That was what we were hoping for. Now, for people who are going to be at CSUN, the Assistive Technology Conference, we’re going to be trying to corral some people to really do some usability tests on this Easy Checks itself. If people are at CSUN, and they want to find us and do that, Shawn and I…Shawn Henry is my coach here at the Education and Outreach working group. We have a couple of different sessions.
Just come find us, because we’d love to get feedback from people about the way that they use it, how they found it to be useful, or how it could be more useful.
Whitney: Since you mentioned CSUN, that’s the CSUN Conference. That’s CSUN in San Diego, from the 18th to the 21st of March. You actually gave me a great lead into what I was going to ask you next. For those of us who work in UX, working with real users is an important part of developing any project.
First of all, I’m really glad to hear that you’re actually testing the Easy Checks, but I want to actually ask you about where you think usability testing fits into accessibility.
Sharron: Oh, Whitney. I think usability testing is so important, because there’s a difference between conformance to a technical standard and usefulness to a person with a disability. I think Education and Outreach, our working group, most definitely has the human perspective. We want to give people resources that certainly, by all means, meet the standards and conform to the standards, because that’s really important in terms of technology interoperability.
But, ultimately, the most important thing is whether someone with a disability can get the information, interact with it, and perform the same functions and do it in an efficient way. I’m so much a fan of your work, because of the fact that you understand that intersection as well as anyone, and it’s an important thing for people to remember.
Conformance, by itself, is almost secondary.
Whitney: Yeah. When I started in usability, we used to do heuristic or expert evaluations, and the way I was taught to do them is, first, you did the expert evaluation, you fixed all the problems that you could see easily, and then, when you had something you really thought was working, you took it to users, and you tried it out with them to make sure that it really worked.
You would really find different things. We would find technical problems, but the usability testing would find problems like, “Yeah, it works, but it doesn’t work the way people want it to work,” or, “It doesn’t really do the things they need.” I think it’s great to hear that getting into accessibility as well.
Sharron: Yeah, and, often, that it doesn’t work the way that they expect it to work. User expectation is something that, I think, in the accessibility field, you have screen reader users who they’re managing some pretty complex interactions with the screen readers in the way they use the keyboards for certain things.
Then, if the designer decides to introduce a keyboard command that contradicts that, maybe, technically, it doesn’t interfere with accessibility conformance, but, when it comes to use, it’s going to be a different story. Fortunately for us on Education and Outreach, we have group participants in the working group who have disabilities of various kinds, so we get that feedback immediately.
We hope that we’ve integrated that into…one of the things you’ll find on the Easy Checks is we have different sections that expand and collapse in order to talk a little bit about the tools that you might use here, or give you some more tips of some more definitions. We had to really fiddle around with that expand-and-collapse function because of the way it interacts with its various assistive technologies and what were the expectations of people with disabilities who would come on the expand-and-collapse function.
Whitney: I also noticed that one of the links on the page links to another page that talks about involving users in evaluating Web accessibility. I think that’s really helpful to have some guidance there as well.
Sharron: Yeah. We also want to not just include that in our own group of people but encourage other people to understand that it’s really not that difficult to include users with disabilities in your testing processes.
Whitney: It sounds like we’ve got a great thing here. We’ve got a strong standard that’s an international standard with some choices about where to start, some tools to help you get started, that’s been informed by actually users with disabilities as well as experts, and also guidance to help people who are evaluating their own website, include people with disabilities in that testing.
Just to say it again, you can find the Easy Checks two ways: if you go to the home page of the Web Accessibility Initiative, you can look for Easy Checks under “Evaluating Accessibility,” or let’s repeat the URL, it’s: www.w3.org/wai/eval/preliminary.
Before we run out of time and wrap up, Sharron, I would love you to tell us about AccessU, your conference is coming up May 13 to 15 in Austin, Texas. Full disclosure: Sarah Horton and I, are both really excited that we’ll both be presenting at this year’s event.
Sharron: Oh yeah. We’re very excited that you’re coming. The whole usability track at AccessU this year is going to be one of the strongest that it’s ever been, thanks to the work that you, Sarah, and others who are doing so. Yeah, we’re very excited about AccessU this year.
It’s the 12th annual AccessU. We get the run of the St. Edward’s University campus. It’s a beautiful campus in South Austin, looking right over downtown, and they’re in between classes, so we have the full run of the campus for those three days. We really tried to provide very practical…just like the Easy Checks. Something that’s practical, that you can take home and use right away.
We have tracks in usability, we have technical tracks, policy and managing tracks, and really hope to see as many people as possible come to Austin in May. We haven’t turned on the big heater yet.
Whitney: Who are some of the other stars that’ll be there?
Sharron: Derek Featherstone, from Simply Accessible, is going to be there. Glenda Sims — she’s the stalwart, always a great contributor to AccessU. Estelle [?] is going to be there. We have quite a bit of expertise of HTML 5, CSS, all the new techniques that people are using, as well as some very basic and very introductory classes as well.
Whitney: So, to work for someone just getting started and for someone who’s trying to do innovative design.
Whitney: Excellent. I really look forward to seeing you there. Sharron, thank you so much. This has been Sharron Rush, from Knowbility, talking to us about Easy Checks and getting started with accessibility.
Sharron: Thanks for having me, Whitney. It was my pleasure.
Whitney: And thanks to all of you for listening in, and, of course, a special thanks to our sponsors, UIE, Rosenfeld Media, and the Paciello Group, for making this series happen. Be sure to follow us at A Web for Everyone on Twitter. That’s @AWebforEveryone. We’ll be posting information about future podcasts there. Of course, if you go to our book site at Rosenfeld Media, we have lots of resources available for you as well.
A Web for Everyone goes global. A few months ago, we were excited when A List Apart published an excerpt from our chapter on easy interaction. Now it’s available in Russian on Frontender Magazine.
Read it in Russian. Or English. Or both.
Thanks to George Sapronov and translator Natalia Lukanyuk (Наталья Луканюк) for their work in making this excerpt available.
Carol is one of the personas from our book, A Web for Everyone. No set of personas can represent the entire world of people with disabilities, but we wanted to bring some of the statistics and demographic data to life in the stories of these personas.
Carol: Grandmother with macular degeneration
Carol has always loved reading, so her fading eyesight is a real sorrow to her. She tried recorded books, but she didn’t like listening instead of seeing the words in front of her.
As a bookkeeper for 25 years, she made the transition from ledgers to a software program, so she’s happy to use the computer. She has an old home computer, which she uses the same way she always did her work—carefully checking everything as she goes. She loves getting emails from her grandkids (and a few friends). She likes reading magazine articles online, especially when they are free. Last year, she discovered that she could get her prescriptions more cheaply online, and now she buys some things from the web.
Her biggest problem is that the text is so small. She’s learned how to click on the symbol to make the text bigger, but is frustrated when it doesn’t work the same way on every site.
She also finds that her hands aren’t as steady as they used to be, and she can’t always click on things accurately. She likes her “old fashioned” mobile phone with large buttons that she can feel easily. As her eyes get worse, she wonders how long she’ll be able to keep using the computer. All that light gray text on a white screen. It’s just too hard to see. Maybe it’s really better for younger people.
I don’t understand what the screen is saying
In Chapter 5, Carol explains some of her problems understanding how to use the web. “I love seeing photos of my grandchildren, particularly since they live so far away. My granddaughter set up a place where she can put up pictures and notes for me. I was excited, but it took me three tries and a phone call to get me connected. I thought I filled in all the answers correctly, but the same questions kept appearing. I’m sure that program was trying to tell me what to do, but I just couldn’t understand what the screen was saying.”
Why can’t the text be just a little bit larger?
In Chapter 7, Carol has a simple request. “I’ve always loved reading, but my eyesight has been going for years. Now, it’s getting worse with this macular degeneration in one eye. A friend gave me a magnifier that she used for needlework. It sits over my book, so my hands are free. That helped for a long time. But even though I’m not very good at using the computer, I still like to try, especially to see the photos my grandkids send me. I love keeping up with them that way.
“Some sites have text that’s just so small. I don’t know what I can do. I’ve learned how to set up my browser so that the text is bigger. It makes the links bigger, too, so I can click on them more easily. I wish all the sites would do this. Some just don’t seem to work. The text stays the same size, and I can’t read it at all.”
Snapshot of Carol
- 74 years old
- Husband passed away a year ago
- Lives in an apartment near one of her daughters, so she can be near some of her six grandkids (ages 6 to 16)
- Graduated from business college
- Retired; worked as a bookkeeper for a construction company for 25 years
- Older computer at home; basic mobile phone
The A’s: Ability, Aptitude, Attitude
- Ability: First signs of macular degeneration, mild arthritis; hearing aid; no special AT on computer
- Aptitude: Used computers when she worked as a bookkeeper, but now her grandkids keep her old home computer updated
- Attitude: Willing, but not adventurous
- Enlarges text, but little other adjustment
To see what the world looks like with one of nine degenerative eye diseases, download VisionSim from the Braille Institute (for iPhone, iPad, Android)
The Bigger Picture
Sources: CDC, A Nation Online, U.S. Department of Commerce, Braille Institute, Census
- 11 million people in the U.S. have age-related macular degeneration; many more have other forms of degenerative eye diseases.
- After age 65, people have steep increases in disability, with over 59% experiencing a loss of hearing, vision, or dexterity. (U.S. Census says 38% of all adults have disabilities.)
Maria is one of the personas from our book, A Web for Everyone. It’s important to remember that a person with a disability is, first, a person. They like their hometown sports team or love going to the theater. They are funny or quiet, or quick to anger, just like everyone else.
You can download an overview of all the personas from our Resources page. The personas images, created by Tom Biby, twofinechaps.com, are available on Flickr. Tune in for a new persona every Tuesday until all eight are posted.
Maria: Bilingual community health worker
Maria comes from a traditional Mexican extended family. She grew up helping her parents and older relatives navigate the English-speaking world. Her work as a community health worker is a natural extension. She does outreach and health education in the Spanish-speaking community in LA.
Her husband is good with the computer, and bought one for home, so their kids would be able to use it for their homework. It’s become an important way to keep up with their family back home. They post videos of the children and use Skype to keep up with cousins and friends.
Her real lifeline is the smartphone that her family got her last year. Her daughter set up all of her favorite sites in her bookmarks, and she uses the calendar to keep track of her appointments. To tell the truth, she isn’t really sure how it all works, but it’s wonderful that it does.
She prefers to read in Spanish, especially when she’s looking up information that she needs to share with a client in Spanish. Her daughter showed her how to translate a page on the browser. It’s not very good, but she can use it to get the general idea of what a page says.
A lot of her professional health education has online videos. Captions help her understand the lectures better, especially for scientific words.
When a site is confusing, I just leave.
Talking about sites with clear purpose (in Chapter 3), Maria says, “My clients, most don’t speak English well, so I need sites that have health information in Spanish, too. I can read it with them and make sure that they understand it, and that they know the words to tell their doctor.
“To tell you the truth, on my own, I don’t stay on a site long if it’s confusing. On many sites, there is so much crammed in that I can’t find anything at all. It just makes my head hurt to even try. I like the sites that are simple and don’t have so many decisions I have to make. When I find a site that works for me, I stick to it. I have a nice health site that I use most of the time. For anything else, I just search.”
When I hear and see it, health information makes more sense.
She also talks about how text-to-speech features help make media more accessible for her (in CHapter 9), “My new phone is so good for my work. I don’t have to carry around so much paper because I can pull it up from my bookmarks. I even tried watching one of my health educator’s videos, but the captions were hard to read on the phone. Those captions are very nice. I can see the words spelled out while I hear them, so I learn how to spell them, too. It’s also nice to give videos to my clients. Sometimes they don’t read English well, but they can listen OK.”
Snapshot of Maria
- 49 years old
- Community college + healthcare certificate
- Married, grown children
- Bilingual (Spanish dominant)
- Community health worker
- Smartphone from her phone service, home computer primarily her husband’s, for his business
The A’s: Ability, Attitude Aptitude
- Ability: Prefers Spanish language sites, when she can find them; needs information and instructions written clearly
- Aptitude: Adventurous, but not very proficient; husband and daughter set up bookmarks for her
- Attitude: Thinks it’s wonderful to be able to have her favorite websites with her at all times
- Translation sites
The Bigger Picture
Source: National Center for Health Statistics and U.S. Census, Marketing Charts
- 17.8 million people in the U.S. speak English “less than well.”
- Hispanic U.S. adults are more likely to use mobile devices and mobile search. They are more likely to take mobile pictures and video.