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How to Test Accessibility in HealthTech Apps

Tomislav B.9 min readSep 11, 2023Technology
How to Test Accessibility in HealthTech Apps

When creating applications or websites, we often unintentionally exclude potential users, missing the chance to help countless individuals. Accessibility testing addresses this issue by ensuring that digital products are not just functional but also usable and accessible to people with disabilities, including those with visual, hearing, motor, and cognitive impairments.

Designers, developers, and QA testers, among others, all contribute to making digital products more inclusive. Accessibility testing can take two forms: manual and automated testing, each with its own set of advantages and limitations. Accessibility testers rely on an accessibility testing checklist, which helps to identify and address potential accessibility issues. This is especially important in manual testing scenarios, where it aids testers in recognizing and resolving accessibility issues that might be overlooked during automated testing.

In this blog post, we will explore accessibility testing for health applications, examining its significance, testing methods, and the specific considerations for both web and mobile accessibility testing.

Why is accessibility testing important in health applications?

Conducting accessibility testing in health applications is crucial to ensure that all users, regardless of their abilities, can readily access and make the most out of the applications’s services. This practice not only aligns with ethical standards and legal requirements but also supports the goal of providing comprehensive and effective healthcare resources to a wide-ranging user base.

Some of the reasons why we conduct accessibility testing:

  • Inclusivity and equal access

  • Health applications aim to provide valuable services to a wide range of users, including individuals with disabilities. Accessibility testing ensures that people with varying abilities can access and use these applications without barriers, promoting equal access to healthcare resources.

  • Legal and regulatory compliance

  • Many countries have laws and regulations that mandate digital products, including health applications, to be accessible to individuals with disabilities.

  • Medical and health needs

  • Individuals with disabilities might have specific medical or health needs that necessitate using health applications. Accessibility ensures that these users can effectively manage their health conditions, communicate with healthcare professionals, and access important medical information.

  • Usability and user experience

  • Health applications often involve critical tasks like managing medications, scheduling appointments, and accessing medical records. Ensuring accessibility improves the overall usability and user experience.

  • Assistive technologies

  • Many individuals with disabilities rely on assistive technologies like screen readers, magnifiers, and voice recognition software. Accessibility testing ensures that health applications are compatible with these technologies.

  • Medical ethics

  • Health applications often deal with sensitive medical information. Accessibility testing ensures that individuals with disabilities can maintain their privacy and confidentiality while using these applications.

  • Avoiding discrimination

  • Excluding users with disabilities from using health applications due to poor accessibility can be discriminatory. Accessibility testing helps prevent such discrimination and ensures everyone can benefit from the application's services.

  • Aging population

  • As the global population ages, the prevalence of age-related disabilities increases. Accessibility testing ensures that health applications remain usable for older adults who might have vision, hearing, or mobility impairments.

  • Medical professionals and researchers

  • Health applications used by medical professionals and researchers also need to be accessible. This ensures that healthcare providers and researchers with disabilities can effectively use the applications for medical decision-making and research purposes.

How to conduct accessibility testing

Let’s explore the significance of accessibility testing for both web and mobile applications.

Web accessibility testing

To meet the accessibility acceptance criteria, the QA team needs to follow a comprehensive checklist, which includes:

  • Running automated testing tools to ensure no new issues are introduced.

  • Testing with at least one common screen reader.

  • Navigating the web page using only a keyboard (no mouse) to ensure all actionable elements are accessible via keyboard.

  • Checking for parsing errors within the accessibility scope of the specific ticket being tested.

These steps ensure that digital products meet accessibility standards.

Automated testing tools

Automated accessibility testing tools are software applications designed to automatically evaluate websites, web applications, and digital content for accessibility issues based on established accessibility guidelines and standards. These tools help identify potential barriers that could hinder people with disabilities from effectively using and navigating digital content. Automated accessibility testing tools are particularly useful for quickly identifying common accessibility issues, but they are not a substitute for manual testing and user testing with individuals with disabilities. Some examples of popular automated accessibility testing tools are DubBot, Wave, Axe, etc.

While automated accessibility tools are helpful for spotting common issues, they may miss some, especially those tied to user interactions, context, and subjective user experiences. For a thorough accessibility assessment, it’s recommended to blend automated, manual, and user testing involving individuals with disabilities. Manual testing and human judgment are crucial for interpreting and addressing complex accessibility challenges.

Testing using keyboard navigation

When testing accessibility using only a keyboard, these are some of the common steps you should follow:

  • The first step in manual testing is to throw away your mouse. Try navigating the page, including all menus and interactive elements, using only the keyboard.

  • Use the TAB, ENTER, SPACE, and UP and DOWN ARROW keys for navigation.

  • TAB through the page to see if it’s in the logical order. See if you can activate all interactive elements using the ENTER or SPACE keys.

  • Pay attention to features like videos, audio files, calendars, Flash content, and photo carousels.

Testing using screen readers

Accessibility testing using screen readers is crucial for assessing website and app accessibility for visually impaired individuals. Screen readers are software applications that convert digital content into synthesized speech or output it as Braille, enabling blind or visually impaired users to access and interact with digital content. When conducting screen reader tests, follow keyboard navigation steps and listen to how the screen reader interprets the page.

Testing parsing errors

Parsing involves writing clean code for HTML, CSS, or JavaScript in a way that browsers and assistive technologies can easily understand. This baseline test requires error-free element and attribute syntax, as well as properly nested start and end tags, to avoid errors that could prevent user agents from parsing the content reliably. If the content cannot form a data structure, different user agents, including assistive technologies, may interpret it differently or even fail to parse it altogether.

Some of the important components to check:

  • Elements have complete start and end tags: ensure that your HTML includes both start () and end tags () wherever necessary. Missing end tags can cause semantic information from one element to spill over to the next, affecting assistive technology users who rely on semantic information for browsing.

  • Elements are properly nested: HTML has strict standards for element nesting. Avoid placing a div tag inside a span or a li tag inside a div without the appropriate ul or ol tags. While some of these bugs may become apparent during automation testing and HTML validation, it’s best practice to prevent them to ensure a smooth experience across all assistive technologies.

  • Avoid duplicate attributes: duplicate attributes, such as providing the same attribute multiple times to a single element (e.g., using alt text twice for an img tag or applying a title attribute twice to a form control), can lead to HTML validation failures. While they may not always directly impact assistive technologies, it’s important to maintain valid HTML.

  • Ensure unique IDs: developers should confirm that every element on a page has a unique ID. Reusing the same ID for multiple elements can lead to automation failures and affect assistive technologies. Duplicate IDs can disrupt the retrieval of information associated with the first occurrence of ID. Once the duplicate ID is provided, assistive technologies will not provide correct information even if other WAI-ARIA attributes are correct. For example, if both ‘First name’ and ‘Last name’ fields share the same ID ‘username’ screen, readers may read both as ‘First name’ after the association is established. Automation tools can help identify duplicate IDs.

Mobile testing

Statistics show that over 55% of web traffic originates from mobile devices, and users expect to have a high-quality mobile web experience. Mobile devices are not going away anytime soon; their usage and increasing popularity make this concept critically important for organizations striving to connect with their audience more effectively. An accessible mobile web experience ensures equal access to content for everyone using a mobile device.

When we talk about mobile, two dominant operating systems, iOS and Android, take center stage. We will go through mobile accessibility testing, including using the device’s default screen reader (TalkBack or VoiceOver) and verifying contrast levels to guarantee an optimal user experience.

Optimizing mobile app accessibility through screen reader testing

When it comes to ensuring the usability and inclusivity of websites and applications, accessibility testing using screen readers is a crucial part, particularly for individuals with visual impairments. Screen readers are specialized software applications that convert digital content into synthesized speech or Braille, making it possible for blind or visually impaired users to access and interact with digital content effectively.

How to conduct accessibility testing using a screen reader

  • Installation and setup

  • Begin by installing and configuring your chosen screen reader on your testing device.

  • Familiarize yourself with screen reader commands

  • Take the time to familiarize yourself with the commands used to control the screen reader.

  • Navigating through content

  • Pay close attention to how the screen reader announces headings, landmarks, and other structural elements. Ensure that the hierarchy and structure of the content are accurately conveyed.

  • Evaluating alternative text

  • Listen to how the screen readers read alternative text (alt text) for images. Confirm that images have descriptive alt text that effectively communicates their meaning to users who rely on this information and cannot see them.

  • Testing interactive elements

  • Interact with buttons, links, form fields, and other interactive elements using the screen reader. Verify that these elements provide clear auditory cues regarding their purpose and functionality.

  • Testing forms and error messages

  • Fill out forms and observe how the screen reader announces form fields, labels, and validation errors. Ensure that users are provided with clear and accurate instructions.

  • Evaluating dynamic content

  • Test dynamic content like dropdown menus, accordions, and modals to ensure that the screen reader accurately conveys changes in content or state.

  • Verifying multimedia content

  • Test multimedia content, such as videos and audio players, to confirm that captions, transcripts, and other alternatives are available to users with disabilities.

  • Noting interaction feedback

  • Pay attention to how the screen reader provides feedback for user interactions. Verify that users receive sufficient information about their actions and the resulting changes.

  • Documenting issues

  • Take notes of any accessibility issues you encounter while using the screen reader. These notes will be helpful when communicating these issues to developers for remediation.

    Remember that proficiency in conducting accessibility testing with a screen reader may require some practice. Additionally, consider involving individuals with visual impairments in your testing process to gain valuable insights into their user experience, helping you identify issues that might not be apparent to someone who does not regularly use a screen reader.

Ensuring color accessibility for a better user experience

When it comes to color usage, the recommended contrast ratio is 4.5:1 and above. Proper contrast ensures readability, making content accessible to a wider audience. For example, using dark grey text on a black background can be challenging to read, while white text on a black background provides a high-contrast solution.

The readability of text is also influenced by font size and weight. While certain contrasts may work well with larger text, they can become difficult to decipher with smaller or thinner fonts.

Testing Contrast

Testing contrast via Colour Contrast Analyzer

Color choices become especially critical when conveying information. It’s important to note that individuals with color blindness may face challenges in distinguishing between similar shades, such as green and red. To address this, consider supplementing color cues with additional elements, such as icons, to signify different states or messages, such as success or failure.

To stay informed about important considerations, you might find resources like the “Colorblind Accessibility Manifesto” valuable. By being mindful of color contrast, text readability, and the specific needs of users with color blindness, you can significantly improve the accessibility of your content, resulting in a better user experience for all.

Color contrast

A must-have for all industries

In conclusion, integrating accessibility testing into every industry, including HealthTech, is not merely a regulatory necessity but a moral and practical imperative. Shifting it from a “nice-to-have” to a “must-have” practice is crucial. From a moral standpoint, it ensures inclusivity, allowing everyone to access your app. From a business perspective, it broadens your user base and leaves a positive impact. In the context of the HealthTech industry, neglecting accessibility testing means denying essential health-related resources to those who need them.

To simplify the whole process, there are a lot of guidelines available on this topic. One of the most widely used web accessibility guidelines is the “Web Content Accessibility Guidelines (WCAG).” Remember that, although this blog is written from the perspective of a tester, accessibility involves not only testers but designers and developers. As we already mentioned, consider involving individuals with different impairments in your testing process. If you do this early in the process, it will help you better understand what their problems really are.

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