1. Presented on Friday 11th September, 2009
Designing for Disabilities
Richard J. Appleyard, PhD
Clinical Assistant Professor, Medical
Informatics, OHSU
Business Technology Manager, City of Portland
Holistic Technology Guru
2. My Background
• Webmaster, Oregon Health & Science
University, www.ohsu.edu , appleyar@ohsu.edu
• Director Disability Informatics, Oregon Institute
on Disability & Development, www.oidd.org
• Web Development Instructor, PSU
• Holistic Technology Guru, www.enablingit.com ,
richard@enablingit.com
• Business Technology Manager, Bureau of
Development Services, City of Portland,
www.portlandonline.com/bds
6. Overview
• What are disabilities?
• Why care about them?
• How do I design technology for people
with disabilities?
• How do I design websites for people
with disabilities?
• What tools can I use in accessible Web
design
8. Audience Poll
• How many people have a disability?
• How many people
– have glasses/contacts?
– have had corrective
eye-surgery?
9. World Health Organization
• “An impairment is any loss or abnormality of
psychological, physiological or anatomical structure
or function; a disability is any restriction or lack
(resulting from an impairment) of ability to perform an
activity in the manner or within the range considered
normal for a human being; a handicap is a
disadvantage for a given individual, resulting from an
impairment or a disability, that prevents the fulfillment
of a role that is considered normal (depending on
age, sex and social and cultural factors) for that
individual”
11. Prevalence of Disability
Disability
Estimated Size
(US population)
Source
Self-reported disability
(unable to perform
ADLs)
~50 million (20%);
~14 million > 65y (42%)
U.S. Census Bureau, 2000
http://www.census.gov/main/www/
cen2000.html
Visual Impairment 8.1 million (3.2%)
1.3 million legally blind
5 million > 65y
(1 million severely)
U.S. Census Bureau, 1994-95;
U.S. National Center for
Health Statistics, 1994,1995
Hearing Impairment ~20 million (8.6%),
~30 million > 65y (29%)
U.S. National Center for
Health Statistics. Vital Health
Statistics, 1990-91
Cognitive Disabilities
(MR, Brain Injury,
Dementia / Alzheimer’s)
~15 million (~7%)
~20 million (8.6%),
including Mental Health
U.S. Census Bureau, 1990;
NIH, 1998; BIA; Alzheimer's
Association, 2003; Arc, 2004
12. Disability Informatics
“The discipline of science that
researches the development and use of
information, telecommunications and
information technology, such that
benefits may be derived from that
information by the users, and more
specifically people with disabilities”
15. Web Accessibility
"The power of the Web is in its
universality. Access by everyone
regardless of disability is an
essential aspect."
-Tim Berners-Lee, W3C Director,
inventor of the World Wide Web
16. Inverse information law
“…access to appropriate
information is particularly difficult
for those who need it most.”
–Gunther Eysenbach (BMJ, 2000)
17. Digital Divide - Computer UsePercentageof
workingageadults
http://www.microsoft.com/enable/research/ (2003)
18. Adapted from online article in Digital Web magazine, RIP!
Excuses for
Lack of Accessibility
• It’s not something [we] want to think about
• It is not really required (reasonable accommodation)
• It’s the law but there’s none to follow
• There is no immediate benefit
• It’s just a technical problem
• It’s too much work (reasonable accommodation)
• It seems like a party pooper
• Nobody complains / No students with disabilities
• There is no leader to follow
19. Web Accessibility Laws
• Rehabilitation Act (1973, 1998)
– Section 508 (June 25, 2001) requires
federal agencies Web sites to be
accessible
• Americans with Disabilities Act (1985)
– Title I: Employment
– Title II: State/Local Government activities
– Title III: Public Accommodations
20. ADA Legal Cases
• Tyler v. City of Manhattan [student] (1994)
• Hooks vs. OKBridge [cognitive] (1999)
• Natl Federation of the Blind vs. AOL [Title III] (2000)
• The UC Davis and UC Berkeley Settlement
[deaf students] (1999)
• Southwest Airlines vs. Robert Gumson and Southwest
Airlines vs Access Now [blind user] (2002)
• Martin vs. MARTA (Metropolitan Atlanta Rapid Transit
Authority) [Title II] (2002)
• Spitzer Agreement / Travel Web sites [Title III] (2004)
• National Federation of the Blind (NFB) vs. Target (2006)
21. Web Developer
Accessibility Survey
• 55% of Web developers do not use
Web development standards
• Of the 45% that do,
Only 20% use Web Accessibility
guidelines or requirements
still a lack of awareness of the
importance of Universal Web Design
– Internet Professionals NW, May 2005
23. Universal Design
“The design of products and
environments to be usable by all
people, to the greatest extent
possible, without the need for
adaptation or specialized design”
(The Center for Universal Design,
NC State University)
24. http://www.design.ncsu.edu/cud/about_ud/about_ud.htm
Principles of
Universal Design
• Physical Environment
– Equitable Use
– Flexibility in Use
– Simple and Intuitive Use
– Perceptible Information
– Tolerance for Error
– Low Physical Effort
– Size and Space for
Approach and Use
• Computer/Web Environment
– Equitable Use
– Flexibility in Use
– Simple and Intuitive Use
– Perceptible Information
– Tolerance for Error
– Low Physical Effort
– Independence of computer
platform / user agent or device
/ assistive technology
25. Assistive Technology
“any item, piece of equipment, or
product system, whether acquired
commercially, modified, or
customized, that is used to
increase, maintain, or improve
functional capabilities of individuals
with disabilities”
– AT Act of 1998 (Section 508)
30. Web History
Accessibility Perspective
• <1990 – Terminal (TTY), Dial-up (Modems)
• 1990-5 Graphical User Interface (GUI)
Images without text description
Barrier to people who are blind
• 2000-5 Dial-up Broadband (Cable, DSL)
Video without text description
Barrier to people who are deaf
• 2005-present Media Convergence
Rich, complex Web interfaces
Barrier to people with cognitive disabilities
• 2008-present Mobile Web
Smartphones (Browser diversity)
31. Principles of
Universal Web Design
Web Content Accessibility Guidelines
(v.2, due Spring 2005….delivered December 2008!)
1. Perceivable. Ensure that all intended function and information can
be presented in form(s) that can be perceived by any user - except
those aspects that cannot be expressed in words.
2. Operable. Ensure that the interface elements in the content are
operable by any user.
3. Navigable. Facilitate content orientation and navigation.
4. Understandable. Make it as easy as possible to understand the
content and controls.
5. Robust. Use Web technologies that maximize the ability of the
content to work with current and future accessibility technologies and
user agents.
http://www.w3c.org/WAI/
32. Visual Impairments
• Text is preferred to images
• Adjustable font preferred to fixed font
• Alternate text for images / visual content
• Adjusting for linear processing
– nature of text-to-speech browsers (JAWS)
• Use CSS for layout instead of Tables
• Accessible Tables & Forms
33. Color Blindness
• Affects 8 to 12% of males of European origin
and about half a percent of females
• Avoid using color to indicate something
specific on a Web page
• Avoid using red and green colors together
• View Web pages desaturated (in grayscale)
in order to determine their effectiveness
34. Color Blindness
• Affects 8 to 12% of males of European origin
and about half a percent of females
• Avoid using color to indicate something
specific on a Web page
• Avoid using red and green colors together
• View Web pages desaturated (in grayscale)
in order to determine their effectiveness
35. Hearing Impairments
• Initially not as badly impacted since the Web
is a very visual environment
• However, the Web is increasingly rich with
multimedia and video with audio tracks
– Transcripts of audio and sub-titles to video are
needed to make them accessible (Section 508)
– This will also be of benefit to
• Speakers of other languages
• Internet devices that are not sound equipped.
36. Mobility Impairments
• Many users have difficulty using the mouse
and keyboard
• Addressed by assistive technology (AT)
hardware and software
• It is worth being sensitive to mobility issues
– avoid long navigation sections before main
content, provide a “skip to main content” link
– avoid image maps with extremely fine positioning,
– always ensure that Web page elements can be
navigated by keyboard (such as client-side image
maps, Java, ActiveX)
37. Cognitive Impairments
• There are many types of cognitive
impairments ranging from
– severe, e.g., Alzheimer’s
– mild reading and learning disorders
• Few accessibility guidelines for cognitive
disabilities
– Lack of user interface research and empirical data
• Benefit from general “usable” site design
– maintaining the content at a 6-8 grade school level
– the use of icons graphics and multimedia that aids
in understanding
http://www.webaim.org/articles/cognitive/
38. The Web Challenge
• Accessibility requirements for one
group of users often conflicts with those
for another,
– Sensory disability, Cellphone, Search
Engine
emphasis on text-based
– Cognitive or Learning disability, low literacy
emphasis on image/video/multimedia-
based
42. HTML Validation
• Many checks can be done without tools
– Turn off images, sounds, and style sheets
– Test site with a text browser/alternate devices
– Consult users with disabilities
– Set monitor to black & white
But Watch Out!
• Many checks cannot be performed by tools
– Utility of ALT text
43. Validation Tools
• Built-in to many development tools
– e.g., Dreamweaver
• W3C HTML validator
– http://validator.w3.org/
• WAVE (WebAIM) validator FREE
– http://wave.webaim.org/
• A-Prompt (W3C) FREE
– http://www.w3.org/People/Raggett/tidy/
• Bobby (Watchfire)
– http://www.cast.org/products/Bobby/
44. Web Browser Toolbars
• Web Developer Extension (Firefox)
http://chrispederick.com/work/firefox/webdeveloper/
• Web Accessibility Toolbar (IE)
http://www.visionaustralia.org.au/ais/toolbar/
45. JAWS
• Full interface
control
– Windows OS
– Many
applications
• Version 7.0
• Expensive
– $900 - $1300
• Demo version available
– 40 minute limit
http://www.freedomscientific.com/fs_products/software_jaws.asp
46. Perform Usability testing
• Involve users early and often
• Use an iterative process
– design, test, design, test, etc.
• Test early and often
– The earlier usability issues are
discovered…
the easier and cheaper it is to fix
them
• Usability tests do not have to have huge samples of
participants
– using 5 testers -> 85% of the usability problems
– using 1 tester with a screen reader -> 100% of the
accessibility problems
47. Final Thoughts
• Accessibility is an approach to design,
not a stamp of approval
• Separating content from layout is
an essential strategy for accessible design
• Emerging standards continue to make the
Web accessible
• Many competing standards and different
ideas about “accessibility”
• Avoid retrofitting by planning for accessibility,
awareness is the first and most critical step
49. Additional Resources
• W3C Web Accessibility Initiative, www.w3c.org/WAI
• WebAIM (Accessibility in Mind), www.webaim.org
• Information Technology Technical Assistance and Training
Center (ITTATC), www.ittatc.org
• National Center on Accessible Information Technology in
Education (ACCESS-IT), www.washington.edu/accessit
• National Center for Accessible Media, ncam.wgbh.org
– Accessible Digital Media, ncam.wgbh.org/publications/adm
• Regional ADA Centers: 1-800-949-4232
• Useit.com (Nielsen), http://www.useit.com/alertbox/9706b.html
• Google, www.google.com
My thanks to Judy for inviting me to talk to you today.
I will give an overview of an area of research that I have focissed on, namely Disability Informatics.
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First, a little bit on my background…
I am a former post-doc fellow in Medical Informatics at OHSU
From there, OHSU Webmaster for 5 years
Moved to the OIDD to lead their research program in Technology and People with Disabilities
I have a couple of great videos I would like to share with you, some may have already seen them
The first is one that aptly describes what it is like to manage a large Web site like OHSU…
Before I continue, I have to warn you that like most people in a specialized field, I have a tendency to get a little carried away with the technology and its acronyms so I want take this opportunity to interrupt me for clarification should I use a term that you are not familiar with
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And this is equally applicable to acronyms
Information Technology professionals such as myself are notorious for dropping acronyms like they are going out of fashion
But I think they are equally rivaled by academics who will massage project titles until they create a catchy sounding name derived from the first letters of each word
So…if you see “Alphabet Soups” that are not explained, yell “Acronym Alert”
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To be sure that someone explains them to you
Defining disability is fraught with conflicting statements, different use and definition of the same terminology.
The WHO tries to distinguish different terms; impairment vs. disability vs. handicap
In reality, handicap Is an older term that has fallen out of favor, become politically incorrect.
Disability has remained PC, but must be used in a person first manner. Person with a disability vs. Disabled person.
Impairment is often used to describe a milder disability state, I.e. one that does not severely impact the individual enough to be legally disabled.
Many people have impaired vision but today, assistive technology such as eyeglasses, contacts and the latest surgery can compensate or even correct the impairment.
So what about people with disabilities? Well it is a larger population than you might think. Disability is broadly broken down into physical, sensory (vision &hearing) and cognitive.
In 2000 Census, ~50 million people in the US reported having a disability.That’s 1 in 5 or 20% of the population. The US Census Bureau defines disability as “a health problem or disability which prevents [you] from working or which limits the amount of work that [you] can do” - fairly inclusive. Interestingly, 14 million people over 65 reported a disability, That’s 42% of the seniors in the US.
US Census statistics also showed that 8.1 million people have a visual impairment, with 1.3 million qualifying as legally blind. But 1.5 million of them are computer users
The National Center for Health Statistics determined that ~20 million people or 8.6% of the US has a hearing impairment
And it is estimated that ~15 million people, or 7% of the US have a cognitive disability. Closer to 20 million if you include mental health problems or diseases.
Basically there are a large number of people with a wide array of disabilities within the regular population. These need to be taken into account when designing and creating content for the Web.
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So what is Disability Informatics?
Informatics is the science of information use
Medical Informatics- health care professionals
Information Retrieval – Literature, Web
Electronic Health Record (EHR)
Radiological image Management
Consumer Health Informatics- patients and consumers
Disability Informatics- people with disabilities and those that provide services to them
Health Care- Clinical Assessment / Evaluation
Rehabilitation
Occupational therapy
Physical therapy
Special Education
Assistive Technology
Replace function (Sensory, Physical)
Train / Restore function (Cognitive)
Wrote chapter in recent book in Consumer Health Informatics
So, why should we care about people with disabilities…
Tim Berners-Lee who should not need any introduction, recognized this in his vision for the Web in that it should be accessible to all, and not discriminate based on a person’s ability or disability.
You would think that given that we are creating the Web in a post-ADA world, we would be sensitive to accessibility and careful to create an accessible environment from the start.
And yet, due to a lack of awareness or concern about Web accessibility issues, we are re-engineering access barriers into the online world just as we did in the physical. [stats on the percentage of accessible Web pages on the Internet]
One of the main motivations for me for doing research in this area is really to address the increasing digital divide between those who have access to the online world in the information age and those who do not.
Be it the general public trying to access health information in 1995
Or people with disabilities trying to access online information in 2002
The irony of it all is also that this results in inverse information accessibility as noted by an medical informatics colleague of mine, Gunther Eysenbach. Those who could most benefit from the information find it the most difficult to access it.
And one of the main motivations for me to be working in this area is really to address the increasing digital divide between those who have access to the online world in the information age and those who do not. People with disabilities represent one of the disenfranchised groups from the Internet.
People with disabilities are less likely than people without disabilities to be online (43% v. 57%), and are less likely to be online from work (16% vs. 30%) because far fewer are working (Krane et al., NOD / Harris Poll, 2000)
Paradoxically, the Internet has the potential for a greater positive impact on the lives of adults with disabilities because it provides resources and information, as well as opportunities for socialization and support.
Section 508 of the Rehab Act
Title II requires State/Local Governments provide equal access to programs and services
Tyler v. City of Manhattan (1994)
Student with a disability sued a university for failure to provide the reasonable accommodations needed to participate equally in school. The court decided that ADA had been violated, in part, because of its response to students on a case-by-case manner.
Hooks vs. OKBridge (1999)
Person with cognitive disability filed suit after his membership to a online Bridge Web site was terminated. Dismissed as OKBridge was unaware of the individual’s disabilty.
National Federation of the Blind vs. AOL (2000)
NFB filed against AOL based on public accommodation (Title III). Similar cases against Barnes & Noble and the Claire&apos;s Stores. All cases settled out of court.
The UC Davis and UC Berkeley Settlement
Students contended that their rights under the ADA had been violated by not providing reasonable help to deaf and hearing-impaired students.
In court settlement, the two universities agreed to improve services for hearing-impaired and deaf students, to pay each of the five students in the suit $10,000, and to pay $1.1 million in lawyers&apos; fees, but they did not admit fault.
Southwest Airlines vs. Robert Gumson and Southwest Airlines vs Access Now (2002)
individual who was blind sued under Title II since he was not able to effectively purchase an online ticket and that excluded him from special Web-only fares not available over the phone
Surprisingly, the Judge ruled that the ADA public accommodation provisions apply only to physical spaces, such as restaurants and movie theaters, and not to the Internet.
Martin vs. MARTA (Metropolitan Atlanta Rapid Transit Authority)
Individuals sued MARTA claiming it failed to &quot;make information available to people with disabilities&quot; because they were unable to secure routes and schedules from their Web site (Title II - &quot;effective communication”). MARTA countered that the plaintiffs could call for this information during business hours or ask ahead of their need and MARTA would print up Braille schedules.
The Judge ruled that MARTA was, in fact, violating the provisions of the ADA.
Spitzer Agreement (2004)
New York State Attorney General Eliot Spitzer announced settlements with two major travel Web sites (Ramada.com, Priceline.com) that will make the sites far more accessible to blind and visually impaired users.
National Federation of the Blind (NFB) vs. Target (2006)
Settled out of court. $6million in damages, Target made website accessible
The principle of Universal Design
Universal design has 7 guiding principles
Equitable Use: The design is useful and marketable to people with diverse abilities.
Flexibility in Use: The design accommodates a wide range of individual preferences and abilities
Simple and Intuitive Use: Use of the design is easy to understand, regardless of the user&apos;s experience, knowledge, language skills, or current concentration level
Perceptible Information: The design communicates necessary information effectively to the user, regardless of ambient conditions or the user&apos;s sensory abilities.
Tolerance for Error: The design minimizes hazards and the adverse consequences of accidental or unintended actions.
Low Physical Effort: The design can be used efficiently and comfortably and with a minimum of fatigue.
Size and Space for Approach and Use: Appropriate size and space is provided for approach, reach, manipulation, and use regardless of user&apos;s body size, posture, or mobility.
These can equally be applied to the Web with the possible exception of #7.
&gt;1990 – Terminal (TTY), Dial-up (Modems)
1990-5 Graphical User Interface (GUI)
Images without text description
Barrier to people who are blind
2000-5 Dial-up Broadband (Cable, DSL)
BB reaches critical mass in 2004
http://www.pcw.co.uk/news/1157453 - Nielsen / NetRatings - &gt;50% US Households
http://www.connectedhomemag.com/HomeOffice/Articles/Index.cfm?ArticleID=42357 - InStat/MDR - &gt;20%
Video without text description
Barrier to people who are deaf
Today Media Convergence
Rich, complex Web interfaces
Barrier to people with cognitive disabilities
Wherever possible, normal text is preferred to images with text since they can be spoken, and also enlarged by the browser for low vision users.
Using alternate text, or ALT tags, is one of the easiest steps to take to make images & animations accessible to the blind, particularly when an image is used as a hypertext link or an image map.
The more challenging problem is appreciating the linear nature in which the voice browsers operate and that graphically pleasing pages are often difficult or impossible to navigate. However, with a little foresight is design, it is often possible to avoid this.
Tables are also a source of confusion when read line by line but there are techniques for improving the “speakability” of these as well.
Problems due to color blindness can be discovered by simply viewing graphics in black & white to ensure sufficient contrast in the color value. This principle also provides a good indication of the readability of colored text on a colored background.
Problems due to color blindness can be discovered by simply viewing graphics in black & white to ensure sufficient contrast in the color value. This principle also provides a good indication of the readability of colored text on a colored background.
Understand limitations of validation tools
Validate code to W3C standards.
Validate both CSS and HTML/XHTML
The WAVE validator is useful to linearize tables
A-Prompt is a free downloadable tool to validate and fix errors for an entire website
Bobby is now owned and marketed by Watchfire – it’s use as a free tool is limited
Accessibility is an approach to design, not a stamp of approval
Emerging standards continue to make the Web accessible – stay tuned to new tools and best practices
Separating content from layout is an essential strategy for accessible design
Competing standards and different ideas about “accessibility” are widespread – do your best!
Avoid retrofitting by planning for accessibility
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A wealth of accessibility information exists on the web – find it using google.com
WebAIM.org is an excellent one-stop source for accessibility information
The National Center on Accessible Media is another excellent resource
Making Educational Software and Website Accessible
Regional ADA Centers: 1-800-949-4232
