Improving Accessible Health Information
It’s been quite a week for banging my head against the wall with the challenges of a healthcare system which breaks its own rules and law. Take for example, people with visual health needs.
It started with a man with severe sight impairment being repeatedly sent his medical information in standard font letters. It developed into a rant from me to a friend about how challenging the eye clinic I attend was from a patient perspective. And it all went digital, when my wife, who has perfect eyesight couldn’t see black text on a dark green background on a health-check tool.
The hope is emerging best practice in evaluating and improving how patients access information.
RNIB campaigning for the patient
Starting with the patient who keeps asking his local healthcare provider to communicate information in a way he can access. It’s not unreasonable. It’s law. Commenting on the case, the UK patient charity, the Royal National Institute of Blind People (RNIB), said:
“As per the Accessible Information Standard and Equality Act, all health trusts have a legal duty to provide communication in a format that is accessible to their patients. The treatment…received is unacceptable and, in our view, unlawful, but unfortunately it is not uncommon.
“We often hear from people across the UK who tell us that their local NHS trust or health board has not complied with the law and sent important information in a way that is unreadable to the patient.” – Samantha Fothergill, Legal Adviser at RNIB
Throwing out accessibility standards
Next visual challenge is from the Welsh National Health Service, in a health-check site called Add to your Life. It’s a clinically thought-out, comprehensive health review which takes in your answers, and makes recommendations.
It also has at the front end an icon for Browsealoud, a specific screen reader app. In theory then, if a visually-disabled person views the site, they could for example first apply the accessibility settings on their device to find out if that sorts out the site’s design issues. Alternatively, they could somehow spot the Browsealoud icon and click on it, assuming that they have the software and know how to use it.
Yet, when most people open up the site, they will see `helpful’ dark green explanatory boxes which seem to flout all patient design standards. There is almost no contrast between the dark green background and black text. It’s a choice driven by design, not patients, nor patient information standards. It could easily be avoided. We all expect the National Health Service to model best digital practice, and this example undermines the well-written and useful content of the site.
Living in the patients’ shoes
In face-to-face practice, my eye clinic has improved a lot. We used to be shoved in a narrow corridor, cluttered with furniture – trip hazards galore. Unbelievably, when bedridden patients needed to be taken for eye exams and treatment, all the waiting patients and furniture had to be removed to get the bed into the narrow corridor.
Now we have a converted maternity unit. It’s still a bit challenging to get beds and wheelchairs around, but the lighting has been designed for people with visual needs. However, some simple understanding of the patients’ needs is needed. For example, my clinic is typically mostly filled with people aged over 70. Many have mobility challenges and it is a long, confusing way from the waiting area to the treatment rooms, particularly with sight issues.
Many have hearing issues too. Every time I attend, there’s always a few occasions where a nurse will mumble someone’s name across a crowded, open area of chatting patients with no sound-absorbing surfaces, and then wonder why no-one is responding.
But of course, we are repeatedly told that our feedback is important. So important in fact that we are given a feedback form at the start of each visit on grey paper, probably chosen for its high recycled content. Typically, even those like me lucky to have relatively good sight, will have drops for the examination which take that away. Then everybody with a sight issue is expected to read dulled text on grey low-contrast paper. Because our feedback is important…
Getting it right takes planning
In fairness to the UK National Health Service, it does create a huge amount of patient-facing material.
Getting accessibility completely right can be complex. Part of NHS Digital, at the heart of the UK’s digital health literacy, gives some insight into that complexity and how to improve.
The NHS Digital Health and Social Care Information Centre has a page which publicly identifies where its own site is non-compliant with NHS and other accessibility standards. Critically, it commits to specific actions and deadlines for improvement.
The page includes:
- Simple tips for patients to make the site easier to read and use (applicable to most sites)
- How patients can access information in formats more suitable for their specific needs
- A frank and transparent evaluation of the site’s current accessibility informed by weekly audits
- How to report accessibility issues with the site
- Technical guidelines that the site should currently live up to, but only partially does
- Known technical issues
- A public, transparent action plan on tackling known issues, with deadlines for each task.
Although this level of planning and ongoing evaluation is less likely outside a national healthcare body, keeping all digital materials under review is vital. Just as