How accessible are the websites of health services for people who have had a stroke?

Background: After sudden onset conditions (e.g., stroke), people commonly search for information online about healthcare and health services. Accessible websites are important for people with support needs, such as aphasia, to maximise their access to health service information. The accessibility of stroke-related health service websites against the Web Content Accessibility Guidelines (WCAG) and stroke-related access needs is not known. Therefore, the present study examined website accessibility of Australian health organisations, and their services, that provide post-stroke healthcare.

Method: A cross-sectional descriptive study design was used to identify relevant health services in Victoria and South Australia. Organisation homepages and service webpages were assessed for WCAG errors and alerts using the WAVE® Web Accessibility Evaluation Tool. A 16-item stroke accessibility checklist was used to document accessibility issues for people with stroke-related communication, cognitive and sensory processing impairments. The checklist assessed webpage navigation, readability and formatting. Publication of an accessibility statement or policy on the website was recorded. Issues were classified according to perceivability, understandability, operability and robustness (POUR) domains.

Results: A total of 185 webpages (126 homepages and 59 service-specific webpages) were evaluated against WCAG standards. Most webpages (n = 150, 81.1%) had at least one WCAG error (Median = 5 errors); the most prevalent being empty links that could not be read by a screen reader (n = 92, 49.7%). Checklist evaluations were completed for 105 webpages. Only 17 websites had an accessibility statement. Nearly all webpages had a reading level above Flesch-Kincaid Grade 6. Problems with readability, line height, font size, paragraph length, and bolding of key information were common. All had issues with 'perceivability' and 'understandability', and all but one website had operability issues. Only 10% of webpages contained robustness errors that could lead to compatibility issues across various browsers, devices, and assistive technologies. Government organisation websites had significantly fewer POUR accessibility issues than private sector sites.

Conclusions: Health services should take concerted steps towards ensuring that their websites are accessible for all healthcare consumers, including people with language, cognitive and visual processing impairments, which are common after stroke. Online service information provides a key role in enabling stroke survivors to access information and make decisions about their healthcare.