Compliance with web content accessibility guidelines in ophthalmology social media posts

Abstract

This is a cross-sectional exploratory analysis of publicly available Internet data to examine compliance to web content accessibility guidelines (WCAG) on patient education social media posts in ophthalmology. WCAG ensures web content accessibility for those with disabilities (including visual impairment). A total of 100 social media posts were sampled from ten ophthalmology patient education social media pages and ten non-ophthalmology (cardiopulmonary) pages as the comparison group. Three independent graders evaluated the selected posts based on the WCAG 2 checklist by WebAIM, a non-profit affiliated with Utah State University, after its adaptation for social media posts. Validated accessibility standard labels: "0" for not meeting any standards, "1" or "A" for meeting bare minimum accessibility requirements, "2" or "AA" for meeting legal accessibility requirements, or "3" or "AAA" for exceeding accessibility requirements. There was not enough evidence to detect a difference in WCAG scores between ophthalmology and non-ophthalmology posts (p = 0.80). Forty-nine percent of scores for ophthalmology social media posts showed no compliance with any WCAG. The most common reasons that ophthalmology posts failed to meet criteria were due to color and contrast issues (39%). Most ophthalmology social media posts had low WCAG scores, indicating poor compliance to WCAG. Because social media is highly visual, reduced compliance to WCAG may create barriers for low vision individuals to successfully access patient education social media content.

Keywords: Americans with disabilities act; Ophthalmology social media; Social media; Visual impairment; Web accessibility; Web content accessibility guidelines.

Figure 1

Overall scores and lowest scores for ophthalmology social media posts. Accessibility scores of ophthalmology social media posts according to guidelines of Web Content Accessibility Guidelines (WCAG 2) adapted checklist. A Bare minimum accessibility, AA accessibility meeting legal requirements, AAA exceeds accessibility requirements. (A) Distribution of all scores for 50 ophthalmology posts obtained from three independent graders (n = 150), (B) Distribution of lowest scores for 50 ophthalmology posts. The lowest score of the three scores obtained from three graders for each of the 50 ophthalmology posts was used (n = 50).

Figure 2

Overall scores and lowest scores for non-ophthalmology social media posts. Accessibility scores of ophthalmology social media posts according to guidelines of Web Content Accessibility Guidelines (WCAG 2) adapted checklist. A bare minimum accessibility; AA accessibility meeting legal requirements, AAA exceeds accessibility requirements. (A) Distribution of all scores for 50 non-ophthalmology posts obtained from three independent graders (n = 150), (B) Distribution of lowest scores for 50 non-ophthalmology posts. The lowest score of the three scores obtained from three graders for each of the 50 non-ophthalmology posts was used (n = 50).

Figure 3

Failing criteria for ophthalmology and non-ophthalmology social media posts determined by three independent graders. Independent graders recorded the criteria from the web content accessibility guidelines (WCAG) adapted checklist that caused a post to fail. The failing criteria were divided into four categories: audio and images, layout, descriptions, and contrast and colors. Graders could choose more than one failing criterion for each post. Distribution of failure criteria is shown for all ophthalmology (n = 150) and non-ophthalmology (n = 150) scores from the three graders.

Figure 4

Lowest WCAG scores for non-ophthalmology and ophthalmology social media posts. Distribution of the lowest score obtained from the three graders for each ophthalmology (n = 50) and non-ophthalmology posts (n = 50).