Rachel Jenkins, BSc, Taylor & Francis; Dawn Nicewarner, PhD, CMPP, Organon; Steve Palmisano, BSc, The Lockwood Group; Kelly Soady, PhD, CMPP, Oxford PharmaGenesis.
Email your questions and comments on this article to TheMAP@ismpp.org.
What Does Accessibility Mean in Medical Communications?
Healthcare information has never been more readily available than it is now. However, accessibility goes beyond mere access to information; it encompasses ensuring that all individuals—regardless of physical, sensory, or cognitive ability—can access, understand, and benefit from healthcare content.
Benefits of Accessible Healthcare Content
Accessibility is not a niche concern; it is a universal imperative that strengthens the foundation of effective, patient-centered healthcare. Clear, inclusive, and accessible healthcare information empowers everyone to understand their health better, make informed decisions, and engage confidently with healthcare providers.1 This is especially important because health literacy—the ability to understand and use information to promote health—varies widely, and poor health literacy can negatively impact outcomes.1 By designing communications that are easy to navigate, comprehend, and act upon, we support equitable access to care.
This commitment to accessibility becomes even more critical when we consider the needs of people with disabilities. Globally, one in six people live with significant disabilities, and almost everyone will experience a temporary or permanent disability at some point in their lives.2 As populations age, the number of individuals with disabilities is expected to rise.2 Yet people with disabilities often face greater healthcare challenges and more barriers to accessing care than those without disabilities.3,4 Ensuring that healthcare content is accessible can help to close these gaps.
Furthermore, when we enhance accessibility for people with disabilities, we often unlock broader benefits that improve accessibility for everyone. For instance, adding subtitles to videos aids people with hearing impairments but also helps those watching in a second language, in noisy settings, or without sound. These kinds of inclusive design choices extend the reach and usability of healthcare content, making it more effective across diverse audiences. In this way, accessibility serves as a catalyst for innovation, elevating the standard of healthcare communication for all.
Current Accessibility Standards
The good news is that there are established accessibility standards across the globe, such as those outlined in the Americans with Disabilities Act (ADA), the European Accessibility Act (EAA), and the Web Content Accessibility Guidelines (WCAG; pronounced Wuh-KAG). These standards provide frameworks for accessible digital content, including provisions for visual, auditory, and mobility accommodations, helping to ensure that digital communications meet essential accessibility requirements. Table 1 summarizes some key accessibility guidelines, laws, and acts from around the world.
Table 1. Summary of key accessibility guidelines, laws, and acts from around the world
| Country | Name | Abbreviation | Link |
|---|---|---|---|
| Global (World Wide Web Consortium, W3C) | Web Content Accessibility Guidelines | WCAG | https://www.w3.org/WAI/standards-guidelines/wcag/ |
| United States of America | Americans with Disabilities Act | ADA | https://www.ada.gov/ https://www.section508.gov/ |
| European Union | European Accessibility Act | EAA | https://ec.europa.eu/social/main.jsp?catId=1202&intPageId=5581&langId=en |
| European Union | Employment Equality Directive | EED | https://ec.europa.eu/social/main.jsp?catId=166&langId=en |
| United Kingdom | Equality Act 2010 | EqA/EA 2010 | https://www.legislation.gov.uk/ukpga/2010/15/contents |
| Australia | Disability Discrimination Act 1992 | DDA | https://www.legislation.gov.au/C2004A04426/2018-04-12/text |
| South Korea | Act on the Prohibition of Discrimination Against Persons with Disabilities, Remedy Against Infringement of Their Rights | Disability:IN | https://elaw.klri.re.kr/eng_mobile/viewer.do?hseq=45890&type=part&key=38 |
| India | Rights of Persons with Disabilities Act, 2016 | RPwD Act | https://cdnbbsr.s3waas.gov.in/s3e58aea67b01fa747687f038dfde066f6/uploads/2023/10/202310161053958942.pdf |
| Japan | Act to Facilitate the Employment of Persons with Disabilities | AEPD | https://www.japaneselawtranslation.go.jp/en/laws/view/3845/en#je_toc |
| Brazil | Statute of Persons with Disabilities | LBI (Lei Brasileira de Inclusão) | https://disabilityin.org/country/brazil/ |
| Argentina | Law on Comprehensive Protection of Persons with Disabilities | Disability Law 23,592 | https://disabilityin.org/country/argentina/ https://www.rivermate.com/guides/argentina/rights |
Common Barriers to Accessibility
Despite the clear benefits for all stakeholders and the need to meet legal and ethical requirements, implementing accessibility is often challenging. Disabilities encompass a range of needs, affecting abilities like cognition, mobility, dexterity, hearing, communication, and vision.3 Therefore, barriers to accessing content can be similarly wide-ranging, from the use of complex language and small fonts to poor color contrast and the lack of transcripts or captions. Meeting the diverse needs of all individuals can feel overwhelming, especially when balancing other demands such as limited budgets, tight timelines, and the expectations of multiple stakeholders. As a result, accessibility considerations sometimes fall by the wayside. Additionally, it can be tempting to avoid implementing changes in processes until a ‘perfect’ approach to creating accessible content is agreed. However, aiming for perfection can hinder progress. Instead, the focus should be on making small, simple improvements to enhance accessibility.
Removing Barriers to Creating Accessible Content
Key Accessibility Tools*
Several commonly used computer software applications contain accessibility checkers that can quickly and easily be used to evaluate the accessibility of healthcare content. There are also freely available online tools to support accessibility efforts. They scan digital content to identify barriers to effective access, flag issues such as missing alternative text (alt text) and offer tips to improve usability. Alt text is a brief written description of an image, figure or table that helps people using screen readers understand its content and function for images. These include:
- Microsoft 365: Word, PowerPoint, and other apps have built-in accessibility checkers that identify potential issues (Figure 1)
Figure 1. Example of a built-in accessibility checker in Microsoft Word
Alt text: Image of a Microsoft Word document with the location of the built-in ‘Check Accessibility’ tool on the ‘Review’ tab indicated with a red circle.
- PDF Readers: Adobe Acrobat and other PDF readers offer features to meet accessibility standards
- Color Contrast Checkers: Tools like Color Contrast Checker (https://colourcontrast.cc/) and the WebAIM contrast checker (https://webaim.org/resources/contrastchecker/) help to ensure adequate contrast for readability by identifying whether background and text color combinations meet the WCAG guidelines for accessibility
- Color Blindness Simulators: Programs such as Coblis (https://www.color-blindness.com/coblis-color-blindness-simulator/) help designers to understand content from the perspective of someone with color blindness (also known as color vision deficiency)
*Information provided is for illustrative purposes only. Neither the authors nor ISMPP endorse any particular softwarefor assessing accessibility.
Limitations of Accessibility Tools
Currently available accessibility checkers, although valuable, have limitations such as varied availability across different apps and operating systems, limited language and cultural context, false-positive results on certain elements, and an inconsistency to recognize missing alt text for tables. Therefore, although accessibility tools can aid the implementation of improved accessibility standards, it remains important for content creators, reviewers, and publishers to review healthcare content from an accessibility perspective and, when possible, to include end users as reviewers.
Role of Artificial Intelligence in Accessibility
Artificial intelligence (AI) is increasingly being used to improve accessibility. Emerging AI tools can assess and recommend adjustments to enhance accessibility, detecting issues that might be overlooked in manual checks. AI integration makes accessibility evaluations more efficient and effective.
Our Role in Accessibility
We all have a role to play in accessibility. Pharmaceutical company employees can familiarize themselves with accessibility standards to improve inclusivity, advocate to include accessibility practices in their standard operating procedures, use accessibility tools, and promote open access and plain language summaries (PLS) or plain language summary publications (PLS-P) to support broader access to information. Medical communication agencies can stay up to date on accessibility standards, educate their clients about accessibility best practices, and implement accessibility tools early in the development process.
Publishers can also promote accessibility by identifying and addressing common barriers such as inadequate color contrast or missing alt text for images and videos. Including accessibility considerations in author guidelines may help to encourage improved accessibility standards across medical publishing. Journals can lead the way by ensuring their sites incorporate accessible website design principles, including consistent layout, keyboard navigation, and compatibility with screen readers. Journals should apply these standards not only to their websites but also to submission portals.
Journal Best Practices for Accessibility
Examples of journal best practices for accessibility include:
- Text Accessibility: Simple layouts, high-contrast fonts, and alt text for images, aiding readability and screen reader compatibility
- Audio Accessibility: Key articles available as podcasts, with transcripts for those with hearing impairments
- Video Accessibility: Videos including captions, subtitles, and descriptive audio
- Interactive Materials: Accessible PDFs and navigable interactive elements, supporting users with motor impairments
A plain language summary publication (PLS-P) and video article example are shown in the case study section below, with highlighted comments to show accessibility best practices.
Introducing an Accessibility Checklist
To simplify the process of creating accessible healthcare content, the ISMPP Digital/Visual Communications Committee developed a checklist for common communication formats (Figure 2). This checklist provides actionable steps to ensure accessibility for websites, presentations, posters, and multimedia formats. Adopting the approaches in this checklist may help your organization to take their first, or next, step toward improving accessibility.
Figure 2. Accessibility checklist, identifying the main roles and responsibilities for key stakeholders when creating medical content
Alt text: Infographic showing a circular diagram divided into three segments: pharma/biotech, communication agency, and journal publishers. The circle shows how these three groups should work together to improve accessibility. Each segment outlines key accessibility responsibilities for each group. Pharma/biotech roles and responsibilities include advocating for accessibility requirements in standard operating procedures, meeting geographical region requirements, and setting expectations internally and with agency partners. Communication agency roles and responsibilities include knowing accessibility guidelines, deploying accessibility tools, and educating clients on accessibility. Journal Publisher roles and responsibilities include knowing accessibility guidelines and testing content with assistive technologies.
PLS, plain language summary; SOP, standard operating procedure.
Case Studies: Accessibility in Action
Simple modifications can make a world of difference to individuals with accessibility needs. Below are some case studies showing how applying small changes can improve accessibility.
Case Study 1: Color Use in an Email
Clever use of color can help to highlight or differentiate key points and aid understanding; however, when used without consideration for those with diverse needs, color can inadvertently reduce accessibility. Figure 3 shows how simple modifications can support accessibility for those with color blindness/color vision deficiency.
Figure 3. Example of two simple modifications to increase the accessibility of an email
Alt text: Image showing two versions of the same email, which includes a table with information on several congresses. The first version uses the colors red and green in the table to highlight the congresses that are low priority and time sensitive, respectively. The second version has been modified to improve accessibility for people with color blindness/color vision deficiency and those using screen readers. Instead of relying on color coding in the table, the text in the main body of the email states which congresses are low priority and which are time sensitive, and also offsets the congress names with indented bullets. The table has also been developed within the email as an editable table, allowing assistive technology to read all text within the table.
Case Study 2: Accessible Design for a PLS-P
PLS-Ps can help to broaden access to healthcare information. Figure 4 shows how content, layout, design, and technical considerations all combine to enhance the accessibility of a PLS-P.
Figure 4. A PLS-P designed with accessibility in mind, featuring an adequate minimum font size, optimized color contrast, audio description for technical words, and easily accessible links, published as a PDF that is compatible with screen readers. PLS-P published by Taylor & Francis. Sprague SM et al. Effectiveness of tenapanor for treating hyperphosphatemia in patients receiving dialysis: a plain language summary of the OPTIMIZE study. Current Medical Research and Opinion, 40(8), 1335-1343 (2024). Full PLS-P available here: Accessible PLS-P example
Alt text: Image of a plain language summary publication, with key accessibility points annotated in text boxes. The annotations highlight that the PDF is compatible with a screen reader, that a link to the main article has been provided immediately after the text where it is mentioned, that an audio description of key technical words has been included, and that the text is an adequate font size with optimized color contrast.
Case Study 3: Accessibility Across Multimedia Formats
Video journal articles can support wider dissemination of healthcare information. Figure 5 shows how the inclusion of text alongside the video can enhance accessibility.
Figure 5. Video article featuring a clear structure with subtitles, captions, a full transcript, and optimized color contrast. Published by Taylor & Francis. Rugo H. P-REALITY-X: real-world evaluation of overall survival with palbociclib plus aromatase inhibitor in HR+/HER2- metastatic breast cancer. Video Journal of Biomedicine (2023). Video article available here: Accessible video article example
Alt text: Image of a video article with key accessibility points annotated in text boxes. The annotations highlight that the video article content has optimized color contrast and includes a full transcript, subtitles, and captions.
Conclusion
Adopting an accessibility-first approach makes healthcare communications inclusive and impactful, fulfilling legal and ethical responsibilities. Accessible medical content broadens the audience who can benefit from it, thus improving the reach and effectiveness of critical healthcare information. The work of our Committee to raise awareness of accessibility and provide support to improve the accessibility of healthcare communications is ongoing. Together, we hope to make the creation of accessible, inclusive visual and digital healthcare content the standard for all publications.
This article is derived from the ISMPP Digital/Visual Communications Committee of which the authors are members.
Acknowledgements: The authors thank the ISMPP Digital/Visual Communications Committee Subgroup on Accessibility for defining the need and assembling a plan to help to raise awareness and educate constituents on how to begin to remediate the matter. We also thank Anna Geraci, ISMPP’s Senior Director, Communications and Strategic Programs, for her assistance in providing feedback during the development of this article; The Lockwood Group Creative Services, for the development of the ‘Designing Accessible Digital Content’ figure; and Katie Payne, Oxford PharmaGenesis, for editorial support. ChatGPT was used during development for brainstorming and summarizing some content.
References
1. World Health Organization. Health literacy. (Accessed May 2025 at https://www.who.int/teams/health-promotion/enhanced-wellbeing/ninth-global-conference/health-literacy.)
2. World Health Organization. Global report on health equity for persons with disabilities. 2022. (Accessed May 2025 at https://www.who.int/teams/noncommunicable-diseases/sensory-functions-disability-and-rehabilitation/global-report-on-health-equity-for-persons-with-disabilities.)
3. Centers for Disease Control. Disability impacts all of us infographic. 2024. (Accessed May 2025 at https://www.cdc.gov/disability-and-health/articles-documents/disability-impacts-all-of-us-infographic.html?CDC_AAref_Val=https://www.cdc.gov/ncbddd/disabilityandhealth/infographic-disability-impacts-all.html.)
4. Centers for Disease Control. Disability inclusion. 2025. (Accessed May 2025 at https://www.cdc.gov/disability-inclusion/about/?CDC_AAref_Val=https://www.cdc.gov/ncbddd/disabilityandhealth/disability-inclusion.html.)
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