What we learned about doing accessibility research on the NHS website
The NHS is for everyone. That means that the NHS website should work for everybody. That includes people who have a disability or need that affects the way they use the internet.
This isn’t just about meeting moral or legal requirements. We believe that if we make the NHS website work better for people who have the most complex needs, then we can make it work better for all.
That’s why as we’ve been working on the redesign of the NHS website, we make sure we test what we’re working on with people who have access needs at every stage.
We do research in a number of ways that help us understand how people use the website and where we can make it better. We use surveys, online studies and face-to-face interviews to do research and test designs. Since June 2018, we’ve done 79 face-to-face interviews with members of the public. Over half of these (45) have been people who have access needs. We’ve spoken to people who have sight loss, dyslexia, Parkinson’s disease, autistic people and others.
In this blog, I want to share some of what we’ve learned about recruiting and doing website research with people who have access needs.
Recruiting people with access needs
Ask recruiters. If they can’t help, ask others
We often use specialist recruiters to invite people to take part in our research. This can often save a lot of time and money.
Our first approach is simply to ask them if they could find people who have access needs. Some recruiters will say it will be too hard or there will be an extra cost to do this. But by asking a number of different recruiters and getting a number of different quotes we’ve had success in finding ones who can help us find people who have different needs, at no extra cost.
Build and nurture relationships with charities
We’ve done a lot of research to find charities and organisations who represent or work with people who have access needs. We’ve found that when we talk to these organisations and tell them about the work we were doing, they are happy to help us get in touch with people.
We have interviewed members of the Voluntary, Community and Social Enterprise (VCSE) Health and Wellbeing Alliance, NHS England Learning Disability and Autism Advisory Group, Parkinson’s UK, Leeds Hearing and Sight Loss Service, Technology Association of Visually Impaired People and others.
Building and nurturing strong relationships with these organisations is important so we can keep using their help in our work.
In a busy team, it can be easy to forget to keep in touch with these organisations. We make sure we do by sharing how their feedback and time has influenced changes to the website. We give talks to, take part in meetups and arrange webinars with these organisations to let them know the value of their input. We also offer to give them something back by sharing training and advice.
Make sure venues are suitable
If you are running research in a lab, whether your team have their own, or you are hiring one, make sure that it is accessible. That means checking that people who use wheelchairs or have limited mobility have access using a ramp or lift and that there are accessible toilets. We try to use facilities that are on the ground floor.
Arrange transport if needed
Some users may not have their own transport or might be unable to use public transport. Ask users if they need you to arrange transport for them. Use a taxi company with accessible vehicles and give the participant plenty of notice about what time they’re going to be picked up and dropped off so they can plan around this.
Be prepared on the day of the research
On the day, give your participants plenty of time before the research session to get to the venue and get settled in. Make sure there’s a seat available in the room for a chaperone or helper. Ask participants to bring along any assistive tech they use, such as a laptop with a screen reader. If you’re testing with a prototype, make sure it’s hosted somewhere the user can access it from their own device and that there is free WiFi available. Consider making a short URL using Bitly or another service.
Be prepared to go to people’s homes
Be prepared to travel to the participant’s home. Some users may simply not be able to get to a research venue or use assistive tech that they can’t bring with them. It can also be valuable to see them in their natural environment.
When you do go to a person’s home, make sure you don’t go alone, but also don’t take the whole team. 2 or 3 people is enough. Make sure you take along any recording equipment you might need, such as a video camera or dictaphone and get the users permission to record in their home. Arrange a time to start and finish the research, and stick to it.
Make sure people feel safe
Let participants know they can end a session or take a break if they need to. Take time to reassure participants that there are no right or wrong answers and that their honesty is valued. If something isn’t working, let participants know that it’s not their fault.
When you invite members of your team to observe your research, let them know how they can be a considerate observer. I like to send a poster like this from the Government Digital Service (link downloads a PDF document) with the invite, and put in the wall in the observation room.
Look after each other
Doing research with people who have access needs can sometimes be tiring and emotional. Sometimes users might tell you stories that are hard to hear or you might see them struggle. It’s important that your team support one and other when doing or watching research.
It’s okay to take some time out during a day of research or as a user researcher, ask for someone to stand in for you. Be sure to check in on your teammates during and after the research, and take time to reflect as a team.
Things we can do better
We’ve had a lot of success in the research we’ve been doing while redesigning the NHS website. We’ve managed to do lots of research with users who have access needs, which has helped us make decisions about how it is designed. But we know there are things we can do better.
Make it easier to give consent
We need to improve the way we get consent from people who take part in our research. Currently, we ask users to read and sign a paper form. This isn’t always possible, especially if a user has a visual impairment or doesn’t understand the words.
Find more people who use assistive technology
The majority of people who take part in our research have access needs, and some of these use assistive technology. But the number who do is still small, so we want to find ways to reach more people who use assistive technology, such as screen readers.
Be better at sharing findings
We need to find better ways of recording and sharing the findings we make from our research. Currently, we write our research findings and recommendations in reports which are stored on a system that is hard to access and doesn’t work well. We need to find better ways to share our research so others can learn from it.
