





































 V37 N3 / 2022 

©2022 American Medical Writers Association. All rights reserved.  
ISSN 2163-5315

AMWAJournal.org     16

ABSTRACT 
According to the Centers for Disease Control and Prevention, 

about 1 in 4 Americans have a disability.1 As the popula-

tion ages, there is an increased need for technology and 

accessibility (equal access), including Web accessibility. 

Accessibility is often defined in terms of 2 distinct mea-

sures: compliance with standards and usability for people 

with disabilities. The most common accessibility guide-

lines are the Web Content Accessibility Guidelines (WCAG) 

2.0/2.1 and the Section 508 of the Rehabilitation Act. They 

are written to support the accessibility of HTML content. 

According to the W3C Web Accessibility Initiative, “Web 

accessibility means that websites, tools, and technologies 

are designed and developed so that people with disabilities 

can use them.” ² Business owners, medical writers, tech-

nical editors, social media managers, Web designers, and 

information technology administrators play a critical role 

in ensuring a better Web experience for all of us. In this arti-

cle, we share practical ideas for you to show your commit-

ment to diversity, equity, and inclusion with changes you 

can make to your website and content today. Accessibility 

solutions, such as using image alternative text, camel case 

in hashtags, white space around headings, margins, inden-

tations, and columns, and strategically using fonts and color 

contrasting, are a few of many effective ways to provide 

accessible content to a larger audience. We also share other 

ways to address accessibility with creative strategies, such as 

podcasting. For medical communicators, strategies in com-

munication, such as descriptive language and the use of sto-

rytelling techniques, are vital to ensuring your audience has 

a clear understanding of the message.

According to the Centers for Disease Control and Prevention, 

about 1 in 4 Americans have a disability.1 Disabilities can be 

situational, temporary, or permanent. Some are hidden, 

such as chronic fatigue syndrome, diabetes, depression, 

visual and auditory disabilities, or learning difficulties. As the 

population ages, there is an increased need for technology 

and accessibility (equal access), including Web accessibility.

 Most information today is shared via the Web, and the 

Web is the first impression someone gets of your organiza-

tion. If your information isn’t accessible to those who have 

different abilities and disabilities, your information will not 

have the desired effect, and your organization’s reputation 

may be in jeopardy.

 Think about it this way—what thoughts do you have 

about information and organizations when you cannot 

access their information on the Web? Maybe they choose 

not to have a website, or the colors give you a headache, 

or maybe that autoplay video has a sound you find irritat-

ing, so you turn it off. How do you feel about the organiza-

tion and/or the information they are trying to share at that 

moment? For people with different abilities and/or disabil-

ities, this is a routine experience for everything in the world 

around them.

 Accessibility is often defined in terms of 2 distinct mea-

sures: compliance with standards and usability for people 

with disabilities. According to the W3C Web Accessibility 

Initiative, “Web accessibility means that websites, tools, and 

technologies are designed and developed so that people 

with disabilities can use them.”2 So, why should you care 

about accessibility? Here are several reasons:

• It helps ensure equal access.

• You’ll broaden your audience and expand your cus-

tomer base.

• It means search engines will be able to read your site 

more completely.

• It’s done for legal reasons.

• It generates a positive media response.

• It supports corporate social responsibility.

• It’s also the right thing to do. This builds trust and 

brand loyalty.

• It improves usability for users in general.

We all benefit from a win-win approach.

 Business owners, medical writers, technical editors, 

social media managers, Web designers, and information 

Dean Colston, PhD; Rebecca Fein, DHSc; Killian Kleffner, PhD; and Vanessa Saunders, PhD / A Flock of Scientists, LLC, 
Phoenix, AZ

Diversity, Equity, and Inclusion Embraces Accessibility

SOCIAL MEDIA

http://www.amwajournal.org
https://www.nccn.org/professionals/physician_gls/pdf/myeloma.pdf
https://www.nccn.org/professionals/physician_gls/pdf/myeloma.pdf
https://www.accme.org/sites/default/files/2021-06/902_20210615_2020%20Data%20Report.pdf
https://www.accme.org/sites/default/files/2021-06/902_20210615_2020%20Data%20Report.pdf
https://accme.org/sites/default/files/2021-06/884_20210624_New%20Standards%20Standalone%20Package.pdf
https://accme.org/sites/default/files/2021-06/884_20210624_New%20Standards%20Standalone%20Package.pdf
https://accme.org/sites/default/files/2021-06/884_20210624_New%20Standards%20Standalone%20Package.pdf
https://jamanetwork.com/journals/jama/article-abstract/2778925
https://www.fda.gov/patients/learn-about-expanded-access-and-other-treatment-options/understanding-unapproved-use-approved-drugs-label
https://www.fda.gov/patients/learn-about-expanded-access-and-other-treatment-options/understanding-unapproved-use-approved-drugs-label
https://www.fda.gov/patients/learn-about-expanded-access-and-other-treatment-options/understanding-unapproved-use-approved-drugs-label
https://accme.org/sites/default/files/2021-06/884_20210624_New%20Standards%20Standalone%20Package.pdf
https://accme.org/sites/default/files/2021-06/884_20210624_New%20Standards%20Standalone%20Package.pdf
https://accme.org/sites/default/files/2020-12/883_20201210_Standards%20for%20Integrity%20and%20Independence%20Toolkit.pdf
https://accme.org/sites/default/files/2020-12/883_20201210_Standards%20for%20Integrity%20and%20Independence%20Toolkit.pdf


AMWAJournal.org     17Diversity, Equity, and Inclusion Embraces Accessibility

technology administrators play a critical role in ensuring a 

better Web experience for all of us. Many people like graphs 

and other data visualizations, but these can create difficulty 

for users who are visually impaired and/or blind. Why? 

Screen readers may not always read and interpret these dis-

plays correctly. A screen reader is a software program that 

allows people who are blind and have low vision to read the 

content on a computer screen. It's done with a voice syn-

thesizer or braille display. So, it is important to have a text 

description and/or plain text summary to ensure that the 

data can be accessed by everyone.

GUIDELINES
The most common accessibility guidelines are the Web 

Content Accessibility Guidelines (WCAG) 2.0/2.1 and the 

Section 508 of the Rehabilitation Act. They are written to 

support the accessibility of HTML content.

 The WCAG 2.0 have long been the gold standard for 

accessibility on the Web. They were published in 2008. WCAG 

2.1 were released in 2018, and it covers a wide range of rec-

ommendations for making Web content more accessible.

Three Levels of WCAG 2.0/2.1 Conformance
WCAG 2.0 A, AA, and AAA standards all have success crite-

ria that must be met.

A—Minimal compliance

AA—Acceptable compliance (Aim here)

AAA—Optimal compliance

 The principles underlying WCAG 2.0 and 2.1 make the 

acronym “P.O.U.R.”:

• Perceivable

• Operable

• Understandable

• Robust

 First, your content must be perceivable. Second, the 

interface elements in the content must be operable. Third, 

the content and controls must be understandable. Finally, 

your content must be robust enough to work with current 

and future technologies.

 What are some easy and fast changes you can make to 

your website and content today to be more inclusive? We 

have some practical ideas for you to show your commitment 

to diversity, equity, and inclusion.

ACCESSIBLE SOCIAL MEDIA BEST PRACTICES
Alternative text is the first principle in Web accessibility. 

Web accessibility is likely to become a major ranking factor 

for Google in the future. Adding relevant alternative text 

to your images is one easy and effective way of doing it to 

improve your visibility.

 An alternative text is a written description of an image or 

graphic that a screen reader can read out loud. Alternative 

text is often referred to as “alt text,” “alt tags,” or “alt attributes.” 

It communicates the graphic’s purpose and context. It’s not 

too long, so aim for a maximum of 100–125 characters. In 

addition, don’t feel like you need to describe everything.

 One can think of it as an alternative to viewing the image 

for users who are blind or have low vision. It is also help-

ful for people with sensory processing disorders or learn-

ing disabilities. A missing alternative text is one of the most 

common image accessibility complaints, and it’s one of the 

easiest things to fix.

 An alt tag can help your photo be more accessible and 

discoverable. It can also boost your image search engine 

optimization. Remember, Google is pushing for the use of 

alt text because it can’t see the images that you upload to 

your site. But alt text helps the search engine categorize 

your photos.

Image Alt Text
When using image alt text, it should not include “picture 

of” or “image of.” A screen reader already tells the user this 

information. On the other hand, it is acceptable to use the 

words “this screenshot” or “this illustration” in your alt 

text. In certain situations, it may be helpful to distinguish 

between paintings, screenshots, or illustrations. But it’s a 

best practice to avoid the more generic use of terms, such as 

image, icon, or picture.

Here’s an example of a good alt text:

Two chocolate brownies stacked on top of each other 

with blueberries, raspberries, and mint leaves on top 

(Figure).

 

Figure. Two chocolate brownies stacked on top of each other with 
blueberries, raspberries, and mint leaves on top. © [nata vkusidey] /
Adobe Stock.

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AMWAJournal.org     18Diversity, Equity, and Inclusion Embraces Accessibility

Here’s an example of a substandard alt text:

Brownies

 As a general rule, there must always be an alternative 

description tag for every image. However, if you wish for the 

screen reader to just bypass or jump over the image, a null 

or "" is put in the text section of the tag: for example, <alt> 

"" </>. In this case, a decorative image doesn’t need alter-

native text. A decorative image is used only to evoke a feel-

ing or reinforce accompanying copy rather than to convey 

meaning on its own. Simply putting a null mark in every alt 

text would technically pass a lot of software-generated vali-

dation tools, but the image would not be accessible. Again, 

it's important that whoever is designing or adding content 

to the page makes a decision regarding the purpose of the 

image and what it is intended to convey. When in doubt, it is 

acceptable to add descriptive alternative text.

Complex Images and Long Descriptions
Complex images can be challenging for many people to 

understand. For example, people with low vision, learning 

disabilities, and limited subject-matter experience often 

find them confusing. A good practice is to simplify the 

image or graphic.

 For charts, graphs, diagrams, illustrations, and other 

complex images, simple alt text may not be sufficient to 

convey the information. In this case, the image’s alt text 

should direct the user to the long description conveyed by 

the image.

 Here’s a tip: use lists, headings, and other structural  

elements to organize content in a long description.

Headings
Headings are an important part of an accessible website. 

Sections must have headings that identify them. Make sure 

your content is well-formatted with headings and lists. That 

way, readers can use their screen reader’s quick navigation 

keys to find their way. This adds clarity and orients users to 

the overall document structure.

Navigation
Your website needs to be navigable. But can it be navigable 

without a mouse? People who are blind or have low vision 

use the keyboard to navigate, not a mouse. For a website to 

be accessible, it must work without the use of a mouse.

Color and Contrast
Your website needs to be distinguishable for an optimal 

experience. What are some best practices on using color?

Text (paragraph text) and interactive portions should have a 

contrast ratio of 4.5:1. For large text, your text ratio can be 3:1.3

 Color alone should not convey information on a web-

site. Why? Some people are blind, have color blindness, or 

have color-contrast deficiencies. The most common form of 

color deficiency is deuteranopia, red-green. Plus, the most 

common offender: links. Other best practices one should 

consider include:

• Avoid using the following color combinations: red/

green, blue/green, and yellow/red.

• Use plenty of white space.

 Two reputable contrast checkers that should be 

included in your toolbox:

https://userway.org/contrast/000000/ffffff

https://webaim.org/resources/contrastchecker

Use Camel Case in Hashtags
To make your hashtags more accessible, capitalize the first 

letter of each word. This is called "camel case.” When you 

capitalize the first letter of each word, screen readers now 

have the indication they need and are much more likely to 

read the hashtag as intended. Note how these 2 examples 

are written:

#StateOfMentalHealthInAmerica2021

#notcamelcase

The first example is using camel case in hashtags; the 

second is not.

 In the same theme, capitalize the first letter of each word 

in a URL. According to the American Foundation for the 

Blind, this will make it easier to understand for people who 

are blind or have low vision when they use screen readers.4

 Here’s the bottom line: it's not only friendlier for people 

who are blind or visually impaired who use screen readers, 

but it's also friendlier for people with dyslexia or cognitive 

disabilities. In essence, #CamelCase is easier for everyone  

to read.

Emojis and GIFs
Limit the use of nontext objects like Emojis and GIFs. You 

can write a description of an emoticon in parenthesis or 

brackets after sending it.

:) <smiling face>

 In addition, double-check the emoji’s description before 

using them. Plus, place emojis at the end of posts and tweets 

to avoid clarity issues.

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AMWAJournal.org     19Diversity, Equity, and Inclusion Embraces Accessibility

GIFs and Animations
Avoid sharing GIFs that contain rapid flashing content that 

may trigger epileptic seizures in people with photosensi-

tive epilepsy. Plus, ongoing animation can be distracting for 

people with attention deficit hyperactivity disorder (ADHD).

Multimedia Content
Audio and video content can be difficult for some users. For 

example, people who are deaf or blind or have low vision or 

hearing loss may not be able to perceive video or audio con-

tent. In addition, people with cognitive impairments may 

find the pace of multimedia content challenging.

 One of the best alternatives for multimedia content is a 

text transcript. Written transcripts are recommended for all 

video and audio content. In that theme, videos should be 

described and captioned.

 Closed captioning has been around for many years. It 

can help make a video or movie more accessible. It benefits 

people with learning disabilities, ADHD, autism, and hear-

ing loss. In addition, it helps people in other ways, such as 

when we are in a noisy environment or if our audio is poor. 

Captions can also support us if the person in the video is  

a fast talker or has an accent. Some captioning apps  

include MixCaptions, Clipomatic, AutoCap, Kapwing, Clips, 

and Threads.

 On the other hand, an audio description is a newer 

technology that can supplement closed captioning.5 It is a 

form of narration used to provide information surrounding 

key visual elements in videos for consumers who are blind 

or have low vision. In other words, you can think of audio 

description as providing a verbal version of the visual image.

Live-Streaming Tips for Accessibility
For live-streaming events, consider these 3 tips:

1. Use video services that have live-captioning capabili-

ties like Zoom or Google Meet.

2. Provide a transcript or fully captioned video soon after 

your event ends.

3. Hire an on-camera interpreter for an additional level 

of accessibility.

Images With Texts
As a general rule, images of text are not allowed. If you 

cannot avoid images of text, it’s best to have the same text 

in the alt attribute. Remember, Google likes text-based con-

tent. Exceptions can be made for company logos, brand 

names, and other situations in which the way that the text is 

presented visually is crucial to its meaning.

White Space
Standardize site structure and page creation by liberal use 

of white space. Active white space is intentionally used to 

create structure and flow on a page. It can serve other pur-

poses, such as helping readers to process the text more effi-

ciently and directing them to important information. Be 

sure to use white space around headings, margins, inden-

tations, and columns. Learning how to properly use white 

space can garner attention, sales, and impact.

Font Style
Font style is a critical element of accessible website design. 

In this case, readability is the most important factor. Choose 

a font that has easily recognizable characters, such as sans 

serif fonts: Arial, Calibri, Helvetica, or Verdana.

 “The US Department of Health & Human Services 

unofficially recommends the following fonts for PDF files: 

Times New Roman, Verdana, Arial, Tahoma, Helvetica, and 

Calibri.”6

 The minimum font size on your website is 16 points or 

16 px. It depends on the font because fonts tend to vary.

 When users zoom in on the page, they have to be able to 

zoom to 200% without affecting the content.

 Finally, avoid italics, all caps, bold type, or other format-

ting that could affect readability.

Acronyms, Abbreviations, and Jargon
Spell out acronyms when they’re first introduced in your 

text to your readers. Plus, avoid abbreviations, jargon, and 

figurative language.

Web Content Reading Level
Create content for the appropriate reading level. The general 

standard for Web content is eighth grade. The goal is to keep 

sentence structure simple and paragraphs short. It’s OK to 

be conversational, but keep it clear and concise. This helps 

many users with cognitive and visual disabilities.

Adding Hyperlinks
Avoid these words or phrases in links:

• Click here

• Read more

• More info here

• Link to (some link destination)

 It is best to tag the actual message as a hyperlink. If it is a 

link, it automatically means click here.

 Another way to address accessibility is with creative 

strategies such as podcasting. Podcasting can use audio to 

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AMWAJournal.org     20Diversity, Equity, and Inclusion Embraces Accessibility

assist the visually impaired, but it can also have text cap-

tions or a transcript to assist people with hearing loss.

DEVELOP A NEW STRATEGY—PRESENT LIKE A 
PODCASTER
As a medical communicator, drafting and scripting presen-
tations can become an important part of your job, in addi-
tion to making presentations oneself. A great way to learn 
how to inform, educate and entertain an audience without 
relying solely on visual aids can be derived from the art of 
podcasting. So... what is a podcast?
 One way to think of a podcast is a television show for the 
ears. Podcasts are a series of recorded audio files that, in a 
similar manner to a television show, tend to tell a story with 
a focus on a specific theme, generally within 25 to 45 min-
utes. Much like a presentation they can be used to inform, 
educate, or entertain an audience.
 Leaning on lessons learned from professional podcast-
ers and storytellers, the following are some key strategies to 
make presentations audio friendly.

Scripting the introduction
• Focus on the subject and clarify it to listeners by tell-

ing the audience what to expect from the presentation. 
(eg, “You will learn or discover X as a result of the  
findings that will be shared today.”).

• Insert a question to engage the audience and start the 
thought process.

• Establishing the concept with the necessary back-
ground (eg, “In order to understand X, let me first 
explain Y.”).7

Scripting the narrative to ensure the speaker is not reliant 
on visual aids to explain key findings.

• Using clear, descriptive language that emphasizes the 
main points.

– Recommended: the research found that feature X 
is expressed in 30% of the population and feature Y 
in 60% of the population, with other features repre-
senting 10%, indicating that feature Y is more prev-
alent in Z population (speaker uses a pointer to 
highlight information on the chart).

– Not recommended: if you look at the above pie 
chart, in which the blue represents feature X and 
the green represents feature Y, you will see that  
feature Y is more widely expressed in our popula-
tion (listener has no concept of how wide the  
gap in expression is or the expression level of  
other features).

• Use delivery notes within the script to introduce 
pauses, emphasis, pace, and other strategies to  

prevent the audience from losing focus due to a 
monotone presentation.8

Script the conclusion to emphasize the main point of the 
presentation.

SUMMARY
With approximately 25% of the US population having a dis-
ability, a focus on the use of accessibility features in tech-
nology and comprehensive communication is critical for 
the clear and accurate dissemination of knowledge. For an 
organization, the benefits of presenting accessible content 
can range from ensuring that a broad customer base under-
stands the value the organization provides to legally meet-
ing compliance standards. Accessibility solutions, such as 
using image alternative text and strategically using fonts 
and color contrasting, are a few of many effective ways to 
provide accessible content to a larger audience. For medi-
cal communicators, strategies in communication, such as 
descriptive language and the use of storytelling techniques, 
are vital to ensuring your audience has a clear understand-

ing of the message.

Author declaration and disclosures: The authors note no  
commercial associations that may pose a conflict of interest in 
relation to this article.

Author contact: aflockofscientists@gmail.com

References
1.   Centers for Disease Control and Prevention. CDC: 1 in 4 US adults 

live with a disability. Centers for Disease Control and Prevention 
website. Published August 16, 2018. Accessed April 5, 2022. 
https://www.cdc.gov/media/releases/2018/p0816-disability.html

2.    W3C Web Accessibility Initiative. Introduction to web 
accessibility. W3C website. Published February 2005. Accessed 
March 24, 2022. https://www.w3.org/WAI/fundamentals/
accessibility-intro/

3.    WebAIM. Contrast and color accessibility: understanding WCAG 
2 contrast and color requirements. WebAIM website. Updated 
January 9, 2021. Accessed February 23, 2022. https://webaim.org/
articles/contrast/

4.    American Foundation for the Blind. AFB's social media 
accessibility guidelines. AFB website. Updated August 27, 2021. 
Accessed February 22, 2022. https://www.afb.org/consulting/afb-
accessibility-resources/afbs-social-media-accessibility-standards

5.    American Council of the Blind. The audio description project. 
Audio Description Project website. Accessed January 8, 2022. 
https://adp.acb.org/

6.    Bureau of Internet Accessibility. Best fonts to use for website 
accessibility. Bureau of Internet Accessibility website. Published 
May 20, 2017. Accessed May 2, 2022. https://www.boia.org/blog/
best-fonts-to-use-for-website-accessibility

7.    MacAdam A. How audio stories begin. NPR website. Published 
July 26, 2016. Accessed April 7, 2022. https://training.npr.
org/2016/07/26/how-audio-stories-begin/

8.   Hammer D. Podcast basics: how to write a podcast script. Castos 
website. Published April 29, 2022. Accessed May 4, 2022. https://
castos.com/podcast-script

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