Manual evaluation using assistive technology for a representative sample of user journeys on the University Hospital Southampton (UHS) public website - June 2023

About the Evaluation

Evaluation commissioner: Sian Bryant
Report creator: Dr Neil Rogers
Evaluation date: Wednesday 28 to Thursday 29 June 2023

Executive summary

University Hospital Southampton (UHS) requested a manual evaluation by Microlink of five user journeys that were a representative sample of the public UHS website. The evaluations were undertaken using the NVDA screen reader because the public will be using the website, many of whom may not be able to afford JAWS. Alongside this a test of the C Level Floorplan in PDF format for the Southampton General Hospital was undertaken and a report provided.

In addition, a request was made to undertake an evaluation of the colour contrast for the tagging labels under Trust Highlights for Ophthalmology, Diabetes and Endocrinology, and Clinical Research on the UHS homepage. The following indicates where UHS has met Best Practice followed by recommendations that address improvements that will have the greatest impact.

Best practice:

Based on the above user journeys the UHS website provides breadcrumb trails which meets the WCAG Success Criteria (SC) 2.4.8 Location (AAA). The breadcrumb trails are accessible to a screen reader user, but also may help those who have cognitive impairments and older adults. Enabling the user to select a different hospital within the bread crumb trail when on the Southampton General Hospital page, when visited through the For Visitors main menu tab, is useful. This may help a user who has a motor impairment when using a switch as this will save time having to re-navigate through the web page.

Alternative text (alt-text) descriptions were used correctly for the user journeys. For example, images/icons that supported links were described by the links and are therefore decorative images that do not require alt-text, which were correctly ignored by the screen reader. Both icons and images that are clear and sharp may help a user with a visual impairment.

Recommendations

The radio buttons and checkbox are unlabelled on the cancellation form and would prevent a screen reader user from using the form. The information in the green box on the cancellation page will need to be read aloud first by the screen reader or have an accessible modal pop up in separate browser window. Ensure that all form fields that require interaction have the relevant information text read aloud prior to entering data. Missing form field text highlighted in red maybe problematic for a person who is colour blind.

It is also important this information is read aloud by the screen reader and may help the user if a preview of the final form is presented prior to submission. Missing or incorrectly entered form fields, such as an email address, can be corrected, and the form resubmitted. Once the cancellation form is submitted it may help the screen reader user to have an accessible modal window appear announcing that the cancellation has been successful with brief relevant information.

When using the Find your consultant page finder feature, it may help a screen reader user to know when an action such as a search is complete. For example, to be given instruction after the search for Simon Hughes has been undertaken that a link is provided. Alternatively focus could be moved to the Simon Hughes link but with a notification to the screen reader user that this is going to happen.

On the Southampton General Hospital page, the heading Parking is H3 but needs to be changed to H2. The PDF document Southampton General Hospital – C level floor plan requires remediation. PDF remediation refers to making PDFs accessible for disabled people.

The expandable lists on the Find Departments or Service page may help a screen reader user if they are divided into alphabetic groups with an initial capital letter as a heading.

The YouTube video content on the Gastrointestinal medicine useful links page would benefit screen reader users having transcripts made available. Ensure all external links provided on the Useful Links page open in a new browser tab.

Finally, a help page, glossary of terms and abbreviations and an accessibility statement, using Sample accessibility statement - GOV.UK (www.gov.uk) would be required for the UHS website.

Scope of the evaluation

Website name: Public website of the University Hospital Southampton

Scope of the website: Testing five user journeys for the University Hospital Southampton (UHS) public website. Located at https://www.uhs.nhs.uk/

WCAG Version: 2.1

Conformance target: AA

Accessibility support baseline: Microsoft Edge with NVDA.

Additional evaluation requirements: The report will include a description of the problem for any errors listed for the manual audit using NVDA with recommendations.

Please note we have also provided a headline report for PDF remediation requirements using the third party AI based platform.

Detailed audit results of user journeys

The following five user journeys were tested manually using the NVDA screen reader and included the use of the shortcut keys NVDA+down arrow, Tab, arrow keys, H (1 – 6 inc. Shift), and NVDA + F7 (elements list) and other keys relevant to page content.

Home:

https://www.uhs.nhs.uk/

Home > Cancel your appointment > Change or cancel your appointment > Submit form

The home page and the Change or cancel your appointment page can be read aloud, starting from the top, using NVDA+down arrow. Skip to Main Content is provided as a link on all pages. Providing key words such as form in the heading, or first sentence helps the screen reader user know what information to expect and therefore what shortcuts are required. The link wording ‘Accessibility’ in the footer on the homepage would be helpful for a user who has a cognitive impairment to see the wording ‘Accessibility Statement’. Alt-text was used correctly for the Children’s Hospital and Southampton Hospitals Charity graphics.

The following can be navigated to, selected, and then activated using NVDA:

The cancel your appointment (quick link) on the home page using the Tab, up/down arrow keys, the K key, and NVDA+F7.
Sub navigation menu on the Change or cancel your appointment page using the Tab, up/down arrow keys, the K key, and NVDA+F7.
The cancellation form can be navigated to using the Tab, up/down arrow keys, the F key, and NVDA+F7.
Focus is visible and correctly ordered and links can be reached in a meaningful sequence. No keyboard traps were found.

Loading complete is stated after activating the quick link for the cancel your appointment.

When navigating the form, the radio buttons for ‘Cancel my appointment and write to me with a new appointment’ are unlabelled. The ‘Would you like the opportunity to see your appointments online’ Yes check box is unlabelled.

The text in the green box is partially duplicated in the main text and the information contained within this area will need to be read aloud first by the screen reader. The green box will need to be labelled or given a heading as a quick overview. Alternatively, this may be better suited to a notification provided on an accessible preview modal that pops up in a separate browser window.

The form would benefit from headings (H2 or H3 as required) for About you, Your contact details etc.

The form fields can have text input and deleted correctly by NVDA, and the calendars can be navigated using NVDA.

Ensure that all form fields that require interaction have the relevant information text read aloud prior to entering data. For example, ‘your hospital number: required 7 characters required (between 7-7) characters’. The information buttons can be navigated to using NVDA+F7.

The missing form field text, highlighted in red as an error, is not announced to the screen reader user as a notification prior to submission. The text in red would be problematic to a user who is colour blind.

Once the submit button is activated a modal notification that is screen reader accessible will be required to announce that the cancellation has been successful including a reference number and other brief relevant information. Alternatively required missing field need to be announced to the screen reader so the form can be re-submitted. It may be helpful to the screen reader user to have an additional step to check a final version of the populated form prior to submitting.

Find your consultant:

Home > For patients > find your consultant > use finder to select Simon Hughes

The For patients’ page, the find your consultant page, and the Dr Simon Hughes page can be read aloud, starting from the top, using NVDA+down arrow. Skip to Main Content is provided as a link. Alt-text was used correctly for the icons on the For patients page, in that they were decorative and ignored correctly by the screen reader. The alt-text for the consultant thumbnail images passed.

The following can be navigated to, selected, and then activated using NVDA:

The For patients’ main menu tab using the Tab, the K key, and NVDA+F7.
Sub navigation menu on the For patients page using the Tab, up/down arrow keys, the K key, and NVDA+F7.
The Find your consultant quick link using the Tab, up/down arrow keys, the K key, and NVDA+F7.
Sub navigation menu on the Find your consultant page using the Tab, up/down arrow keys, the K key, and NVDA+F7.
The Browse by surname, Or Search, Filter by department, and Clear using the Tab, up/down arrow keys, the K key, and NVDA+F7.
Sub navigation menu on the Dr Simon Hughes page using the Tab, up/down arrow keys, the K key, and NVDA+F7. H, H1-H6 (Incl. shift) enables navigation through headings.
Focus is visible and correctly ordered and links can be reached in a meaningful sequence. No keyboard traps were found.

Loading complete is stated after activating the quick link for find your consultant.

When navigating the Browse by surname, Or Search, and Clear buttons once activated a notification that the action has been completed is not given to the screen reader user. It may help the screen reader user, for example, to be given instruction after the search for Simon Hughes has been undertaken that a link is provided or that focus is moved to the Simon Hughes link but with a notification to the screen reader user that this is going to happen.

Colour contrast check: The Axe DevTools Edge browser extension was used to undertake a colour contrast check of the tagging labels under Trust Highlights for Ophthalmology, Diabetes and Endocrinology, and Clinical Research. No colour contrast issues were flagged. However, we would recommend that the text size of the labels be a minimum of 14pt (19 px) as this may help dyslexic users. Users of the UHS website may find reading all caps problematic and it is suggested that the label text be written in sentence case, although this is not a WCAG requirement.

C level floor plan:

Home > For visitors > Southampton General Hospital > Site maps and accessibility guides to Southampton General Hospital > C level floor plan

The For visitors, Southampton General Hospital and Site maps and accessibility guides to Southampton General Hospital pages can be read aloud, starting from the top, using NVDA+down arrow. Skip to Main Content is provided as a link. The icons used on the Southampton General Hospital page were correctly specified as decorative images. The alt-text for the entrance image to the Southamtpon General Hospital passed.

The following can be navigated to, selected, and then activated using NVDA:

The For visitors’ main menu tab using the Tab, the K key, and NVDA+F7.
The Southampton General Hospital link using the Tab, the K key, and NVDA+F7.
Sub navigation menu on the Southampton General Hospital page using the Tab, up/down arrow keys, the K key, and NVDA+F7.
The Site maps and accessibility guides to the UHS link on the Southampton General Hospital page using the Tab, the K key, and NVDA+F7.
Sub navigation menu on the Site maps and accessibility guides to the Southampton General Hospital page using the Tab, up/down arrow keys, the K key, and NVDA+F7.
The link to the PDF document Southampton General Hospital – C level floor plan using the Tab, the K key, and NVDA+F7.
Focus is visible and correctly ordered and links can be reached in a meaningful sequence. No keyboard traps were found.

On the site maps and accessibility guides to Southampton General Hospital the heading Parking is H3 but needs to be changed to H2. Site maps and accessibility guides to the UHS link text needs to be changed to Site maps and accessibility guides to the Southampton General Hospital link. We recommend that the PDF document Southampton General Hospital – C level floor plan is remediated.

In addition the PDF available at https://www.uhs.nhs.uk/Media/UHS-website-2019/Docs/For-visitors/clevelmap-southamptongeneralhospital.pdf) was tested for compliance to WCAG 2.1 and the detailed report ( clevelmap-southamptongeneralhospital_tested_PAC_WCAG_Report.pdf ) indicates that the PDF is not compliant. We recommend that this is remediated. Microlink can do the heavy lifting for UHS by providing cost effective social value PDF remediation at scale using an AI platform.

Departments:

Home > Departments > Brain, spine and nerves > Wessex Neurological Centre > Neurophysiology

The Departments page, Brain, spine and nerves, Wessex Neurological Centre, Neurophysiology can be read aloud, starting from the top, using NVDA+down arrow. Skip to Main Content is provided as a link on all pages. No images were present.

The following can be navigated to, selected, and then activated using NVDA:

The Departments main menu tab using the Tab, the K key, and NVDA+F7.
The Brain, spine and nerves expandable list using Tab and NVDA+F7.
The Wessex Neurological Centre link using Tab or up/down arrow.
Sub navigation menu on the Wessex Neurological Centre page using the Tab, up/down arrow keys, the K key, and NVDA+F7. H, 1-6 (incl. Shift) enable navigation through correctly nested headings.
Sub navigation menu on the Neurophysiology page using the Tab, up/down arrow keys, the K key, and NVDA+F7. H, 1-6 (incl. Shift) enable navigation through correctly nested headings.
Focus is visible and correctly ordered and links can be reached in a meaningful sequence. No keyboard traps were found.

On the Find Departments or Service page we recommend the expandable lists be divided into alphabetic groups with an initial capital letter as a heading. For example:

Anaesthesia

Asthma, allergy, and clinical immunology

Audiology

On the Wessex Neurological Centre page, the H3 links do not need to be headings only links. We would recommend that visually the existing H3 links need to be a text size between the existing H3 headings and the body text size. For example:

Neuroradiology

Neurosurgery

Head injury

The link Neurophysiology on the Wessex Neurological Centre page page should read Clinical Neurophysiology. This may help a user who has a cognitive impairment or an older adult to know they have reached the correct page.

Gastrointestinal medicine:

Home > Departments > Gastroenterology > Gastrointestinal medicine > Useful Links

The Gastrointestinal medicine and Useful Links page can be read aloud, starting from the top, using NVDA+down arrow. Skip to Main Content is provided as a link on all pages. No images were present, other than the YouTube video that had a description Monogenic Inflammatory Bowl Disease (IBD).

The following can be navigated to, selected, and then activated using NVDA:

The Departments main menu tab using the Tab, the K key, and NVDA+F7.
The Gastroenterology expandable list using Tab and NVDA+F7.
The Gastrointestinal medicine link using Tab or up/down arrow.
Sub navigation menu on the Gastrointestinal medicine page using the Tab, up/down arrow keys, the K key, and NVDA+F7. This includes navigating to Useful Links in the sub menu. H, 1-6 (incl. Shift) enable navigation through correctly nested headings.
The links provided on the useful links page using NVDA+F7 and K. H, 1-6 (incl. Shift) enable navigation through correctly nested headings.
Playing the Monogenic IBD Information for Patients YouTube video.
There were no deadlinks provided on the useful links page that are visible.
Focus is visible and correctly ordered and links can be reached in a meaningful sequence. No keyboard traps were found.

Although captions are provided for the Monogenic Inflammatory Bowl Disease (IBD) Information for Patients YouTube video they are provided on a semi-transparent background, and they partially obscure the image. We recommend having captions provided in the black letterbox bar at the bottom of the video player. Alongside this a transcript of the video will be useful to screen reader users, where slide information within the video and the details about James Ashton will need to be included. Audio description may be required for other videos and the Web Accessibility Initiative (WAI) provide a resource for Making Audio and Video Media Accessible | Web Accessibility Initiative (WAI) | W3C.

Ensure all external links provided on the Useful Links page open in a new browser tab.