JMIR Publications

ABSTRACT

Background:

Accessibility is acknowledged as a key to inclusion in the Convention of Rights for People with Disabilities (CRPD). Inaccessible design can create exclusion from eHealth and cause disability among people who have impairments.

Objective:

The aim of this scoping literature review was to investigate how eHealth services have been developed and evaluated regarding accessibility for people with impairments.

Methods:

In line with Arksey and O’Malley’s framework for scoping studies and using the PRISMA-ScR we conducted a search in four databases PubMed, Scopus, IEEE and Web of Science in October 2020 and an update of the search in June 2022. The search strategy was structured according to the PICO model: Population/Problem - Digital accessibility for users with impairment; Intervention - Healthcare delivered by any digital solution; Comparison - not applicable; Outcome - Use of and adherence to i) WCAG, ii) other accessibility guidelines, iii) other means, for designing and/or evaluating accessibility in eHealth services. A Boolean search was conducted with combining terms related to accessibility and eHealth. All authors participated in screening abstracts for eligibility criteria. Each publication, containing a potentially relevant abstract, was read in full text and assessed for eligibility by two authors independently and pairwise. Publications deemed eligible were read by all authors and discussed for consensus.

Results:

A total of 8643 publications were identified. After abstract screening, 131 publications remained for full text-reading. Of those, 116 publications were excluded due to not meeting eligibility criteria. Fifteen publications from studies of 12 eHealth services were included in the study. Two of the 15 publications provided a definition of accessibility, five publications provided an explanation of accessibility, and eight publications did not provide any explanation. Five publications used the WCAG guidelines to evaluate accessibility when developing eHealth services. One publication used standards from the International Organization for Standardization (ISO) 29138, ISO 2941 and ISO/IEC 30071-1 together with the Spanish standard UNE 139803. Eleven publications used other means to address accessibility comprising: text-level grading; literature review about accessibility; user tests, focus groups, interviews and design workshops with target group of patients, relatives and healthcare professionals; and comparative analysis of existing technical solutions to provide information about useful requirements.

Conclusions:

Although a clear definition of accessibility can enhance operationalisation and thus measurability when evaluating accessibility in eHealth services, accessibility was insufficiently defined in most of the included studies. Further, accessibility guidelines and standards were used to a very limited extent in the development and evaluation of eHealth services. Guidelines for developing complex interventions that include guidance for accessibility are motivated to ensure that accessibility will be considered systematically in eHealth services.