Accessibility & Health Literacy Design

A patient who cannot open an appointment reminder with a screen reader, and a patient who reads a discharge letter three times and still does not know what to do next, are both locked out of care, for different reasons. Accessibility and health literacy design is the focus area concerned with removing both kinds of barrier, so that people can use a health service and understand it. It is a compliance lens as well as a design one.

What it covers

Digital accessibility means designing so that people with disabilities can perceive, operate and understand a service. The W3C, the body that maintains web standards, organises this around four ideas: content should be perceivable, operable, understandable and robust. Robust means that assistive technology, meaning tools such as screen readers and voice control, can read the content reliably.

Health literacy is the ability to find, understand and use health information. The US Office of Disease Prevention and Health Promotion splits it in two: what a person can do, and how far an organisation makes it possible for people to do it. That second half puts responsibility on the service, not only the reader.

The domain treats the two together because both are barriers between a person and their care, and because they overlap. One is largely about ability and the tools people use; the other is largely about understanding. W3C notes that cognitive and learning disabilities can affect memory, language, attention and comprehension, and that some cognitive needs are not addressed by its existing standards. A service can pass technical checks and still be hard to follow.

Who is affected

The groups include people with disabilities (the NHS service manual says almost 1 in 5 people in the UK have one), people with cognitive or learning disabilities, older adults, and people who need more time than others. They also include people with limited health literacy, which the CDC says is not confined to people with limited reading skill: complex self-care routines or a frightening diagnosis can be enough. The groups overlap, so the aim is one service that works for all of them, not a special version for a few.

What drives the design

The one factor is removing barriers to using and understanding the service. The barriers are not only about ability. A 2017 study of 100 adults aged 65 and over, with focus groups of 23, found that health literacy was not the main barrier to patient portal use; seeing a clear benefit mattered more. Its authors suggest task-specific training and links to phone and face-to-face contact.

What it looks like in practice

• Accessible components and content: text alternatives for images, a clear heading structure, enough colour contrast, text that can be enlarged, visible keyboard focus and labelled form fields. W3C's quick checks cover these, as a first look only.
• Plain language: Digital.gov defines it as content that is "clear and easy to understand". A 2025 review of 1,165 online resources for people with intellectual disability found Easy Read layouts common, and cautioned that simple wording alone does not guarantee understanding.
• Alternatives to digital channels: a phone or in-person route for people who cannot finish a task online.
• Testing with the people affected: NHS guidance suggests recruiting through charities and agencies, aiming for roughly one participant in five with access needs. GOV.UK recommends combining automated tools with manual tests and an audit.
• An accessibility statement where one is required: W3C says a statement should give a commitment, the standard applied and a contact. UK public sector websites and apps have had to publish one since 23 September 2018.

Where the law points

Many rules and policies name WCAG, the W3C's accessibility guidelines, as the technical benchmark. The version named and the legal force differ by region and by type of organisation. For example, GOV.UK requires services to meet WCAG 2.2 Level AA, the middle of three conformance levels. See Accessibility & Regulation for how instruments in several regions refer to the standard.

Where to read next

• Health Literacy & Plain Language: how stress affects what people take in, and writing techniques.
• Accessibility & Regulation: the WCAG standard and how rules in different regions refer to it.
• Design for Vulnerable Users: the wider barriers, including assisted digital support and shared access for carers.
• UX Patterns for Health: forms, alerts and flows where these barriers show up.
• Process & Research: running studies with disabled people and people who find health information hard.

Related Showcase cards

• Status is never colour alone - a WCAG 2.2 accessibility citation applied to a health reading.
• Write the dose the patient reads, not the dose the chart stores - accessibility and health literacy applied together to a medication schedule.