Health and Wellbeing Alliance: accessibility and inclusion guidance

Produced in partnership with the Health and Wellbeing Alliance, this document is designed to support you to communicate in a way that is accessible to as many people as possible.

This guide is designed to support you to communicate in a way that is accessible to as many people as possible. It will help you remove as many barriers or obstacles that could prevent people accessing your content.

Barriers may be experienced by those who have one or more of the following:

  • A visual impairment
  • Are d/Deaf or have hearing impairment
  • A learning a disability
  • A mental health problem
  • A mobility issues e.g. wheelchair users
  • Are colour blind
  • Are not fluent in English (i.e. no/limited English)
  • Are dyslexic
  • Are autistic

The guidance includes advice on the use of inclusive language for those in these groups.

It brings together advice and guidance from organisations who have experience in supporting inclusion and accessibility into one place for Health and Wellbeing Alliance members to easily access.

It is important to remember that those who experience difficulty with accessibility are not ‘disabled by those differences’ but are ‘disabled by the barriers they face in an environment and society’. The environment and materials within it need to be amended to ensure that all are able to access what they need with ease and dignity. For this reason, this document also includes examples of ways to remove barriers to ensure effective communication and accessibility for all.

This is the second draft of the guidance. It includes our core principles that we will adopt in all our communication activities.

Why adopting accessibility guidelines is important

Following accessibility guidelines as a standard in your organisation makes information easier for everyone to access. It can help groups with a wide range of disabilities either permanent or situational. Being accessible ensures everyone can access the information that you are trying to share. Adopting accessible approaches also ensures that you are meeting some legal requirements.

How to ensure that accessibility is considered?

  • Always put accessibility first and take time and care when making your information accessible. Where possible build it into your service development and delivery cycles (noting that extra time may be needed)
  • Consider the purpose of your document and the intended audience.
  • When your organisation is producing a range of documents (such as a large print version, an easy-read version, and versions in foreign languages) design them so they look and feel like they belong in a set and are equally important. That way no group will feel excluded.
  • Take an approach to writing that allows you to create accessible content the first time, every time. Many professional audiences also prefer content in an easier to read simpler format because it makes information easier to digest.
  • Co-produce or test your content or presentation with your audience. Ideally, do this in advance. Organisations who can help with this may charge but will be only too happy to help.
  • Make it easy for your service users to contact you in whatever format works for them and to let you know what their needs are.

5 core principles for accessibility

We commit as members of the Health and Wellbeing Alliance:

  • To use this guidance to help shape all our communication activities with the populations we support.
  • To champion the use of accessible communication standards with our partners and stakeholders.
  • To adopt, at least, the 5 core accessible communication principles in all our communications.

The Health and Wellbeing Alliance core accessible communication principles:

  1. Our content is easy to read: Sentences are short and Language is tested for readability
  2. We will use a minimum of font size 14 and a Sans Serif font style
  3. We will adopt inclusive language as best practice
  4. We will add image descriptions and alt text for online content
  5. We will organise meetings ahead of time, checking audience requirements and sending materials in advance

1. Writing easy to read content

Making our content more readable will make sure as many people as possible can read and understand the message we are trying to get across.

We will ensure that:

  1. sentences are short (10 to 15 words).
  2. the reading age of our content is around the age of 9.

Things you should also consider when you begin to write are as follows:

  1. Start and finish a sentence on the same page.
  2. Do not split a word across two lines with a hyphen.
  3. Start a new line for a new word.
  4. Remove words from sentences that are not needed.
  5. Each sentence should have one idea and one verb.
  6. Use active sentences, for example, “we are following up your complaint” (active tense) not “your complaint is being followed up” (passive tense).
  7. Use full words not abbreviations. There are a few exceptions to this where the abbreviation is very well known, for example NHS.
  8. Use images, symbols or photographs which support the text. This will help the reader in understanding meaning and key messages. Do this consistently throughout the document.
  9. Only use tables for data. Keep tables simple: avoid splitting or merging cells.

To test the readability of your content. You can use free tools like the Hemingway App to measure readability as you write and edit copy.

2. Designing easy to read content

A clean design using a basic font and large font size will help make your content easier to read.

We will ensure that we use:

  1. at least a font size of 14.
  2. a “sans serif” font such as Arial.

Things you should also consider when you begin to design your document are as follows:

  1. Use plenty of white space – consider using double space between paragraphs.
  2. Align text to the left and avoid “justifying” text.
  3. Use sentence case for headings and body text. Avoid all-caps text and italics.
  4. Avoid underlining, except for links.
  5. Ensure you highlight links in a different colour
  6. Documents with single continuous columns of text are easier to make accessible than documents with a complex layout.
  7. Images, symbols, or photographs should follow the left-hand margin of the page, with text to their immediate right.
  8. Limit the length of documents to no longer than 24 pages. If content suggests a need for a longer document, split the document.
  9. Use page numbers and, for longer documents, a contents page.
  10. Break up your document to make it more readable. Use bullet points, numbered steps, and meaningful subheadings.
  11. Do not use bold to mark up subheadings. Use styles (available in most word document formats) to create a hierarchy of headings: “heading 1”, “heading 2” and so on.
  12. Use styles for tables and bullet lists. That way, a screen reader will recognise the formatting and correctly read out the content.
  13. Only use tables to present data rather than to improve layout.

Colour can make your document more attractive. The following tips will mean colour does not make the document harder to read:

  1. Do not use things like colour or shape alone to show meaning. Instructions like “select the big green button” rely on the user to see the page and someone who is colour blind may not see the green button.
  2. Avoid pale colours on pale or white backgrounds (and dark colours on dark backgrounds).
  3. Consider using a small colour palette. Try to keep it to 3 colours only.
  4. Gradients can be confusing or distracting, use block colours instead.

Specific presentation design guidance

  1. Use two to four short bullet points per slide.
  2. Use a plain background.
  3. Only use one or two colours that contrast with the background (this means using a light colour on a dark background or a dark colour on a light background).
  4. People who do not read very well often prefer pictures.
  5. Only have a maximum of three pictures per slide.
  6. Pictures need to be big enough to see.
  7. Keep pictures simple.

3. Using inclusive language

Members of the Health and Wellbeing Alliance are all experts in supporting excluded and marginalised groups. This means that we are well placed to guide each other in our use of language when referring to these groups.

We will ensure that:

  1. we use and share this knowledge with each other.
  2. we use this across all our communications.

Things that you should consider when writing about excluded or marginalised groups are:

  1. Use gender-inclusive language where possible (they/them instead of he/she). Or, in some cases where you are talking about a specific person (e.g. a case study) ask them what their pronouns are.
  2. Try to avoid phrases that talk about victimhood, particularly when talking about disabilities, e.g. “suffers from”.
  3. Avoid phrases that could reinforce existing stigma, particularly when talking about mental health. eg ‘died by suicide’ rather than ‘committed suicide’
  4. Warn readers about content that could be difficult to read for some viewers or provoke an unintended response – Twitter users often state “TW” for trigger warning or “CW” for content warning.
  5. Avoid labelling groups of people, separating them from the overall population. For example use the term disabled people rather than ‘the disabled’

Specific language guidance

The table below includes guidance from a variety of experts. It covers the terms to use and those to avoid when referring to certain characteristics, conditions or groups. This is guidance only. There may be local or other experiences that suggest alternative approaches.

Condition/characteristic: Deafness

  • Terms to use: Deaf, Deafened, partially deaf or hearing, hard of hearing, Deafblind
  • Terms to avoid: Deaf-mute, Deaf and dumb, As deaf as a post, stone deaf, hearing impaired

Condition/characteristic: Homelessness (Source: Crisis "Talking about homelessness introduction to framing)

  • Terms to use: people facing/ experiencing homelessness, people rough sleeping
  • Terms to avoid: the homeless/ homeless people, Rough sleepers

Condition/characteristic: Ethnicity

  • Terms to use: Ethnicity, Ethnic minorities, people from a (insert ethnic group) background, the (insert ethnic group) ethnic group
  • Terms to avoid: race, non-white, BAME, BME

Condition/characteristic: Disability

  • Terms to use: disabled people/person, people with health conditions or impairments
  • Terms to avoid: The disabled, sufferers, handicapped, invalid, retard

Condition/characteristic: Blind/sight loss

  • Terms to use: is blind, blind person; partially sighted, limited vision or sight, visually impaired
  • Terms to avoid: the blind, poor sight

Condition/characteristic: Learning disabilities

  • Terms to use: learning disabilities
  • Terms to avoid: mentally handicapped, retarded, backward

Condition/characteristic: Physical disability

  • Terms to use: physical disabilities, physically disabled, wheelchair user, uses a wheelchair
  • Terms to avoid: cripple, handicapped, invalid, lame, wheelchair-bound, confined to a wheelchair

Condition/characteristic: LGBT people

  • Terms to use: 
    LGBT people, LGBT communities, LGBT populations, LGBT individuals LGBT, LGBT+, LGBTQ+, LGBTQIA+ are all acceptable when referring to the whole group. ‘Queer people’ is sometimes appropriate when used by LGBT people, but considered by some to be offensive If referring to specific groups, use the term to describe the group rather than the general term LGBT+ (e.g, lesbian and gay if only referring to lesbian and gay people, Bi+ if referring to people who are attracted to multiple genders) Sexuality, orientation, sexual and romantic orientation, marginalised sexual orientations Questioning sexuality Terms individuals have used to self-describe
  • Terms to avoid: Gays, Gay people (except when specifically referring to gay men), queers, homosexuals Some people consider ‘the LGBT Community’ to be a term that excludes them Lifestyle Confused about sexuality

Condition/characteristic: Gender identity / trans and nonbinary people

  • Terms to use: (for trans women and men, and nonbinary people) is a woman/man/nonbinary person Trans man, trans woman Trans people Is trans (as an adjective) Transgender Nonbinary, non-binary, identifies outside of the gender binary questioning gender identity Pronouns Referring to specific physical features when relevant (has a penis, has breasts, has a uterus, has a prostate, has periods) Terms individuals have used to self-describe
  • Terms to avoid: (for trans women and men, and nonbinary people) identifies as a woman/man/nonbinary person Transman, transwoman Trans (without ‘people’, used as a noun) Transgendered (as an adjective) Transexual Transvestite (when referring to trans people) Other, third gender (when referring to nonbinary people) confused about gender identity Preferred pronouns Born as a woman/man Body of a woman/man MTF or FTM Assigned male at birth (AMAB), assigned female at birth (AFAB) (unless relevant and physical traits cannot be described)

Last review: March 2023. NB. this is not a complete or exhaustive list. This will be reviewed and updated periodically.

4. Making online content accessible

Images can make our content more interesting, engaging and easier to understand. Taking care to describe the images for screen readers helps those who are visually impaired get the most out of our content too.

We will add image descriptions and alt text to our images.

There are a few tweaks for making content a lot more legible by screen readers:

  • Try not to use non-standard symbols (for example mathematical symbols) and emojis instead of words, as these can confuse screen reading software. For e.g. always type “and” or “plus” rather than “+”.
  • Where possible, write hashtags in “pascal case” (capitalise the first letter of every word in a hashtag), e.g. #FixTheDigitalDivide. This makes it easier to read and ensures that there will be pauses given between words for those using screen readers.
  • Where possible, include the hashtag (#) at the end of the text to prevent disrupting the flow of the words.
  • Don’t convey information via photos or images alone.
  • Publish in HTML format wherever possible so that your documents use your users’ custom browser settings. It can be difficult to make other formats easier to read. For example, PDF documents.

5. Organising accessible meetings

Taking time to prepare for meetings will mean you are better able to meet the needs of your audience. Small changes can make a big difference to how comfortable people feel and how able they are to take part.

We will:

  • organise meetings ahead of time
  • check audience requirements and
  • send materials in advance.

Things you should also consider when planning a meeting are as follows:

  • Give people plenty of notice for the meeting, including all the details and what to expect:
    • Tell people who will be at the meeting and what their role is.
    • Where possible give people photos of the people organising the meeting.
    • Send meeting papers to people before the meeting.
  • Consider the timing of the meeting to fit with public transport times
  • Offer payment in advance or on account for transport for those who need it
  • Make sure you ask before the meeting:
    • If people need communication support (like sign language interpreters or hearing loops for people who use hearing aids).
    • How do people want to get the information (for example, do they use Easy Read, email, in the post)?
    • What other things do people need to be able to come to the meeting?
    • If people have any dietary requirements.
    • If someone will be coming with a support worker (agree expenses in advance with the organisers).
  • Plan regular breaks. This will help reduce the cognitive load for people who have communication difficulties.
  • Have good lighting to aid lip reading / sign language.
  • Consider having a note taker to ensure that those who need to can revisit the content of the meeting afterward.

Specifically for face-to-face meetings:

  • Make it possible for people to check out the meeting room before the meeting.
  • Allow people to choose where to sit.
  • Arrange a space where people can go if they need a bit of peace, and tell people before the meeting.
  • Give people clear directions to the meeting.

Specifically for online meetings:

  • Use a video conferencing solution that allows users to enable closed captions (eg Teams, Meet).
  • Consider your position relative to the screen, and be close enough to allow lip-reading.
  • Be thoughtful about using a second screen so that you don’t regularly have your profile showing.
  • If sharing screen a presentation be sure to share it in an accessible format in advance.
  • Reduce background noise: ask colleagues to mute their microphones or to use headsets with noise cancelling microphones.
  • Send a how-to-use guide for those unsure how to use video conference solutions.
  • Describe everything on the slide, don’t assume people can see it.

Additional guidance when publishing your written content

If you decide to publish your content consider the following:

  • Print on matt paper.
  • If printing double-sided ensure that the paper is of sufficient thickness to avoid text showing through from the other side.
  • Provide an option for printing on different coloured backgrounds.
  • Publish in HTML format wherever possible so that your documents use your users’ custom browser settings. It can be difficult to make other formats easier to read. For example, PDF documents.

Some people may benefit from receiving your content in an alternative format. For example: large print, braille, easy read, and translated content.

There may be times when you should consider publishing your content in an alternative format alongside standard documents. It is most likely to be appropriate when:

  • the document contains information that is relevant to people who may have a need for information in an alternative format;
  • you would like to include people who need information in an alternative format in decisions about their health or care; and / or
  • you would like to help people to provide feedback or to raise a concern or complaint to a single point of contact.

Make it as easy as possible for people to ask for translation, transcription, or reformatting. Provide a contact point where people can do this.

Where you can find more information

Many resources were used to make this document. Most of these resources are publicly available. For more information you may find the following documents and links below helpful:

Thank you

  • Members of the Good Things Foundation Online Centre Network
  • Members of the Health and Wellbeing Alliance Inclusion Subgroup
  • Good Things Foundation A-team (our internal accessibility champions)
  • Felicity Smith, Senior Contracts and programme manager, NHS England
  • All who took time to steer, review and make recommendations on the development of the guidance

 

Related resources