Do Physicians Make Their Articles Readable for Their Blind or Low-Vision Patients? An Analysis of Current Image Processing Practices in Biomedical Journals from the Point of View of Accessibility

Abstract

Visual content in biomedical academic papers is a growing source of critical information, but it is not always fully readable for people with visual impairments. We aimed to assess current image processing practices, accessibility policies, and submission policies in a sample of 12 highly cited biomedical journals. We manually checked the application of text-based alternative image descriptions for every image in 12 articles (one for each journal). We determined whether the journals claimed to follow an accessibility policy and we reviewed their submission policy and their guidelines related to the visual content. We identified important features concerning the processing of images and the characteristics of the visual and the retrieval options of visual content offered by the publishers. The evaluation shows that the actual practices of textual image description in highly cited biomedical journals do not follow general guidelines on accessibility. The images within the articles analyzed lack alternative descriptions or have uninformative descriptions, even in the case of journals claiming to follow an accessibility policy. Consequently, the visual information of scientific articles is not accessible to people with severe visual disabilities.Instructions on image submission are heterogeneous and a declaration of accessibility guidelines was only found in two thirds of the sample of journals, with one third not explicitly following any accessibility policy, although they are required to by law.

Design Recommendations for an Inclusive Online Sexual Health Clinic for Blind and Partially Sighted People

“…We also report the importance of web accessibility in mediating digital health's inclusive usability. The findings affirm and extend existing literature [18,29], highlighting how poorly designed interfaces compound the assistive technology BPS people use, creating barriers towards accessing care [14]. We also report concerns about interacting with an eSHC, particularly self-sampling.…”

“…A recent modification to WCAG 2.0 2018 ensures interfaces improve accessibility for those with a visual impairment [35]. Of particular concern is when visual information such as images, tables and diagrams in scientific articles are not accessible to BPS who use screen readers [29]. However, healthcare tends to use scientific images to explain conditions; thus, these elements must be interpreted in text for those who cannot engage with visual content.…”

Accessibility of graphics in STEM research articles: Analysis and proposals for improvement

“…The same articles had been used as a sample of academic publications in previous studies by Splendiani et al. (Splendiani & Ribera, ; Splendiani et al., ,). Table shows the selected articles.…”

“…In current practice, the alternate text and actual text attributes (and also the alt attribute in the img element of HyperText Markup Language [HTML] documents) are absent or incorrectly applied in academic publications belonging to STEM domains (Splendiani & Ribera, ; Splendiani, Ribera, & Centelles, ; Splendiani, Ribera, Garcia, & Termens, ). The literature points to images lacking a descriptive text alternative as one of the most common accessibility barriers in research journals (Coonin, ), digitized documents in academic libraries (Southwell & Slater, ), and websites (Petrie, Harrison, & Dev, ).…”

“…Ideally, the authors themselves should write the alternative text, but they are not aware of the barriers that people with special needs experience in reading academic journals. Text alternatives are not part of current content development practices and publishing habits (Splendiani & Ribera, ). Text alternatives are not required by publishers as a condition of image submission (Splendiani & Ribera, ; Splendiani et al., ,). The task of writing a text alternative is challenging and time‐consuming, because it consists of including “as much information as possible in the fewest characters without sacrificing intelligibility” (Slatin, , p. 78). Currently accessibility experts recommend keeping alternative text shorter than 125 characters (DO‐IT Knowledge Database, ). Some international organizations, such as the EDItEUR group, the World Intellectual Property Organization (WIPO) and the Daisy Consortium, have addressed the inclusion of accessibility policies in the publishing workflow at the organizational level by proposing guidelines to publishers (Hilderley, ), but they have not yet been widely adopted.…”