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This article was originally printed in the April 2003 issue (Vol 9, No. 4)


About the Authors

Ginny Redish is President of Redish & Associates, Inc.

Mary Frances Theofanos works for the National Cancer Institute in Rockville, Maryland, USA.

See also:
Guidelines for Accessible and Usable Web Sites: Observing Users Who Work With Screen Readers
by J Mary Frances Theofanos and Janice (Ginny) Redish
 A related article from Interactions presents 32 guidelines for web design and content authoring based on this material  

STC Usability SIG Newsletter

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Usability Interface

Observing Users Who Listen to Web Sites

by Janice (Ginny) Redish and Mary Frances Theofanos

The Communications Technology Branch at the United States National Cancer Institute (part of the National Institutes of Health and the Department of Health and Human Services) has been conducting usability testing with blind and low-vision users to:

  • Understand how blind and low-vision users work with web sites.
  • See the relationship between accessibility and usability.
  • Assess the usability of specific web sites for blind and low-vision users.

In this article we focus on the first of these goals and give you some of the fascinating findings about how vision-impaired users work with web sites.

(The goal of ubiquitous usability is to make web sites work for everyone. We recognize that vision-impairment is only one of many disabilities that hinder people from using web sites and other products. We recognize that our sample is only of English-speaking people in one part of the U. S. and that we are reporting here only on users who must rely on listening. This is just the beginning of work on understanding users with special needs. Our second study, now underway, is with low-vision users who use software that magnifies what is on the screen.)

The project

Between November 2002 and February 2003, we observed and listened to 16 vision-impaired users as they worked with web sites using assistive devices that read the screen to them ("screen readers"). Participants in the study used the screen reader that they work with regularly. Twelve used JAWS, the most popular English-speaking screen reader (; four used Window-Eyes, the second most popular screen reader (

Each participant spent two hours with us in a typical usability-testing environment. We allowed them to customize the screen reader software in any way they wanted. We then watched and listened as they worked on scenarios (tasks) that we suggested to them. Ginny facilitated the sessions, sitting with the participant, encouraging participants to think out loud, and engaging in discussions of screen readers and sites. Mary and others observed and took notes from a second room where they had a large-screen view of the participant's screen with picture-in-picture views of the participant's face and the keyboard.

Our two other partners on this project are Abhijit Ghosh, a technology transfer fellow with the National Cancer Institute, and Jo Miller, a specialist in accessibility and U. S. government Section 508 requirements.

What we learned

The web is critically important to these users. It is liberating. For many of our participants, the web has brought a greater sense of independence than ever before. The web allows them to "read" a newspaper for the first time. It gives them an easy way to shop. It makes them less dependent on others. And for those who are employed, it is absolutely essential to their work.

Screen-reader users scan with their ears

These users are just as impatient as sighted users. They want to get the information they need as quickly as possible. That means that they do not listen to every word on the page - just as sighted users don't read every word. They "scan with their ears" just as sighted users scan with their eyes. They listen to the first few words of a link or a line of text. If it doesn't seem relevant, they move quickly to the next link or next line of text. Where a sighted user might find a keyword by scanning with their eye, a blind user may not hear that keyword if it isn't right at the beginning of the link or the line of text.

Many work by listening to links

Screen readers allow users to tab quickly from link to link. They also allow users to open a box that lists all the links on a page - and just the links. Within that box, users can then move quickly through the links or jump to a link by typing the first letter. Our participants used this feature regularly. But if many links start with the same first word, they get frustrated and can't find what they need. If a link they are looking for is there but not with the keyword they first consider, they also may not find it - and again get frustrated.

Some jump directly to headings

The latest version of JAWS allows users to jump from heading to heading in a document. For users who know about this feature, it can be extremely useful. One participant used this to get immediately to the content. If the page has headings in the content, jumping to the first one bypasses all the navigation at the top and left. However, this feature only works if headings are properly coded in HTML. JAWS recognizes the heading tags. If headings are normal type bolded and enlarged, JAWS cannot tell that those are headings.

Also, unfortunately, many of our participants did not know about this new "heading jump" feature. Just as with sighted users, even though they may have updated their software, they may not have learned all the new ways to work with it. We still think it is critical for content to have frequent, meaningful, and correctly coded headings. More and more screen reader users will learn about this feature.

Many want to skip the navigation, but don't use that feature

Many Web sites include a link to "Skip Navigation" at the beginning of each web page. Clicking on that link bypasses the navigation at the top (and left - depending on where the developer has ended the "skip navigation"). Our participants desperately wanted to avoid listening to the navigation each time they got to a page. They wanted to get right to the content. Some ranted to us about the problem of having to listen to the same "stuff" on each page. Some jumped to the bottom and scanned the pages backwards to avoid the navigation at the top. But only half knew what "Skip Navigation" means.

Think about it. "Navigation" is web jargon. It's not common language. Some developers have used the phrase "Skip to Content" instead of "Skip Navigation." Good idea. But it does not work because "content" in English can be a noun or an adjective. JAWS reads it here as an adjective with the accent on the second syllable. So it does not make sense to users. A solution that does seem to work is "Skip to Main Content." JAWS reads that correctly as the noun "content" with the accent on the first syllable.
Screen readers are amazingly good at reading, but they still mispronounce some words
"Content" is just one example of the problems that screen readers have. Both JAWS and Window-Eyes read amazingly well, but unusual words trip them up. When "homepage" is written as one word, the screen reader says "hommapage." Write it as two words.

If you do not tag acronyms and abbreviations properly and tell screen readers to read the letters, they read them as words. "FY" (for fiscal year) is read as "fie." "VA," the abbreviation for the state of Virginia, is read as "va," like the Spanish word for "go." Made-up words like MEDLINEplus (a very large database of links to medical information) or LiveHelp trip up the screen readers.


Accessibility is not the same as usability. A site is not really accessible if it is not also usable. Compliance with accessibility guidelines and standards such as the U.S.'s Section 508 is necessary for people with visual impairments to use Web sites. However, as our research has shown, meeting those requirements does not guarantee that users of assistive technologies will be able to use the site.

Automated accessibility tools are useful for checking site compliance, but they do not check usability. Usability testing is required to determine if vision-impaired users (or users with any other special needs) will be able to use the site. Our goal is to extract usability guidelines from the insights we are getting through our studies to help you bring your sites closer to both accessibility and usability.

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