The ProVisu directory is a unique and innovative guide to trustworthy information on the promotion and the prevention of eye diseases for all citizens. The accessibility service allows an access to the Web equally, and independently of the development of a site, the technology or the platform used. The implementation of the accessibility in ProVisu responds globally to the accessibility barrier on the Internet, not only at the level of a given site. Through these simple solutions ProVisu demonstrates that respecting elementary rules and using appropriate web technology such as the bookmarklet, then the Internet could be an integration and autonomy vector and become a space of freedom for all of us.
Along with trustworthiness, accessibility and usability are two of the most important topics related to the publishing of online medical and health information. Indeed, the design and the way of providing health and medical information on the Internet to citizens should be adapted to the needs of all citizens: people suffering from reading disabilities, visual disabilities, dyslexics, people with intellectual handicaps, with neurological and physical impairment, elderly, and patients amongst others. Paradoxically, this group of people use the medical Internet more and more in order to preserve their wellness, to look for new treatments, to find suitable advices, to choose their doctor or hospital.
Accessibility can be declined in the following aspects:
- Readability: typeface, size, colour and background
- Speech-enabled web sites
- Readability: complexity of the page layout
- Health literacy: complexity of the content
The Health On the Net foundation  is an innovative approach to helping people combat disease and live healthy lives by offering practical guidance to certified medical information and support on the Internet. Pioneering the multilingual access to trustworthy medical and health information with HONselect and MedHunt services - available in more than 5 languages-, the Foundation pursues its contribution of accessible information to all citizens with ProVisu [2, 3, 4]. The ProVisu project has the goal to raise awareness with the citizen and health professionals about the increasing number of citizen at risk for age-related eye diseases and the need for early detection and rehabilitation services; to provide an one stop information service to and inform the community and the general practitioner about all eye diseases, available treatments, and associations; and to be accessible to blind or visual impaired person.
WAI (Web Accessibility Initiative) is a programme of the World Wide Web Consortium to develop technology, guidelines, and tools to increase Web accessibility for people with disabilities . Despite of initiatives such as the one from the NIH with a checklist to assess the accessibility of Web site, only few Web sites abides by Web accessibility specifications [6, 7]. According to the survey HON conducted with the European ENABLED project 36% of the 269 survey respondents say they make special efforts to produce accessible Web sites or applications . They cite a wide variety of reasons, all pointing to the need for higher prioritisation of accessible Web and application design. And 58% of survey respondents were not aware of the WAI guidelines. This survey confirmed that a large number of websites are not fully accessible, mainly because website developers, designers and managers are not aware of accessibility issues or lack the proper knowledge or training to fully use the available tools. The survey results also highlight the responsibility of software manufacturers, who could do more to provide tools to produce accessible Web content. Indeed the implementation of the WAI guidelines is not straightforward and requires specific training. So in the daily use, the application of these guidelines in the development of a Web site is rare.
As a result of these findings different approaches have been implemented in the ProVisu project: a) the seamless speech-enabled service and the navigation with the keyboard, b) the reading comfort and c) the adaptation of external websites to a sight-enhanced style via a specialised bookmarklet.
- the seamless speech-enabled service and the navigation with the keyboard,
One of the aspects of accessibility is speech-enabled web sites. The progress and the quality of text to speech synthesis technology (TTS) and synthetic voices with a near-to-human quality voice allow integrating this service not only for the target population, dyslexic and visually impaired persons but also for the entire Internet community. Furthermore, this service is affordable both at the integration into a web site as at the price levels, and available in many languages. In ProVisu we enriched the navigation within the site with text to speech features and adapted short cuts.
4 text sizes and 4 colours of the text and backgrounds are proposed to the citizen in order to adapt the display of the ProVisu site as much as possible according to his/her vision (Fig. 1).
- the adaptation of external websites to a sight-enhanced style via a specialised bookmarklet
The ProVisu’s site content is devoted to the promotion and the prevention of eye diseases and blindness by providing comprehensive and trustworthy information on a large coverage of eye diseases and anatomic structure (325 eye-related terms). In order to provide such service we analysed what is available on the Web and what type of information the citizen is looking for. A directory and a search facility have been created from objective, trustworthy, and accurate health information collected on only Web sites respecting elementary ethical and quality standards such as the HON’s Code of Conduct and the European Quality Criteria for Health related Websites [9, 10, 11].
Web sites has been automatically skimmed and retrieved from the Web by the HON’s specialised robot, MARVIN  armed with a eye diseases dictionary. Then, information has been gathered and aggregated via HON’s dynamic content production tool.
The eye diseases directory categorised according to a sub-group of the MeSH  offers information structured in the following groups: Generality/Definition, Prevention, Symptoms, Treatment, Statistics, Illustrations and Information for the specialist (Fig. 2 and 3).
(SSIM Days 2006, Bale)
Fig. 1: the ProVisu project available in French and English.
Fig. 2: screenshot of the eye diseases directory, here the Glaucoma information structured in the following groups: Generality/Definition, Prevention, Symptoms, Treatment, Statistics, Illustrations.
Fig. 3: screenshot of the French version of the Glaucoma information.
Fig. 4: external Web site adapted to the reading comfort
Fig. 5: original web site page