Digital accessibility

Digital accessibility means creating documents, websites and apps that people with disabilities can use. This includes people who use screen readers, keyboard-only navigation or other assistive tools. 

In April 2024, the U.S. Department of Justice issued a rule under the Americans with Disabilities Act (ADA) Title II. State and local government websites and documents must meet a standard called WCAG 2.1, Level AA by April 2027. 

This guide gives you what you need to create accessible documents. For a deeper look at the standard itself, visit WCAG in Plain English.

Always begin with the most recent template from Brandwise. Templates have accessible styles, colors and layouts already built in. Starting from a template saves time and prevents common mistakes. 

Before you start any document, go to Brandwise > Downloads and download the latest version of the template you need (Word or PowerPoint).

A well-built Word document will usually produce a well-built PDF. Getting Word right is the most important step. 

Key rules 

• Use heading styles. Apply Heading 1 for the title, Heading 2 for sections and Heading 3 for subsections. Do not just make text big and bold. Screen readers rely on heading styles to help people navigate. 
• Add alt text to images. Right-click any image, choose “View Alt Text,” and write a short description. If the image is decorative, check “Mark as decorative.” 
• Write descriptive links. Replace “click here” or bare URLs with clear link text, like “Download the patient booklet.” 
• Build tables correctly. Use Insert > Table. Check “Header Row” in the Table Design tab. Do not merge or split cells. 
• Check color contrast. Text should have at least a 4.5:1 contrast ratio against its background. Never use color alone to show meaning. 
• Use a clear file name and title. Set a title in File > Properties. Avoid names like “final_final_v3.docx.” 

How to run the accessibility checker 

1. Open your document in Word. 
2. Review tab > Check Accessibility. 
3. Look at the results panel. Fix any errors and review warnings. 
4. Do a quick manual check too. The checker cannot tell if your alt text is accurate, if headings are in order or if the reading order makes sense. 

The best way to create an accessible PDF is to start with an accessible Word or PowerPoint file and export it correctly. Fixing an untagged PDF later is slow and often requires Adobe Acrobat Pro. If you need help fixing issues in a PDF, you may reach out to Marketing & Communications. 

How to export a PDF from word 

1. Go to File > Save As > PDF. 
2. Click “Options.” 
3. Make sure “Document structure tags for accessibility” is checked. 
4. Click OK, then Save. 

Important: Never use Print > Save as PDF. This strips out all tags, headings and alt text. 

What makes a PDF accessible 

• Tagged. Tags are invisible labels that tell screen readers what each piece of content is (i.e., heading, paragraph, list, table,ior mage). 
• Selectable text. If the PDF is a scan, run Optical Character Recognition (OCR) in Acrobat first so the text can be read by assistive tools. 
• Title and language set. In Document Properties, add a clear title and set the language. 
• Alt text on images. Decorative images should be marked as artifacts. 
• Logical reading order. Content should flow in the order a person would expect. 
• Proper table headers. Data tables need header tags, so screen readers can announce column or row names. 

How to check a PDF in Adobe Acrobat Pro 

1. Open the PDF in Adobe Acrobat Pro. 
2. Go to All Tools > Prepare for Accessibility. 
3. Click Check for Accessibility > Start Checking. 
4. Review flagged items. Right-click any item to fix or explain options. 

For a free step-by-step video walkthrough, visit Section508.gov: How to Test and Remediate PDFs.

Key rules 

• Use built-in slide layouts. Go to Home > New Slide and pick a layout (i.e., Title Slide, Title and Content). Do not start from a blank slide and add text boxes by hand. 
• Give every slide a unique title. Screen readers navigate by slide title. If two slides cover the same topic, add a number (for example, “Symptoms 1 of 2”). 
• Check the reading order. Go to Home > Arrange > Selection Pane. Items are read from bottom to top, so the first thing to be read should be at the bottom of the list. 
• Add alt text to every image, chart and SmartArt graphic. 
• Use at least 24-point font for body text. Make sure text and background have strong contrast. 
• Keep tables simple. Avoid merged cells. 
• Caption any embedded videos. 

How to run the accessibility checker 

1. Open your presentation in PowerPoint. 
2. Review tab > Check Accessibility. 
3. Fix errors and review warnings. 
4. Do a manual check too. The checker cannot confirm if alt text is meaningful, if reading order is correct or if content makes sense when read aloud. 

Run through this list before sharing any Word document, PDF or PowerPoint file. 

☐ Downloaded the most recent template from Brandwise.
☐ File has a clear, descriptive name (not “final_v2.docx”).
☐ Document title is set in File > Properties.
☐ Document language is set correctly.
☐ Headings use heading styles, in order (H1, H2, H3).
☐ Every meaningful image has alt text. Decorative images are marked as decorative.
☐ Tables use Insert > Table with a header row. No merged cells.
☐ Lists use bullet or number buttons, not manual dashes or numbers.
☐ Link text is descriptive (not “click here”).
☐ Color contrast is at least 4.5:1 for normal text.
☐ Color is not the only way meaning is shown.
☐ The built-in Accessibility Checker shows no errors (Review > Check Accessibility).
☐ For PDFs: exported with File > Save As > PDF with structure tags checked. Not Print > PDF.
☐ For PDFs: Acrobat accessibility checker shows no errors. Reading order reviewed.
☐ Videos are captioned.
☐ Audio has a transcript. 

What automated checkers miss 

Automated tools are helpful, but they cannot catch everything. They will not tell you if alt text is accurate, if headings describe the content below them, if link text makes sense on its own or if reading order is logical. Always pair the checker with a quick read-through. 

A good test: If I could not see this document, could I still understand it? 

• Microsoft: Make Your Word Documents Accessible 
• Adobe: Creating Accessible PDFs 
• Microsoft: Make Your PowerPoint Presentations Accessible 
• Section508.gov: Document Training Videos 
• WebAIM: Word Accessibility 
• WebAIM: PDF Accessibility 
• WCAG in Plain English 
• W3C: Introduction to Web Accessibility 

If you have questions, reach out to Marketing & Communications or submit a project request at nebraskamed.com/support-request.