Accessibility and responsive bits

This journal entry represents a mammoth effort to add high-quality content to the site.

  1. I developed and added the patient story. This was based on a characteristics list which I worked through rather vigorously on the afternoon of the 25th. This is still in handwritten form, so I will link to it as a google doc later on. I have included some key references for that process below. I want to highlight the National Joint Registry (2016) data, which was particularly helpful during the process of defining the patient story. Also the specific images that I used will be cited on the portfolio site (including cc0 works; royalty-free works) as I feel it is always very important to include the provenance of images in any context, but especially when engaging in a thought process based on a fictional patient/nurse interaction.

  2. I added images to support the patient story. These images were sourced from pixabay and one of my all-time faves, Creative Commons search as a means to filter Flickr images by license (

  3. I recreated the images that I found for the patient story as drawings in Adobe Illustrator. I wanted the images in the timeline to be small (100px x 100px); this is a limited amount of ‘bandwidth’ to communicate a visual concept. For this reason I decided to use Adobe Illustrator to trace the images and then re-paint them, so that I could accentuate certain aspects through the use of selective colour. This worked well and I did investigate whether these images could be included as svgs, but the visual information was too complex as they were based on photographic materials. As a result I stuck with .png format as the final output.

    svg version of image - less visual information
    ] .svg version of a timeline image - quite a bit of artifacting (tech-speak for mess) in the image render and it looks too sketchy
    screenshot of the png version image
    .png version of the same image in Adobe Illustrator - more of the visual information from the original photograph is retained. This version has the right level of abstraction.

  4. All of the images were optimised using Honestly, I absolutely love this tool and will be using this from now on for all my images. Their algorithm somehow trims off the excess while keeping the core visual information.

  5. Accessibility. I ran an accessibility analysis on the site using the WAVE Web Accessibility Tool ( It is pretty good, I still have a few aria, alt and title tags to include here or there but I have made progress in this area.

  6. Infuriating. As someone who uses Reader View (I found out that this is the official name for it) mode in Firefox and the equivalent in Safari, I was very frustrated by the restrictive and arbitrary local style sheet implemented by this mode. I have spent way too much time customising how the site looks in this context, but it really mattered to me as this would really put me off a site. Also, focusing on it has highlighted the importance of the semantic web; the reader mode taps into the and other html5 element definitions. With a bit of hardcore tweaking, I finally have something that I can stand behind. The tweaking is outlined in this development post, however I found out by digging into the reader displays in the respective browser stylesheets that they will ignore certain css classes. Specifically I needed to implement a class called .hidden which is the container for the flickity carousel dots. The ‘dots’ are completely useless in the reader view and just look like an orphaned ordered list. I also instituted a .sr-only class which is applied to loading GIFs and other elements which should not be shown in the reader mode. All of this digging will serve me well for the print stylesheet, no doubt…

  7. I ran the Google mobile accessibility test on the site - It passed! Here is the proof: There is still a lot of content to add, but it is great to know that I am on the right track.


BBC (2013, January 16). Going paperless “would save NHS billions.” BBC Health. Retrieved from

BBC (2016, September 7). NHS: Health apps to inform patient records. BBC Health. Retrieved from

Booth, R. (2016, December 13). The doctor on your Xbox? The NHS needs more digital ambition. The Guardian. Retrieved from

BS EN ISO 13485:2016 Medical devices. Quality management systems. Requirements for regulatory purposes. (2016). Retrieved 22 December 2016, from https://bsol-bsigroup-com/Bibliographic/BibliographicInfoData/000000000030339592

BS ISO 13606-2:2008 Health informatics. Electronic health record communication. Archetype interchange specification. (2008). Retrieved 22 December 2016, from https://bsol-bsigroup-com/Bibliographic/BibliographicInfoData/000000000030170710

Choices, N. (2016, November 1). Health and fitness trackers. Retrieved January 2, 2017, from

Dolatabadi, E., Babak, T., & Alex, M. (2014). Vision-based approach for long-term mobility monitoring: Single case study following total hip replacement. Journal of Rehabilitation Research and Development, 51(7), 1165–76.

Farmer, A. Wearables sector grows as smartwatches increase in popularity. Retrieved January 2, 2017, from

Heartfield, R., Loukas, G., & Gan, D. (2016). You are probably not the weakest link: Towards practical prediction of susceptibility to semantic social engineering attacks. IEEE Access, 4, 6910–6928. doi:10.1109/access.2016.2616285

Institute for Quality and Efficiency in Health Care (2014). What can help relieve anxiety before surgery? - PubMed health - national library of medicine - PubMed health. Retrieved from

Johansson Stark, Å., Charalambous, A., Istomina, N., Salanterä, S., Sigurdardottir, A. K., Sourtzi, P., … Bachrach-Lindström, M. (2016). The quality of recovery on discharge from hospital, a comparison between patients undergoing hip and knee replacement - a European study. Journal of Clinical Nursing, 25(17-18), 2489–2501. doi:10.1111/jocn.13278

Nasr, N., & Enderby, P. (2014). Redefinition of life experience following total hip replacement: Analysis of narrative as performance. International Journal of Orthopaedic and Trauma Nursing, 18(2), 89–98. doi:10.1016/j.ijotn.2013.07.005

National Information Board. (2015, March 4). National information board’s workstreams. Retrieved January 2, 2017, from

National Joint Registry. (2016). 13th Annual Report 2016 National Joint Registry for England, Wales, Northern Ireland and the Isle of Man Surgical data to 31 December 2015. Retrieved from

NHS Choices. (2015, November 3). Health Apps library - NHS choices. Retrieved January 2, 2017, from

Press Association (2016, September 7). NHS to have one website for appointments, prescriptions and advice. The Guardian. Retrieved from

Pulkkinen, M., Junttila, K., & Lindwall, L. (2015). The perioperative dialogue - a model of caring for the patient undergoing a hip or a knee replacement surgery under spinal anaesthesia. Scandinavian Journal of Caring Sciences, 30(1), 145–153. doi:10.1111/scs.12233

Rudolfsson, G. (2013). Being altered by the unexpected: Understanding the perioperative patient’s experience: A case study. International Journal of Nursing Practice, 20(4), 433–437. doi:10.1111/ijn.12195

Wilson, D. (2016). An overview of the application of Wearable technology to nursing practice. Nursing Forum. doi:10.1111/nuf.12177

Wilson, C. J., Mitchelson, A. J., Tzeng, T. H., El-Othmani, M. M., Saleh, J., Vasdev, S., … Saleh, K. J. (2015). Caring for the surgically anxious patient: A review of the interventions and a guide to optimizing surgical outcomes. The American Journal of Surgery, 212(1), 151–159. doi:10.1016/j.amjsurg.2015.03.023

Image source: “Calendar days of the week” by 422737 is licensed under CC0 1.0

Fiona MacNeill
Fiona MacNeill
Learning Consultant &
UX Researcher

Passionate about creating inclusive and accessible experiences, tools, and services for learning and doing.