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Auditing and redesigning Midi Health’s website and services for users using assistive technologies.


Timeline: 6 Weeks

Roles: UX Researcher, Accessibility Auditer, Product Designer

Overview: Midi Health and Treatment for Menopausal Women


Midi Health is a telehealth platform designed specifically for women navigating menopause, providing personalized care through virtual consultations and tailored treatment plans. The platform combines evidence-based therapies with a user-friendly interface, offering services such as hormone therapy, lifestyle coaching, and mental health support. 

I was a fall design intern for MIDI health on a variety of projects, specifically for external and internal branding redesigns (marketing collateral and slide decks), and quality assurance on a new website that they launched!

Recently, their design and development teams have been working on migrating their site hosting, alongside some major design changes. While the design team does use design best practices that include accessibility, “they have not tested with screen readers or assistive technologies, since our main product concerns are prioritizing breadth over a depth of specific demographics. We only test with general users, and haven’t yet run accessibility tests with our website or product.” I found this to be an expected response, especially as a young startup with a small design and research team. In this case study, however, I will dive into the underserved populations we may be able to assist with an accessibility audit and improved experience.

Persona: Menopausal women + visual impairments + assistive technologies


I considered the subsets of menopausal women, especially those who may have overlooked conditions or disabilities. Through my research, I found that women aged 45-60 and in menopause have a higher prevalence of visual impairments, especially conditions like age-related macular degeneration (AMD), diabetic retinopathy, or cataracts. They might begin to experience the progression of visual impairments, which can compound challenges like dealing with the physical symptoms of menopause (e.g., hot flashes, sleep disruptions) while also managing declining vision. Overall, aging can lead to the cumulative impact of physical and cognitive changes, making it more difficult to use traditional healthcare tools without assistive technologies — for example…

Take Susan, for instance. Susan is a 55-year-old woman experiencing the challenges of aging, including worsening vision from AMD (age-related macular degeneration) and changes due to menopause. She’s retired and wants to stay active but struggles with managing her health due to difficulty reading fine print and navigating traditional healthcare tools.

Midi Health’s current design practices deprioritize accessibility testing, which impacts approximately 25% of women exactly like Susan in this demographic who experience vision loss. By focusing on "breadth over depth," the platform excludes a significant group of users.

Methodology and Testing


Therefore, it is imperative to provide equity to the many women like Susan who may feel like their needs are not met, and may even turn users away from the Midi service completely. For the betterment of the Midi patients and the company, it's important to consider:

“How might we improve the accessibility of the Midi website and services for those that need to use assistive technologies?”

4.0: Low-Fi Mockups


Through my ideation while keeping Duolingo's approach in mind, I opted to build a camera tool for Chinese learners to capture familiar artifacts from the world around them — if heritage speakers are having trouble with reading media that’s interesting to them, why not save and practice those phrases in particular? This significantly expands the vocabulary that Duolingo users practice when using the app, and ensures that they’re truly relevant and words of interest for the user.

  1. Upon navigating to the camera icon in the navigation bar, users are prompted by Duo to begin “capturing snapshots” with their phone camera.

  1. Users can change between languages they’re currently learning.

  1. From there, recognized phrases and words will be highlighted, where users can select and confirm the phrase of interest.

  1. They are then taken to the phrase’s definition page, where the pronunciation, definition, and example phrases are provided.

  1. Inside the Practice Hub, “Snapshots” are now an additional collection and a type of daily review.

  1. The Snapshots collection displays all the previously collected phrases alongside their respective pictures.


Thus, I conducted a comprehensive accessibility audit, going through multiple simulated run throughs of the website and service with the following methods:

  1. Individual Technology Testing: I systematically tested the website/app using assistive technologies such as screen readers (e.g., NVDA, VoiceOver), keyboard navigation, black-and-white color filters, and screen zoom. These tools were used individually to assess specific aspects of accessibility, such as perceivability, operability, and readability for users with diverse needs.

  2. Compounded Technology Testing: I tested scenarios where users might rely on multiple assistive technologies simultaneously (e.g., navigating via keyboard while using a screen reader or adjusting the display with screen zoom and color filters). This step helped identify compounded challenges and ensure the design supports seamless functionality across layered accessibility needs.

  3. Assessing Common WCAG + Assistive Tech Pitfalls: I assessed common WCAG compliance and assistive technology pitfalls to identify and address barriers to accessibility. I reviewed all links to ensure they used clear, descriptive anchor text instead of vague phrases like "click here," making them more meaningful for screen reader users. I also audited alternative text for images, icons, and non-text content to ensure it accurately conveyed purpose and context. Additionally, I evaluated visually-led content to confirm it was understandable without relying solely on visual cues. This comprehensive review helped enhance accessibility and inclusivity across the platform.

Audit Results & Report


After conducting a thorough accessibility audit, I found the platform to be highly successful in its usability with assistive technologies and without. Midi is already doing an excellent job in ensuring accessibility and meeting many essential criteria — the changes and improvements I am suggesting address minor violations and opportunities for enhancement, which would elevate the platform to AAA-level compliance, solidifying its commitment to accessibility.

Midi's branding is inherently accessible and friendly for all users, and its design systems are completely compliant with all WCAG visual guidelines on sizing, colors, and contrast. Most, if not all of the interactions patterns are easily navigable both with and without assistive technologies — I had very little trouble navigating though the website using each, and multiple, of the technologies.

However, it is still worth observing and making small changes to continue pushing the site's accessibility towards near perfect. The following report outlines three violations and redesigns to address these violations.

5.0: Meet Duolingo Snapshots!


Introducing the interactive prototype of Duolingo Snapshots! With Snapshots, Super Duolingo users are able to capture any written media around them to save and practice, aiding their learning with relevant, real-world vocabulary. With the help of Duo and the rest of the cast, users can bring their environment right to the Duolingo app for more immersive learning.

Next Steps


Of course, much of the usability testing I conducted was a mock or simulated run though — there are may be gaps in my replication of what the persona's experience might be like when navigating through the site. Therefore, the next step in this process is conducting usability testing with real menopausal women using assistive technologies. This testing will provide valuable insights into how users navigate the platform, interact with its features, and overcome any potential barriers!

The primary goals of this research would be to evaluate the accessibility of Midi Health for women with varying degrees of visual impairment and to identify the challenges they face when interacting with core features such as onboarding, scheduling, and video consultations. A key focus is determining whether the platform effectively accommodates the aforementioned assistive technologies. We want to assess whether the presentation of content, including graphs and charts, is accessible without alternative formats like audio descriptions or text-to-speech.

Research would use task-based usability testing to evaluate how well the Midi platform supports women with visual impairments. The main focus would be on accessibility features, such as screen reader compatibility, keyboard navigation, voice commands, and alternative text formats. Testing will be conducted remotely or in-person with screen reader and other assistive technology users.

Desired Participants:

  1. Participants must be 45-60 years old.

  2. Participants must have visual impairments (moderate low vision to blindness). Conditions like macular degeneration, diabetic retinopathy, or glaucoma.

  3. Participants should be in the perimenopausal or postmenopausal stage.

  4. Participants must be comfortable using telehealth platforms and basic assistive technologies, such as screen readers or voice input.

Tasks:

  • Task 1: Conduct onboarding and successfully create an account. Observe how easily the participant can use a screen reader or keyboard navigation to sign up for the platform.

  • Task 2: Schedule an appointment with a healthcare provider. Observe how they interact with the appointment system using voice commands or assistive technologies.

  • Task 3: Access educational resources on menopause (article or video). Evaluate how accessible these resources are when read aloud by screen readers or accessed via text-to-speech.

  • Task 4: Start a video consultation with a healthcare provider. Observe any difficulties with joining the call, accessing the video interface, or interacting with visual elements during the call.


Learnings & Takeaways


Working with Midi Health, a company that already has a strong design system and a solid foundation in best practices, highlighted an important aspect of accessibility work: the scope of impact may feel smaller when auditing a well-established product. However, even small refinements—like ensuring compliance with AAA standards—can make a meaningful difference in creating a more inclusive experience for users who rely on assistive technologies.

A particularly valuable part of this process was learning to use assistive technologies myself. Getting over the initial learning hurdle and engaging firsthand with tools like screen readers gave me a much deeper understanding of how they function and the unique interaction patterns they require. It was eye-opening to see how different the interaction experience is for someone relying on these tools compared to those who don’t, and it reinforced the importance of designing with empathy and inclusivity in mind.

I’ll be sharing this report with the Midi design team, who have been open and receptive to feedback throughout this process. Their commitment to continuous improvement gives me hope that these recommendations will inform future iterations of the platform, further enhancing its accessibility and ensuring a better experience for the women they serve!