Foundational principles to help make electronic documents accessible

How to ensure your written electronic content is accessible for all users

The purpose of this guidance is to serve as a resource for the Executive Branch of the Commonwealth in its ongoing effort to ensure that its written electronic content is accessible for all users. Federal and state laws outline general requirements of nondiscrimination to uphold equal access and opportunity for people with disabilities.

One way to uphold principles of equal access and opportunity is to follow general effective communication requirements. The goal of effective communication is to ensure that people with vision, hearing, or speech disabilities can communicate, receive, and convey information in a manner that is accessible to them. Understanding basic principles of accessibility helps agencies create electronic documents that meet effective communication requirements and are accessible to users with and without disabilities.

The Massachusetts Office on Disability (MOD) intends to provide Massachusetts state agencies with a basic understanding of the accessibility principles to keep in mind when creating content, why they are necessary, and where to access specific instructions on how to create accessible documents. While there are several document-creation tools available, the resources and tips in this memo will be geared toward Microsoft Word 365. This guidance is not intended to be completely exhaustive, but rather meant to provide a general overview and framework for creating accessible materials.

If you have questions or need further clarification after reading this guidance, please call MOD at 617-727-7440. Digital accessibility consulting services are available for Executive Branch agencies only.

Table of Contents

What are accessible documents and why are they important?

An accessible document has been designed, structured, and written in a way that allows people with disabilities to use it effectively. Creating an accessible document ensures that the information you are trying to convey is received and understood by all audiences. People with disabilities might use assistive technology(s), hardware devices, or programs (such as magnification and screen reading software), to help them access information in a digital document. If a document is accessible, individuals utilizing assistive technology should be able to access content in an effective way. If a document has not been designed with accessibility in mind, people with disabilities may be prevented from reading content or might not be able to access the information as readily as a person without a disability. This may violate federal and state antidiscrimination laws.

Tip: Check the accessibility of your Microsoft Office documents (Word, PowerPoint, Excel) using Microsoft’s built-in Accessibility Checker. This feature can be enabled while you work (recommended) or after the document has been created. The Accessibility Checker lists basic errors and warnings, providing authors with an overview of components that would impact the accessibility of the document and tips for mitigation. However, if the Accessibility Checker does not flag any errors or warnings, this is not an indication that your document is fully accessible. Authors should still follow the basic principles of accessibility that are outlined in this document to ensure that their materials can be equally accessed by people who use assistive technologies.

Document structure

For the purpose of this guidance, “document structure” is the organization of a document, including headings, tables, lists, columns, and links. These elements can be interpreted by assistive technology, allowing users to understand the relationship and hierarchy of the content and encourage accurate navigation. Screen readers, for example, render text and image content as speech or braille output and appropriate structure is essential for optimizing document accessibility.

Heading structure

Headings allow for a clear structural outline of a document. Typically, sighted readers can easily distinguish headings based on placement of text, size/boldness of font, or other visual indicators. This allows readers to quickly scan a document to gain an overview and efficiently decide which sections may be of interest to read. For example, in a newspaper, the title of each article would be classified as a heading.

Documents with a proper heading structure allow assistive technology users to view and access a list of all the headings in the document, gain an understanding of the relationship of the content presented, and jump by headings to quickly navigate the content. Assistive technology cannot infer meaning from visual formatting alone. This includes large, bold, or underlined text. Therefore, it is important to ensure that heading tags are created in a way that assistive technology can interpret. In order to provide the same level of easy navigation and understanding for assistive technology users, take steps to embed heading tags into the document in the right way to ensure the structure is built appropriately. This can easily be done by using the “styles” section and is explained in detail below.

Headings should:

  • Accurately and succinctly describe a section of content
  • Be created by selecting the “home” tab in the ribbon and then navigating to the “style” section
  • Be nested appropriately

To properly tag items as headings, highlight the desired text, select the “home” tab in the ribbon, then navigate to the “styles” section (keyboard shortcut: alt+h, l). Here you will be able to select the appropriate heading level.

Identify the main heading for the document and categorize it as a “Heading 1.” Generally, there should be only one Heading 1 per document. Use “Heading 2” to classify next level headings, “Heading 3” to classify third-level headings, and so on. It is important to select the correct subheading level and keep the nesting order in mind. For example, do not select “Heading 4” if it is not going to be a child of “Heading 3.” Heading levels are very important for accessibility because they signify a parent-child relationship between a heading and the associated content, allowing screen reader users to “skim” through headings with their keyboard the way a sighted person may do visually.

To change the format of the headings in your document, right-click (application key) on the desired heading style and select "modify." If you have already formatted the text in your document, highlight the new text that you want to tag as a heading, navigate to the “styles” section, and right click on the desired heading level. Then, select “update style to match selection.” This action will update all headings of the same level in your document.

As you build out your heading structure you can view the list of headings in a document by selecting the “view” tab in the ribbon, navigating to the “show” section, and enabling the “navigation pane” option (alt+w, k).

Author tip:

  • Consider adding a table of contents if your document is lengthy (8 or more pages) using the heading structure you created. Do this by selecting the “references” tab in the ribbon and navigating to the “table of contents” section (alt+s, t). Then, select the “table of contents” menu. Note: use the “update table” option found in the “table of contents” section (alt+s, u) to update the table of contents as headings and page numbers change in the document.


Tables can be an effective way to present structured data in a document. Typically, sighted readers can reference column and row headers to understand the relationship of the content in each table cell. A column header is the row at the top of the table that identifies each column within the table. A row header is the column at the left of the table that identifies each row within the table. Consider that column/row headers serve as a label that helps to identify the content in each cell. Not every table will include column and row headers. For example, a calendar would only include column headers to signify the days of the week, but there is no need for row headers. The proper use of column/row headers allow sighted readers to easily review a table and make sense of the information presented.

Assistive technology users can access and understand the relationship of data in a properly formatted table. If created correctly, most assistive technologies alert the user about how many columns and rows are present as well as whether the table is uniform. Additionally, assistive technology users will be able to retrieve column and row header information, which allows a user to understand the relationship of the information contained in each cell of the table. Necessary properties of a table include identifying column/row headers, setting column headers to repeat on each page, preventing rows from breaking across pages, providing a caption, and providing alternative text.

An accessible table should be uniform and should not contain merged or split cells. A merged cell is the result of two or more cells in a row or column getting combined into one big cell. Conversely, a split cell occurs when one cell is divided into smaller cells.

Most screen readers have the capability to retrieve column and row header information. However, merged or split cells may interfere with this functionality and cause the screen reader to relay the incorrect associated header. Similarly, it is important to avoid blank cells, columns, rows, and nested tables. This is because blank sections and nesting have the potential to cause confusion and relay inaccurate information when a screen reader navigates a table vertically or horizontally. Some screen readers may not indicate to the user that a cell is blank. If there is a situation where it feels appropriate to leave a cell blank, mark the cell with “no data” or “N/A.”

Tables should:

  • Only be used to convey relationships between data
  • Be created using the “insert table” option, not “draw table”
  • Have identified column/row headers (column headers should repeat at the top of each page)
  • Include captions
  • Include alternative text
  • Not contain merged/split cells, or nested tables
  • Not contain blank cells, blank columns, or blank rows
  • Not have table rows that break across pages
  • Not be used purely for layout purposes

How to create an accessible table:

  1. Insert the table appropriately:
    1. Select the “insert” tab in the ribbon and navigate to the “tables” section.
    2. Choose the “table” menu (alt+ n, t).
    3. Choose the appropriate number of columns and rows needed. If your table will include column/row headers, be sure to account for this. If the table has column headers, be sure that this information is contained in the first row of the table. Never use the “draw table” option because this will result in an inaccessible table.
  2. Set the properties of your table:
    1. To access a table’s settings, insert your cursor anywhere in the table. This will enable the “table tools” to open in the ribbon, which include a “design” and “layout” tab (alt+j,t and alt+j,l). From here, you will be able to customize settings.
  3. Set the properties for column/row headers:
    1. Select the “table design” tab and navigate to the “table styles options” section. If your table includes column headers, enable the “header row” option. Column header information should be contained in the first row of the table.
    2. If your table includes row headers, enable the “first column” option. Be aware, these settings might be enabled by default. Ensure these options are not enabled if the table does not contain column/row headers.
    3. If your table includes column headers, it is important to make sure that the column header row is set to repeat at the top of each page. To have the column headers repeat at the top of each page, place your blinking cursor anywhere in the first row that contains the column headers. Right click, then select “table properties.” In the “table properties” dialog box, select the “row” tab and check the box “repeat as header row on top of each page.”
  4. Prevent the table rows from breaking across pages:
    1. First, highlight the entire table. In the “table tools” menu, select the “layout” tab, navigate to the “table” section, choose the “select” menu group, then choose the “select table” option (alt+j,l,k,t).
    2. Once the table is highlighted, right click on the table and select “table properties.” In the table properties dialog box, select the “row” tab and uncheck “allow row to break across pages.”
  5. Include a caption, ideally located above the table:
    1. An accurate and concise caption should include the title and can be further used to provide any user with a high-level summary of the content contained within the table (generally recommended for complex tables). Table captions are particularly helpful for readers with cognitive disabilities.
    2. Include a caption by first highlighting the table following the instructions above. Once the table is highlighted, right click on the table and select “insert caption.” Type your caption in the “caption” edit field. Ensure that the “label” option is set to “table” and that the “position” option is set to “above.”
  6. Include alternative text:
    1. When used correctly, alt-text can provide assistive technology users with a summary of table contents, including structure and layout.
    2. The alt-text should first specify the title of the table, then it should include a brief description of the information contained in the table. For example, the alt-text for a table titled "Boston Rental Properties" might include the following: “Boston rental properties. Column one includes property name and address. Other columns show the number and types of rooms available.” This helps assistive technology users easily choose which table to navigate to after pulling up a list of all tables in the document.
    3. To include alt-text, right click in the table and select “table properties.” In the “table properties” dialog box, select the “alternative-text” tab. Write the alternative-text in the description field. It is not necessary to use the title field.

Note: It is important to remember that a table should only be inserted when it is necessary to convey relationships between pieces of data. Do not insert a table for layout purposes alone.

Author tips:

  • Microsoft Word does not provide assistive technology with the best support for navigating and reading complex tables. Complex tables are best reserved for alternate file formats such as HTML or PDF.
  • Authors should use table borders to differentiate information and keep it organized. This will aid low vision users with navigating/reading a table.


Lists can be a helpful formatting tool to organize and group information in a document. Usually, sighted readers can understand the hierarchy and relationship between list elements at a glance, which then allows them to quickly digest and compartmentalize the provided information. Specifically for people with learning or cognitive disabilities, lists can significantly increase comprehension because of the blank space separating smaller sections of text.

Assistive technology users also benefit from lists. It is important to create lists in the right way to allow assistive technology users to navigate throughout the document by jumping from list to list, navigate between list items, and understand how a group of items are related. To ensure accessibility, your list should be inserted correctly.

There are three types of lists that might be helpful for organizing information during the document creation process:

  1. Using bullets to identify a group of items that have no specific order (alt+h, u).
  2. Using numbers to identify a set of items that are meant to be followed in a sequential order (alt+h, n).
  3. Multi-level lists, with nested items to accurately relay hierarchy, order, and the relationship between items (alt+h, m).

It is important to consider what kind of information you are presenting in a list before taking steps to create one. Determine if you need a bulleted, numbered, or multi-level structure based on the type of information that you are conveying.

Lists should:

  • Be bulleted, numbered, or multi-level, depending on the type of information presented
  • Be created in the right way, using the “paragraph” section (alt+h, u)
  • Be nested appropriately, using the “tab” key, once the list format is used
  • Not be made manually by adjusting the margins or using the “tab” function

How to create an accessible list:

  1. Type out the first item in your list, which can be anything from one word to an entire paragraph of text. Then, create a carriage return (i.e., hit “Enter”) and continue to do this for the remainder of list items.
  2. Highlight all the items in the list. Identify the type of list you need, then navigate to the “home” tab, select the “paragraph” section (alt+h, u), and choose the desired list type.
  3. Once the list format is created, use the “tab” key to nest items as needed.

Note: Do not create a list manually by adjusting the margins or using the “tab” function. The “tab” function should only be used to nest items in a list once the list formatting is used.


Columns are a useful choice to organize a text-heavy document. Often, columns are helpful for conveying information in brochures, reports, and other step-by-step instructions. Authors can choose to have this newspaper style layout for the entire document, or just for specific sections depending on the desired look and feel. Regardless, sighted readers can follow the layout of the information, and in turn understand it in the way it is presented: top to bottom and left to right, moving from column to column.

If columns are created appropriately, assistive technology users will be alerted that they are in a new section of the document and will be notified about the number of columns that are present. Also, the information contained in the columns will be relayed in the desired reading order, and the experience will mirror that of a sighted reader.

Columns should:

  • Be limited to three per document
  • Be created by selecting the “layout” tab, navigating to the “page setup” section, and choosing the “columns” menu.
  • Not be created using tab stops or the space bar

To create an accessible column:

  1. Select the “layout” tab in the ribbon, navigate to the “page setup” section, and choose the “columns” menu (alt + p, j).
  2. Then, you will find options that allow you to select the number of columns needed.

It is important to avoid using tab stops or the space bar to create the appearance of columns, as this will cause assistive technology to ignore the intended reading order and relay the information from left margin to right margin.

When selecting a column layout, authors should avoid using more than three consecutive columns for text, especially when using portrait orientation. Using more than three columns may cause screen magnification users to easily get lost when reading across a line, causing their focus to inadvertently move from one column to another. Additionally, readers with learning and cognitive disabilities may find that there is not enough text within a column to understand what they are reading.


Links are used to guide readers to information contained in another section of the document or to an external source, like a website. Links appear as blue underlined text as opposed to standard black font, which allows sighted and color blind readers to scan the document and easily distinguish links from other body copy.

Assistive technology can notify a user that there is a link present when reading the document and will allow users to activate the link if desired. Additionally, assistive technology users can choose to pull up a list of links that are found in the document for easy navigation. To ensure that individuals using assistive technologies can access links, it is important that they have accessible characteristics and are created correctly.

Links should be named in unique and specific ways, and a user should be able to identify the purpose of the link without the need for additional context. This is because assistive technology users can pull up a list of links found in the document for navigation purposes and will be interacting with a list of links out of context. Link text that is as meaningful as possible will help users choose which links to follow from this list.

Ambiguous links (like “click here” or “more information”) do not give the user a clear indication of the purpose of the link and its intended destination. If a screen reader user encounters an ambiguous link, they are forced to read the link in context of the surrounding text for more clarity. This becomes especially confusing if a user is presented with a list of multiple links that are named using the same ambiguous text.

While a link should be named in a unique and specific way, it should also be concise. If linking to an external website, do not use the URL to name the link. Often, URLs contain lengthy, random text strings before and after relevant text. Screen reader users do not have the benefit of visually scanning a URL text string to determine its purpose/destination as easily and efficiently as a sighted reader. Using a URL as a link name forces a screen reader user to listen to random bits of incoherent information to determine the link purpose/destination.

Links should:

  • Have a unique, specific, and concise name in the “text to display” edit field (instead of using the URL)
  • Be created by highlighting the desired text, right clicking, and selecting “link” (ctrl + k)
  • Use the default underlined and color format

To create and embed an accessible link, first highlight the desired text. Then, right click to pull up the context menu, and select “link.” In the “text to display” edit field, include the name of the link that you wish to appear within the document if it is not already present in the “text to display” edit field. Remember: be specific and concise! In the “address” edit field, include the URL.

Screen tip: if you wish to have a URL present in the document, consider creating a more specific link adjacent to it and then include the URL as static (non-linked) text in parenthesis.

After creating the link, do not remove the underline format. Color alone should not be the only way to convey that something is a link, because color blind readers rely on the underlined text to differentiate between regular text and linked text.

Visual presentation and style

There are certain visual and stylistic choices that affect the accessibility of a document. Specifically, font, images, color contrast, and paragraph line spacing are some of the more important elements to keep in mind.

Visual presentation alone isn’t usually enough to ensure accessibility. Typically, there should be a textual or structural alternative that makes the style choice understandable to assistive technology users. It is never a good idea to rely only on visual cues to relay meaning.


Font choice, size, use of italics, underlining, capitalization, and other choices can impact low vision users and severely affect the accessibility of a document. To ensure maximum accessibility:

  • Choose a sans serif font, like Calibri, Ariel, or Verdana. Serif fonts, such as Times New Roman, can be difficult to read for individuals with low vision.
  • Use a minimum of twelve-point font: anything smaller is too hard for people with low vision to see. Fourteen- to eighteen-point font is an appropriate size for large-print documents. Eighteen-point font is preferred.
  • Avoid italics for long sections of text, as it can be challenging for people to read.
  • Avoid underlining words in a document for emphasis, as underlines are expected to denote text that is part of a link.
  • Avoid all caps, as it can be hard to read for some users. Use minimally, if at all.
  • When using abbreviations and acronyms, make sure to include the full text at least once in your document.  


For the purpose of this guidance, images can be defined as non-text content. Typically, images are a visual aid that work alongside written information to increase the overall comprehension of a document. However, some users with disabilities will be unable to see an image and will need an alternative, non-visual way to access the information. The following considerations will help you ensure that "most users” are able to access and understand the images included in a document:

  1. Position the image to be in line with text to allow assistive technology to recognize the image and ensure proper reading order of the content. This may be the default setting, but if not, right click on the image and select the “wrap text” sub-menu. Then, select the “in line with text” option.
    1. Avoid floating images with text wrap. Images should be in line with text. Floating images with text wrap are less accessible to screen readers than images that are in line with the text. In some cases, these images might be completely inaccessible depending on the assistive technology.
  2. Add meaningful alternative text that adequately describes the image: Right click on the image and select the “edit alt text” option. Alt-text provides a description of an image for people who are blind or visually impaired. When used correctly, alt-text clearly communicates the purpose, intent, and meaning of an image in a way that serves as a true alternative for an individual who is unable to perceive it visually.

The description should provide a comprehensive and clear representation of the meaning of the image, so that the user can understand what the image represents and why it is included in the document. To ensure that the alt-text that accompanies an image is doing the intended job of making an image accessible, consider the following tips:

  • Make alt-text brief and concise. Do not describe everything about the image in excruciating detail. The goal is not to over provide information, but rather to describe what the image is conveying. Alt-text should give a user the right information to understand the purpose of the image and the reason it is included in the document.
  • Ensure alt text is accurate and meaningful. It is critical that the text chosen to describe an image accurately reflects the nature of the image, and that it is relevant.
  • Do not use the phrases "image of ..." or "graphic of ..." to describe the image. It is usually apparent to an assistive technology user that the item they are interacting with is an image. If the image is of a painting or illustration, it might be a good decision to include this distinction in the alt-text.
  • Avoid including duplicative information in alt-text. If you have already included certain information in the body of the document relatively near the image, there is no need to include that same information in the alt-text. Simply reference that the information is included in the text of the document while providing a summary of the image content.
  • If you add a very complex image, such as a graph or chart, it may not be possible to describe the visual aid in a few words. If that is the case, it may make sense to repeat the information from the image in the page text that follows the image. Everyone who reads the document can then focus on the important information found in the image, including assistive technology users.
  • Add a caption to the image. Alt-text is only valuable to a person using a screen reader. On the other hand, captions are useful for all users. Even if the document is printed, captions will still be there to give some additional insight about the image. Consider using captions whenever there is an image in the document. Place the caption below the image whenever possible. To include a caption, right click on the image and select the “insert caption” option.

Author tips:

  • Avoid text boxes. They are inaccessible to assistive technology.
  • Don't insert a watermark. A watermark is an image or text that appears behind the main text of the document. It is usually a lighter shade than the text. Text watermarks are often used to show the purpose of a document with words such as “DRAFT.” Watermarks are not read by assistive technologies and can be visually distracting if text is placed in front of it.

Color contrast

Document authors should be mindful when choosing and using colors to enhance the visual presentation of a document. To be considered accessible, the contrast between font (foreground) and background colors should be sufficient for your readers to distinguish the text on the page. Failure to provide sufficient contrast may cause difficulty for readers who are low vision or color blind, as the content may appear to be blended together. Consider the following to ensure accessibility:

  • Avoid using variant shades of the same color (e.g., light blue and dark blue) as foreground and background colors, since the contrast between the two may not be sufficient.
  • Foreground and background colors should have a minimum of a 4.5:1 color ratio, with 7:1 ratio being preferred. Font larger than 18-point can have a 3:1 color ratio, but it is not encouraged.
  • Avoid using color as the only method of conveying meaning. Color blind readers and screen reader users may not be aware of the change in color throughout the document. Use an additional method of conveying information without the reliance on color alone.
    • Example: In a document, there is a list of terms for review that are color coded using red, yellow, and green. Red signifies terms to avoid, yellow denotes terms to use with caution, and green is an indicator that it is always appropriate to use the terms. The information conveyed using this method alone is not sufficient for readers who are color blind or utilizing assistive technologies for several reasons. A color blind user might not be able to distinguish one color from another, assistive technology might not notify the user of the color change, and some users may utilize a different color scheme that inverts colors, making it impossible to ascertain the intended meaning of the color-coded list.
  • Solution to ensure accessibility: Using the example above, authors could choose to create either three separate lists or one big list with three top level items e.g., “terms to avoid”, “terms to use with caution”, and “terms to always use”. The terms for each category can be listed below the top level (parent) items as sub-level listed items. Please refer to the topic on creating appropriate lists found elsewhere in this document.

Author tips:

Paragraph line spacing

For many users who have cognitive or learning disabilities, a well-structured document will help with visual processing and overall comprehension of the content. There are some choices related to paragraph line spacing that will either increase or decrease accessibility.

Many document authors may choose to distinguish specific sections of a document by increasing the white space between text. Often this is used to visually separate specific sections or paragraphs within a document. Document authors should use Microsoft Word’s line spacing options to achieve this desired look and feel rather than creating white space using carriage returns (blank lines). Creating white space using carriage returns might impact the accessibility of the document. When a screen reader user encounters a carriage return, this is generally indicated to the reader as “blank.” Several contiguous blank lines in a document creates extra verbiage, which in turn distracts a user from the content and can be overwhelming to listen to. Additionally, a user might think that they have reached the end of the document.

Similarly, avoid right justification when it comes to paragraph spacing and formatting blocks of text. Right justification stretches out the text and can cause distracting rivers of white space throughout the document. Individuals with reading or cognitive disabilities might have difficulty reading the material due to the distracting layout.

Additional accessibility principles

  • Make sure to include a title and subject for each document. The title of the document should relay the main point of the content and can be similar to the file name. Including a title is especially important when converting a document to an alternative file format, such as a PDF, as this information will be read out first to assistive technology users. A subject allows users to have a bit of information about the document without needing to open it. Assistive technology users may find this information helpful, limiting the necessity of opening a document in order to determine if it's the one they're looking for. The subject should convey the intended scope of the document. Navigate to the “file” tab in the ribbon, select “info”, then select “properties”, then select “advanced properties” (alt+f, i, q, s).
  • Include header and footer information. If you have information in a header or footer, duplicate the vital information at least once in the body of the main document (e.g., “confidential”, “draft use only”, etc.)
  • Identify distinct foreign languages if applicable. Doing this will help to ensure that speech output converts to the appropriate foreign language. To do this, highlight the desired text, select “review” tab in the ribbon, navigate to the “language” section and select the “language” option (alt+r,u).


Ultimately, document creators should have a goal of ensuring that content is accessible to a wide range of audiences. If you follow the principles outlined in this document, you will be on your way to achieving that goal.

Prior to posting, distributing, or converting your document to an alternative format, authors should run the accessibility checker to double check that the document is free of errors and warnings. Taking the time to build structural elements into a native Word document helps to ensure that these properties remain when converting to an alternative format (e.g., PDF). Authors should view the following Microsoft support article when Creating Accessible PDFs. Although your hard work to create a Word document that is structurally and stylistically accessible will pay off, it might be necessary to mitigate any errors that arise after conversion in a PDF editing program like Adobe Pro D.C. As technology, software, and accessibility standards continue to evolve, we encourage you to conduct your own supplemental research by exploring the following resources:

Additional Resources

MOD’s contact information

Phone: 617-727-7440


Address: Massachusetts Office on Disability, One Ashburton Place, Room 1305, Boston, MA 02108

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