The Internet has brought the spirit of global communication and collaboration to nurses and other healthcare professionals in ways never before thought possible. These resources are offered to expand your opportunities for discussion, reference, education and research.

I have a colleague who was telling me of a student with dyslexia who was enrolled in a Web-based class. This student, already a professional, had developed several mechanisms to cope with performing on the job, did it extremely well, and was continuing academic education for an advanced degree. Taking a Web-based course was a matter of scheduling and convenience, but the amount of reading required caused some concern. Having printed materials recorded was one option, but the sheer volume of material made that impractical.

Making Internet-based materials available to the widest number of individuals is a key feature of user-friendly sites, but accessibility and user-friendliness are not necessarily synonymous. "In 1998, Congress amended the Rehabilitation Act to require Federal agencies to make their electronic and information technology accessible to people with disabilities" (http://www.section508.gov). This section of the Act describes in detail those measures that federal agencies are required to meet for software applications, Web-based applications, telecommunications, and more.

Although most Web-based courses do not fall under Section 508 guidelines, all sites can benefit from the application of usability principles. Jakob Nielsen's Web site at http://www.useit.com has long been regarded as the reference resource on usability issues. Most of the material is now fee based, but his "Alertbox" e-mail newsletter is still free and is published every 2 weeks.

The National Cancer Institute was the original agency that developed Usability.gov (http://www.usability.gov). It's now managed by the Web Communications Division in the US Department of Health and Human Services' Office of the Assistant Secretary for Public Affairs, and according to the Web site, "Usability.gov is the primary government source for information on usability and user-centered design. It provides guidance and tools on how to make Web sites and other communication systems more usable and useful." What distinguishes this site is the use of research-based guidelines and assessment of the relative strength of each recommendation based on available evidence.

For those concerned about extensive reading assignments in courses, there are several text-to-speech applications readily available on the Internet, many with a free version. Natural Reader (http://www.naturalreaders.com/) reads text that has been copied and pasted into the program. Although the voice is rather mechanical (but far better than computer speech several years ago), the pronunciation is generally quite good. It does occasionally try to pronounce abbreviations as words, but this doesn't happen often enough to make the program unpleasant to use. One special feature of this application is the ability to save the converted speech as an MP3 file that can be copied to a CD or MP3 player.

ReadPlease (http://www.readplease.com) is another text-to-speech application that is available in a free "light" version and as a fee-based version. Buying the commercial version of these software packages gets you more "natural" sounding voices and some additional features. For the occasional user, the free version should work well.

My colleague's student tried screen readers and reported they worked pretty well, especially if the computer "read aloud" while the student followed along in the reading. In addition, the instructor created narrated PowerPoint files for the class Web site. The combination of visual and auditory approaches seemed to reinforce the materials.

If you have clients with special needs that might be met with these text-to-speech applications, why not give them a try? Free versions are readily available, and your Internet tools may find a wider audience.

William Perry, MA, RN