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Perhaps the most significant conclusion we can make from these survey results is that there is no typical screen reader user. As developers, we sometimes view screen reader accessibility as JAWS or Window Eyes or VoiceOver (or whatever) compatibility. This survey emphasizes that screen reader accessibility is about real people - and people that have diverse abilities and preferences. As developers, we must do our best to accommodate the needs of this diverse group.
Survey link [webaim.org]
It is clear that providing a heading structure is important to screen reader users with 76% always or often navigating by headings when they are available.which is one of the reasons i typically use the w3c Semantic Data Extractor [webmasterworld.com] to analyze pages i am working on.
As developers, we must do our best to accommodate the needs of this diverse group.
If the client is willing to pay for it. I am a big fan accessibility, and have worked hard to learn the endless choices and options. However, I have moved away from giving it away (unless my own project). If the client won't pay for the extra they don't get the extra.