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The use of gender neutral language in the CervicalCheck public information and education resources

In advance of its introduction of HPV cervical screening in March 2020, the National Screening Service (NSS) embarked on a series of tests to make sure that the language used by CervicalCheck was accessible and inclusive of everyone in the population.

Population screening programmes are publicly-funded services that are available for defined groups of the population, such as by age or gender. It is important that all those who are eligible for screening have an opportunity to take up the offer. We know that certain groups – such as those in poor social circumstances, those with disabilities, members of the Traveller community, members of the LGBT community - can feel excluded from using health services for many reasons.

In screening we know that lower participation in the programmes reduces the quality of the programme, so it is very important to offer services that meet the needs of the people who are eligible. The NSS is committed to reducing health inequalities, and the measures needed to achieve this, including health promotion activities in key populations where uptake is low; having communications materials translated into languages other than English; and using inclusive and accessible language in our communications materials.

The NSS reviewed its language in web content, invitation letters, results letters and information leaflets during the winter of 2019/20.

The marketing communications company, Core Research, was engaged to conduct qualitative research to explore women's knowledge and attitudes regarding cervical cancer, and all aspects of cervical screening in Ireland.

The groups examined communication materials, and explored the fears and issues around cervical screening, and identified what might reassure and restore trust in the screening service. The insights from this research were used to inform the communications strategy, channels, messages, and tone of CervicalCheck’s communication materials.

Core Research tested sample material among 27 women, comprising healthcare professionals (smear takers, practise nurses and GPs), representatives from the NSS’s Public Patient Participation panel; and nominees from the Irish Cancer Society, the Marie Keating Foundation and the 221+ Group.

A breakdown of the 27 women by gender, age and county of residence can be viewed by clicking here.

The process involved drawing verbal responses from groups of three people, called triads. The Core Research moderators used 'topic guides' as an agenda for the discussions, and to ensure consistency in the conversations across different groups. The topic guides can be viewed by clicking on the following links:

Among the findings of this research was that the stakeholder groups believed all communications (verbally and text) should be aligned. One stakeholder group said: "Us, the HSE, Cervical Screening and the GP need to have the same message for women or it could be a disaster."

Another stakeholder group said: "The words used are so important, it needs to be informative and specific, there is no more room for tolerance for ambiguity."

Core Research summarised the findings: "Empathy, clarity and concreteness are the key ingredients."

The National Screening Service’s Clinical Advisory Group agreed to: "Consider changing the wording from 'women’ to ‘people with a cervix'."

Core Research tested the following gender-neutral sentence with the triads: "Cervical screening saves lives and is available to women and people with a cervix aged 25-65."

The advice from the moderators on the stakeholders' reaction to this sentence was: "No issues with the gender inclusion phrase. Perhaps re-word to 'women or other people with a cervix' or 'anyone with a cervix aged 25-60yrs'."

The full report, presented by Core Research titled, HSE Cervical Screening 2020 campaign; Review of early stage communication & creative can be viewed by clicking here.

CervicalCheck's Clinical Advisory Group agreed to include a caveat on all documentation to explain that references to 'women' refers to 'women or people with a cervix'.

The HPV Primary Screening Project Steering Group endorsed the letters and leaflets that were to be used in the new CervicalCheck information campaign "on the basis that the process followed to develop them was robust and inclusive".

Following the above process, the Communications Working Group for the introduction of HPV cervical screening adopted the phrase 'person with a cervix' in place of 'woman', and other gender-neutral phrases. This approach fed into our leaflets, letters and web communications such as here.

The NSS uses the Plain English Service of NALA (the National Adult Literacy Agency) in the creation of its leaflets, letters and web communications. NALA accepted gender-neutral language on the basis that it had been user-tested.

The programme strives to be accessible in its communications, and inclusive of everyone in its target population. We have now received feedback on our new information. 

An NSS Communications Working Group, chaired by our Public Health division, will arrange to meet with participants, healthcare professionals and advocacy groups to assess our new HPV cervical screening information, and consider this feedback. This review process will form part of the work of our wider NSS Equity Strategy. The work of the group will begin before the end of 2020.

The NSS is grateful to all those who took time to provide feedback on our communications, as well as other aspects of our services. All feedback received by the programme is kept on file for our consideration, planning and training. The process of information resource review is also being looked-at so that we can be more systematic in the future, and learn.

If you would like to input directly into our review of our information on HPV cervical screening, which can be found in our programme leaflets and on HSE.ie/cervicalcheck, please email your views by 14 December November 2020 to: info@cervicalcheck.ie

The NSS knows that working in partnership with patients and the public delivers better health outcomes. In support of this ideal, we established the Patient and Public Partnership panel, comprising patient representatives and staff of the NSS who work together to shape policy and communications across our four screening programmes. If you would like to join our Patient and Public Partnership panel, please email PPPlead@screeningservice.ie 

 

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