The UK NHS cervical screening information leaflet: discourse, purpose and potential for change
DOI:
https://doi.org/10.7146/qhc.142625Keywords:
Discourse, gynae cancer, human papilloma virus, preventionAbstract
Background: Cervical cancer screening prevents unnecessary deaths, yet rates of attendance have been dropping in the United Kingdom. Leaflets communicate screening information in invites to everyone eligible to attend. However, these information leaflets are known to be hard to understand and inaccessible. Aim: To understand how cervical screening is constructed in information leaflets and how this might impact engagement with screening programmes. Method: Discourse analysis of the current UK information leaflet, and a version redesigned with a public and patient involvement group. Result: The current leaflet uses discourses of neutrality and patient autonomy, with design akin to scientific texts. The redesigned leaflet presents a simplified, step-by-step guide to screening that aims to motivate and persuade readers. Discussion: The current information leaflet positions intended audiences as rational agents who have responsibility to make a choice to attend screening based on scientific information. The public’s redesign positions the state as responsible for simplifying and convincing people to attend screening. The disjuncture may be due to different underlying ideologies – neoliberalism versus ‘welfarism’. Conclusion: Shifting the current discourse to simplified and clearer language which emphasises choice in the process could help people make an informed decision to engage in screening.
References
Armstrong, N. (2007). Discourse and the individual in cervical cancer screening. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 11(1), 69-85. https://doi.org/10.1177/1363459307070804
Batelaan, K. (2021). ‘It’s not the science we distrust; it’s the scientists’: Reframing the anti-vaccination movement within Black communities. Global Public Health, 17(6), 1099–1112. https://doi.org/10.1080/17441692.2021.1912809
Brown, B. J., & Baker, S. (2012). Responsible citizens: Individuals, health, and policy under neoliberalism. Anthem Press.
Busch, J., Madsen, E. K., Fage-Butler, A. M., Kjær, M., & Ledderer, L. (2021). Dilemmas of nudging in public health: an ethical analysis of a Danish pamphlet. Health Promotion International, 36(4), 1140–1150. https://doi.org/10.1093/heapro/daaa146
Cancer Research UK. (n.d.). Cervical cancer statistics. https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/cervical-cancer
Charlton, C., & Rodrigues, A. M. (2024). How do young women approaching screening age interpret the NHS cervical screening leaflet? A mixed methods study of identifying interpretation difficulties, barriers, facilitators, and leaflet interpretation, engagement and future screening behaviour. Health Psychology and Behavioral Medicine, 12(1). https://doi.org/10.1080/21642850.2024.2361005
de Koning, H. J. (2000). Assessment of nationwide cancer-screening programmes. The Lancet, 355(9198), 80-81. https://doi.org/10.1016/S0140-6736(99)00419-5
Dahlborg, E., Tengelin, E., Aasen, E., Strunck, J., Boman, Å., Ottesen, A. M., Dahl, B. M., Helberget, L. K., & Lassen, I. (2021). The struggle between welfare state models and prevailing healthcare policy in Scandinavian healthcare legislative documents. International Journal of Health Governance, 26(1), 51-64. https://doi.org/10.1108/IJHG-04-2020-0041
Davies, L., Petitti, D. B., Martin, L., Woo, M., & Lin, J. S. (2018). Defining, estimating, and communicating overdiagnosis in cancer screening. Annals of Internal Medicine, 169(1), 36-43. https://doi.org/10.7326/M18-0694
Department for Health and Social Care. (2016). Changes to cervical cancer screening. https://www.gov.uk/government/news/changes-to-cervical-cancer-screening
Department of Health and Social Care. (2023). The NHS constitution for England. https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england
Elliott, R., Fischer, C. T., & Rennie, D. L. (1999). Evolving guidelines for publication of qualitative research studies in psychology and related fields. British Journal of Clinical Psychology, 38(3), 215-229. https://doi.org/10.1348/014466599162782
Franco, E. L., Schlecht, N. F., & Saslow, D. (2003). The epidemiology of cervical cancer. The Cancer Journal, 9(5), 348-359. https://doi.org/10.1097/00130404-200309000-00004
Fuchs, J., Banow, S., Görbert, N., & Hippius, M. (2007). Importance of package insert information in the European Union. Pharm Ind, 69(2), 165-172.
Gabe, J., Harley, K., & Calnan, M. (2015). Healthcare choice: Discourses, perceptions, experiences and practices. Current Sociology, 63(5), 623-635. https://doi.org/10.1177/0011392115590061
Ginsburg, O., Vanderpuye, V., Beddoe, A., Bhoo-Pathy, N., Bray, F., Caduff, C., Florez, N., Fadhil, I., Hammad, N., Heidari, S., Kataria, I., Kumar, S., Liebermann, E., Moodley, J., Mutebi, M., Mukherji, D., Nugent, R., So, W. K. W., Soto-Perez-de-Celis, E., & Soerjomataram, I. (2023). Women, power, and cancer: A lancet commission. The Lancet Commissions, 402(10417), 2113-2166.
Hamashima, C., Hearasawa, T., Katayama, T., Sasaako, S., Hosono, S., & Hoshi, K. (2018). Systematic review of overdiagnosis in cervical cancer screening: How should we define overdiagnosis in cervical cancer screening? BMJ Evidence-Based Medicine, 23. https://doi.org/10.1136/bmjebm-2018-111070.92
Hofmann, B., & Stanak, M. (2018). Nudging in screening: Literature review and ethical guidance. Patient Education and Counseling, 101(9), 1561-1569. https://doi.org/10.1016/j.pec.2018.03.021
Katz, M. J. (2009). From research to manuscript: A guide to scientific writing. Springer Dordrecht.
Kirubarajan, A., Leung, S., Li, X., Yau, M., & Sobel, M. (2021). Barriers and facilitators for cervical cancer screening among adolescents and young people: A systematic review. BMC Women's Health, 21(1), 122. https://doi.org/10.1186/s12905-021-01264-x
Malila, N., Leinonen, M., Kotaniemi-Talonen, L., Laurila, P., Tarkkanen, J., & Hakama, M. (2013). The HPV test has similar sensitivity but more overdiagnosis than the Pap test—A randomised health services study on cervical cancer screening in Finland. International Journal of Cancer, 132(9), 2141-2147. https://doi.org/10.1002/ijc.27850
Moll, S., Wyndham-West, M., Mulvale, G., Park, S., Buettgen, A., Phoenix, M., Fleisig, R., & Bruce, E. (2020). Are you really doing ‘codesign’? Critical reflections when working with vulnerable populations. BMJ Open, 10(11). https://doi.org/10.1136/bmjopen-2020-038339
National Literacy Trust. (n.d.). Adult literacy. https://literacytrust.org.uk/parents-and-families/adult-literacy/
NHS England. (2023a). Cervical screening standards data report 2021 to 2022. https://www.gov.uk/government/publications/cervical-screening-standards-data-report-2021-to-2022/cervical-screening-standards-data-report-2021-to-2022
NHS England. (2023b). Women urged to take up NHS cervical screening invitations. https://www.england.nhs.uk/2023/11/women-urged-to-take-up-nhs-cervical-screening-invitations/
NHS. (n.d.). Bowel cancer screening. https://www.nhs.uk/conditions/bowel-cancer-screening/
Office for Health Improvements and Disparities. (2020). PHE screening inequalities strategy. https://www.gov.uk/government/publications/nhs-population-screening-inequalities-strategy/phe-screening-inequalities-strategy
Okan, Y., Petrova, D., Smith, S. G., Lesic, V., & Bruine de Bruin, W. (2019). How do women interpret the NHS information leaflet about cervical cancer screening? Medical Decision Making, 39(7), 738-754. https://doi.org/10.1177/0272989X19873647
Charlton, C., & Rodrigues, A. M. (2024). How do young women approaching screening age interpret the NHS cervical screening leaflet? A mixed methods study of identifying interpretation difficulties, barriers, facilitators, and leaflet interpretation, engagement and future screening behaviour. Health Psychology and Behavioral Medicine, 12(1). https://doi.org/10.1080/21642850.2024.2361005
Öresland, S., Friberg, F., Määtta, S., & Öhlen, J. (2015). Disclosing discourses: Biomedical and hospitality discourses in patient education materials. Nursing Inquiry, 22(3), 240-248. https://doi.org/10.1111/nin.12097
Ottesen, A. M., & Strunck, J. (2024). The discursive construction of person-centredness in online information leaflets addressed to patients with cancer. Qualitative Health Communication, 3(1), 17–31. https://doi.org/10.7146/qhc.136743
Paakkari, L. (2020). Covid-19: Health literacy is an underestimated problem. The Lancet: Public Health, 5(5), e249-250. https://doi.org/10.1016/S2468-2667(20)30086-4
Public Health England. (2021). Cervical screening: Information leaflets. https://www.gov.uk/government/collections/cervical-screening-information-leaflets
Shepherd, M. A., & Gerend, M. A. (2014). The blame game: Cervical cancer, knowledge of its link to human papillomavirus and stigma. Psychology & Health, 29(1), 94-109. https://doi.org/10.1080/08870446.2013.834057
Sørensen, K., Pelikan, J. M., Röthlin, F., Ganahl, K., Slonska, Z., Doyle, G., Fullam, J., Kondilis, B., Agrafiotis, D., Uiters, E., Falcon, M., Mensing, M., Tchamov, K., van den Broucke, S., Brand, H., & HLS-EU Consortium. (2015). Health literacy in Europe: Comparative results of the European health literacy survey (HLS-EU). European Journal of Public Health, 25(6), 1053–1058. https://doi.org/10.1093/eurpub/ckv043
Swindell, J. S., McGuire, A. L., & Halpern, S. D. (2010). Beneficent persuasion: Techniques and ethical guidelines to improve patients' decisions. Annals of Family Medicine, 8(3), 260–264. https://doi.org/10.1370/afm.1118
UK National Screening Committee. (2023). UK National Screening Committee: Screening in healthcare. https://www.gov.uk/guidance/principles-of-population-screening/informed-choice
Wearn, A., & Shepherd, L. (2022). Determinants of routine cervical screening participation in underserved women: A qualitative systematic review. Psychology & Health, 16(1), 1-26. https://doi.org/10.1080/08870446.2022.2050230
Wilding, S., Wighton, S., Halligan, D., West, R., Conner, M., & O'Connor, D. B. (2020). What factors are most influential in increasing cervical cancer screening attendance? An online study of UK-based women. Health Psychology and Behavioral Medicine, 8(1), 314-328. https://doi.org/10.1080/21642850.2020.1769021
Williams, O., Robert, G., Martin, G. P., Hanna, E., & O’Hara, J. (2020). Is co-production just really good PPI? Making sense of patient and public involvement and co-production networks. In M. Bevir & J. Waring (Eds.), Decentring health and care networks: Organizational behaviour in healthcare (pp. 25-43). Palgrave Macmillan. https://doi.org/10.1007/978-3-030-40889-3_1
Willig, C. (2022). Foucauldian discourse analysis. In C. Willig (4th Ed.), Introducing qualitative research in psychology (pp. 132-146). Open University Press.
World Health Organization. (2023). Cervical cancer. https://www.who.int/news-room/fact-sheets/detail/cervical-cancer
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