Helping Cancer Research UK save lives by improving risk communications

For some time now the NHS has offered routine screening for various forms of cancer, such as breast, bowel and cervical. Many of us will have experienced screening and some may even be coping with early treatment as a result.

Significant NHS resources are dedicated to promoting informed screening uptake, including through web-based communications. Effective communications about cervical cancer screening are particularly needed, as most cervical cancer cases could be prevented through screening.

However, screening uptake has been declining recently, and efforts to reduce socioeconomic inequalities in participation have failed. Ongoing research in this field suggests a number of reasons for this decline including how data about health risks is presented to the public. My research, funded by Cancer Research UK, aims to explore this further.

The goal of this three-year project is to improve the design of web-based communications about cervical cancer to help women understand benefits and risks of screening, and promote informed uptake.

Cervical cancer is the most common type of cancer in females under 35 in the UK, with around 3,000 new cases every year. Unfortunately, publicly available cancer risk information can often be too complex for people to understand, particularly if they have low numerical skills.

Research on health graph design has suggested that it is possible to design simple graphs to improve people’s understanding and motivate risk reduction behaviours. Indeed, graphs are commonly used by websites of cancer charities, health and government organisations.

Common examples include ‘icon arrays’—pictorial graphs containing human like figures or circles to communicate probabilities for health outcomes, with for example orange icons representing the number of people who will have an abnormal result after screening, and grey icons showing those who will not (see Figure 1). However even these simple graphs can have limited effectiveness among people with low graph literacy skills. Additionally, there is evidence that some of the graph designs that can promote risk understanding may also undermine healthy choices. I aim to apply my research around designing graphs to help women to understand information about cervical cancer risks and prevention.

Figure 1. Icon array used by Public Health England to show the outcomes of bowel cancer screening (guaiac-based faecal occult blood test or gFOBt). Source: Public Health England.

Ultimately the project aims to improve the websites that women use to make decisions about screening. Although people increasingly search for health information online, of course it’s not only poor web-based communications that deter women from screening. There are emotional and lifestyles factors too, but lack of good understanding of cancer risks and the effectiveness of screening can play a key role.

There are three stages to this UK based research project and these involve:

• Interviewing women about any difficulties they encounter interpreting currently available web-based communications
• A large scale survey testing the effectiveness of simple graphs to overcome difficulties in understanding
• A longitudinal study trialling the most effective graphs over time to improve understanding of benefits and risks of screening, and promote informed screening uptake.

This approach will help us to see how using graphs that are easy to understand may adapt behaviour. By also looking at affective responses to the way information is presented my research will inform other factors around behaviour change too.

It is anticipated that the findings from my research project will be helpful for other forms of cancer screening initiatives. We probably all know someone close to us who ignores their screening invitation, sometimes with sad consequences; this research really matters as regular screening could save many lives.