- What interventions impact the uptake of population screening programmes among under-served groups in the UK?
Many population screening programmes in the UK have disproportionately low uptake among under-served groups. One consequence of this is that people who are typically at higher risk of conditions for which screening programmes are available are less likely to participate in screening and receive benefit. This issue contributes to health inequalities.
Under-served groups can be defined as those less likely to benefit from an intervention because group members have specific needs that the intervention does not address, or who face additional challenges in engaging with the intervention. Work by NIHR-INCLUDE also indicates that under-served groups tend to have lower levels of inclusion in research despite experiencing a higher healthcare burden. NIHR-INCLUDE lists examples of under-served groups. These examples are not exhaustive.
A recent review published by the Office for Health Improvement and Disparities (OHID) examined interventions seeking to improve participation in population screening programmes among under-served groups. The review found good evidence for reminder-based interventions in improving uptake in under-served groups for screening programmes available to young people and adults. However, several evidence gaps were identified. There was minimal evidence relating to certain programmes – such as antenatal and newborn screening, and non-cancer screening – regarding under-served groups and those at high risk of a given condition.
The Public Health Research (PHR) Programme is interested in funding research into interventions seeking to reduce inequalities in participation in population screening programmes among under-served groups, particularly in the areas that have been highlighted in the OHID review as lacking in evidence. Populations of interest include any group for whom there is evidence of inequality in uptake of a screening programme, not only those groups with protected characteristics. Guidance on improving inclusion of under-served groups in research is available.
The focus of this call is intended to be screening programmes approved by the UK National Screening Committee (NSC). Applicants wishing to submit a proposal addressing non-NSC-approved screening initiatives will need to robustly justify their proposed focus and how the research findings would be generalisable, and are strongly advised to contact the PHR Programme at an early stage prior to submission to discuss suitability. Proposals related to NHS Health Checks are out of remit for this call.
Of particular importance to the PHR Programme is generating evidence for how to address the health inequalities experienced by people from ethnic minority backgrounds in the UK, in relation to screening programme uptake. Low uptake of screening among some ethnic minority groups was noted in the Independent Review of Adult Screening Programmes in England.
The PHR Programme is predominantly interested in the evaluation of interventions operating at population level rather than at an individual level, and which address health inequalities and the wider determinants of health. The PHR Programme recognises that interventions are likely to impact different (sub)populations in different ways, and encourages researchers to explore such disparities in their study design.
Research areas of interest could include (but are not limited to):
- interventions focused on intersectionality (for example, those that target the multiple barriers that might be faced due to belonging to more than one under-served group)
- interventions that address access to screening (for example, relating to physical disability; learning disability; geographic location or transport; time barriers and/or other practical challenges)
- interventions seeking to minimise barriers to screening uptake in under-served groups, such as language barriers
- interventions seeking to reduce inequalities in screening uptake experienced by ethnic minority groups
- interventions seeking to reduce inequalities in participation in non-cancer screening programmes, for example:
- newborn and antenatal screening
- diabetic eye screening
- abdominal aortic aneurysm screening
- new programmes such as Targeted Lung Health Checks (noting that targeted lung cancer screening is now NSC-approved)
- translating evidence of successful interventions between screening programmes with similarities
- interventions seeking to improve screening uptake in under-served groups that are seldom heard, for example:
- young parents
- people not registered with a GP
- people with learning disabilities
- homeless people; asylum seekers
- trans and gender diverse populations
- Gypsy, Roma, and Irish Traveller ethnic groups
- sex workers
- people in contact with the criminal justice system
- people with severe mental illness
- people who misuse alcohol or substances
- people with communication difficulties
- studies to determine whether interventions have different effects in different population subgroups
- interventions utilising community engagement approaches, such as interventions drawing on relationships between under-served groups and neighbourhood-based community organisations, faith groups, or voluntary and social enterprise organisations
The PHR Programme recognises that interventions addressing education and health beliefs or those that support people to make informed choices might form part of a solution to improve uptake. However, the Programme cautions against proposals seeking to evaluate interventions that operate within a deficit model of engagement, in which lower screening uptake is considered to relate to a deficiency of knowledge or personal effort. Applications related to socioeconomic deprivation are also advised to take into consideration the multiple ways that deprivation can be measured beyond solely area-based measures.
The PHR Programme does not fund evaluative research of NHS interventions, and research focused on service delivery is not in remit for this call. We recognise that public health commissioning arrangements and responsibilities vary across the devolved administrations of the UK. Please contact the Programme if you would like to discuss whether your proposal would be in remit.
Researchers interested in evaluating service delivery aspects of population screening may wish to consider our Health and Social Care Delivery Research Programme.
Applicants submitting proposals against this call may use a range of study designs, methods, and outcome measures. Researchers will need to identify and justify their chosen methodological approach, and specify key outcomes (including how ‘uptake’ is defined in the proposal) and how these will be measured in the short, medium, and long term. Primary outcomes must be health related.
Understanding the value of public health interventions – whether the outcomes justify their use of resources – is integral to the PHR Programme, where resources relating to different economic sectors and budgets are potentially relevant. The main outcomes for economic evaluation are expected to include health (including health-related quality of life) and the impact on health inequalities as a minimum, with consideration of broader outcomes welcomed. Different approaches to economic evaluation are encouraged as long as they assess the value and distributive impact of interventions. Applications that do not include an economic component should provide appropriate justification.
Researchers must ensure that interventions are culturally competent and are planned, designed, and implemented with the people who will be using them (co-produced). The PHR Programme welcomes involvement from target population groups and from relevant organisations in the design of the evaluation and in the research team. We will consider inclusion of such experts as costed members of the study team if appropriately justified. Researchers should demonstrate the relevance of their proposed research to key stakeholders including, for example:
- local and national decision-makers
- members of relevant population subgroups
- community leaders
- local government public health teams
- other relevant stakeholders
Researchers are expected to be aware of ongoing work or research in this area, including the OHID review and ensure their proposed research is complementary.