By Fiona Ness, General Manager Communications, National Screening Service
We have reviewed and improved our invitation letters and leaflets for women who are eligible for our BreastCheck programme. We want the information in our letters to be relevant, easy to read and easy to understand. We want women to be able to use the information and feel supported to take action.
By improving our letters, we aim to:
- make our information more person-centred and accessible
- increase response and attendance rates
- screen more women by reducing missed appointments and repeat invitations.
What we updated
We focused on:
- the letter welcoming women to BreastCheck
- the letter inviting women for breast screening
- the letter inviting women for a breast assessment.
We also updated the information leaflets we send with our letters.
How we developed our letters
We established a project team that included staff from BreastCheck, communications, public health, behavioural science, and members of our Patient and Public Partnership (PPP).
We worked with BreastCheck teams to understand what women need from a screening invitation letter and what information they want before their appointments. We gathered feedback from women through our Your Service Your Say feedback service. We surveyed staff about what information helps them support women and deliver good care. We also reviewed breast screening communications from other countries and looked at relevant research.
We defined our user need as: ‘I want clear information so I can attend my appointment or rearrange it if needed.’
We reviewed our existing letter and found it was written more from our perspective rather than the reader’s. The information focused more on what we needed than what the woman needed to know. It included several different messages and actions, such as updating address details and contacting a GP if there were symptoms of breast cancer. The letter was also text-heavy, written in long paragraphs, and used a formal tone, including addressing women by surname and a formal sign-off.
We began to redevelop our letters using the World Health Organization’s Better Letters framework. The framework shows that small improvements in appointment letters can significantly increase engagement with the service.
We applied our research, behavioural science and communications best practice guidelines. We used our NSS Communications Toolkit to help us create more accessible communications.
The improvements we made
- We shortened our letters and gave a clear focus to the place, date, and time of the woman’s appointment.
- We used plain language to make our letters easier to read, improving the readability grade from Grade 9 to Grade 4.
- We aligned our language with our communications principles.
- We used clear bullet point style.
- We kept the letter simple and used clear signposting to direct women to important information in the booklet to help them prepare for their appointment.
- We used behavioural science approaches to build trust and encourage action, such as personalisation and using a trusted signatory.
- We structured the letter so key information is easy to find.
Testing and quality assurance
We involved our patient and public representatives in the development process. They took part in content workshops, reviewed draft letters and approved the final versions.
They said our letters were:
- easy to read, with very little jargon
- in a format that made reading easy
- less intimidating for the woman, especially if it is their first appointment
- helpful to women who worried their screening result would not be normal
- helpful to women deciding to go for their appointment.
One patient representative said she was “encouraged by our enthusiasm to reach out to people in the most positive way possible”.
She said the leaflets were clear, and “the fact that there is always someone at the end of a phone or email is reassuring. The desire for clarity and for managing people’s expectations is obvious.”
She said our letters and leaflets aligned with our communications principles.
The National Adult Literacy Agency (NALA) also reviewed the letters and leaflets. They awarded their Plain English Mark, confirming that our leaflets meet international plain English guidelines.
Next steps
We used our letter content to design the BreastCheck information and appointment notifications now being sent to people who use the HSE Health App. Our letters contain a QR code for women who want to see their screening appointments in the app.
We plan to test our letters. We will measure if they will:
- reduce the number of women who do not attend without calling to let us know
- increase the number of people who call us in advance of their appointment to discuss important information, such as an access request
- reduce the number of women who attend screening but can’t be screened because they have had a mammogram in the past year.