By Dr Laura Heavey, Consultant in Public Health Medicine, National Screening Service
We’re piloting the use of a new Health Equity Impact Assessment tool across our screening programmes. The tool has been developed to make sure that equity is considered throughout the planning process when we introduce new services, technologies or ways of working.
Why we developed the tool
People's participation in screening can be influenced by many factors, including where they live, their income, disability, ethnicity, language, age, gender, health status and other circumstances. While screening programmes are designed to improve health outcomes for the population, we know that people do not always have the same opportunities to access and benefit from screening.
When we introduce new services, technologies or ways of working in our screening programmes, there can be intended benefits as well as unintended consequences. A change that works well for one group may create more barriers for another.
The purpose of the tool is to help us identify these impacts early, so that we can maximise positive outcomes and reduce potential inequities before changes are introduced. In practical terms, the tool allows us to ‘equity proof’ proposed changes by systematically considering who might benefit, who could be disadvantaged, and what actions can be taken to improve equity.
How we developed the tool
We reviewed existing approaches and models used in other health systems to assess health equity impact. We adapted the Public Health England Health Equity Assessment Tool for the Irish screening context.
We held a workshop with our staff and patient representatives to test a draft version of the tool. We used feedback from this workshop to further refine the tool, resulting in the version that is now being piloted.
How the tool works
The tool provides a structured process for assessing the potential impact of a programme, project or policy on health equity.
The process begins with gathering evidence and data, including population statistics, screening programme reports, research findings and participant feedback, as well as insights from community organisations and screening participants. The tool then prompts project teams to consider how different groups may be affected by a proposed change.
These groups include:
- people living in areas of deprivation or experiencing poverty
- Travellers and Roma communities
- people experiencing homelessness
- people with disabilities
- neurodivergent people
- migrants and ethnic minority communities
- LGBTQIA+ communities
- people living in rural areas
- people with multiple health conditions
- other groups who may experience disadvantage.
Project team members will work together to identify potential positive and negative impacts, consider any risk of widening inequalities, and agree actions to strengthen the project so that it maximises health equity where possible.
The tool also encourages project teams to consider issues such as digital exclusion, literacy, accessibility, language needs and community engagement. It includes a clear action plan and monitoring framework to help ensure recommendations are implemented and reviewed.
How the pilot will work
We will run the pilot for 1 year.
We will support our staff to use the tool through presentations and learning sessions on how the tool works, how it can support their work and how it can be applied in practice.
We will use the tool to assess an upcoming project or service change across each of our 4 four screening programmes. For each assessment, we’ll gather evidence, facilitate workshops and document the findings. Project teams will consider recommendations arising from the assessment through the relevant screening programme governance structures.
At the end of the pilot year, we will bring together evidence from all 4 programmes and share our learnings to understand the impact of the tool.
How we will evaluate the pilot
We have built evaluation into the tool itself:
- Each assessment will include a monitoring and evaluation plan.
- Reviews will take place 6 to 12 months after the assessment is completed.
- Project teams will consider if agreed actions were implemented and if they helped reduce potential inequalities or improve inclusion and accessibility.
We will also ask staff who have used the tool to complete a short survey about their experience using the tool, including its usefulness, relevance, practicality and the resources required to implement recommendations.
The findings of the evaluation will help us determine if the tool should become part of routine practice across our screening programmes and if any further refinements are needed.
Looking ahead
Improving equity in screening is an ongoing process. This pilot represents an important step in ensuring that equity considerations are embedded in how we design and deliver our screening programmes. We can make more informed decisions by taking a structured approach to understanding the needs of different communities and help ensure that everyone can benefit from screening.
After the pilot and evaluation, we hope to share our learnings more widely and explore opportunities to make the tool available to support broader health service improvement initiatives in the future.
Find out more about our work to improve equity in screening:
· visit: hse.ie/equityinscreening
· email: equity@screeningservice.ie