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Published: 22 October 2024

Using behavioural science to improve screening awareness and participation

By Dr Alice Le Bonniec, Behavioural Scientist, National Screening Service

We use behavioural science to help us understand why people take part in screening and why they don’t. This helps us to develop interventions to increase awareness about our screening programmes and to help people to make a decision about screening.

So, what is behavioural science?

Behavioural science aims to explain how people make decisions and why they adopt - or not - a behaviour, using scientific methods.

We know from behavioural science that key factors have an influence on people’s behaviour. Those factors can be related to our individual characteristics, for example our personal beliefs. We are also influenced by our culture, by other people around us, and more generally by the society in which we live.

Why is it important to screening?

We know from research that screening programmes are effective at improving population health.

Screening is a personal choice. It’s important that everyone who is eligible understands what screening can and can’t do so they can make an informed choice about taking part.

Behavioural science can help us to understand how people make these choices. It can also help us to understand screening uptake by exploring the barriers and enablers to taking part in screening across our four screening programmes.

We can use these insights to improve our resources to support people to make an informed choice about screening.

What we have learned from behavioural science

  • While educating people about screening programmes is essential, it’s not enough to change behaviour. Knowing the benefits of screening does not always lead to participation in the screening programme.
  • People are more likely to take part in screening if they know that other people in their community take part, for example, their friends or family.
  • People are more likely to take part in screening if the process looks accessible and they feel they are able to take part.
  • People’s intended behaviour does not always match their actions.

How we can use behavioural science to improve screening awareness and participation

Screening can save lives and improve health outcomes by preventing disease or finding it early when it can be easier to treat. High uptake of screening is important for it to be effective. Using behavioural science, we can:

  • explore the knowledge, attitudes and trust of the eligible population towards screening and the screening service
  • explore the barriers and enablers to taking part in screening
  • tailor information needs for specific populations
  • develop interventions designed to support people to take part in screening, and assess their impact
  • explore the roles, intentions and behaviours of healthcare professionals involved in screening
  • co-design resources with key stakeholders to communicate about screening
  • apply behavioural theoretical models and principles to develop new research projects.

Examples of how we’re using behavioural science

  • We used behavioural science principles and theories in the development of an interventions toolkit to help community health workers to support people in their communities to take part in screening. The toolkit outlines several steps from assessing community needs, designing the interventions with community members, to evaluating the effects of the intervention.
  • We used input from behavioural science literature to develop information inviting women aged over 60 for HPV cervical screening.
  • We’re working on a review of literature to identify the views and experiences of HPV self-sampling in high-income countries. This is part of the Cervical Cancer Elimination initiative and the results will inform the potential future implementation of HPV self-sampling in our CervicalCheck programme.
  • The Department of Health recently published a discussion paper about how behavioural science can be applied to improve productivity in the health sector. Invitation letters have been found to be an effective way to increase uptake of cancer screening. We follow this evidence-based approach of sending invitation letters to people eligible for BowelScreen, BreastCheck and CervicalCheck. The discussion paper suggests that it might be possible to increase uptake in screening by incorporating insights from behavioural science into our invitation letters. We have already started work in this area through the ‘Better Letters Initiative’ which aims to use behavioural insights to increase uptake of BowelScreen.