This project examines whether adding visual representations to printed NHS bowel cancer screening service materials could improve clarity and inclusivity for adults aged 50–74. My role is to design and lead user‑centred research to evaluate how these materials are interpreted in practice, with particular focus on understanding, trust, and avoiding unintended exclusion for underserved groups.
The case study documents how staged qualitative and quantitative research is being used to support an evidence‑based recommendation about whether, and how, visual changes should be integrated into the screening service.
The messaging used in bowel cancer screening service materials is already effective, but uncertainty remained about whether visual representations of participation could strengthen or undermine that message. The key research question was not whether to change the message, but whether changing how participation is visually communicated would meaningfully improve understanding and relatability for a diverse older population.
The primary risk was that poorly handled representation could reduce clarity, trust, or inclusivity, particularly for minority ethnic and low‑income groups who already experience lower screening uptake. Getting this wrong would mean embedding changes into service materials that unintentionally alienated some recipients or obscured the core message.
To reduce this risk, the work is structured as a two‑phase research programme. Think‑aloud interviews are used to examine how different versions of the materials are interpreted, followed by a comparative A/B survey to assess which version performs best against the current materials. Together, these phases are designed to support a clear, evidence‑based service decision about whether visual changes should be adopted.
One of the printed service material variants being evaluated to assess clarity, trust, and perceived inclusion.
This research focuses on adults aged 50–74, the group who receive printed bowel cancer screening service materials and make screening decisions based on them. Uptake is known to be lower among some minority ethnic and low-income groups, so this phase intentionally prioritises strong representation from these audiences to ensure materials do not unintentionally exclude or disengage those most at risk.
The planned think-aloud phase involves a small but diverse sample of adults, with purposeful oversampling of participants from minority ethnic and low-income backgrounds to explore interpretation, relatability, and potential alienation in depth. The planned A/B testing via survey then expands to a large UK wide sample (~1,000) stratified by gender, ethnicity, and income, allowing evidence based comparison while still centring underserved perspectives.
I lead the user‑centred research for this work, with responsibility for designing and delivering a multi‑phase research programme from early concept evaluation through to evidence‑based service recommendations. My responsibilities include developing versions of the printed bowel cancer screening service materials, designing think-aloud interviews, planning large scale A/B testing via comparative survey, and defining outcome measures aligned with behavioural science and public sector practice.
I work closely with two senior health psychology academics with expertise in behaviour change, seeking their input at key decision points such as interview design and survey structure. Day to day, I operate with a high degree of autonomy, collaborating with clinicians and statisticians to ensure the research remains feasible, ethical, and robust while keeping inclusion and clarity at the centre of decisions.
The research approach is structured in two stages to proportionately reduce risk before making a service decision about printed bowel cancer screening service materials. The primary goal is not discovery, but optimisation and inclusion, ensuring visual changes enhance clarity and relatability without causing confusion or exclusion.
The first stage uses think-aloud interviews with adults aged 50–74 to explore how visual versions of the materials are interpreted. This method is appropriate given the sensitivity of the topic and the age group involved, allowing nuanced reactions around trust, representation, and understanding to surface in ways that would not be visible through survey data alone. These sessions focus on clarity of message, perceived inclusion or exclusion, and how visual formats influence comprehension and intention.
Insights from the think-aloud phase inform refinement of the materials before moving to the second stage, a large scale comparative survey. This phase is designed to assess which version performs best against the current materials across defined outcome measures, including comprehension, trust, perceived norms, acceptability, and intention. Stratified sampling ensures evidence reflects responses across gender, ethnicity, and income, while still centring underserved groups who experience lower uptake.
Alongside study design, I prepared detailed protocols, participant materials, and ethics documentation to ensure the research is inclusive, accessible, and appropriate for older adults participating remotely. Together, this phased approach balances depth and scale, using qualitative insight to reduce risk before quantitative comparison supports a clear, evidence based recommendation for the service.
Think‑aloud prompts were designed to explore interpretation and comfort without pressuring participants about health decisions.
Data collection has not yet started and is pending ethics approval. This section sets out the key patterns the research is designed to surface and the criteria that will be used to interpret results, rather than reporting findings.
The research is designed to assess how different forms and levels of visual representation affect whether recipients feel the materials reflect “people like me” without appearing tokenistic or exclusionary.