Digital exclusion in population screening programmes

An Equality Impact Assessment of channel shift from printed media to online information within NHS England’s population screening programmes


This research was commissioned by Public Health England’s Screening Team. There has been a proposed change to the way important information for the public about population screening programmes will be produced. The proposal is to reduce printed leaflet numbers and increasingly refer people to online information. Some people may not have access to the internet or the ability to read information online. The purpose of this work was to provide Public Health England with an assessment of the potential impacts of these changes. The intention was to:

  • Identify differences in the impacts of change, across the 11 screening programmes and on different types of people (like older people and disabled people).
  • Make recommendations to Public Health England about how to manage change and reduce any risks.


A mix of research and assessment methods were used:

  • Reading existing reports covering this subject (a literature review).
  • Looking at Public Health England’s performance data, existing research and blog posts.
  • Carrying out online surveys, telephone interviews and attending focus groups.
  • Analysing data about the types of people being invited to screening and about people who aren’t online.
  • Risk scoring, weighting and rating.


The two screening programmes with the highest risks associated with the changes, are the Bowel Cancer and Diabetic Eye screening programmes, because of the large numbers of people involved and the percentage of them estimated to be offline.

This report recommends a phased approach to reducing printed leaflets, ensuring they remain included with the first invitation letter that people receive. Additionally, Public Health England and NHS screening services should ensure that people still have a choice about how they receive information and can continue to access it in a range of formats based on their needs.


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