When everything moved online (1m03s)

Sareh Heidari opens with the 2020-2021 shift: pandemic lockdowns moved weddings, theatre, conferences, GP appointments and vaccination bookings into the browser. 20 million UK adults booked a vaccination online — for most, their first ever digital healthcare interaction.

"20 million adults in the UK booked vaccinations online, and that's about 61 million vaccinations"

"for the vast majority of people, it was their first time using an online tool for healthcare reasons"

"she didn't need to take the morning off work, pay for travel, have the inconvenience of waiting in a waiting room... she could have that appointment in the convenience of her own home"

Who actually got left behind (7m19s)

The flip side: rural users with flaky 3G can't reliably receive booking SMS, users of assistive technology can't navigate inaccessible sites, people without fixed postal addresses (the homeless, Roma and Traveller communities) get refused GP registration — a 2019 study found 48% of GP practices wrongly refused to register someone without a postcode.

"in 2019... 48% of GP practices contacted wrongfully refused to register that person — it's a legal right for everybody to have access"

"the system that they're using required them to have a postcode and that kind of information"

"one in every five people in the UK are in poverty"

The COM-B model of behaviour change (11m58s)

The COM-B framework from behavioural science breaks down access into Capability (can the person operate the technology?), Opportunity (do they have a device, internet, time?) and Motivation (have repeated rebuffs trained them out of even trying?). A real person's exclusion is usually a combination.

"capabilities, opportunities, and motivation are three key factors for capability of changing behaviour"

"groups of people who [are] historically marginalised... might be reticent to try over and over again when they keep getting rebuffed"

"a person's experience doesn't just fit neatly into a category either"

Research-led and user-centred, not product-centred (14m32s)

Sareh emphasises user-centred over product-centred research. Product-centred research asks "how well does my app do?", user-centred research asks "what is happening in the user's actual life?" — and the difference matters because the second one notices that asking someone without a fixed address to take a private video call in a public library isn't a solution.

"user-centred rather than product-centred — because we're really focused on our product and validation for the things that we are doing"

"let's now go through some aspects where we can take some of the research that's already been carried out by other people and find out what they've learned"

"would you like to have your private doctor's conversation in a local library when you've got lots of people listening in?"

Simplify the language (17m47s)

15% of UK adults read at the level of a 9-to-11-year-old. Health content is full of jargon, acronyms and passive voice. The Plain English Campaign stamp on books and websites signals that the language has been simplified to active voice, second person and plain terms — which helps every reader, not just the minority who structurally need it.

"15% of adults in England have English literacy levels at the age of nine to eleven years old"

"an information helpline is also operated by ABC Hospital Trust for the convenience of patients... [vs] we also run an information helpline for your convenience"

"the idea is that it's talking to you in a really helpful way, as though somebody is explaining something to you directly"

Pee and poop: what plain language really means (22m33s)

The NHS content style guide is the gold standard for plain-language health writing, with the most-quoted research result being that stool sample tested worse than poo. The NHS decided across the board to use pee and poop instead of urine and stool because the research showed it worked best.

"they made a decision overall, across the board, to change the word and decided against using 'urine' and 'stool', instead 'pee' and 'poop' — because that worked best"

"over six in 10 [adults] struggle with content that includes stats... not just like numbers, but also tables and graphs"

"when you design with the most marginalised people at the centre, you improve the experience for everybody"

Simplify the technical complexity (24m08s)

A lot of users are terrified of clicking on something they don't understand because the consequences (a missed GP appointment, an unfilled prescription) feel disproportionate. The fix is the inverse of the developer instinct: fewer accordions, fewer hover-tooltips hiding link text, one action per page, no compound forms.

"they're terrified of breaking things... if they do the wrong thing then that might lead to their GP not getting a message"

"you've got one action, it's really clear, and then you can move on to the next stage"

"what is your NHS number? One clear action, one field to fill in, and one action to submit"

Equity over equality (27m12s)

Giving everyone the same booking form is equality; giving each user the path that actually works for them — phone line, paper form, web form, live chat with a real human — is equity. The NHS's procurement criteria for digital service providers now include their approach to digital inclusion.

"equality is everyone given the same tool to use... some people face fewer barriers and they can use that just fine, and other people have more barriers and that tool just doesn't cut it"

"do they have an alternative to the web form, like a phone line, so that people who have questions about filling in their appointment booking can really talk to somebody"

"digital first should not mean digital only"

Lived experiences and building trust (31m26s)

To research the people who don't fill in your customer-feedback form, you have to go to them — partner with community grassroots organisations, run user research in people's homes with their own assistive devices, and use the qualitative findings to test on the actual devices your users own (not your shiny iPhone).

"if you send out an email to your users and they reply and say 'yeah I'm really eager', they're probably the people who will vocally complain — no, you need to actually go out into the community to find people who are not interacting with your services at all"

"we did some accessibility user research into how people are navigating a new website... the user research went to people's homes in order to actually experience how they were interacting with things"

"you can't design something if you don't have a relationship with that community"

Device banks, data banks and the right to access (37m07s)

The Good Things Foundation runs a National Device Bank (corporate equipment redirected to people who need it) and a National Data Bank (free internet data for 500,000 people from partner telcos). The closing question is the political one: if shelter and education are universal human rights, and the NHS is treated as one, then access to the digital systems the NHS now runs on has to be too.

"the Good Things Foundation has done a lot of research into digital exclusion and as a result set up... the National Device Bank... [and] the National Data Bank"

"if your company has a lot of phones and laptops and things that they don't need... give them a shout, you can donate them"

"now that we are using technology and the internet and digital means in order to further the reach of healthcare... access to the internet becomes a human right as well"