Guidance

AAA screening: reducing inequalities

Updated 24 June 2021

Applies to England

1. Evidence-based recommendations

Researchers in Scotland in November 2017 carried out a systematic review of factors influencing attendance at abdominal aortic aneurysm (AAA) screening and interventions to reduce inequalities.

They made the following recommendations.

1. Once men have been invited for screening it may be useful to provide extra support and personal reminders to those less likely to attend.
2. Services should give increased consideration to travel time to clinics, particularly for those men less likely to attend, and public transport use.
3. It may help to work alongside colleagues who share an interest in improving men’s engagement with healthcare. For example, services may be able to use times when men attend other health or social care services, such as GP or acute hospital services, to discuss screening.
4. Interventions to reduce inequalities implemented locally should be evaluated and the results widely disseminated, so effective interventions can be implemented elsewhere and ineffective ones can be stopped.

2. Reducing barriers to initial screening attendance

Screening providers must make it as easy for disabled people to use health services as it is for people who are not disabled. This is called making reasonable adjustments.

Reasonable adjustments can mean making sure screening clinics are held in accessible buildings. They can also mean changes to policies, procedures and staff training to make sure services work equally well for people with physical or sensory disabilities, learning disabilities or long-term conditions such as dementia.

In future, providers may also be able to access the Reasonable Adjustment Flag, which is being developed by NHS Digital and NHS England to enable services to record, share and view details of reasonable adjustments across the NHS.

The cohort information in the national AAA Screening Management and Referral Tracking (SMaRT) IT system includes:

• phone numbers
• email addresses
• preferred language
• interpreter requirements

This cohort information, where available, supports services in reducing barriers to screening.

Other examples of best practice to lower barriers to initial attendance reported from AAA screening services include:

• offering and publicising Saturday or evening appointments
• varying the days and times of clinics to allow more flexibility for people to attend
• including directions to clinic locations and details of car parking facilities
• offering a variety of screening venues
• GP endorsement letters with screening invitations
• sending reminder letters 2 weeks before appointments
• using text message reminders
• holding awareness-raising campaigns, particularly in areas with low uptake
• routinely sending a list of other clinic venues with all initial invitation letters, so that people have a choice if they want to change venue
• displaying AAA screening information in GP practices

3. Improving access for underserved groups

Many of the conditions we screen for, including AAA, are more common in underserved groups than the rest of the population.

To help improve access to screening for men in underserved groups, providers, commissioners and other partners should follow national guidance, including:

• Population screening: reducing inequalities for people with learning disabilities
• Population screening: access for people with severe mental illness
• NHS population screening: information for transgender people
• Population screening: reducing inequalities in secure settings
• NHS population screening: support for carers, which includes guidance on assessing capacity, the principles of the Mental Capacity Act and making a best interests decision

3.1 Supporting men with learning disabilities

It is a legal duty to make reasonable adjustments for people with learning disabilities.

To help explain AAA screening to men with learning disabilities, providers can download and print off copies of:

• Abdominal aortic aneurysm screening: easy guide
• AAA screening: easy read invitation letter template

If possible, these resources should be printed single sided and in colour.

Other examples of best practice in reducing barriers to AAA screening for men with learning disabilities include:

• having a nominated screening technician to manage the screening of men with learning disabilities
• involving carers to help improve access to screening for men with learning disabilities – see example of how the South Devon and Exeter AAA screening service adapted its screening pathway

4. Engaging with public and professionals

Examples of best practice from AAA screening services in all 4 nations include:

• completing insight questionnaires with members of the public
• holding workplace awareness events
• holding community awareness events
• promotional work, displaying posters that show screening clinic dates and venues at venues such as post offices, bowling clubs, local shops, pharmacies, community centres, village halls, coffee shops, tennis clubs, hotels, community hospitals, swimming pools and golf clubs
• promoting AAA screening at public events and shows
• offering simple awareness training for GP practice and pharmacy staff
• attending promotional events
• working in partnership with partners who deliver health promotion interventions
• developing a ‘train the trainer’ approach
• inviting men from postcodes with the worst uptake first in the cohort year, giving services longer to encourage attendance later in the year
• working with GP practices to overcome language barriers
• working with GP practices and community organisations to raise awareness of AAA screening in rural areas
• publicising the service through the AAA screening explained video (below) developed by Dorset and Wiltshire AAA screening service

AAA screening explained video

5. Prior notification list and DNA analysis

Examples of best practice from AAA screening services in all 4 nations include:

5.1 Validate your cohort at the start of each cohort year

Contact each GP practice to ask if there are any individuals requiring reasonable adjustments. For example, this can include men with a learning disability, men who require a home visit and men with language, communication or interpreter requirements.

5.2 In-depth analysis of DNA rates and health profiles of surveillance and referral subjects

This can help providers form a rounded picture of behavioural patterns and trends. For example, it can include areas where men are less likely to attend AAA screening and potential high risk areas for positive screening results. This information can help focus efforts on high priority areas which need the most intervention.

5.3 Look at uptake rate by GP practice

Contact those practices with the highest did not attend (DNA) rate and ask them to review list of eligible patients.