Introduction. Cervical cancer remains a disease of inequity for people with intellectual disability due to low screening rates. ScreenEQUAL, a Targeted Cancer Research study, co-produced and evaluated a suite of accessible screening resources, supporter materials and accredited healthcare professional (HCP) online training with people with intellectual disability (including our lived-experience co-presenter) to support national scale-up.
Methods. Three parallel single-arm pre-post studies evaluated ScreenEQUAL resources. In Study 1, people with intellectual disability aged 21-74 participated in accessible workshops facilitated by trained supporters. Informed decision-making was defined as adequate knowledge (≥4 out of 8 correct items) and concordant attitudes and intentions, assessed using an Easy Read co-produced survey. Pre-post changes in informed decision-making and knowledge scores were analysed using logistic regression and paired-samples t-tests. Studies 2 and 3 evaluated supporter resources and the HCP training module using pre-post surveys. Changes in supporter health literacy and HCP confidence in providing trauma-informed screening were assessed using Wilcoxon signed-rank tests and repeated-measures analyses.
Results. Study 1: Thirty-three people with intellectual disability (21-67 years) attended one of six workshops. Mean knowledge scores significantly increased from pre-to-post (5.4, SD 2.4 vs 6.8, SD 2.6; p<0.001) and participants were more likely to make an informed screening decision post-intervention (OR=2.7). Study 2: Supporters (n=9; 18-65 years) showed health literacy improvements that did not reach statistical significance (p=0.058). Study 3: Among 245 HCPs (28-72 years), confidence in providing trauma-informed healthcare significantly increased after training (40.3 vs 50.6; F(1,244)=509.9, p<0.001). Exploratory analyses suggested greater improvements among older HCPs (p=0.032).
Conclusion. Co-produced accessible cervical screening resources improved informed decision-making among people with intellectual disability. Accompanying materials increased supporters’ understanding of cervical screening for people with intellectual disability and targeted training increased HCP confidence to provide inclusive, trauma-informed healthcare for this group. ScreenEQUAL offers a scalable strategy to advance equitable cervical cancer elimination.