HPV self-testing UR findings: unhappy paths, reminders and nudges

app/hpv-self-testing/2025/08/ur-unhappy-paths-reminders-and-nudges/index.md

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+---
+title: August User Research - Unhappy paths, reminders and nudges
+description: Highlighting findings from the user research sessions conducted on unhappy paths, reminders and nudges.
+date: 2025-08-31
+tags:
+  - hpv self testing
+  - cervical screening
+  - user research
+  - screening
+author:
+  - Chrissie Bradley
+---
+
+[[toc]]
+
+## Research aims
+
+- To better understand user perceptions of reminder and nudge content within the digital journey for HPV self-testing.
+- To assess how effective reminder messaging is in encouraging users to complete their self-testing kit.
+- To explore how different user groups interpret and respond to reminder content, particularly in relation to motivation, awareness, and perceived relevance.
+
+## Hypothesis
+
+- Non-responders to cervical screening will be resistant to repeated reminders and may respond negatively to reminder content.
+- Reminder (nudge) content will be more effective for users who already understand the benefits of cervical screening, while those who are less engaged, time-poor, or lack awareness may be less likely to act on it.
+
+## Recruitment
+
+We had 5 participants in total. All participants met our definition of a non-responder, meaning they had not attended cervical screening for 10 years or more.
+
+Participants were recruited via:
+
+- Leeds City Medical Practice, where a text message (created by the team) was sent to patients identified as non-responders to cervical screening.
+- The Primary Care Network associated with Leeds City Medical Practice, which extended the reach of the recruitment message to approximately 48,000 patients.
+- Initial interest was received from 56 potential participants following the outreach.
+- Working with local healthcare providers helped ensure access to participants from diverse communities, including those with English as a second language and those experiencing economic deprivation in the Leeds area.
+
+## Participant breakdown
+
+Out of 5 participants:
+
+### Ethnicity
+
+- Asian/British Indian - 20%
+- Asian/British Pakistani - 20%
+- Black/British Caribbean - 20%
+- White British, Irish - 20%
+- Another white background, Romanian - 20%
+
+### Previous screening attendance
+
+- Never attended - 60%
+- Has attended some - 40%
+
+### Disability or condition
+
+- Neurodivergent (such as Austism, Dyspraxia, Dyslexia, ADHD) - 20%
+- Polycystic Ovary Syndrome (PCOS) - 20%
+- Vaginisimus - 20%
+
+### Age
+
+- 25 to 34 - 20%
+- 35 to 44 - 60%
+- 55 to 64 - 20%
+
+### Gender
+
+All participants identified as female
+
+### Sexuality
+
+- Heterosexual - 80%
+- Prefer not to say - 20%
+
+## Research methodology
+
+**Prototypes:** HTML prototypes (reminder and nudge communications, error screens)
+**Device:** iPhone SE
+**Where:** In person, User Research Lab in Leeds (central location near Leeds City Medical Practice)
+**Length:** 1 hour
+
+Participants were given scenario-based tasks to reflect realistic interactions with the HPV self-testing service.
+
+We tested the following journey points:
+
+- Letter invitation to take part in HPV self-testing
+- Reminder (second invitation, sent 28 days after initial invite)
+- 1st nudge (24 hours after starting but not completing the journey)
+- 3rd nudge (72 hours after receiving the kit, prompting sample return)
+- Error screens
+
+## Research findings
+
+### Invitation (letter)
+
+![The invitation letter shown to participants, detailing that they are being invited to complete a HPV test at home. It explains what HPV is, why the participant is being invited, what HPV self-testing is, how to order a kit, why HPV testing matters, how the participant will get their results, other ways the participant can get tested and how to order a kit via telephone.](letter-invitation.png)
+
+Most participants had questions after reading the letter invitation.
+
+4 out of 5 participants raised queries, particularly around whether HPV self-testing replaces traditional cervical screening.
+
+This aligns with previous findings, where participants with conditions such as vaginismus or vaginal atrophy want clarity upfront on whether traditional screening will still be required. For these users, cervical screening can be physically painful and emotionally distressing.
+
+There were also concerns about the effectiveness of the test.
+
+Although many participants had not attended screening, they were broadly aware of the traditional process and questioned whether outcomes would be comparable, particularly for detecting high-risk HPV.
+
+When questions were unanswered, most participants said they would search online for more information.
+
+### Reminder (second invitation)
+
+![The NHS app reminder shown to participants. It explains that the participant was recently invited to to a HPV test at home, but that they haven't ordered a kit yet. There are further details on why the participant is being invited, what HPV self testing is, what HPV is, how the test works, how to get your results and other ways to get tested.](app-reminder.png) ![The SMS reminder shown to participants. It explains that the participant was recently invited to to a HPV test at home, but that they haven't ordered a kit yet. There are further brief details on why the participant is being invited, what HPV self testing is, how the test works and how to order a kit.](sms-reminder.png) ![The email reminder shown to participants. It explains that the participant was recently invited to to a HPV test at home, but that they haven't ordered a kit yet. There are further details on why the participant is being invited, what HPV self testing is, what HPV is, how the test works, how to get your results and other ways to get tested.](email-reminder.png)
+
+![The reminder letter shown to participants, detailing that they haven't yet ordered a kit to complete a HPV test at home. It explains what HPV is, why the participant is being invited, what HPV self-testing is, how to order a kit, why HPV testing matters, how the participant will get their results, other ways the participant can get tested and how to order a kit via telephone.](letter-reminder.png)
+
+Participants responded positively to reminder messages.
+
+All participants said they would be willing to engage with a text message reminder, particularly when told it would be sent alongside an email.
+
+This is an improvement on previous rounds, where SMS invitations were often perceived as scams.
+
+Participants expected reminders to be timely:
+
+-	all participants felt a reminder within a week would be appropriate
+-	delays longer than this risk users forgetting due to busy lifestyles
+
+### Nudge to complete order
+
+![The NHS app nudge message shown to participants, explaining that they started an order for an HPV self testing kit, but haven't completed it yet. It also provides a link for them to order a kit.](app-nudge-to-complete.png) ![The SMS nudge message shown to participants, explaining that they started an order for an HPV self testing kit, but haven't completed it yet. It also provides a link for them to order a kit.](sms-nudge-to-complete.png)
+
+Participants found nudge messages clear and easy to understand.
+
+All participants noted the shorter format compared to reminders and appreciated that it could be quickly scanned.
+
+2 participants said they would complete their order immediately after receiving the nudge.
+
+However, some participants wanted additional support:
+
+- 1 participant wanted more information to create a sense of urgency
+-	2 participants suggested including a link to provide feedback or explain why they had not completed the order
+-	1 participant wanted the option to opt out at this stage
+
+### Nudge to return sample
+
+![The NHS app nudge message shown to participants, explaining that they were sent an HPV self testing kit but it hasn't been returned yet. It asks participants to return the kit as soon as they can, and explains that if the participant has already sent it then they don't need to do anything else. There is also a contact phone number if the participant requires help.](app-nudge-to-return.png) ![The SMS nudge message shown to participants, explaining that they were sent an HPV self testing kit but it hasn't been returned yet. It asks participants to return the kit as soon as they can, and explains that if the participant has already sent it then they don't need to do anything else. There is also a contact phone number if the participant requires help.](sms-nudge-to-return.png)
+
+Participants understood the purpose of the reminder to return their sample after receiving the kit.
+
+The timing (72 hours after kit receipt) was generally considered appropriate, though some participants indicated that flexibility or additional reminders may be helpful depending on personal circumstances.
+
+### Error screens
+
+![The NHS app error message shown to participants who have already ordered a kit. It explains that the participant can not order another kit because they have already ordered one. It also provides a contact phone number if the participant believes this to be incorrect.](app-error-already-ordered.png) ![The NHS app error message shown to participants who have not been invited to take part in HPV self testing. It explains that the service is being tested with a small number of people, and can only be used by those who have been invited. It also explains that anybody who has recently attended a cervical screening appointment is not eligible for this service. There is some information on what to do if the participant thinks this information is incorrect, as well as some guidance that HPV self testing is not recommended whilst pregnant.](app-error-cant-use-service.png)
+
+![The NHS app error message shown to participants when the service is unavailable. It explains that the participant is currently not able to order a kit, and to try again later or speak to their GP](app-error-service-unavailable.png) ![The NHS app error message shown to participants who are having issues with their internet connection. It advises the participant to try using WiFi or to move to a place with a better connection. It advises users to call 1 1 1 if they still cannot connect to the internet and need urgent medical advice](app-error-internet-connection.png)
+
+Error screens were included in testing to assess clarity and recovery.
+
+Participants were generally able to understand when an error had occurred, but clearer guidance on next steps would improve usability and reduce friction in completing the journey.
+
+## Recommendations
+
+In the invitation, clarify whether HPV self-testing replaces cervical screening.
+
+Users need clear, upfront information on whether self-testing is an alternative or part of a wider screening pathway. 
+
+Include clearer information on how HPV self-testing works, its reliability, and how it compares to traditional screening. This will help build trust and support informed decision-making.
+
+Participants expected reminders sooner than 28 days. Testing earlier reminders (for example within 7 days) may reduce drop-off and improve completion rates.
+
+Enhance nudge content with optional support: 
+
+-	additional context to encourage action
+-	a way to provide feedback on why they have not completed the journey
+-	a clear opt-out option
+
+Sending SMS alongside email increases trust and engagement. Maintaining consistency across channels will help reduce perceptions of messages being scams.
+
+Error screens should provide clearer guidance on what went wrong and how users can resolve the issue to continue their journey.
+
+## What's next
+
+We will take forward updates to invitation, reminder and nudge content based on these findings, focusing on clarity around screening pathways and test accuracy.
+
+Reminder timing will be further tested during Private Beta to assess the impact on engagement and drop-off rates.
+
+Additional support options, such as feedback mechanisms and opt-out journeys, will be explored and validated in future testing.
+
+We will continue working with content and clinical stakeholders to ensure messaging is accurate, consistent and meets user needs.
+
+Further rounds of research will include a broader range of participants to validate findings at scale and ensure the service works for diverse user groups.