Inclusive content: sex, gender and sexuality

sarawilcox commented 5 years ago

From February 2022, please use this issue to discuss the inclusive content page about sex, gender and sexuality in the service manual.

This issue and the web page are about the language around sex, gender and sexuality. However, this is a changing area and we are reviewing our guidance.

If you are looking for information about asking questions about sex or gender for general demographic data, we recommend using the GOV.UK equality pattern.

If you need to ask users about sex or gender for an operational reason:

for PDS matching, we recommend using the latest PDS FIHR API, which allows you to match patients without asking about sex
for a clinical or other operational reason - we do not yet have clear guidance on this, though there are teams working on it

The content below dates back to August 2020.

For GitHub training 15 August On the inclusive language page: https://service-manual.nhs.uk/content/inclusive-language Add a heading “Gender neutral language” above: “We do not label people with their gender identity or sexuality”.

Below the example “You should see your GP...”, please add the following heading and paragraphs.

Add an H3 heading: When to use "sex" and when to use "gender"

Then this text: [START]

Sex is biological – male, female or intersex.

We use "sex" or, better still, the body part associated with biological sex when we're writing about things like screening that is sex specific, for example, breast and cervical screening.

Gender is more complex. It’s about social and legal status and social expectations. It’s also about how people feel and think about themselves.

Someone may see themselves as a man, a woman or neither (non-binary). They may identify with a gender opposite to the sex they were assigned at birth or neither.

We use “gender” when we’re:

discussing the social idea or identity as opposed to the biological sex, for example, if we're writing about gender dysphoria or transgender writing about a survey or report based on gender, such as gender and professions [END]

[Agreed at July 2019 Style Council meeting. See issue #60 ]

sarawilcox commented 5 years ago

Updated. This should go live next week.

henocookie commented 3 years ago

Note also these comments noted by @sarawilcox, copied over from this ticket: #140, which I'm now closing.

Content under heading for Gender and sexuality

On inclusive language page: https://service-manual.nhs.uk/content/inclusive-language

Under heading for Gender and sexuality, where we say: “We make content gender neutral wherever possible”, please add: "Only mention sex, gender or sexuality if relevant. Avoid gender markers, such as Mr, Miss, Mrs, Ms."

Also, add an H3 heading “Gender neutral language” above: “We do not label people with their gender identity or sexuality”.

[Agreed at July Style Council meeting. See #60.]

henocookie commented 3 years ago

Note also these comments noted by @sarawilcox, copied over from this ticket: #141, which I'm now closing.

On inclusive language page: https://service-manual.nhs.uk/content/inclusive-language

where we have this paragraph and bullet list:

"We do not label people with their gender identity or sexuality. Instead we say:

trans woman or trans man trans and non-binary people lesbian woman gay man men who have sex with men" Please replace it with the following paragraphs:

"We do not label people with their gender identity or sexuality. Instead we say:

trans woman trans man trans lesbian woman gay man men who have sex with men We use "trans woman" for someone who was assigned male at birth. We use "trans man" for someone who was assigned female at birth.

We use “trans woman” or “trans man” in content about the particular health needs of trans people - for example, screening or treatments that trans people need to be aware of, like advising a trans man about cervical and breast screening.

Otherwise we use “trans” as an umbrella term to cover the diverse range of identities outside the traditional male/female definitions. These include transgender, gender fluid and non-binary."

[Agreed at July Style Council meeting. See #60.]

henocookie commented 3 years ago

Note also these comments noted by @ericlamarca and @sarawilcox , copied over from this ticket: #60, which I'm now closing.

@ericlamarca commented on 10 Apr 2019

Latest

Do we use "people with a cervix", "people with a prostate"?

Already dealt with

Some people have raised questions about the age section on the Inclusive language page of the content style guide.

For example:

embryo: from 2 to 9 weeks
unborn baby: from week 10 to birth
infant: under 2 years
toddler: 1 to 3 year
older person: 60 to 70 years
elderly person: over 70 years

Do these reflect our latest thinking?

@sarawilcox commented on 10 Apr 2019

We've got someone reviewing the Inclusive language page. Hopefully it'll come to the content Style Council meeting at the end of May.

@sarawilcox commented on 6 Aug 2019

We're making final changes to agree proposals following the July Style Council meeting.

@sarawilcox commented on 14 Aug 2019

We have clinical approval. The outcomes of this ticket have been captured in the above tickets. We'll make the changes as part of the 15 August GitHub training. Now closing this issue.

@sarawilcox commented on 14 Aug 2019

We're taking the last bit of 'Age' forward in the ticket for fetus and baby: #136

@sarawilcox commented on 6 Sep 2019

We need to review the page in the light of recent feedback, including comments on Twitter. To come back to the October 2019 Style Council meeting?

@sarawilcox commented on 15 Nov 2019

Revised content to be discussed at November 2019 Style Council meeting.

@sarawilcox commented on 7 Jan

Consulted on revised content. Approved at November Style Council meeting, with clinical approval. Now published in style guide: https://beta.nhs.uk/service-manual/content/inclusive-language

henocookie commented 3 years ago

Note also these comments noted by @sarawilcox, copied over from this ticket: #139, which I'm now closing.

On inclusive language page: https://beta.nhs.uk/service-manual/content/inclusive-language

Change <h2>Gender and sexuality</h2> to <h2>Sex, gender and sexuality</h2>

[Agreed at July Style Council meeting. See #60.]

henocookie commented 3 years ago

Ask users for gender or sex #185 will likely need reviewing from a content perspective, to ensure it is an inclusive pattern when asking users about gender or sex.

mcheung-nhs commented 3 years ago

A recent inclusion survey by NHS Digital for the staff had this question for gender identity: gender-identity

Zeno001 commented 3 years ago

Male and female are the terms for the two sexes: why on earth use them for 'gender identity' and why are they collecting information on 'gender identity' anyway? What information do they think they are capturing and for what purpose? If it's an inclusion survey, surely the important factor is to determine whether they are unlawfully discriminating - and that is dependent on the protected characteristics in the Equality Act 2010. Sex is a protected characteristic but 'gender identity' is not.

sarawilcox commented 2 years ago

Some feedback on this page:

You fail to draw a distinction between the terms sexuality and sexual orientation, terms that are often used, incorrectly and interchangeably. In fact, you provide a definition of sexuality which is actually the definition of sexual orientation: http://www.differencebetween.net/language/difference-between-sexuality-and-sexual-orientation/

iaincamerononeill commented 1 year ago

The CRM we are collecting data for has Title as a required field. Of course we are going to ask for it to not be a required field but until then, I might be a good idea to include some options for title that allow people more choices, as well as an opt-out for those who prefer not to gender themselves.

Cllr Dr Hon Master Miss Mr Mrs Ms Mx Prof. Sir Prefer not to say

sarawilcox commented 1 year ago

We're sometimes asked for up to date guidance on gender-inclusive language. It is something that the NHS website team is looking into. We’ve done some user research but haven’t yet firmed up our position.

What the service manual does say at the moment is that:

we address the user as “you”
we make content gender neutral as far as possible
we only mention sex, gender or sexuality if they’re relevant

The teams we’re in touch with tend to approach the issues around gender-inclusive content with a mix of the following, depending on the content or context:

gender-neutral language (e.g. “you”)
additive language (e.g. “women and people with a cervix”)
gender-specific language (e.g. “men” when quoting statistics which the research was about “men”)
community specific language (e.g. content aimed specifically at trans and non-binary communities)

In the absence of clear guidance, we're asking teams to test their content with their audience and take an appropriate approach depending on their user research findings.

We’d be very interested to hear what you find.

sarawilcox commented 1 year ago

The CRM we are collecting data for has Title as a required field. Of course we are going to ask for it to not be a required field but until then, I might be a good idea to include some options for title that allow people more choices, as well as an opt-out for those who prefer not to gender themselves.

Cllr Dr Hon Master Miss Mr Mrs Ms Mx Prof. Sir Prefer not to say

Hi @iaincamerononeill, yes, we'd suggest following the GOV.UK guidance on names. It says:

Avoid asking for a person’s title

Avoid asking users for their title.

It’s extra work for them and you’re asking them to potentially reveal their gender and marital status, which they may not want to do.

It’s also hard to predict the range of titles your users will have. If you have to ask for someone’s title, use an optional text input not a select.

Remember to correctly use people’s names in any resulting correspondence.

iaincamerononeill commented 1 year ago

Thanks, that clarifies things nicely.

Best, Iain

On Thu, 2 Feb 2023, 16:22 Sara Wilcox, @.***> wrote:

The CRM we are collecting data for has Title as a required field. Of course we are going to ask for it to not be a required field but until then, I might be a good idea to include some options for title that allow people more choices, as well as an opt-out for those who prefer not to gender themselves.

Cllr Dr Hon Master Miss Mr Mrs Ms Mx Prof. Sir Prefer not to say

Hi @iaincamerononeill https://github.com/iaincamerononeill, yes, we'd suggest following the GOV.UK guidance on names https://design-system.service.gov.uk/patterns/names/. It says:

Avoid asking for a person’s title

Avoid asking users for their title.

It’s extra work for them and you’re asking them to potentially reveal their gender and marital status, which they may not want to do.

It’s also hard to predict the range of titles your users will have. If you have to ask for someone’s title, use an optional text input https://design-system.service.gov.uk/components/text-input/ not a select https://design-system.service.gov.uk/components/select/.

Remember to correctly use people’s names in any resulting correspondence.

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Alice-Pearson commented 1 year ago

Findings from user testing of content about HRT that addressed the user as "you":

Users did not comment on lack of gendered language.
Users did not identify any blockers or issues for them in the language used.
Users were able to state who the content was aimed at, and were confident that it was aimed at them.

drpaulatkinson commented 1 year ago

Has anyone looked at this from the perspective of GP Patient Registration? At the moment we ask for a salutation and then go to ask for gender and sex assigned at Birth.

Also, there is NHSE guidance that seems to suggest we should be asking about gender at every face-to-face interaction:

https://www.england.nhs.uk/wp-content/uploads/2017/10/implementation-guidance-fundamental-standard-for-sexual-orientation-monitoring.pdf

Zeno001 commented 1 year ago

Do you have a spec or a screenshot of the GP Patient Registration form, @drpaulatkinson?

nhsuk / nhsuk-service-manual-community-backlog