Tell users about content updates - "Page updated"

[sarawilcox]

What

A pattern to let users know about recent changes to a page that they may be interested in. It is designed to reassure them that they are looking at up to date information.

Why

We've been using "Page updated" in the service manual. When we launched the service manual a couple of years ago, our user research suggested that people find it helpful to know when something has been changed on a page. It reassures them to see a recent date. In the service manual, we placed the date at the bottom of the page, following the style of the review date which is used on the NHS website.

Related pattern

This pattern may sit alongside the Review date pattern, which lets users know when whole page was last checked and will be checked again. It is designed to reassure users that the information as a whole is accurate and up to date.

More information

In the service manual, we don't explain on the page what the change is but users can find this information in the What's new section or changelog. We could do with testing further whether this works for users.

We have seen some interest in this pattern from the medicines team.

Some GOV.UK pages provide more information in context - see examples below.

Also GDS has a GitHub issue for showing text changes. Some examples highlight new and important updates that users need to be aware of.

[sarawilcox]

(Originally posted on the GitHub issue for review dates in November 2020.)

We say this about the review date in the design system: "The dates should show when we last reviewed the page and when we will review it again."

In a content huddle this afternoon, we talked about how we use them, for example, when we've made minor but important clinical changes between review times.

We could do with:

• finding out what users think about review dates, including checking for service desk tickets
• rethinking how we use them

We also have some related functionality in our syndication features that covers other updates.

See NICE CKS updates

See also GOV.UK update approach

[sarawilcox]

(Reply from @KarinMochan, originally posted on the review date GitHub issue in November 2020. Karin, have your team thought any further about this?)

In reply to @sarawilcox [@ameliaengland @KarinMochan Would you mind adding a bit more info about what you've been considering here, please? With a screenshot of the GOV.UK approach?]

How do we let people know when key bits of info/advice have changed?

Here on the Meds A to Z, the pregnancy and breastfeeding advice for azathioprine has been completely re-written, following feedback from an expert forum run by the MHRA. We were contacted by a professor who said a patient was refusing to take this medicine in pregnancy, against their doctor's orders, because of what they had read on our page.

However, we have not reviewed the full page and so the review dates (at the bottom of the page) remain as they were. How would a returning visitor know that the pregnancy information has changed?

Is there a case for adding a new field to say "last updated" with the option to add a brief description of what changed?

On Gov.uk pages, there is the option to record updates. I attach a screengrab.

[sarawilcox]

BMJ example

[sarawilcox]

Another GOV.UK example with more info about the nature of the update:

[ameliaengland]

Hi Sara - as Karin mentions, the gov.uk example is exactly what we've been looking at. To have the ability to add details about updates would add a lot of value to our pages and let users know that we are responding to updates from MHRA and others.

We haven't done much else about it yet as aware this would need to be a site-wide change.

[sarawilcox]

Thanks @ameliaengland. Have you tested any designs with users or seen that users want this info?

[sarawilcox]

Another way to deal with updates

Some recent examples of updates on NHS website pages: I had a chat with @Alice-Pearson, who may be able to share more info after talking with the meds team.

[Alice-Pearson]

I've checked with the rest of the current Medicines team, but there hasn't been any more work or discussion on this in the last 12 months, or any user testing about dates. The original issue (showing users that pregnancy information has changed) is now less important because we are doing pregnancy updates as part of 3 year reviews, so the review date is changed when the medicine is updated. However we do sometimes need to update medicines pages between reviews for changes such as MHRA updates, and currently there's nothing to show users that there's been a change.

[Alice-Pearson]

We have used "updated" dates on warning callouts, as in the examples above, for time-sensitive updates such as a medicine being temporarily unavailable, but this only works for updates that don't need to be integrated into the text.

[sarawilcox]

Updates info is probably most useful when it tells users what's changed.

[sarawilcox]

This came up as an issue in a meeting between clinicians and the senior content team at NHS.UK. We're going to investigate this issue (including the user need for it) and to look at the options for adding a last updated date.

Probably for clinical content (and policy changes?) but not changes to links or typos.

I'm going to check feedback we've received on the issue and will set up a small group to take it forward.

Two issues to consider:

• whether clinicians will need to sign off the wording of update info as well as the change
• whether this will have an impact on working practice and resourcing and how

[sarawilcox]

GOV.UK example: Living safely with respiratory infections, including COVID-19

With a jump link to more detail at the bottom of the page:

[sarawilcox]

From NHS.UK Slack:

On GOV.UK, any publicly relevant updates required a 'change note' which featured in a notification to users with relevant subscriptions (using Notify), as well as appearing at the bottom of the page. The GOV.UK CMS (Whitehall Publisher) also accommodated internal 'comments' for minor updates that didn't trigger any change on the front-end.

GDS use the same approach for updating the GOV.UK content design guidance. The change notes usually contain hyperlinks direct to the relevant section of the manual.

The NHS.UK Platforms teams has found research evidence to say that there is a need for review dates, but also that there is an additional need for ‘updated’ notification on specific documents within a page.

[sarawilcox]

An example from NHS Digital's website.

[sarawilcox]

Some info re the GOV.UK service manual template. Originally it had a 'Last updated' date at both the top and bottom of the page. The team removed the date at the top because some users were discounting the info because it was 'old' (and this wasn't time sensitive info).

[jackiemellorbrownlee]

Here's some research from our service

This page https://digital.nhs.uk/services/registration-authorities-and-smartcards is the central resource area for Registration Authority managers and Registration Authority agents. It’s their job to grant, maintain and remove access to clinical data , for users who authenticate via Care Identity Service.

We’ve done about a dozen contextual interviews and some targeted 5-user testing about how RAs become aware, prepare for, use and leave our service, and this page is central to aware/prepare.

They come back to the website again and again ‘to keep up to date’ - not just about RA but about multiple things. Here’s the feedback when we showed them digital.nhs.net and asked how they use the website as a whole, from the 5 users we zoomed in on with our Aware/Prepare questions

General website I do like it and use it Often go on to look at guidance Covid virtual route for guidance - making sure its correct per national policy Colleague noticed that someone has added address in the policy - that we should be capturing address information, and it hasn’t been communicated

Pharmacy Summary Care Record Right to Work rules Yes - website used in conjunction with the pharmacy work And for SCR rules & get more clarity about the rules that change often Used recently in conjunction with government website re remote appointments - had something through re 17 May, but then heard it had been pushed back to June 17 The May date came from the internal recruitment team - Right to work checks - not through these channels on the websites - maybe conversation / email from manager. Confirmed with recruitment team from gov website

RA & Smartcards page We need to know if there are any changes to the NHS identity checks policy BUT don’t always get told - we have to check ourselves Go in quite often - every couple of days

General website Yes - various pages …Would look at it to keep up to date

General website If there is anything I’m not sure of, just to see if there is any information

This seems to indicate the following:

• Users are returning a common set of digital.nhs.net service pages. Those pages aren’t necessarily linked from an nhsd perspective, but from the user perspective they are all connected by the task ‘give user access to data’
• Users return often to those pages, to check whether policy or guidance has changed
• Users proactively search large documents or blocks of content to see if it has changed

Recommendations would be:

• Add a date indicator to individual blocks of content or documents
• Say what has changed, as well as when it changed
• When communicating change with users, think about how they might need to view changes by job role / theme, and not just individual services e.g. RAs are involved in onboarding, information governance and IT, which all combine to give the right person the right access to the right data at the right time

[sarawilcox]

A review of NHS website service desk tickets since November 2021 (about 6 months)

Area of site | Number of service desk tickets Health A to Z | 6 Coronavirus | 5 Service profiles | 4 Mental health | 1 Medicines | 1 Total | 17

It’s clear that some users do look for review dates and notice when we miss them. Some know about recent research, policy or other changes that we haven’t referred to. For example, that some medicines are no longer prescription-only in some strengths.

Some people say:

• outdated information undermines trust
• they will not use our page while the information is outdated
• outdated information undermines patient choice

Some users appear to be:

• expert patients (e.g. in fibromyalgia)
• people who work with information (librarians or academics)
• professional staff who follow policy or evidence changes

But not all users appear to fall into these groups. It seems that not all users have a particular interest in the topic or high levels of literacy.

There is a particular issue with rapidly changing topics like COVID information, where people are monitoring research or policy changes.

There also seems to be an issue with information supplied by other organisations or systems. For example, surgery details where we quote opening times “last updated 2011”. (We have seen, in viewer side of the NHS Profile Manager, that “Last updated” has tested well, where participants knew that “last updated” meant the last date that a particular piece of information had been updated.)

[sarawilcox]

Example from an NHS Profile services page.

[sarawilcox]

See this NHSX page which was updated a number of times in 2021: https://www.nhsx.nhs.uk/digitise-connect-transform/unified-tech-fund/unified-tech-fund-prospectus/#version-history. Users needed to know about changes to existing funds or about new funds being added.

[sarawilcox]

Some more comments from users about review dates and updates - from NHS.UK survey data:

Condition pages:

• [Gender dysphoria] "The page did seem a little outdated but the review date (April 2019, viewing July 2019) gives me confidence that this may be improved soon."
• [UTIs] "The page relating to recurrent UTIs in children is slightly past its specified review date"
• [Phlebitis] What could be improved? "Maybe dates alongside the health information as to when last updated."
• [Temperature in children] Ex-nurse: What could be improved? "Perhaps more regularly update the pages. Things seem to change regularly with regard to information on children so 3 years between updates is a bit too long."
• [Coughs] "Update coronavirus symptom information. It is out of date for over a year. The lack of updates means I cannot trust any of the information here. It is either incompetence of the service or political interference."
• [PCOS] "Abide by review by dates. This page was meant to be reviewed 01 Feb 2022, however the page says it was last reviewed on 01 Feb 2019."
• [Kidney stones]: "It was good to see the dates when info provided would be reviewed. Very reassuring."
• [Diarrhoea and vomiting] - "The advice was not high quality and totally up to date. For instance it advised .... However there is evidence that .... This felt like very out of date advice therefore. Review all your health advice at least annually."

Medicines pages:

• "I saw that the information is a year old and things may have changed since then. The info itself was very clear...I'm just not sure how often the site is updated [What could be improved?] Making dates clear, or when the info is next up for review."

Baby development:

• "I like that there’s dates for when content was last updated and will next be updated."

Prescription charges:

• "I was unsure as to how up-to-date the information on the website was as the topic had last been reviewed on 4/3/20 with the next review date being 4/3/23. My query was today 20/4/22. I presume the information would have been updated since 4/3/20 if there had been any relevant change in the information. Maybe a note stating as much could be made alongside the review dates to make it clearer for the public."

Travel vaccinations:

• "Update sooner, seems there was meant to be a review on the page i visiting in December 2021 so it is out of date."

URL unknown:

• "There is always room for improvement but it is up to the health service to keep reviewing their sites with dates of the reviews."
• "More reassurance that information is correct and up to date. Page had not been reviewed for over a year and was not due to be reviewed for 2 more years, makes you wonder if there is more up to date info out there."

[sarawilcox]

An example from the Campaign Resource Centre

[sarawilcox]

We had some feedback from a service manual user that it would help them if we had on-page information about latest updates to the page.