Eligibility - how we write about it

[carolinefinucane864]

For example, eligibility for a service (free COVID tests), or for an NHS treatment. We talk about this in many services and pages.

I believe this is how the COVID Pass letter mentions it:

...but the word 'eligibility' can be avoided altogether on start pages by doing it like this:

However, in the COVID Testing service we find it's a hard word to avoid as we need to say things like "You are not eligible for this service". I'm not sure there is a good alternative - eg 'suitable' isn't quite right. And policy teams often insist on using this word. GOV.UK use the word a lot in their services.

In which case, can we develop some rules around this - for example, use the word 'eligible' sparingly (eg only in the heading) and then use simple terms to follow. And/or do we define it in brackets? And perhaps we avoid 'eligibility' altogether.

Do we have any insight re people's understanding of this word?

Would welcome views and good examples!

Related to: Start page pattern

[sarawilcox]

The term "eligibility" does seem to be widely used on GOV.UK: https://www.gov.uk/search/all?keywords=eligibility&order=relevance.

[sarawilcox]

This is the approach we took on the NHS Get a coronavirus test start page back in 2020 - tested and iterated.

[laura-hajba]

Some notes from recent transactional services on NHS.UK:

On a few of the transactional services we worked on more recently we've said things like "You can use this service if:" with a bulleted list.

Find your NHS number Find your NHS number still has this type of message (minus the bullets): https://www.nhs.uk/nhs-services/online-services/find-nhs-number/

Get a shielding note

Exit screen text: [No screen] [H1] You cannot get a shielding note

You can only get a shielding note if all of these apply:

• you’re at high risk from coronavirus – you received a letter from the NHS saying you’re high risk
• you work in an area where shielding advice is in place, but live outside this area
• you cannot work from home or in an area where there’s no shielding advice in place
• you live in England

If you live and work in an area where shielding advice is in place, you will get an email or letter telling you if you need to shield. You can use this to get Statutory Sick Pay (SSP) or Employment and Support Allowance (ESA).

[Inset text box] If you’re not sure if this applies to you, speak to your GP surgery, your employer or visit GOV.UK to find out which areas have local restrictions (link opens in a new window).

[terrysimpson99]

The Plain English Campaign gives alternate words for 'eligible': http://www.plainenglish.co.uk/the-a-z-of-alternative-words.html

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eligible allowed, qualified

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[sarawilcox]

Here's the COVID-19 vitamin D service from January 2021.

[carolinefinucane864]

Would love to see some examples of 'exit pages' explaining why ppl are not allowed to use the service (with insight).

[emma-cuthbert]

Most of our users (Apply for a National Insurance number) don't have English as their first language; many don't have it as their second language.

'Eligible' and especially 'eligibility' tested poorly with users whose English wasn't fluent. 'Who can apply' and 'Who cannot apply' tested better.

[sarawilcox]

The GDS pattern for Checking a service is suitable uses "eligible": https://design-system.service.gov.uk/patterns/check-a-service-is-suitable/. With a blog post: We've published the check before you start pattern. It would be good to know from GOV.UK services whether they've tested "eligible" and what they've found.

[sarawilcox]

I was checking some GOV.UK benefits pages a while back and they use the word "eligibility", e.g. on this PIP page: https://www.gov.uk/pip/eligibility or the Attendance Allowance page: https://www.gov.uk/attendance-allowance/eligibility. It seems to be a standard section in benefits content which I imagine is well tested. But they do explain "You can get it if"...

Note, in our learning disabilities topic, we updated it to: 'Who can have' or 'Who can get'. That was in response to stakeholder group request as people did not understand the term 'eligible'.

[jasonprice2]

I have a few small insights from testing the National Booking Service (COVID vaccine booking). This probably won't be that helpful for every other service given the nature of eligibility for the COVID vaccine, but I thought it was worth sharing!

The eligibility criteria during the vaccine rollout was extremely complex and often changing on a daily/weekly basis. The service was reliant on user's records being correct and up to date. Given the urgency and complexity, many users were also trying to book 'early' when they were not yet eligible.

We found that telling users on our exit pages that they 'were not eligible' caused a lot of anxiety and anger - especially in users who were eligible, but unable to book using the service. This could be because:

• they were trying to book too early
• their vaccine record was not up to date
• a system error
• an error with their personal details, such as DOB
• their cohort was unable to booking using NBS, but was eligible for the vaccine

We also had to ensure that we were not giving away any personal information about a user's vaccination status in the information we were providing - to avoid making it easy for other users to look up people they knew and check their history. So we often couldn't tell users exactly what the problem was, even if we knew.

All this is to say that we changed the heading of 'you are not eligible' to 'you are not currently able to book using this service'. Eligibility for the vaccine did not always align with who could actually use the service and book a vaccine, or it may not be the user's fault that they can't book and could lead to putting them off getting the vaccine.

I've attached a screenshot with the exit page I'm talking about, although the content on it changed frequently as the rollout continued.

[carolinefinucane864]

Thanks all. Insights from the COVID Testing transactional service:

1. Generally, users want to know if they are eligible before they start the journey, even if the journey has screening questions to check their eligibility. They don't expect to answer lots of questions only to be thrown out of the journey b/c they're not eligible and were not told this upfront.
2. However, users do not read lots of content on start pages - so the 'who can use it' bit must be high up and concise (use bullets?)
3. Good to have filter questions in the service to 'do the hard work for the user', but hard stops/exit pages can cause anxiety and burden GPs if not helpful (eg written in the right tone, with a useful link guiding the user elsewhere and away from GPs)
4. Take care with start page headings, especially for services that are no longer widely available. People do not expect to suddenly not be eligible for the service when they once were. For example, "Get a free PCR test" is misleading when the majority now cannot do this, even when you qualify it with a line about who can use the service.
5. Avoid using any vague 'summary lines' on start pages such as "You might be able to [use this service]" - you may be saving on words, but it's not helpful
6. We know 'eligible' is not understood by some users - best to use 'who can apply/who can use this service', 'you can only use this service if...' and to experiment with "not qualified" or "not allowed" (more research needed on the latter!)

[emma-cuthbert]

@carolinefinucane864 - The first two of your insights definitely also apply to the Apply for a National Insurance number service:

1. Users want to know if they're eligible before they apply, even though our service has lots of screening questions. (We are not allowed by policy to prevent users for applying for a NINo, although we can use what they tell us in the screening questions as reasons to refuse their application)

2. Most users don't read most of the content on gov.uk:

   • Bullets and a small number of headings are useful.
   • Using too many headings / bullets means the user doesn't know what to focus on and may miss key information.
   • Including a heading with words they don't understand (e.g. 'eligibility') turns users off and increases the likelihood of them scrolling to find a green button to click.

[terrysimpson99]

Very interesting discussion. In user research sessions, I've seen participants receive an incorrect answer for eligibility (possibly due to poor questions). It's always considering that definitive statements to a user about eligibility might actually be wrong. That's painful for the user and can damage the reputation of government. One way to mitigate that is to be slightly less definitive in the message such as 'Based on your answers....'

[MaxineClayman]

On the who can use the NHS App page we talk about eligibility more in terms of who can/ cannot have an account/use the app/access services https://www.nhs.uk/nhs-app/nhs-app-help-and-support/getting-started-with-the-nhs-app/who-can-use-the-nhs-app

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[carolinefinucane864]

Thanks all. To summarise so far then:

GOV.UK use the word 'eligible' throughout their services but this is not understood by all users (and can sometimes cause anxiety/anger).

The word probably should, and can, be avoided. I haven't yet any findings from GDS which support use of this term.

This is how we can avoid it:

• On start pages, try "You can [use this service/ask for a test/apply] if - [bullets]"
• On exit pages, try (h1) "You cannot [use this/get this]; followed by (h2) "You can only [xxx] if: [bullets]"
• On exit pages, soften with 'Based on your answers' - if we kick people out when we shouldn't have, this is less definitive
• Experiment with plain English alternatives when necessary (allowed, qualified)

Still not resolved:

At the start of a digital service, how do we present complex eligibility rules, which vary according to nation and change frequently?

It would be too much content writing it out on the start page using the 'you can' approach - people ignore it/don't read.

For example - in England, you're only eligible for a test if you have symptoms or otherwise in 3 very specific asymptomatic scenarios (eg you work for an NHS commissioned h/c provider); it differs for Scotland, and again for Northern Ireland.

The service deals with this using filter questions, but we know users want some sort of heads up on whether they can use the service before they start the journey.

Can we, for example, experiment with interaction design or borrow a pattern to present this in a clear, succinct and prominent way?

Another idea: could we use an interruption card early on in the journey to flag eligibility, to relieve the burden on the start page?

Do we need an equivalent card in the 'design' thread of this community?

Please do comment if you can help with this outstanding issue, or if there's more to contribute generally.

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NB - Why it's important we get this right

• causes anxiety/stress/anger/confusion
• results in users calling their GP
• affects demand/supply of product being restricted

[sarawilcox]

A recent screenshot of "eligibility criteria" from the NHS.UK Tools team's work on the blood pressure tool redesign. It says that users 18 and over can use it and users 17 or under shouldn't.

Usually we wouldn't duplicate a criterion in the "Who it's for" and "Who it's not for" bulleted lists. We have not seen any evidence that users need the message reinforced in both lists.

However, in this instance:

• the tool does not ask for someone's age so isn't able to give appropriate messaging once users are in the tool - there is no mechanism to stop underage users using the tool
• there is no interruption card to stop users and ask them to check eligibility
• clinicians felt the best solution to manage clinical risk was to list the criterion in both the "Who can use" and "Who should not use" lists