To ask or not to ask (about sex)? by Micol Artom (NHS)

111 online is a triage service which directs people to the best place for their symptoms. All users are asked 'What was your sex at birth?' at the beginning of their journey, and not answering prevents them from progressing further. For certain conditions, a user's biological sex may affect the clinical questions they're asked, however not all health problems will be affected by sex at birth.

The 111 online have received feedback from users indicating that they have barriers in answering the sex at birth question. Some users struggle to answer the question accurately, do not understand the reason why the question is asked and experience discomfort in having to provide this information. The question has also prevented some users from using the 111 online service entirely.

We conducted five rounds of research including with more than forty remote interviews with users who were gender diverse or had differences of sex development to better understand what barriers they face in answering questions about sex and gender, and how the way 111 online collects information about them could be improved. We completed discovery research, tested more than 15 different designs and worked with clinicians and developers to assess the feasibility of the desired changes. The key finding was that the service didn't always need to ask for sex upfront.

This talk will firstly give a brief overview of the context, methods, and findings of the research. It will then focus on the methodological and clinical challenges the researchers faced in conducting the research and developing a strategy for implementing its recommendations. The audience will take-away inclusive approaches to recruiting for, interviewing and analysing research about sex and gender. They will also learn about novel ways of communicating sensitive findings to clinicians in a way that fosters change whilst still prioritizing clinical safety.