A six-phase co-design framework for dual-audience health education in intellectual disabilities: Development and feasibility testing for breast cancer prevention.

Abstract

OBJECTIVE: To develop, implement, and describe a systematic six-phase methodology for creating accessible breast cancer education materials for people with intellectual disabilities (PwIDD), integrating WHO translation guidelines, Inclusion Europe standards, and co-production principles. METHODS: A six-phase sequential methodology development study conducted January-November 2024. Five official Polish breast cancer education materials underwent readability analysis using validated linguistic software. Dual-audience materials were developed following Inclusion Europe guidelines, adapted with permissions from Macmillan Cancer Support and the Get in Touch Foundation. WHO translation protocols guided Polish-to-English adaptation. Pilot testing employed participatory methodology with PwIDD and their carers. International pilot testing at a European training event assessed cross-cultural applicability. RESULTS: Readability analysis revealed all existing materials scored 4-5/7 on a 7-point difficulty scale, exceeding accessibility thresholds (recommended: 1-2/7). Developed materials successfully employed a dual-audience approach providing simplified content for PwIDD and detailed information for carers. WHO-guided translation maintained semantic equivalence and accessibility features across languages. Pilot testing with 36 participants (18 PwIDD, 18 carers) across two workshops confirmed comprehensibility, cultural appropriateness, and practical usability. International testing indicated that the methodology was feasible to apply across cultural contexts. CONCLUSION: The systematic methodology successfully addressed accessibility barriers in existing health education resources, producing materials that performed effectively in pilot testing across cultural contexts. The dual-audience approach represents a methodological advancement supporting collaborative healthcare decision-making while respecting individual autonomy. Longitudinal evaluation of educational effectiveness is needed before broader equity impact claims can be substantiated. PRACTICE IMPLICATIONS: The six-phase framework offers a replicable, evidence-based approach for healthcare systems and policy-makers developing accessible health education materials. Provider communication guidelines support clinical implementation. The methodology addresses the urgent need for accessible cancer prevention resources and has potential for application across diverse health topics and populations.