BMJ  2007;335:490 (8 September), doi:10.1136/bmj.39308.392176.BE (published 30 August 2007)

Research

Patients' experiences of screening for type 2 diabetes: prospective qualitative study embedded in the ADDITION (Cambridge) randomised controlled trial

¹ General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR , ² MRC Epidemiology Unit, Strangeways Research Laboratory, Cambridge CB1 8RN , ³ Research Unit in Health, Behaviour and Change, School of Clinical Sciences and Community Health, The University of Edinburgh, Medical School, Edinburgh EH8 9AG

Objectives To provide insight into factors that contribute to the anxiety reported in a quantitative study of the psychological effect of screening for type 2 diabetes. To explore expectations of and reactions to the screening experience of patients with positive, negative, and intermediate results.

Design Prospective qualitative interview study of patients attending a screening programme for type 2 diabetes.

Setting Seven general practices in the ADDITION (Cambridge) trial in the east of England.

Participants 23 participants (aged 50-69) attending different stages in the screening process.

Results Participants' perceptions changed as they progressed through the screening programme; the stepwise process seemed to help them adjust psychologically. The first screening test was typically considered unimportant and was attended with no thought about its implications. By the final diagnostic test, type 2 diabetes was considered a strong possibility, albeit a "mild" form. After diagnosis, people with screen detected type 2 diabetes tended to downplay its importance and talked confidently about their plans to control it. Participants with intermediate results seemed uncertain about their diagnosis, and those who screened negative were largely unaware of their remaining high risk.

Conclusions This study helps in understanding the limited psychological impact of screening for type 2 diabetes quantified previously, in particular by the quantitative substudy of ADDITION (Cambridge). The findings have implications for implementing such a screening programme in terms of timing and content.

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