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

Abstract

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.

‘I saw what the future direction would be…’: Experiences of diabetes risk and physical activity after diabetes screening

“…A high-risk status was expressed as something already presumed but as yet non-imminent. A negative diagnosis and asymptomacy played a major role in scepticism concerning the risk, providing false reassurance, again as found in previous studies (Adriaanse et al, 2002;Eborall et al, 2007b). So far, qualitative studies have addressed false reassurance as a phenomenon decreasing one's risk perception.…”

“…The expressions used indicated the difficulty of dealing emotionally with one's risk status; people were embarrassed by their risk status and they used social comparisons to gain an unrealistically positive view of their situation, increasing hope, and enhancing their self-esteem (Taylor & Lobel, 1989). They also made excuses to explain the risk away (see Eborall et al, 2007b). In addition, they downplayed the risk by taking it for granted, which may imply attempts to avoid negative emotions and to disengage with the risk (Carver & Connor-Smith, 2010).…”

“…However, cross-sectional studies indicate that in general an awareness of one's elevated risk of diabetes increases the likelihood of adopting a healthy lifestyle (Okosun, Davis-Smith, & Seale, 2012;Qureshi & Kai, 2008), although others have claimed that people who are aware of their risk do not have intentions to change their lifestyle (Adriaanse et al, 2002;Eborall et al, 2007b;Green, Bazata, Fox, & Grandy, 2007). A recent study (Vähäsarja et al, 2012a) indicated that 74% of highrisk individuals did indeed perceive a need to increase their physical activity after screening.…”

“…anxiety, depression, and a decreased quality of life, appear to be minimal regardless of the diagnosis (Adriaanse & Snoek, 2006;Eborall et al, 2007a;Paddison et al, 2011). However, the absence of adverse effects may stem merely from people's tendency not to regard diabetes as a serious disease (Adriaanse et al, 2002;Eborall, Davies, Kinmonth, Griffin, & Lawton, 2007b;Skinner et al, 2006), or to have a low risk perception, due for example to an optimistic bias (Jones, Roche, & Appel, 2009;Kemple, Zlot, & Leman, 2005;Kim et al, 2007). Overall, it seems that responses to screening tend to be fairly indifferent: screening does not appear to cause emotional distress, nor does a negative screening result cause relief (Adriaanse & Snoek, 2006).…”

Type 2 Diabetes Mellitus in Family Practice: Prevention and Screening

“…Only a quarter of this group intended to have their blood glucose tested in future. Another study, which interviewed participants at different stages of a stepwise screening process (Eborall et al, 2007b), reported similar findings but noted that the stepped nature of the screening process appeared to help participants to adjust psychologically.…”