Why do people take part in atrial fibrillation screening? Qualitative interview study in English primary care

Abstract

ObjectivesThere is insufficient evidence to support national screening programmes for atrial fibrillation (AF). Nevertheless, some practitioners, policy-makers and special interest groups have encouraged introduction of opportunistic screening in primary care in order to reduce the incidence of stroke through earlier detection and treatment of AF. The attitudes of the public towards AF screening are unknown. We aimed to explore why AF screening participants took part in the screening.DesignSemistructured longitudinal interview study of participant engagement in the SAFER study (Screening for Atrial Fibrillation with ECG to Reduce stroke). We undertook initial interviews face to face, with up to two follow-up telephone interviews during the screening process. We thematically analysed and synthesised these data to understand shared views of screening participation.Setting5 primary care practices in the East of England, UK.Participants23 people taking part in the SAFER study first feasibility phase.ResultsParticipants were supportive of screening for AF, explaining their participation in screening as a ‘good thing to do’. Participants suggested screening could facilitate earlier diagnosis, more effective treatment, and a better future outcome, despite most being unfamiliar with AF. Participating in AF screening helped attenuate participants’ concerns about stroke and demonstrated their commitment to self-care and being a ‘good patient’. Participants felt that the screening test was non-invasive, and they were unlikely to have AF; they therefore considered engaging in AF screening was low risk, with few perceived harms.ConclusionsParticipants assessed the SAFER AF screening programme to be a legitimate, relevant and safe screening opportunity, and complied obediently with what they perceived to be a recommendation to take part. Their unreserved acceptance of screening benefit and lack of awareness of potential harms suggests that uptake would be high but reinforces the importance of ensuring participants receive balanced information about AF screening initiatives.Trial registration numberISRCTN16939438; Pre-results.

Why do people choose not to take part in screening? Qualitative interview study of atrial fibrillation screening nonparticipation

“…Interviewees' considerations about not taking part, and their deviation from what could be considered ‘acceptable’ behaviour, offer insights into the possible limits of screening obligation. Interviewees' accounts were different from those who took part in AF screening who sometimes struggled to articulate exactly why they did so, as inherently obvious as it was to engage in screening 34 . This echoes Polak and Green's 59 preventative medication decision‐making study: while statin‐takers presented ‘no‐choice’ but to take them, nontakers stressed their need to ‘think about it’, prioritising their concerns about medication side‐effects to explain their decision to deviate from a clinician‐endorsed approach.…”

“…Interviewees identified many costs to participating in AF screening. While their views differ from those who chose to participate in SAFER and who presented the screening decision as straightforward and easy, 34 it seems likely that it is not that the costs were different but that the burden of them was differently felt 64 . Identifying these nuances deepens our awareness that screening participation can be harmful and is never cost‐free.…”

“…In previous work, we found that SAFER participants considered AF screening to be legitimate and worthwhile. They considered their nonparticipating peers to be deviating from good preventative practice and to be putting themselves at risk, characterising them as ‘uninformed, indolent, irresponsible, wilfully ignorant, or gratuitously anxious’ 34 . However, our scoping study of nonparticipation showed that those not taking part were neither uninformed nor wilfully ignorant: they recognised the value of screening and thought it worth overcoming inconveniences to take part 37 .…”

“…30,31 While the expectation of participation in well-established population-based screening programmes may be fortified by societal concern about and fear of the disease (e.g., cancer) 32 or expectancies of responsible parenthood (pregnancy and neonatal screening), 33 AF screening is a novel offer for a condition that is not widely known by the public. 34 This, then, is an opportunity to explore how people respond to an invitation to engage with screening and account for their decision, outside of established screening programmes that may be considered routine. 8 In particular, it provides a more neutral context in which to focus on personal choice not to participate, and the reasons people draw on when accounting for their decision to decline (cf., McCaffery et al).…”

“…However, our scoping study of nonparticipation showed that those not taking part were neither uninformed nor wilfully ignorant: they recognised the value of screening and thought it worth overcoming inconveniences to take part 37 . Moreover, for SAFER participants, engaging in the screening seemed to be almost a ‘non‐decision’ because it was so clearly the ‘right’ thing to do 34 . This suggested that to not participate, to not comply, may be a decision.…”