Patients' Experiences of Screening for Type 2 Diabetes: Prospective Qualitative Study Embedded in the ADDITION (Cambridge) Randomised Controlled Trial

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.