title: More than measurement: practice team experiences of screening for type 2 diabetes.
abstract: BACKGROUND
  The feasibility, cost-effectiveness and best means to implement population screening for type 2 diabetes remain to be established.
  
  
  OBJECTIVE
  To learn from the experiences of practice staff undertaking a diabetes screening programme in order to inform future screening initiatives.
  
  
  METHODS
  Qualitative analysis of interviews with staff in six general practices in the 'ADDITION-Cambridge' trial; three randomly allocated to intensively manage screen-detected patients and three providing usual care. We conducted semi-structured interviews with seven nurses, four doctors, three health care assistants and four managers. Four researchers analysed the transcripts practice by practice, preparing vignettes and comparing interpretations. Participants commented on a summary report.
  
  
  RESULTS
  Each practice team implemented the screening and intervention programme differently, depending on numbers at risk and decisions about staff contributions. Several emphasized the importance of administrative support. As they screened, they extended the reach of the programme, testing patients outside the target group if requested, checking other risk factors, providing health information and following up people with impaired glucose tolerance. Staff felt that patients accepted the screening and subsequent management as any other clinical activity.
  
  
  CONCLUSIONS
  Although those developing screening programmes attempt to standardize them, primary care teams need to adapt the work to fit local circumstances. Staff need a sense of ownership, training, well-designed information technology systems and protected time. Furthermore, screening is more than measurement; at the individual level, it is a complete health care interaction, requiring individual explanations, advice on health-related behaviour and appropriate follow-up. The UK 'NHS Health Checks' programme should embrace these findings.
authors.affiliation: Institute of Public Health, General Practice & Primary Care Research Unit, University of Cambridge, Robinson Way, Cambridge CB2 0SR, UK. jonathan.graffy@phpc.cam.ac.uk
authors.forename: Jonathan
authors.initials: J
authors.lastname: Graffy
authors.forename: Julie
authors.initials: J
authors.lastname: Grant
authors.forename: Kate
authors.initials: K
authors.lastname: Williams
authors.forename: Simon
authors.initials: S
authors.lastname: Cohn
authors.forename: Sara
authors.initials: S
authors.lastname: Macbay
authors.forename: Simon
authors.initials: S
authors.lastname: Griffin
authors.forename: Ann Louise
authors.initials: AL
authors.lastname: Kinmonth
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001291:Attitude of Health Personnel; D001786:Blood Glucose / Q000032:analysis; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000628:therapy; D058006:General Practice; D058005:General Practitioners; D006801:Humans; D007407:Interviews as Topic; D008403:Mass Screening / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D008875:Middle Aged; D009726:Nurses / Q000523:psychology; D010820:Physicians / Q000523:psychology; D011364:Professional Practice; D012307:Risk Factors; D006113:United Kingdom
chemical_list: D001786:Blood Glucose
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