Impact of an informed choice invitation on uptake of screening for diabetes in primary care (DICISION): randomised trial.
OBJECTIVE
To compare the effect of an invitation promoting informed choice for screening with a standard invitation on attendance and motivation to engage in preventive action.


METHODS
Randomised controlled trial.


METHODS
Four English general practices.


METHODS
1272 people aged 40-69 years, at risk for diabetes, identified from practice registers using a validated risk score and invited to attend for screening.


METHODS
Intervention was a previously validated invitation to inform the decision to attend screening, presenting diabetes as a serious potential problem, and providing details of possible costs and benefits of screening and treatment in text and pie charts. This was compared with a brief, standard invitation simply describing diabetes as a serious potential problem.


METHODS
The primary end point was attendance for screening. The secondary outcome measures were intention to make changes to lifestyle and satisfaction with decisions made among attenders.


RESULTS
The primary end point was analysed for all 1272 participants. 55.8% (353/633) of those in the informed choice group attended for screening, compared with 57.6% (368/639) in the standard invitation group (mean difference -1.8%, 95% confidence interval -7.3% to 3.6%; P=0.51). Attendance was lower among the more deprived group (most deprived third 47.5% v least deprived third 64.3%; P<0.001). Interaction between deprivation and effect of invitation type on attendance was not significant. Among attenders, intention to change behaviour was strong and unaffected by invitation type.


CONCLUSIONS
Providing information to support choice did not adversely affect attendance for screening for diabetes. Those from more socially deprived groups were, however, less likely to attend, regardless of the type of invitation received. Further attention to invitation content alone is unlikely to achieve equity in uptake of preventive services.


BACKGROUND
Current Controlled Trials ISRCTN 73125647.
Marteau
Theresa M
TM
King's College London, Psychology Department (at Guy's), Health Psychology Section, Psychology and Genetics Research Group, Guy's Campus, London SE1 9RT. theresa.marteau@kcl.ac.uk
Mann
Eleanor
E
Prevost
A Toby
AT
Vasconcelos
Joana C
JC
Kellar
Ian
I
Sanderson
Simon
S
Parker
Michael
M
Griffin
Simon
S
Sutton
Stephen
S
Kinmonth
Ann Louise
AL
D000328:Adult; D000368:Aged; D002755:Choice Behavior; D016000:Cluster Analysis; D003657:Decision Making; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis*; D005194:Family Practice; D005260:Female; D006293:Health Promotion; D006801:Humans; D007258:Informed Consent; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D012307:Risk Factors
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