title: Can informed choice invitations lead to inequities in intentions to make lifestyle changes among participants in a primary care diabetes screening programme? Evidence from a randomized trial.
abstract: OBJECTIVE
  To test whether information about benefits and harms of screening for type 2 diabetes increases intentions to make lifestyle changes amongst attenders, predominantly among the socially advantaged and those with a strong future time orientation.
  
  
  METHODS
  Planned subgroup analysis of attenders for screening participating in a randomized controlled trial of an informed choice invitation vs a standard invitation to attend for type 2 diabetes screening.
  
  
  METHODS
  Potentially eligible participants were identified from practice registers using routine data which were used to calculate risk scores for diabetes for all aged 40-69 years without known type 2 diabetes and area deprivation based on post code. In total, 1272 individuals in the top 25% risk category were randomized to receive one of two invitations to attend their practices for screening: an informed choice invitation or a standard invitation. The subsequent attenders completed self-report measures of future time orientation and deprivation immediately before undergoing a screening test.
  
  
  RESULTS
  Individual-level deprivation demonstrated a significant moderator effect [F (4,635) = 4.32, P = 0.002]: individuals who were high in deprivation had lower intentions to engage in lifestyle change following receipt of the informed choice invitation. However, intentions were not patterned by deprivation when it was assessed at the area-level using the Index of Multiple Deprivation 2007. The hypothesized moderating effect of future time orientation on invitation type was also supported [F(14,613) = 2.46, P = 0.002): individuals low in future time orientation had markedly lower intentions to engage in lifestyle change following receipt of an informed choice invitation compared with a standard invitation for screening.
  
  
  CONCLUSIONS
  Efforts to enhance informed choice where the implications of diagnosis are a requirement for lifestyle change may require that the immediate benefits are communicated, and efforts to address the apparent barriers to diabetes self-care are made, if the potential for inequity is to be avoided.
authors.affiliation: General Practice & Primary Care Research Unit, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge CB2 2SR, UK. ik261@medschl.cam.ac.uk
authors.forename: I
authors.initials: I
authors.lastname: Kellar
authors.forename: E
authors.initials: E
authors.lastname: Mann
authors.forename: A L
authors.initials: AL
authors.lastname: Kinmonth
authors.forename: A T
authors.initials: AT
authors.lastname: Prevost
authors.forename: S
authors.initials: S
authors.lastname: Sutton
authors.forename: T M
authors.initials: TM
authors.lastname: Marteau
mesh_terms: D000328:Adult; D000368:Aged; D002755:Choice Behavior; D054626:Consumer Health Information; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis*; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D012042:Registries; D012959:Socioeconomic Factors