title: Internalizing the threat of risk--a qualitative study about adolescents' experience living with screening-detected celiac disease 5 years after diagnosis.
abstract: BACKGROUND
  Mass screening could identify those with unrecognized celiac disease (CD), but the experience of being detected through screening and living with screening-detected CD should be explored before considering this as acceptable intervention. For this study we invited screening-detected adolescents to describe their experience living with screening-detected CD five years after diagnosis with the aim to explore how their perceptions, practices, and beliefs evolved.
  
  
  METHODS
  Adolescents who were diagnosed through a population-based CD screening were invited to write narratives after being diagnosed. Of 153 adolescents who were eventually diagnosed through the screening, 91 wrote narratives one year after diagnosis and 72 five years after diagnosis. A qualitative content analysis resulted in a theme and categories that describe the experience living with screening-detected CD five years after diagnosis.
  
  
  RESULTS
  The overall theme--Internalizing the threat of risk--illustrates that being detected through screening and the internalized threat of future health complications have impacted how these adolescents felt about the diagnosis, coped with the gluten-free diet (GFD), and thought about CD screening. This theme is supported by four categories: maintaining an imposed disease identity describes how they continued to define their diagnosis in relation to the screening. They also expressed moving from forced food changes to adapted diet routines by describing habits, routines, coping strategies, and the financial burden of the GFD. They had enduring beliefs of being spared negative consequences, however, even after five years, some doubted they had CD and worried that being detected and eating a GFD might not be beneficial, i.e. continuing to fear it is "all in vain".
  
  
  CONCLUSIONS
  There was maintenance and evolution in the perceptions, practices, and beliefs of the adolescents after five years. Some have adjusted to the disease and adapted new habits and coping strategies to deal with the GFD, while others still doubt they have CD or that being detected was beneficial. The transition to adapting to the disease and GFD is ongoing, illustrating the importance of providing ongoing support for those with screening-detected CD as they adjust to this chronic disease and the GFD.
authors.affiliation: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden. katrina.nordyke@epiph.umu.se.
authors.forename: Katrina
authors.initials: K
authors.lastname: Nordyke
authors.forename: Anna
authors.initials: A
authors.lastname: Rosén
authors.forename: Maria
authors.initials: M
authors.lastname: Emmelin
authors.forename: Anneli
authors.initials: A
authors.lastname: Ivarsson
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D001294:Attitude to Health; D002446:Celiac Disease / Q000175:diagnosis / Q000523:psychology*; D055050:Diet, Gluten-Free / Q000523:psychology; D005239:Fear / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D033262:Narration; D036301:Qualitative Research; D012306:Risk