Helbredsscreening i almen praksis. Et kvalitativt studie om menneskers tanker og erfaringer
Doctoral thesis, Peer reviewed
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Despite the lack of evidence of the actual effects of general health screenings, it is still being discussed whether the screenings should be a public offer. There is a lack of scientific investigations concerning the influence of health screening on individual level over time, especially in relation to the screened people who have been cleared and the people who have declined the screening offer. Only few researchers have conducted detailed investigations regarding the individual’s underlying reasons for declining the screening and how it feels to be declared in or out of risk of illness. In this thesis I have explored understandings and experiences among those who were invited to participate in the Ebeltoft project – a multiphasic health screening, where among other things the participants’ cardiovascular risk score (CRS) was estimated. I have conducted three studies in order to investigate the following three aims 1) How do people with a high CRS identified in the screening, balance health related advice with the life they wish to lead or are able to lead? 2) How do people interpret and act after the screening has shown they are out of risk of a high CRS? 3) Which understandings and experiences can be found among the persons who declined participating in the screening offer? The empirical data are drawn from qualitative semistructured interviews with 14 screened persons, who from the Ebeltoft project were estimated to have a high CRS, 22 screened persons without a high CRS and 18 persons who declined the screening offer. The study is descriptive, analyzed with systematic text condensation and the interpretation is inspired by the Health Belief Model (HBM), Bandura’s theory of self-efficacy and Hollnagel & Malterud’s thoughts on shifting attention from risk factors to health resources. The analysis has demonstrated that a high CRS can give rise to alarm, shock, surprise, and hope (article I). The message of being out of CRS can give reason to relief, feels calming and reduce health worries (article II), while those who did not accept the offer of health screening feared that examinations and results could affect their health and happiness in a negative direction (article III). Among health screened people with a high CRS we found much differentiated conceptions on whether and how the result should have consequences, and several participants made extensive initiatives to change their lifestyle (article I). Participants without a high CRS had attached importance to the confirmation from the experts to their own feelings of being in good health and that their lifestyle therefore was acceptable and could proceed without changes (article II). In time and especially if the quality of life was highly compromised or if difficult circumstances in life arose, the initiated life changes could for those with a high CRS fade into the background (article I), while participants without a high CRS after some time no longer would give much thoughts to the screening results (article II). People who had declined to participate in the health screening, expressed that nevertheless most illness cannot be prevented and that oneself can do several things to prevent illness. They explained how they balanced their own evaluations of being healthy with consideration to the risk of illness caused by heredity or present lifestyle factors and the fear of what screening may give occasion for. Moreover they expressed that a doctor should be for the sick and old people and otherwise only when needed (article III). Practitioners can apply the results from this thesis to 1) be attentive to the emotional reactions that may occur from participating and that these reactions may be connected to the decline of such a screening offer, 2) know that screened persons with a high CRS have decided on the size of the life style changes, that screened people without a high CRS in accordance with the result feel healthy, but some may be unsure of their own body-feeling and lead a worrying lifestyle, that non screened persons attach importance to self-responsibility and 3) that initiatives and attitudes found within health screened people and the people who declined can be perceived as resources by looking at what the participants have succeeded in, focusing on what they can instead of what they lack to do. In general the findings indicate that it may be more important to add – that is to make use of the human beings’ own resources - instead of subtracting by looking for risks or weaknesses.
Has partsPaper I: Bach Nielsen KD, Dyhr L, Lauritzen T, Malterud K. Long-term impact of elevated cardiovascular risk detected by screening. A qualitative interview study. Scand J Prim Health Care. 2005 Dec;23(4):233-8. The article is not available in BORA due to publisher restrictions. The published version is available at: http://dx.doi.org/10.1080/02813430500336245
Paper II: Nielsen KD, Dyhr L, Lauritzen T, Malterud K. “Couldn’t you have done just as well without the screening?” A qualitative study of benefits from screening as perceived by people without a high cardiovascular risk score. Scand J Prim Health Care. 2009;27(2):111-6. The article is not available in BORA due to publisher restrictions. The published version is available at: http://dx.doi.org/10.1080/02813430902808619
Paper III: Nielsen KD, Dyhr L, Lauritzen T, Malterud K. You can't prevent everything anyway: a qualitative study of beliefs and attitudes about refusing health screening in general practice. Fam Pract. 2004 Feb;21(1):28-32. The article is not available in BORA due to publisher restrictions. The published version is available at: http://dx.doi.org/10.1093/fampra/cmh107