Qualitative study on acceptability of screening

1. Qualitative study on acceptability of screening Research team: Alison Heawood (PI, Bristol), Clare Emmett (Qualitative Researcher, Bristol), Niamh Redmond (Trial Coordinator, Bristol), Tim Peters (Bristol), Liz Lenaghan (UEA) & Lee Shepstone (UEA)

2. Background • Qualitative methods are increasingly used within trials to evaluate aspects less accessible to quantitative methods • Questions are often raised about the costs as well as benefits of screening, for example the psychological impact on patients • Quantitative studies have produced diverse findings regarding whether screening for osteoporosis contributes to anxiety in women • Some qualitative studies have examined the psychological impact of screening on patients in other clinical areas (e.g. breast cancer, cervical cancer) • But there has been little qualitative evaluation of the impact of osteoporosis screening on both women and GPs

3. Sample Women: • Purposeful sample of approx. 30 women participating in SCOOP from two study centres: Bristol and Norwich • Will include women in both the high and low risk groups, from different general practices and socio-economic backgrounds GPs: • Purposeful sample of approx. 20 GPs from practices participating in SCOOP from the same study centres • Will include GPs from a variety of practices (e.g. in terms of deprivation), with a range of proportions of women identified as at high risk

4. Interviews with low risk women • Experiences and views of the risk assessment process • Experiences of the DXA scan (for those who received a scan) • Understanding of osteoporosis • Perceptions of their risk of future fracture • Feelings about beingidentified as low risk

5. Interviews with high risk women • Experiences and views of the risk assessment process • Experiences of the DXA scan • Understanding of osteoporosis • Reactions to knowing that they are potentially at risk of a future fracture • Reasons for taking-up or not taking-up the opportunity to discuss the results with their GP • Experiences of consulting the GP to discuss the result and future treatment options (where this option has been taken up) • Thoughts and feelings about using preventative medication

6. Interviews with GPs • Acceptability of the screening process • Reactions to receiving the screening result (a woman’s risk category) and how they interpret this • Experiences of discussing the screening results with women (both high risk women who take up this option as part of the trial, and low risk women who independently seek a discussion with their GP as a result of participating in the trial) • Decision-making about potential preventative treatment options for high risk women