International Journal of Risk & Safety in Medicine 14 (2001) 51–57 IOS Press
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Psychosocial consequences of screening for albuminuria and certain other risk factors Tjeerd Tymstra a,∗ , Edwin W. Spijkers a , Jan Broer b , Wilbert M.T. Janssen c and Paul E. de Jong c a Department
of Health Sciences, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands b Communal Health Services , PO Box 584, 9700 AN Groningen, The Netherlands c Department of Medicine, Division of Nephrology, University Hospital Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands Abstract. Objective: To gain insight into the psychosocial consequences of a screening programme on the progression of heart, vascular and kidney damage. Design: Over 85,000 people aged 28–75 were invited to participate in a screening for albuminuria. Nearly half of them sent in their morning urine of which almost 10,000 had a (slightly) elevated urinary albumin level. This latter group was invited to participate in a follow-up screening (24-hour urine samples, blood pressure, glucose, cholesterol) together with ±3,000 randomly selected subjects with a normal urinary albumin concentration. A questionnaire on the psychosocial consequences of the screening was sent to 335 participants of the screening programme each of whom had received their (positive or negative) screening results two weeks previously. Results: The response rate was 75%. A minority of the respondents, diagnosed for risk factors, expressed some concern. No influence on the well-being of this group of participants could be established. Almost one third of the respondents claimed to follow a healthier lifestyle as a result of the screening. There are, however, also indications for a certain ‘certificate of health effect’: about half of the smokers and the physically inactive considered that the favourable screening results legitimated their unhealthy lifestyle. An unfavourable screening result led to additional medical consumption in almost half of the respondents. The respondents appreciated the screening and especially the less educated had a very positive attitude towards early diagnosis in general. Conclusions: Those screened positive showed no diminished well-being; their health behaviour improved because of the screening and their medical consumption increased. Many of those screened negative considered the test result a reason to continue their unhealthy lifestyle. Keywords: Screening, early diagnosis, risk factors, albuminuria, psychosocial factor
1. Introduction Screening means the active early diagnosis of (risk factors for) disease. Screening procedures make early intervention possible and therefore can have a positive effect on the health and well-being of people. However, the early diagnosis of disease also has its drawbacks: false positive and false negative test results may increase medical consumption, i.e., the medicalisation of society. Many diseases have a large ‘sub-clinical reservoir’ that can be detected by increasingly sensitive diagnostic procedures, and early diagnosis often means that years of carefree life are taken away from people in order to secure the chance – but not the assurance – of a longer life. It is apparent that, in screening, we are confronted with a great variety of advantages and disadvantages and there is much debate on the usefulness and acceptability of screening programmes [1–5]. One aspect of screening is that people may associate favourable diagnostic test results with unjust and incorrect conclusions. They may, for example, consider the results *
Corresponding author: T. Tymstra. E-mail:
[email protected].
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T. Tymstra et al. / Psychosocial consequences of screening for albuminuria
a justification for continuing an unhealthy lifestyle. Such a ‘certificate of health effect’ emerged from the evaluation of a screening programme for cardiovascular risk factors [6]. In the evaluation of screening programmes, benefit accruing to people who are found to have the disease have played a major role and not much attention has been paid to the social and psychological aspects of screening [7]. These latter aspects are the subject of this study. In late 1997, the PREVENDproject (Prevention of REnal and Vascular END-stage Disease), in which people were asked to hand in a vial of early-morning urine for possible traces of albuminuria, started in the city of Groningen in the Netherlands. Albumin loss through the urine is a possible indicator for progressive heart, vascular and kidney damage. The screening results will lead to more in-depth knowledge of this phenomenon, especially through later sub-studies (effect of use of medicine, etc.). A questionnaire among a random sample of PREVEND-participants provided data for an inventory of their experiences. 2. Material and method All inhabitants of Groningen aged between 28–75 (over 85,000 in all) were invited to send in their morning urine; almost half of them complied. A (slightly) elevated albumin level in the urine (urinary albumin concentration 10 mg/l) was found in almost 10,000 participants. These participants were asked to take part in a follow-up screening. An additional 3,000 persons, without albuminuria (urinary albumin concentration
