Student thesis: Doctoral ThesisDoctor of Philosophy


Background: Screening for type 2 diabetes will potentially allow for early diagnosis and treatment. The current doctoral research focused on screening for diabetes in dental settings. The main objective of the research was to determine the impact of preliminary screening for diabetes using HbA1c information alongside a self-report questionnaire, in general dental practices on patient's health behaviours.

Methods: A systematic review of 18 studies was carried out to identify the best ways to communicate individualised risk information to improve screening uptake. Following the completion of the review, a longitudinal study based in two dental practices invited dental patients over 45 years old to participate in preliminary screening for diabetes. The study aimed to determine the uptake of preliminary screening in the dental practice environment using the self-report questionnaire and HbA1c test, and to determine the uptake of further diabetes testing by the GP following the receipt of a high HbA1c reading and a positive result on the self-report questionnaire. A qualitative element of the project involved interviewing participating patients (n=18) and dentists (n=6) to gain insight into their views and experiences of screening in this setting.

Results: The systematic review identified several important methods of risk communication (e.g. presenting in writing and in person) found to increase screening participation or its psychological predictors. These were used to inform the next stage of the research, The longitudinal study indicated that of 520 dental patients taking part, half were found to have an increased level of risk of developing diabetes in the next ten years, based on at least one screening measure looking at personalised diabetes risk, and were advised to seek a diagnostic blood test from their GP. Sixty percent of those referred to their GP following the personalised diabetes risk communication, followed the advice and did so; those who had received two positive screening tests as opposed to just one, were three times more likely to make contact with their GP. When assessing whether certain psychological variables can predict and explain uptake of further testing by the GP, fear of diabetes and vulnerability to developing diabetes were found to be able to explain why some patients made contact with their GP whereas severity, intention, and self efficacy for example, were not associated with attendance at the GP. The qualitative data revealed that dentists and patients both reported positive experiences and patients offered explanations as to why they had or had not contacted their GP for further testing.

Conclusion: the set of studies demonstrated a well-tolerated and largely acceptable personalised diabetes risk screening method, with more than half of those recommended to do so, following advice to seek further diagnostic tests.
Date of Award2017
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorKoula Asimakopoulou (Supervisor) & Suzanne Scott (Supervisor)

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