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. 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 Background

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. 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 being identified as low risk Interviews with low risk women

5. 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 Interviews with high risk women

6. 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 Interviews with GPs