Overall statement

This study (Exploring attitudes and preferences for dementia screening in Britain: contributions from carers and the general public) was conducted to gain a better understanding of how the British public feel about systematic population screening for dementia. The researchers had previously conducted a systematic literature review on attitudes and preferences to dementia screening; in order to explore these findings further and gain a deeper understanding, qualitative data were collected through discussions that took place during a PPI event. Reference is made to the thematic analysis of data, and the statement is made that the qualitative aspect of the study indeed produced findings/themes that were not identified during the systematic review process.

This study is an important contribution to dementia and healthcare research in the UK, given the current burden of dementia and the ongoing narratives (in policy, research, and practice) around screening, risk reduction and dementia prevention.

Comments on each section will be stated, followed by numbered suggestions for revisions.

Abstract/background

The title and abstract provide clear and appropriate information about the study and its findings. Regarding the references; although there are only 12 references, all are relevant, recent, and used appropriately. The most recent versions of policy documents are referenced.

The small number of references is likely due to this study being a follow-on to a systematic review. By referencing both the review in question, and the review protocol on Prospero, the reader has access to several more references that support the work.

The rationale for looking at dementia, screening, and in the UK context is clearly laid out. The argument for screening is laid out, and it is made clear that no research as yet has looked at the public acceptability of screening. (Perhaps here a reference could be made to another type of screening programme - has this 'acceptability' been researched elsewhere?)

The importance of the current research has been stated, and the section ends with the statement of the research question, which is justified given the context already provided.

Methodology

Strengths

The rationale for PPI is clear and evidence-based. The 2011 census was used as a guide to the ideal sample, as the target was the general population of England. The purposive method adopted was justified. Clear description of the recruitment of partners and the qualitative aspect of data collection. Member checking used though sending summaries of the thematic analysis to partners for confirmation of data interpretation.

Weaknesses

There is very little discussion on the questionnaires used (to collect data on attitudes and preferences to screening for dementia) - were they pre-validated or bespoke? Are they suitable for use in this population? Why were those specific items chosen? Also, very little information provided on the analysis of questionnaire data, other than descriptive.

Results

23 key themes were identified in relation to carer and general population attitudes and preferences towards dementia screening. The themes were further categorised to correspond with 3 stages of screening, as identified by the study authors: pre-screening, in-screening, and post-screening. Figure 1 (model of themes identified) is a very useful visual aid at this point. The results are well laid out in accordance with the 3 stages mentioned above, with the remaining themes discussed under the heading of 'cross-cutting themes'.

The results are presented appropriately for a thematic analysis, with each theme presented with the inclusion of supportive quotes taken from the data. This allows for ease of interpretation and understanding.

The questionnaire results contain no statistical analysis. It was stated that descriptive statistics would be presented, but the results section contains only statements such as 'fewer delegates said they would like to know if they had a problem with their memory'. This could be more appropriately supported with some simple statistics. Although table 2 is useful here in providing a direct comparison of pre- and post-intervention results.

Discussion/conclusion

The discussion section begins with an explicit statement of the main findings in response to the research question. Following this there is discussion of the most frequent themes to emerge. However the discussion section is short and although it offers interpretations of the findings, these interpretations lack reference to other relevant research. Relating the findings to relevant research would give this discussion a more critical standpoint.

The section preceding the discussion called 'impacts and outcomes', provides some further context on the research findings and how they relate in a UK context.

Limitations of the study are outlined in a clear and transparent manner, and not understated. As a conclusion, the take-home message states that this research has found the UK general public to be sceptical of dementia screening due to a perceived lack of benefit. The recommendation for large-scale qualitative studies to help understand how to change public perspective on this topic is useful, and a logical next step in this particular field of research. These final statements make it clear what new knowledge this study has brought, and how this could be built on in the future.

Suggestions for revisions

Introduction 1. Are there any other health screening programmes for which this kind of public acceptability research has been carried out? And if not, then could these methods be transferable to others

Methodology 2. Further information on the questionnaires used is required. What instrument was chosen and why? Or did the authors create the instrument? Has it been validated for use in this population?

Results 3. Perhaps Table 4 (themes identified in studies) is not necessary as it is repetition of the results section text. Figure 1 (model of themes identified) provides a sufficient visual aid on the identification of themes.

Discussion 4. It would be good to see some reference to relevant research in the discussion section. Are these results what the authors expected? Are the findings particularly similar or dissimilar to other research findings?