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Misinterpretation of a negative test results in health screening may initiate less preventive effort and more future lifestyle-related disease. We predict that misinterpretation occurs more frequently among individuals with a low level of education compared with individuals with a high level of education.

The empirical analyses are based on unique data from a randomized controlled screening experiment in Norway, NORCCAP (NORwegian Colorectal Cancer Prevention). The dataset consists of approximately 50,000 individuals, of whom 21,000 were invited to participate in a once only screening with sigmoidoscopy. For all individuals, we also have information on outpatient consultations and inpatient stays and education. The result of health behaviour is mainly measured by lifestyle-related diseases, such as COPD, hypertension and diabetes type 2, identified by ICD-10 codes.

The results according to intention-to-treat indicate that screening does not increase the occurrence of lifestyle related diseases among individuals with a high level of education, while there is an increase for individuals with low levels of education. These results are supported by the further analyses among individuals with a negative screening test.

The purpose of this paper is to explore doctors' experiences with participation in a quality assurance programme for gastrointestinal endoscopy (Gastronet).

An explorative and qualitative approach was used, and data were generated through semi‐structured interviews with eight doctors (endoscopists) in Norway.

The respondents' notion of a “high‐quality colonoscopy” included being able to communicate with the patient while performing the technical procedure. They were reluctant to use analgesics to improve their score on the rate of painful examinations due to the negative effects of analgesics on the communication with the patient. The individual feedback reports on colonoscopy quality had been read by most respondents and some respondents described they had used the reports actively to monitor performance. There was some reluctance towards the programme among the respondents since some performance measures were thought to have a negative effect on the atmosphere in the endoscopy suite.

The small sample size and the homogenous cultural setting limit the generalisability of the results to other countries.

The concept of “high‐quality colonoscopy” might be ambiguous, and it is important to clarify what quality means when implementing a quality assurance programme for gastrointestinal endoscopy. Workshops and educational meetings facilitate two‐way communication between leaders and participants in the quality assurance programme, and may build ownership and increase motivation among participants.

In addition to quality indicators, it is important to agree upon the meaning of “quality” when initiating a quality assurance programme.