Making non-emergent abnormal results actionable: a short-term longitudinal qualitative study in two hospital-affiliated health examination centers in China.

BACKGROUND: Abnormal laboratory results in routine health examination reports can initiate prevention, confirmation, monitoring, or further consultation. Disclosure alone, however, does not make a result actionable: recipients must construct meaning, calibrate risk, and identify a feasible next step. This study examined non-emergent abnormal results as public health communication events in a regional hospital-affiliated health examination setting in China. METHODS: A short-term longitudinal qualitative study was conducted with 48 adults who had received at least one non-emergent abnormal laboratory result at two health examination centers. Baseline interviews used participants' own de-identified reports and result vignettes as elicitation materials. A purposively selected subsample of 28 participants completed follow-up interviews 28-43 days later. Reflexive thematic analysis was the primary analytic methodology, supported by framework matrices for cross-case, site-level, and longitudinal comparison. RESULTS: Five themes explained the result-to-action pathway: abnormality was noticed before it was understood; meaning was negotiated through biography, family, and social consequences; risk was alternately normalized and amplified; follow-up required navigation work; and participants described communication as more actionable when it was respectful, proportionate, time-bound, and linked to a service route. Follow-up trajectories included clinician-linked follow-up, planned monitoring, family or online advice without formal care by follow-up, self-directed repeat testing, and delay or no action. Clinician input or repeat results could feed back to reinterpret the original finding. CONCLUSION: Participants did not simply lack information; they encountered a health literacy environment that often transferred interpretive and navigation work to recipients and families. Health examination systems may support more proportionate and navigable follow-up by combining priority labels, plain-language meaning and uncertainty, time-bound next steps, trusted support, and recipient-controlled sharing. These communication components require clinical, usability, and implementation validation and should not be interpreted as clinical guidelines.