Oluwaseun Egunsola1, Laura E Dowsett1, Ruth Diaz1, Michael H Brent2, Valeria Rac3, Fiona M Clement4. 1. Department Community Health Sciences, Teaching Research and Wellness Building, Calgary, Alberta, Canada; Institute of Health Economics, Edmonton, Alberta, Canada; O'Brien Institute for Public Health, Calgary, Alberta, Canada. 2. Diabetic Retinopathy Program at Diabetes Action Canada-CIHR SPOR Network, Toronto, Ontario, Canada; Donald K. Johnson Eye Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada. 3. Diabetic Retinopathy Program at Diabetes Action Canada-CIHR SPOR Network, Toronto, Ontario, Canada; Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada. 4. Department Community Health Sciences, Teaching Research and Wellness Building, Calgary, Alberta, Canada; Institute of Health Economics, Edmonton, Alberta, Canada; O'Brien Institute for Public Health, Calgary, Alberta, Canada. Electronic address: fclement@ucalgary.ca.
Abstract
OBJECTIVES: Diabetic retinopathy is a common microvascular complication that leads to vision loss. Despite national and international organizations developing guidelines for diabetic retinopathy screening, patients with diabetes remain unscreened. Our aim was to understand facilitators and barriers influencing diabetic retinopathy screening attendance and to examine factors that promote program success. METHODS: MEDLINE, Embase, PsycINFO and CINAHL from inception until September 23, 2019, were used for data collection. Studies were included if they were original qualitative research articles, included adults >18 years of age and assessed diabetic retinopathy screening programs or retinopathy screening as a component of a general diabetes care program. A "best-fit" framework synthesis methodology was used for this analysis. RESULTS: Twenty-nine articles involving 1,433 participants were identified. Six themes of barriers to, and facilitators of, diabetic retinopathy screening were identified, including access to screening, knowledge and information sharing, training and skills competency, service delivery, cultural competency and psychological factors. Cost and competing interests were common barriers to access; lack of knowledge about screening services was also a frequently reported barrier. Both patients and providers identified the need for improved service delivery, especially the referral and follow-up process. Providers recognized the need for additional training, patients enumerated several psychological barriers to screening uptake and cultural considerations were believed to be important, particularly among Indigenous communities. CONCLUSIONS: To improve screening uptake, the identified challenges must be addressed while also reinforcing the facilitators. Furthermore, program administrators could model new and unsuccessful screening programs after the successful ones while also considering local peculiarities.
OBJECTIVES: Diabetic retinopathy is a common microvascular complication that leads to vision loss. Despite national and international organizations developing guidelines for diabetic retinopathy screening, patients with diabetes remain unscreened. Our aim was to understand facilitators and barriers influencing diabetic retinopathy screening attendance and to examine factors that promote program success. METHODS: MEDLINE, Embase, PsycINFO and CINAHL from inception until September 23, 2019, were used for data collection. Studies were included if they were original qualitative research articles, included adults >18 years of age and assessed diabetic retinopathy screening programs or retinopathy screening as a component of a general diabetes care program. A "best-fit" framework synthesis methodology was used for this analysis. RESULTS: Twenty-nine articles involving 1,433 participants were identified. Six themes of barriers to, and facilitators of, diabetic retinopathy screening were identified, including access to screening, knowledge and information sharing, training and skills competency, service delivery, cultural competency and psychological factors. Cost and competing interests were common barriers to access; lack of knowledge about screening services was also a frequently reported barrier. Both patients and providers identified the need for improved service delivery, especially the referral and follow-up process. Providers recognized the need for additional training, patients enumerated several psychological barriers to screening uptake and cultural considerations were believed to be important, particularly among Indigenous communities. CONCLUSIONS: To improve screening uptake, the identified challenges must be addressed while also reinforcing the facilitators. Furthermore, program administrators could model new and unsuccessful screening programs after the successful ones while also considering local peculiarities.
Authors: Sharon M Hudson; Bobeck S Modjtahedi; Danielle Altman; Jennifer J Jimenez; Tiffany Q Luong; Donald S Fong Journal: Clin Ophthalmol Date: 2022-04-04