Effectiveness of peer support to increase uptake of retinal examination for diabetic retinopathy: study protocol for the DURE pragmatic cluster randomized clinical trial in Kirinyaga, Kenya

Mwangi, Nyawira; Ng’ang’a, Mark; Gakuo, Esbon; Gichuhi, Stephen; Macleod, David; Moorman, Consuela; Muthami, Lawrence; Tum, Peter; Jalango, Atieno; Githeko, Kibata; Gichangi, Michael; Kibachio, Joseph; Bascarán, Covadonga; Foster, Allen

doi:10.1186/s12889-018-5761-6

Cited by 5 publications

(13 citation statements)

References 50 publications

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“…The setting of the study is described elsewhere [3]. Briefly, Kirinyaga county is a rural agrarian county in Central Kenya.…”

Section: Settingmentioning

confidence: 99%

“…They received two days of training using a curriculum developed through the process described in Additional file 1. The content of the training and the key messages that the peer supporters delivered to participants are described in the protocol [3]. An allowance was provided to peer supporters for telephone communication with participants, but no other financial incentives were given.…”

Section: Settingmentioning

confidence: 99%

“…The benefits of regular screening have been documented [1], but uptake remains low for people living with diabetes (PLWD) in settings without systematic DR screening programs [2]. Diabetes Support Groups (DSGs) provide an opportunity for demand-side interventions to increase attendance at screening and confront this inequity [3]. However, there is need for evidence on the factors that influence implementation and outcomes of DR interventions involving DSGs.…”

Section: Introductionmentioning

confidence: 99%

“…The DURE (Uptake of Retinal Examination in Diabetes mellitus) trial was a 6-month pragmatic cluster randomized controlled trial (cRCT) to evaluate the effectiveness of a complex intervention to promote screening for diabetic retinopathy among members of DSGs in Kirinyaga County, Kenya. The DURE trial interventions have been described in detail [3]. Briefly, the trial compared the proportion of PLWD who attended screening in seven DSGs that received the intervention with seven "usual care" DSGs that did not receive the intervention.…”

Section: Introductionmentioning

confidence: 99%

“…The theory proposes four methods of changing self-efficacy in order to change behavior: providing mastery experiences (e.g., recalling previous screening for other diabetes complications); vicarious learning (e.g., from hearing experiences of peers who have had DR screening); verbal persuasion (of the need for screening); and addressing psychological and affective states (such as anxiety about taking a screening exam) [6]. The theory-driven conceptual framework of intervention effect is illustrated in the protocol [3].…”

Section: Introductionmentioning

confidence: 99%

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Peer-support to increase uptake of screening for diabetic retinopathy: process evaluation of the DURE cluster randomized trial

et al. 2020

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Background: There is limited evidence on how implementation of peer support interventions influences effectiveness, particularly for individuals with diabetes. We conducted a cluster randomized controlled trial to compare the effectiveness of a peer-led health education package versus usual care to increase uptake of screening for diabetic retinopathy (DR). Methods: Our process evaluation used a mixed-method design to investigate the recruitment and retention, reach, dose, fidelity, acceptability, and context of implementation, and was guided by the Consolidated Framework for Implementation Research (CFIR). We reviewed trial documents, conducted semi-structured interviews with key informants (n = 10) and conducted four focus group discussions with participants in both arms of the trial. Three analysts undertook CFIR theory-driven content analysis of the qualitative data. Quantitative data was analyzed to provide descriptive statistics relevant to the objectives of the process evaluation. Results: The trial had positive implementation outcomes, 100% retention of clusters and 96% retention for participants, 83% adherence to delivery of content of group talks (fidelity), and 78% attendance (reach) to at least 50% (3/6) of the group talks (dose). The data revealed that intervention characteristics, outer setting, inner setting, individual characteristics, and process (all the constructs of CFIR) influenced the implementation. There were more facilitators than barriers to the implementation. Facilitators included the relative advantage of the intervention compared with current practice (intervention characteristics); awareness of the growing prioritization of diabetes in the national health policy framework (outer setting); tension for change due to the realization of the vulnerability to vision loss from DR (inner setting); a strong collective sense of accountability of peer supporters to implement the intervention (individual characteristics); and regular feedback on the progress with implementation (process). Potential barriers included the need to queue at the eye clinic (intervention characteristic), travel inconveniences (inner setting), and socio-political disruption (outer setting). Conclusions: The intervention was implemented with high retention, reach, fidelity, and dose. The CFIR provided a valuable framework for evaluating contextual factors that influenced implementation and helped to understand what adaptations may be needed during scale up.

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“…The setting of the study is described elsewhere [3]. Briefly, Kirinyaga county is a rural agrarian county in Central Kenya.…”

Section: Settingmentioning

confidence: 99%

Section: Settingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Peer-support to increase uptake of screening for diabetic retinopathy: process evaluation of the DURE cluster randomized trial

et al. 2020

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Patient and provider perspectives on barriers to screening for diabetic retinopathy: an exploratory study from southern India

Kumar

Velu

et al. 2020

BMJ Open

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ObjectiveDiabetic retinopathy is one of the leading causes of visual impairment after cataract and uncorrected refractive error. It has major public health implications globally, especially in countries such as India where the prevalence of diabetes is high. With timely screening and intervention, the disease progression to blindness can be prevented, but several barriers exist. As compliance to diabetic retinopathy screening in people with diabetes is very poor in India, this study was conducted to explore understanding of and barriers to diabetic retinopathy screening from the perspectives of patients and healthcare providers.MethodsUsing qualitative methods, 15 consenting adult patients with diabetes were selected purposively from those attending a large tertiary care private eye hospital in southern India. Eight semistructured interviews were carried out with healthcare providers working in large private hospitals. All interviews were audiotaped, transcribed verbatim and analysed using the framework analytical approach.ResultsFour themes that best explained the data were recognising and living with diabetes, care-seeking practices, awareness about diabetic retinopathy and barriers to diabetic retinopathy screening. Findings showed that patients were aware of diabetes but understanding of diabetic retinopathy and its complications was poor. Absence of symptoms, difficulties in doctor–patient interactions and tedious nature of follow-up care were some major deterrents to care seeking reported by patients. Difficulties in communicating information about diabetic retinopathy to less literate patients, heavy work pressure and silent progression of the disease were major barriers to patients coming for follow-up care as reported by healthcare providers.ConclusionsEnhancing patient understanding through friendly doctor–patient interactions will promote trust in the doctor. The use of an integrated treatment approach including education by counsellors, setting up of patient support groups, telescreening approaches and use of conversation maps may prove more effective in the long run.

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Inclusion of diabetic retinopathy screening strategies in national-level diabetes care planning in low- and middle-income countries: a scoping review

Curran

Piyasena

Congdon

et al. 2023

Health Res Policy Sys

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Background Diabetes is a major public health concern, with approximately 80% of the burden falling on low- and middle-income countries (LMICs). Diabetic retinopathy (DR) is one of the most common microvascular complications of diabetes, and early detection through diabetic eye screening programmes is essential to prevent visual impairment and blindness. Careful planning at a national level is crucial for effective implementation of such programmes. Methods A scoping review was conducted, and the protocol was published previously to explain the methods in detail. Data were collected from databases and searches, including grey literature. Furthermore, consultations were conducted with key informants from LMICs. Results Lower-middle-income countries (29/50, 58%) and upper-middle-income countries (27/59, 45.8%) are making more progress than low-income countries (4/29, 13.8%) in terms of DR policy planning. However, no identified data for published policies have actually implemented national DR policies. Compared to low-income and lower-middle-income countries, upper-middle-income countries are making the most progress in implementing national diabetic eye screening programmes; however, their progress is still slow, with only 5/59 (8.5%) having such programmes. Conclusion There are significant gaps in the literature, with no data reported for 78/138 (56.5%) LMICs. Further research is clearly needed to support and document DR policy development in LMICs.

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Effectiveness of peer support to increase uptake of retinal examination for diabetic retinopathy: study protocol for the DURE pragmatic cluster randomized clinical trial in Kirinyaga, Kenya

Cited by 5 publications

References 50 publications

Peer-support to increase uptake of screening for diabetic retinopathy: process evaluation of the DURE cluster randomized trial

Peer-support to increase uptake of screening for diabetic retinopathy: process evaluation of the DURE cluster randomized trial

Patient and provider perspectives on barriers to screening for diabetic retinopathy: an exploratory study from southern India

Inclusion of diabetic retinopathy screening strategies in national-level diabetes care planning in low- and middle-income countries: a scoping review

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