A model of culturally‐informed integrated diabetes education and eye screening in indigenous primary care services and specialist diabetes clinics: Study protocol

Abstract

Aims To improve diabetes management in Indigenous Australians using an integrated nurse‐led model of diabetes education and eye screening in indigenous primary care and specialist diabetes clinics. Design A pre–post study. Methods This study will be implemented in indigenous primary care and specialist diabetes clinics in Victoria, Australia. Participants recruited to the study will be existing adult patient with diagnosed diabetes attending study sites. A nurse‐credentialled diabetes educator and certified retinal imager will deliver three study components: (a) retinal photography as a diabetic retinopathy screening and patient engagement tool; (b) lifestyle and behaviour surveys, administered at baseline and at the final visit, in 12 months. Findings from the surveys and participants’ retinal images will be used to guide; and (c) personalized diabetes education. The primary outcomes are participant adherence to diabetic eye screening recommendations and health service diabetic retinopathy screening coverage. Secondary outcomes are baseline DR prevalence and changes in clinical and lifestyle risk factor levels, diabetes knowledge and satisfaction with diabetes care. Discussion Compared with non‐indigenous Australians, Indigenous Australians have a high prevalence of diabetic retinopathy and blindness, low adherence to eye screening recommendations and suboptimal health literacy. Nurse‐credentialled diabetes educators can be trained to incorporate retinal imaging and eye screening into their clinical practice to give image‐based diabetes education to facilitate diabetic retinopathy management. Impact Credentialled nurse diabetes educators who integrate eye screening and diabetes education can facilitate timelier diabetic retinopathy screening, referral pathways and treatment of sight‐threatening retinopathy. We believe that this model of integrated diabetes education and eye screening will also improve adherence to eye screening recommendations, population screening coverage, health literacy, risk factor levels and diabetes self‐care. Clinical Trial Registration: ANZCTRN1261800120435.

Mixed diabetic retinopathy screening coverage results in Indigenous Australian primary care settings: A nurse‐led model of integrated diabetes care

“…Certified retinal imagers and diabetes educators whilst part of the iDEES study protocol can be replaced with locally trained retinal imagers and diabetes educators who could be nurses, community health workers, clinicians or allied health professionals. The tasks undertaken by the nurse in the iDEES protocol are shown in Figure S1 and the detailed imaging protocol is described in the iDEES protocol manuscript (Atkinson‐Briggs et al, 2021). This information allows nurses without additional diabetes qualifications and experience to learn from the novel iDEES model of education based on eye‐screening, which is now a service being promoted by the peak body for CDEs, the Australian Diabetes Educators Association (ADEA).…”

“…Data collection and management are detailed in the published protocol paper (Atkinson‐Briggs et al, 2021. Briefly, the nurse PI obtained demographic and selected clinical data, including the date of the last eye examination if recorded, and presenting visual acuity was assessed.…”

Disease perception and experience in people with diabetic retinopathy: A qualitative study

“…This reveals the urgent need for educational activities that instruct patients on basic eye care knowledge, such as health lectures and health education at health care institutions of all levels (e.g., through media and posters). In addition, previous studies have found that comprehensive education models combining diabetes education and ophthalmic screening can promote timelier DR screening, referral, and treatment of vision-threatening retinopathy (Atkinson-Briggs et al, 2021). Another reason for patients' lack of knowledge may be that DR can develop silently.…”

Glycemic Control Among Type 2 Diabetics: Comparison of Patients Coming to Specialized Clinics vs General Clinics for Diabetes

“…(6) A pre-post study was conducted in Australia, to see improvements in diabetes management using Nurse led model of diabetes education and supported that there model will improve adherence to the best practices and recommendations regarding health promotion, risk factor modifications and self-management of diabetes. (7) Results of a meta-analysis published in 2022 observed a positive impact on HBa1c , cardiac markers and risk factors modifications, when diabetes specialists were integrated in a working plan with primary health care professionals. (8) Another study in Philippines (2022), addressed the issue as Diabetes ecosystem and concluded that efforts can evolve a diabetes ecosystem, which involves awareness compaigns , screening activities, early and accurate diagnosis and affordable treatment plans.…”