A tailored intervention to promote uptake of retinal screening among young adults with type 2 diabetes - an intervention mapping approach

Background: Young adults with type 2 diabetes (aged 18-39 years) are at risk of early onset and rapid progression of diabetic retinopathy, the leading cause of blindness and vision loss in working age adults. Early detection via retinal screening can prevent most vision loss, yet screening rates are consistently lower among this priority population than the general diabetes population. We aimed to test the effect of a tailored, evidence-based brief health behaviour change intervention (leaflet) on self-reported screening uptake, and previously identified social cognitive determinants of retinal screening. Methods: A pragmatic, two-arm randomised controlled trial was conducted from September 2014 to April 2015. Participants were stratified by prior screening uptake (Yes/No) and randomly allocated to intervention (leaflet) or ‘usual care’ control (no leaflet). Primary outcome was self-reported screening uptake four weeks post-intervention for ‘No’ participants who had not previously screened for diabetic retinopathy. Secondary outcome variables were changes in knowledge, attitudes, normative beliefs, intention and behavioural skills for all participants, irrespective of prior screening behaviour. To assess intervention effects on secondary outcome variables, we conducted independent samples t-tests (two-tailed) on pre-post change scores. Results: 129 young adults (26% no prior retinal screen) completed baseline; 101 completed post-intervention. Power to determine effect on the primary outcome was curtailed by low recruitment of individuals with no prior retinal screen and loss to follow-up. Attrition was associated significantly with country of birth, language spoken at home, and marital status. Significant intervention effect was observed for one secondary outcome variable: knowledge of diabetic retinopathy (p=.03) with moderate effect (partial eta squared h2=.05); no adverse effects were reported. Control group participants received the leaflet at study completion. Conclusions: This study confirms that a well-designed eye health and retinal screening promotion leaflet can increase knowledge of diabetic retinopathy, an important screening predictor. The study highlights the challenges of conducting ‘real-world’ health behaviour change research with this priority population, providing insights for clinicians and researchers. Strategies to recruit, engage and retain hard-to-reach populations are discussed including nonconventional alternatives to randomised controlled trial designs. Trial registration: ACTRN12614001110673, UTN No.: U1111-1161-9803. Registered 20 October 2014 - retrospectively registered https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367127

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“…Development of the 8-panel, Who is looking after your eyes? leaflet(Figures 1a and b)is described elsewhere(18).…”

mentioning

confidence: 99%

Effect of a tailored leaflet to promote diabetic retinopathy screening among young adults with type 2 diabetes: a randomised controlled trial.

Lake

Browne

Rees

et al. 2020

Preprint

Self Cite

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show abstract

“…leaflet upon provision of their postal address. We have previously reported the theory-based development of the 54-item survey used in this study (18); all items are listed in Supplementary file 1. In brief, 16 items assessed three knowledge constructs (link between diabetes and vision loss, knowledge of DR, and knowledge of screening).…”

Section: Methodsmentioning

confidence: 99%

“…Effective interventions to promote health behaviour change have shared elements: content grounded in evidence and underpinned by theoretical constructs; targeting modifiable behavioural and psychosocial determinants of the behaviour, and tailored to the priority population (17). Using these principles and a co-design approach, our multidisciplinary project team developed an evidence-based and theoretically-grounded screening promotion leaflet, targeting social cognitive factors previously identified as impacting screening among young adults with T2D (12,18,19). These factors included: knowledge, attitudes, normative beliefs, intentions and behavioural skills.…”

Section: Introductionmentioning

confidence: 99%

Effect of a tailored leaflet to promote diabetic retinopathy screening among young adults with type 2 diabetes: a randomised controlled trial

Lake

Browne

Rees

et al. 2019

Preprint

Self Cite

View full text Add to dashboard Cite

Background young adults with type 2 diabetes (aged 18-39 years) are at risk of early onset and rapid progression of diabetic retinopathy, the leading cause of blindness and vision loss in working age adults. Early detection via retinal screening can prevent most vision loss, yet uptake for this priority population is consistently lower than the general diabetes population. We aimed to test the effect of a tailored, evidence-based brief health behaviour change intervention (leaflet) on self-reported uptake, and previously identified social cognitive determinants of retinal screening.Methods a pragmatic, two-arm randomised controlled trial was conducted from September 2014 to April 2015. Participants were stratified by prior screening uptake (Yes/No) and randomly allocated to intervention (leaflet) or ‘usual care’ control (no leaflet). Primary outcome was self-reported screening uptake four weeks post-intervention for ‘No’ participants who had not previously screened for diabetic retinopathy. Secondary outcome variables were changes in knowledge, attitudes, normative beliefs, intention and behavioural skills for all participants, irrespective of prior screening behaviour. To assess intervention effects on secondary outcome variables, we conducted independent samples t-tests (two-tailed) on pre-post change scores.Results 129 young adults (26% no prior retinal screen) completed baseline; 101 completed post-intervention. Power to determine effect on the primary outcome was curtailed by low recruitment of individuals with no prior retinal screen and loss to follow-up. Country of birth, language spoken at home, and relationship status were significantly associated with study attrition. Significant intervention effect was observed for one secondary outcome variable: knowledge of diabetic retinopathy ( p =.03) with moderate effect (partial eta squared η 2 =.05); no adverse effects were reported. Control group participants received the leaflet at study completion.Conclusions this study confirms that a well-designed eye health and retinal screening promotion leaflet can increase knowledge of diabetic retinopathy, an important screening predictor. The study highlights the challenges of conducting ‘real-world’ health behaviour change research with this priority population, providing insights for clinicians and researchers. Strategies to recruit, engage and retain hard-to-reach populations are discussed including nonconventional alternatives to randomised controlled trial designs. Trial registration: ACTRN12614001110673, UTN No.: U1111-1161-9803. Registered 20 October 2014 - retrospectively registered https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367127.

show abstract

“…We have previously reported the theory-based development of the 54-item survey used in this study (18); all items are listed in Supplementary file 1. In brief, 16 items assessed three knowledge constructs (link between diabetes and vision loss, knowledge of DR, and knowledge of screening).…”

Section: Stage 2 Social Cognitive Determinantsmentioning

confidence: 99%

“…Finally, the Who is looking after your eyes?' leaflet was, by necessity, print-based in a size that could be posted to participants (18). In future, we recommend that the messaging and content can be used in the digital platforms accessed by this priority population.…”

Section: Implications For Policy and Practicementioning

confidence: 99%

Effect of a tailored leaflet to promote diabetic retinopathy screening among young adults with type 2 diabetes: a randomised controlled trial.

Lake

Browne

Rees

et al. 2019

Preprint

Self Cite

View full text Add to dashboard Cite

Background: Young adults with type 2 diabetes (aged 18-39 years) are at risk of early onset and rapid progression of diabetic retinopathy, the leading cause of blindness and vision loss in working age adults. Early detection via retinal screening can prevent most vision loss, yet uptake among this priority population is consistently lower than the general diabetes population. We aimed to test the effect of a tailored, evidence-based brief health behaviour change intervention (leaflet) on self-reported uptake, and previously identified social cognitive determinants of retinal screening. Methods: A pragmatic, two-arm randomised controlled trial was conducted from September 2014 to April 2015. Participants were stratified by prior screening uptake (Yes/No) and randomly allocated to intervention (leaflet) or ‘usual care’ control (no leaflet). Primary outcome was self-reported screening uptake four weeks post-intervention for ‘No’ participants who had not previously screened for diabetic retinopathy. Secondary outcome variables were changes in knowledge, attitudes, normative beliefs, intention and behavioural skills for all participants, irrespective of prior screening behaviour. To assess intervention effects on secondary outcome variables, we conducted independent samples t-tests (two-tailed) on pre-post change scores. Results: 129 young adults (26% no prior retinal screen) completed baseline; 101 completed post-intervention. Power to determine effect on the primary outcome was curtailed by low recruitment of individuals with no prior retinal screen and loss to follow-up. Attrition was associated significantly with country of birth, language spoken at home, and marital status. Significant intervention effect was observed for one secondary outcome variable: knowledge of diabetic retinopathy (p=.03) with moderate effect (partial eta squared h2=.05); no adverse effects were reported. Control group participants received the leaflet at study completion. Conclusions: This study confirms that a well-designed eye health and retinal screening promotion leaflet can increase knowledge of diabetic retinopathy, an important screening predictor. The study highlights the challenges of conducting ‘real-world’ health behaviour change research with this priority population, providing insights for clinicians and researchers. Strategies to recruit, engage and retain hard-to-reach populations are discussed including nonconventional alternatives to randomised controlled trial designs. Trial registration: ACTRN12614001110673, UTN No.: U1111-1161-9803. Registered 20 October 2014 - retrospectively registered https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367127

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A tailored intervention to promote uptake of retinal screening among young adults with type 2 diabetes - an intervention mapping approach

Cited by 70 publications

References 78 publications

Effect of a tailored leaflet to promote diabetic retinopathy screening among young adults with type 2 diabetes: a randomised controlled trial.

Effect of a tailored leaflet to promote diabetic retinopathy screening among young adults with type 2 diabetes: a randomised controlled trial.

Effect of a tailored leaflet to promote diabetic retinopathy screening among young adults with type 2 diabetes: a randomised controlled trial

Effect of a tailored leaflet to promote diabetic retinopathy screening among young adults with type 2 diabetes: a randomised controlled trial.

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