Barriers and enablers to diabetic eye screening attendance: An interview study with young adults with type 1 diabetes

Prothero, Louise; Lawrenson, John G; Cartwright, Martin; Crosby‐Nwaobi, Roxanne; Burr, Jennifer; Gardner, Philip; Anderson, John; Presseau, Justin; Ivers, Noah; Grimshaw, Jeremy; Lorencatto, Fabiana; Investigators, Eros Study

doi:10.1111/dme.14751

Cited by 8 publications

(28 citation statements)

References 31 publications

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“…This study aimed to build on the findings of our earlier qualitative interview study to identify perceived barriers and enablers to DRS in YAs in the UK. [15] The results broadly confirmed our qualitative interview findings in YAs with T1D and converged with the findings from a qualitative study of YAs with T2D in Australia. [13]…”

Section: Discussionsupporting

confidence: 84%

“…Section 2 Perceived influences on DRS attendance: Participants were presented with 30 belief statements representing barriers and enablers to DRS attendance. These statements were developed based on the inductively generated themes based on frequency and elaboration from our semi-structured interview study with young adults in the UK [15](e.g., the theme ‘ Diabetic retinopathy is a concern’ was reflected in the belief statement ‘I worry about diabetic retinopathy’ )). To ensure theoretical coverage and that the wide range of potential influences were considered, belief statements covered 13 of the 14 TDF domains (our earlier qualitative study [15] did not identify themes for the domain Optimism ).…”

Section: Methodsmentioning

confidence: 99%

“…These statements were developed based on the inductively generated themes based on frequency and elaboration from our semi-structured interview study with young adults in the UK [15](e.g., the theme ‘ Diabetic retinopathy is a concern’ was reflected in the belief statement ‘I worry about diabetic retinopathy’ )). To ensure theoretical coverage and that the wide range of potential influences were considered, belief statements covered 13 of the 14 TDF domains (our earlier qualitative study [15] did not identify themes for the domain Optimism ). Participants rated their agreement with each statement using a 5-point Likert scale (strongly agree → strongly disagree).…”

Section: Methodsmentioning

confidence: 99%

“…A part of this research we conducted qualitative interviews with 29 YAs with type 1 diabetes (T1D) aged 18-34 years. [15] We similarly applied the TDF to identify modifiable barriers and enablers to DRS attendance. Key influences fell within the TDF domains: [ Knowledge ] e.g.…”

Section: Introductionmentioning

confidence: 99%

“…In the current study, we used the results of the previous interview study [15] to design an online survey to assess the generalisability of the perceived barriers and enablers in a more diverse sample of YA with regard to particular demographic characteristics (e.g. age, employment, gender, ethnicity, educational level).…”

Section: Introductionmentioning

confidence: 99%

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Barriers and enablers to diabetic eye screening: a cross sectional survey of young adults with type 1 and type 2 diabetes in the UK

Prothero

Cartwright

Lorencatto

et al. 2022

Preprint

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Introduction: Diabetic retinopathy screening (DRS) attendance in young adults is consistently below recommended levels. The aim of this study was to identify barriers and enablers of diabetic retinopathy screening (DRS) attendance amongst young adults (YA) in the UK living with type 1 (T1D) and type 2 (T2D) diabetes. Research design and methods: YAs (18-34yrs) were invited to complete an anonymous online survey in June 2021 assessing agreement with 30 belief statements informed by the Theoretical Domains Framework of behaviour change (TDF) describing potential barriers/enablers to DRS. Results: In total 102 responses were received. Most had T1D (65.7%) and were regular attenders for DRS (76.5%). The most salient TDF domains for DRS attendance were [Goals], with 93% agreeing that DRS was a high priority and [Knowledge], with 98% being aware that screening can detect eye problems early. Overall 67.4% indicated that they would like greater appointment flexibility [Environmental context/resources] and 31.3% reported difficulties getting time off work/study to attend appointments [Environmental Context/Resources]. This was more commonly reported by occasional non-attenders versus regular attenders (59.1% vs 23.4%, P=0.002) Most YAs were worried about diabetic retinopathy (74.3%), anxious when receiving screening results (63%) [Emotion] and would like more support after getting their results (66%) [Social influences]. Responses for T1D and T2D were broadly similar, although those with T2D were more likely have developed strategies to help them to remember their appointments (63.6% vs 37.9%, P=0.019) [Behavioural regulation]. Conclusions: Attendance for DRS in YAs is influenced by complex interacting behavioural factors. Identifying modifiable determinants of behaviour will provide a basis for designing tailored interventions to improve DRS in YAs and prevent avoidable vision loss.

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Section: Discussionsupporting

confidence: 84%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Barriers and enablers to diabetic eye screening: a cross sectional survey of young adults with type 1 and type 2 diabetes in the UK

Prothero

Cartwright

Lorencatto

et al. 2022

Preprint

Self Cite

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Identifying Target Behaviours and Potential Barriers to Change (Phase 2a)

Patey,

McCleary,

Presseau

et al. 2023

How to Reduce Overuse in Healthcare

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A cohort follow-up study for diabetic retinopathy screening incidence in the North Denmark Region

et al. 2023

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Aims To evaluate diabetic retinopathy (DR) screening incidence in a universal healthcare system. Methods Registry-based cohort study based on a Danish regional population from 2009 to 2018. Individuals with diabetes were identified by medication. Screening attendance was estimated by surrogate measures using local and nationwide databases reported by cumulative incidence. Results 18,832 patients were included. By the end of the first year, the cumulative incidence of screening for DR was 60.2% and by the end of the second year 74.2%. The cumulative incidence was 93.9% overall, 97.7% for patients with type 1 diabetes (T1D) and 93.4% for patients with type 2 diabetes. Screening proportions per 1, 2 and 5 years were calculated. Females, patients with T1D, and patients attending screening at hospitals had a higher Hazard Ratio of 1.084, 1.157, and 1.573, respectively. The Cochran–Armitage trend test indicated increased screening frequency from 2009 to 2018. Validation of DR screening was done at hospitals with a mean positive predictive value of 86.78%. Cumulative incidence curves showed a small right shift when censoring the first, second and third screening visits. Conclusions Nearly all patients were screened for DR over a 5-year timespan. Female patients with T1D who attended screening at hospitals were significantly more likely to be screened. Validation of screening visits at hospitals was reported with a high mean positive predictive value. Most other studies, to the best of our knowledge, only report screening attendance for patients already enrolled in a DR screening programme. This study describes the overall screening attendance for the total eligible diabetes population.

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Barriers and enablers to diabetic eye screening attendance: An interview study with young adults with type 1 diabetes

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 8 publications

References 31 publications

Barriers and enablers to diabetic eye screening: a cross sectional survey of young adults with type 1 and type 2 diabetes in the UK

Barriers and enablers to diabetic eye screening: a cross sectional survey of young adults with type 1 and type 2 diabetes in the UK

Identifying Target Behaviours and Potential Barriers to Change (Phase 2a)

A cohort follow-up study for diabetic retinopathy screening incidence in the North Denmark Region

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