Disparities in Diabetic Retinopathy Screening Rates Within Minority Populations: Differences in Reported Screening Rates Among African American and Hispanic Patients

Lü, Yang; Serpas, Lilian; Genter, Pauline; Mehranbod, Christina A.; Campa, David; Ipp, Eli

doi:10.2337/dc15-2198

Cited by 22 publications

(14 citation statements)

References 4 publications

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“…This suggests that the barriers identified in the literature reflect the perceptions of providers more than that those of patients, causing potential provider bias in surveys. Further supporting the notion that DR screening surveys may be inadequate in capturing patient perceptions is the large discrepancy between DR screening rates of African American and Hispanic patients, which could not be explained by any difference in reporting of barriers ( 29 ).…”

Section: Discussionmentioning

confidence: 90%

Divergent Perceptions of Barriers to Diabetic Retinopathy Screening Among Patients and Care Providers, Los Angeles, California, 2014–2015

Lü¹,

Serpas²,

Genter³

et al. 2016

Prev. Chronic Dis.

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IntroductionDespite availability of screening for diabetic retinopathy, testing is underused by many low-income and racial/ethnic minority patients with diabetes. We examined perceived barriers to diabetic retinopathy screening among low-income patients and their health care providers and provider staffers.MethodsWe collected survey data from 101 patients with diabetes and 44 providers and staffers at a safety-net clinic where annual diabetic retinopathy screening rates were low. Barriers specified in the survey were derived from the literature.ResultsPatients surveyed (mean [standard deviation] age, 54.0 [7.7] y; 41% were male) were primarily Hispanics (70%) and African Americans (27%) of low socioeconomic status. Overall, 55% of patients received diabetic retinopathy screening in the previous year. Patients who could not explain why this screening is needed reported more barriers than patients who could (2.5 vs 1.4 barriers, P = .02). Fewer patients reported that they experienced barriers such as transportation (15%), language issues (15%), cultural beliefs or myths (4%), denial (8%), and fear (5%), which providers and staffers considered very or extremely important (all P < .001). Financial burdens (26%) and depression (22%) were most commonly reported by patients as barriers, yet providers and staffers did not rate these barriers as important, P < .001. ConclusionPatients and health care providers had markedly divergent perceptions of barriers to diabetic retinopathy screening. Patients with poor understanding of the need for screening were more likely to report such barriers. These results suggest a need for active community engagement to find key elements for education programs and other interventions to increase rates of diabetic retinopathy screening, particularly among low-income, minority populations.

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Section: Discussionmentioning

confidence: 90%

Divergent Perceptions of Barriers to Diabetic Retinopathy Screening Among Patients and Care Providers, Los Angeles, California, 2014–2015

Lü¹,

Serpas²,

Genter³

et al. 2016

Prev. Chronic Dis.

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“…They know it is important that they go, and so they keep the appointments but they did not know … that screening helped to prevent blindness ’ . In one study, people with diabetes who were not able to explain why diabetic retinopathy screening is needed reported more barriers than those who could . Some were not aware of the difference between diabetic retinopathy screening and routine eye tests; hence, some believed they had attended screening when they had not .…”

Section: Resultsmentioning

confidence: 99%

“…Theme: Fear or anxiety (20 studies) . For some, the fear of losing their vision was a strong incentive to attend screening , but, for others, fear of a diagnosis of diabetic retinopathy was a barrier or fear of the screening procedure itself or of a medical intervention if they were confronted with a diagnosis . In one study, non‐adherent participants expressed less concern about losing their vision than adherent participants .…”

Section: Resultsmentioning

confidence: 99%

Barriers to and enablers of diabetic retinopathy screening attendance: a systematic review of published and grey literature

et al. 2018

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“…In fact, they may not have symptoms recognized early or receive the most effective treatment. Similar to cancer screening, diabetic retinopathy screening is essential for the early detection and treatment of diabetes-related visual impairments and blindness [18]. Yet, it is commonly underutilized among women of lower SES [18].…”

Section: Health Disparities In Diabetes and Its Complications And Comorbiditiesmentioning

confidence: 99%

Impact of Intersecting Systems of Oppression on Diabetic Retinopathy Screening Among Those Who Identify as Women of Low Socioeconomic Status: Protocol for a Convergent Mixed Methods Study

et al. 2021

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Background By 2025, 5 million Canadians will be diagnosed with diabetes, and women from lower socioeconomic groups will likely account for most new diagnoses. Diabetic retinopathy is a primary vision complication of diabetes and a leading cause of blindness among adults, with 26% prevalence among women. Tele-retina is a branch of telemedicine that delivers eye care remotely. Screening for diabetic retinopathy has great potential to reduce the incidence of blindness, yet there is an adverse association among screening, income, and gender. Objective We aim to explore gender disparity in the provision of tele-retina program services for diabetic retinopathy screening in a cohort of women of low socioeconomic status (SES) receiving services in South Riverdale Community Health Centre (SRCHC) between 2014 and 2019. Methods Using a convergent mixed methods design, we want to understand patients’, providers’, administrators’, and decision makers’ perceptions of the facilitators and barriers associated with the implementation and adoption of tele-retina. Multivariate logistic regression will be utilized to assess the association among client characteristics, referral source, and diabetic retinopathy screening. Guided by a grounded theory approach, systematic coding of data and thematic analysis will be utilized to identify key facilitators and barriers to the implementation and adoption of tele-retina. Results For the quantitative component, we anticipate a cohort of 2500 patients, and we expect to collect data on the overall patterns of tele-retina program use, including descriptions of program utilization rates (such as data on received and completed diabetic retinopathy screening referrals) along the landscape of patient populations receiving these services. For the qualitative component, we plan to interview up to 21 patients and 14 providers, administrators, and decision makers, and to conduct up to 14 hours of observations alongside review of relevant documents. The interview guide is being developed in collaboration with our patient partners. Through the use of mixed methods research, the inquiry will be approached from different perspectives. Mixed methods will guide us in combining the rich subjective insights on complex realities from qualitative inquiry with the standard generalizable data that will be generated through quantitative research. The study is under review by the University Health Network Research Ethics Board (19-5628). We expect to begin recruitment in winter 2021. Conclusions In Ontario, the screening rate for diabetic retinopathy among low income groups remains below 65%. Understanding the facilitators and barriers to diabetic retinopathy screening may be a prerequisite in the development of a successful screening program. This study is the first Ontario study to focus on diabetic retinopathy screening practices in women of low SES, with the aim to improve their health outcomes and revolutionize access to quality care. International Registered Report Identifier (IRRID) PRR1-10.2196/23492

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Disparities in Diabetic Retinopathy Screening Rates Within Minority Populations: Differences in Reported Screening Rates Among African American and Hispanic Patients

Cited by 22 publications

References 4 publications

Divergent Perceptions of Barriers to Diabetic Retinopathy Screening Among Patients and Care Providers, Los Angeles, California, 2014–2015

Divergent Perceptions of Barriers to Diabetic Retinopathy Screening Among Patients and Care Providers, Los Angeles, California, 2014–2015

Barriers to and enablers of diabetic retinopathy screening attendance: a systematic review of published and grey literature

Impact of Intersecting Systems of Oppression on Diabetic Retinopathy Screening Among Those Who Identify as Women of Low Socioeconomic Status: Protocol for a Convergent Mixed Methods Study

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