‘I don`t need an eye check-up’. A qualitative study using a behavioural model to understand treatment-seeking behaviour of patients with sight threatening diabetic retinopathy (STDR) in India

Abstract

Diabetic Retinopathy (DR) affects about 27% of patients with diabetes globally. According to the World Health Organization (WHO), DR is responsible for37 million cases of blindness worldwide. The SMART India study (October 2020-August 2021) documented the prevalence of diabetes, and DR in people40 years and above across ten Indian states and one Union Territory by conducting community screening. About 90% of people with sight threatening diabetic retinopathy (STDR) were referred from this screening study to eye hospitals for management, but failed to attend. This qualitative study, a component of the SMART India study, explored perceptions of referred patients regarding their susceptibility to eye related problems in diabetes and the benefits/barriers to seeking care. Perceived barriers from the viewpoint of ophthalmologists were also explored. Guided by the Health Beliefs Model (HBM), 20 semi structured interviews were carried out with consenting patients diagnosed with STDR. They included nine patients who had sought care recruited from eight eye hospitals across different states in India and eleven patients who did not seek care. Eleven ophthalmologists also participated. Four themes of analysis based on the HBM were, understanding of DR and its treatment, perceptions about susceptibility and severity, perceived barriers, perceived benefits and cues to action. Findings revealed poor understanding of the effects of diabetes on the eye contributing to low risk perception. Prohibitive costs of treatment, difficulties in accessing care services and poor social support were major barriers to seeking care. Ophthalmologists acknowledged that the absence of symptoms and the slow progressive nature of the disease deluded patients into thinking that they were fine. The study attests to the need for greater health literacy around diabetes, DR and STDR; for making treatment more affordable and accessible and for the development of effective patient education and communication strategies towards increasing compliance.

Health transition and eye care policy planning for people with diabetic retinopathy in south Asia

“…In addition to systematic DR screening, these clinics monitor DR-associated risks, such as hypertension and obesity, and patient education. 40 , 41 Moreover, community-level public education and advocacy strategies such as the Health and Wellness clinics (India) and Healthy Life Centers (Sri Lanka) may also be implemented in all countries in the region to reduce the rates of undiagnosed diabetes. 42 …”

The Utility of ChatGPT in Diabetic Retinopathy Risk Assessment: A Comparative Study with Clinical Diagnosis

“…The major barriers of DR screening include limited access to DR screening due to financial obstacles, scarce human expertise, inadequate health literacy, and awareness of diabetes management. 4 , 5 …”

“…The major barriers of DR screening include limited access to DR screening due to financial obstacles, scarce human expertise, inadequate health literacy, and awareness of diabetes management. 4,5 Barriers in access to DR screening could delay diagnosis and management, leading to progression of the disease and need for medical and surgical interventions, with guarded visual prognosis, which lead to socioeconomic burdens on the patient and healthcare system. 6 This situation presents a clear need for novel, scalable methods to facilitate early DR detection.…”