Identifying Barriers and Enablers to Attending Diabetic Retinopathy Screening in Immigrants to Canada From Ethnocultural Minority Groups: Protocol for a Qualitative Descriptive Study

Abstract

Background Immigrants to Canada belonging to ethnocultural minority groups are at increased risk of developing diabetes and complications, including diabetic retinopathy, and they are also less likely to be screened and treated. Improved attendance to retinopathy screening (eye tests) has the potential to reduce permanent complications, including blindness. Objective This study aims to identify the barriers and enablers of attending diabetic retinopathy screening among ethnocultural minority immigrants living with diabetes in Quebec and Ontario, Canada, to inform the development of a behavior change intervention to improve diabetic retinopathy screening attendance. Methods The research question draws on the needs of patients and clinicians. Using an integrated knowledge translation approach, the research team includes clinicians, researchers, and patient partners who will contribute throughout the study to developing and reviewing materials and procedures, helping to recruit participants, and disseminating findings. Using a convenience snowball strategy, we will recruit participants from three target groups: South Asian and Chinese people, and French-speaking people of African descent. To better facilitate reaching these groups and support participant recruitment, we will partner with community organizations and clinics serving our target populations in Ontario and Quebec. Data will be collected using semistructured interviews, using topic guides developed in English and translated into French, Mandarin, Hindi, and Urdu, and conducted in those languages. Data collection and analysis will be structured according to the Theoretical Domains Framework (TDF), which synthesizes predominant theories of behavior change into 14 domains covering key modifiable factors that may operate as barriers or enablers to attending eye screening. We will use directed content analysis to code barriers and enablers to TDF domains, then thematic analysis to define key themes within domains. Results This study was approved for funding in December 2017, and the research ethics board approved the conduct of the study as of January 13, 2018. Data collection then began in April 2018. As of August 28, 2018, we have recruited 22 participants, and analysis is ongoing, with results expected to be published in 2020. Conclusions Findings from this study will inform the codevelopment of theory-informed, culturally- and linguistically-tailored interventions to support patients in attending retinopathy screening. International Registered Report Identifier (IRRID) DERR1-10.2196/15109

Barriers to and enablers of attendance at diabetic retinopathy screening experienced by immigrants to Canada from multiple cultural and linguistic minority groups

“…Our study protocol details the study methods 13 . We used a patient‐oriented research approach in which people living with diabetes were recruited as research partners and contributed to study design, recruitment, and materials development including interview guides.…”

The co-development of a linguistic and culturally tailored tele-retinopathy screening intervention for immigrants living with diabetes from China and African-Caribbean countries in Ottawa, Canada

“…Personas generated at the workshops were closely connected to the participants themselves and their lived experiences, more subjective, and may not reflect the broader experiences of the population groups in Ottawa. Thus, to provide a holistic representation of the factors to address, we integrated the barriers to attending tele-retinopathy screening identified by patients in the community workshops with the input of patient and health system partners and our previous research with similar populations in Ottawa and Montreal [ 32 ]. Also, the dynamics of the patients in the community and patient partner groups were different influencing the approach needed to facilitate the workshops.…”

“…At the second workshop, participants were provided with examples of barriers/enablers to DRS previously identified in the literature and from previous work with the same population [ 15 , 32 ]. Participants brainstormed any additional barriers/enablers relevant to attending tele-retinopathy screening for each persona created in the first workshop and prioritized the barriers/enablers for attending screening.…”

Assessing the feasibility, acceptability, and fidelity of a tele-retinopathy-based intervention to encourage greater attendance to diabetic retinopathy screening in immigrants living with diabetes from China and African-Caribbean countries in Ottawa, Canada: a protocol

“…Many barriers identified in our work with immigrants to Canada from multiple cultural and linguistic minority groups [ 16 ] can be addressed by tele-retinopathy screening, for instance, concerns about cost (all testing provided free to patients), access (convenient locations and availability at times outside usual office hours for optometrists and ophthalmologists), and wait times (for specialist ophthalmology services). Nonetheless, our research highlights a range of additional barriers beyond access, time, and cost [ 16 , 22 ] (Table 1 ).…”