Perceived barriers and enablers to the provision of diabetic retinopathy screening for young adults: a cross-sectional survey of healthcare professionals working in the UK National Diabetic Eye Screening Programme

Abstract

IntroductionDiabetic retinopathy screening (DRS) attendance in young adults is consistently below recommended levels. The aim of this study was to conduct a survey of screening providers in the UK Diabetic Eye Screening Programme (DESP) to identify perceived barriers and enablers to DRS attendance in young adults and elicit views on the effectiveness of strategies to improve screening uptake in this population.Research design and methodsMembers of the British Association of Retinal Screening (n=580) were invited to complete an anonymous online survey in July 2020 assessing agreement with 37 belief statements, informed by the Theoretical Domains Framework (TDF) of behavior change, describing potential barrier/enablers to delivering DRS for young adults and further survey items exploring effectiveness of strategies to improve uptake of DRS.ResultsIn total, 140 (24%) responses were received mostly from screener/graders (67.1%). There was a high level of agreement that the DESP had a role in improving attendance in young adults (96.4%) and that more could be done to improve attendance (90.0%). The most commonly reported barriers related to TDF domains Social influences and Environmental context and resources including lack of integration of DRS with other processes of diabetes care, which limited the ability to discuss diabetes self-management. Other barriers included access to screening services and difficulties with scheduling appointments. Less than half (46.4%) of respondents reported having a dedicated strategy to improve screening uptake in young adults. Strategies perceived to be effective included: screening within the community; prompts/reminders and integrating eye screening with other diabetes services.ConclusionsScreening providers were concerned about screening uptake in young adults, although many programs lacked a dedicated strategy to improve attendance. Problems associated with a lack of integration between DRS with other diabetes care processes were identified as a major barrier to providing holistic care to young adults and supporting diabetes self-management.

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

“…This strategy is potentially acceptable to implement in practice, with a recent cross-sectional survey of HCPs working in the UK National Diabetic Eye Screening Program highlighting that screening providers would like to be more involved in discussing screening results with YAs and promoting diabetes self-management. 18 …”

“…This strategy is potentially acceptable to implement in practice, with a recent cross-sectional survey of HCPs working in the UK National Diabetic Eye Screening Program highlighting that screening providers would like to be more involved in discussing screening results with YAs and promoting diabetes self-management. 18 A recommendation by a HCP has been shown to be an important enabler for DRS uptake and receiving a recommendation from a healthcare provider to attend screening is associated with improved attendance. 4 15 However, survey respondents reported that members of the diabetes team did not always check their DRS attendance record or encourage them to attend.…”

“… 17 We have also conducted a cross-sectional survey of HCPs working in the UK National Diabetic Eye Screening Program. 18 We similarly applied the TDF to identify modifiable barriers and enablers to DRS attendance. In terms of the interviews, key influences fell within the TDF domains: Knowledge , for example, not understanding reasons for attending DRS or treatments available if diabetic retinopathy is detected; Social support , for example, lack of support following DRS results; S ocial role and identity , for example, not knowing other people their age with diabetes; feeling ‘isolated’ and being reluctant to disclose their diabetes; Environmental context and resources , for example, lack of appointment flexibility and options for rescheduling; and Emotion , for example, diabetes distress/burnout.…”

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

“…This strategy is potentially acceptable to implement in practice, with a recent cross sectional survey of healthcare professionals working in the UK National Diabetic Eye Screening Programme highlighting that screening providers would like to be more involved in discussing screening results with YAs and promoting diabetes self-management. [20]…”

“…This strategy is potentially acceptable to implement in practice, with a recent cross sectional survey of healthcare professionals working in the UK National Diabetic Eye Screening Programme highlighting that screening providers would like to be more involved in discussing screening results with YAs and promoting diabetes self-management. [20] A recommendation by a healthcare professional (HCP) has been shown to be an important enabler for DRS uptake and receiving a recommendation from a healthcare provider to attend screening is associated with improved attendance. [2,13] However, survey respondents reported that members of the diabetes team did not always check their DRS attendance record or encourage them to attend.…”