Systematic review on barriers and enablers for access to diabetic retinopathy screening services in different income settings

Abstract

Background Diabetic retinopathy (DR) can lead to visual impairment and blindness if not detected and treated in time. Knowing the barriers/enablers in advance in contrasting different country income settings may accelerate development of a successful DR screening (DRS) program. This would be especially applicable in the low-income settings with the rising prevalence of DR. Objectives The aim of this systematic review is to identify and contrast the barriers/enablers to DRS for different contexts using both consumers i.e., people with diabetes (PwDM) and provider perspectives and system level factors in different country income settings. Methods We searched MEDLINE, Embase, CENTRAL in the Cochrane Library from the databases start date to December 2018. We included the studies reported on barriers and enablers to access DRS services based at health care facilities. We categorised and synthesized themes related to the consumers (individuals), providers and the health systems (environment) as main dimensions according to the constructs of social cognitive theory, supported by the quantitative measures i.e., odds ratios as reported by each of the study authors. Main results We included 77 studies primarily describing the barriers and enablers. Most of the studies were from high income settings (72.7%, 56/77) and cross sectional in design (76.6%, 59/77). From the perspectives of consumers, lack of knowledge, attitude, awareness and motivation were identified as major barriers. The enablers were fear of blindness, proximity of screening facility, experiences of vision loss and being concerned of eye complications. In providers’ perspectives, lack of skilled human resources, training programs, infrastructure of retinal imaging and cost of services were the main barriers. Higher odds of uptake of DRS services was observed when PwDM were provided health education (odds ratio (OR) 4.3) and having knowledge on DR (OR range 1.3–19.7). Conclusion Knowing the barriers to access DRS is a pre-requisite in development of a successful screening program. The awareness, knowledge and attitude of the consumers, availability of skilled human resources and infrastructure emerged as the major barriers to access to DRS in any income setting.

General physicians role in stalling the progression of diabetic nephropathy and retinopathy

“…But literature data show that ophthalmologist referral is a problem in other parts of the world as well. 33,34 In the study which researched barriers for retinopathy screening, physicians from 41 countries were included. 33 Beside patients related factors, such as low awareness of the importance of this sort of examination and low level of health literacy, the physicians em-sistemima 33,34 .…”

“…33,34 In the study which researched barriers for retinopathy screening, physicians from 41 countries were included. 33 Beside patients related factors, such as low awareness of the importance of this sort of examination and low level of health literacy, the physicians em-sistemima 33,34 . U studiji u kojoj su ispitivani stavovi u vezi sa preprekama za obavljanje skrining pregleda na retinopatiju kod lekara iz 41 države u svetu 33 , pored faktora u vezi sa pacijentima, a koji se, uglavnom, odnose na nedovoljnu svest o značaju ovog pregleda i nizak nivo zdravstvene pismenosti, kao vodeće prepreke u samim zdravstvenim sistemima lekari su naveli probleme prilikom upućivanja na specijalistički pregled i dugo vreme čekanja na te preglede.…”

“…U studiji u kojoj su ispitivani stavovi u vezi sa preprekama za obavljanje skrining pregleda na retinopatiju kod lekara iz 41 države u svetu 33 , pored faktora u vezi sa pacijentima, a koji se, uglavnom, odnose na nedovoljnu svest o značaju ovog pregleda i nizak nivo zdravstvene pismenosti, kao vodeće prepreke u samim zdravstvenim sistemima lekari su naveli probleme prilikom upućivanja na specijalistički pregled i dugo vreme čekanja na te preglede. Analizom 77 studija koje su se bavile barijerama i faktorima koji bi pospešili odziv na skrining za dijabetesnu retinopatiju u primarnoj zdravstvenoj zaštiti, kao vodeće prepreke navedene su iste stavke 34 .…”

Understanding the uptake of a national retinopathy screening programme: An audit of people with diabetes in two large primary care centres

“…Diabetic retinopathy (DR) is the most common microvascular complication of diabetes. DR affects 8.2% of the Irish population over 50 years with type 2 diabetes (1), and is the leading causes of blindness among adults of working age (2). This estimate is based on self-report; studies among regional cohorts of primary care patients with type 1 and 2, based on objective data, have reported higher estimates (25-26%) (3,4).…”

Eye Examination Recency among African American Older Adults with Chronic Medical Conditions

“…In addition, older African-American adults with late-life vision impairment experience multiple jeopardies related to chronic disease, not having their needs accommodated, additional disability, and health needs that are not cared for by the existing health care system [23]. Knowing the barriers to appropriate eye examination is a prerequisite for the development of a successful screening program [24].…”