Purpose:
To study the efficacy of a culturally competent graphical edutainment fotonovela on DR Screening Compliance.
Methods:
A bilingual (English/Spanish) fotonovela was developed for the Hispanic population with Type 2 diabetes or at risk of developing the disease using data collected from focus groups in Albuquerque, New Mexico and San Antonio, Texas. This fotonovela emphasizes the importance of compliance with DR screening by people with Type 2 diabetes using two parallel stories and two different outcomes resulting from personal knowledge, attitudes, and practices (KAP) about DR screening. 400 fotonovelas were distributed to 400 randomly selected subjects (the intervention cohort), by local community health care workers. The fotonovelas had information on upcoming DR screening events (time and location). Another 100 randomly selected control subjects (the control cohort) were given an announcement flyer with the time and location of the screening events. The primary endpoint for the study was the rate of attendance to screening events between the two study cohorts. The secondary endpoint was a comparison of knowledge, attitudes, and practices among the study cohorts.
Results:
Of the 400 intervention subjects, 330 attended one of 4 no-cost retinal screening clinics. Additionally, 40 subjects received the fotonovela secondhand and attended. Only 10 of the 100 control subjects attended any of the screening events. A KAP survey on DR screening was applied to all the subjects that attended one of the screening events. The intervention group had an average score of 85% versus only 50% in the control group. The median response in terms of willingness to pay for retinal screening was $20-$25.
Conclusions:
Our research supports our hypothesis that a culturally competent communication tool that combines education with entertainment promotes higher compliance with DR screening than plain information. Higher levels of knowledge, attitudes, and practices also point to a higher level of community awareness which may have a multiplicative effect among communities where word of mouth is still an effective source of trust and information.
Keywords: diabetic retinopathy • clinical research methodology • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials