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Elizabeth Fairless, Kristen Nwanyanwu; Barriers to and facilitators of diabetic retinopathy screening in a high-risk population.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1045.
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© ARVO (1962-2015); The Authors (2016-present)
Diabetic retinopathy (DR) is among the leading causes of vision loss in the US, yet an estimated 50% of diabetic patients do not receive yearly eye exams. People with low socioeconomic status and racial/ethnic minorities are at increased risk for underutilization of screenings and vision loss. We examined barriers and facilitators to DR screening in a high-risk diabetic population.
Semi-structured qualitative interviews were conducted with 24 diabetic patients at a federally qualified community health center in New Haven, CT, where 64% of patients seen have income below the poverty line and 69% are Black or Latino. Participants discussed what factors were important in deciding whether to undergo DR screening. The interviews were recorded, transcribed, and analyzed with NVivo software, version 11 (QSR International.) The themes were organized in a theoretical framework based on internal and external factors.
The median age of participants was 57.5 (range 44 –73). Ten participants identified as female and 14 as male. Participants identified as Black (14), White (4), Hispanic (3), and Other/no answer (3). Twenty-three had health insurance. Twenty-three had received an eye exam within in the past year and 17 reported that they receive eye exams at least yearly. 415 comments were coded at 22 nodes under 7 broader themes and two overarching categories. Internal factors were: vision status, competing concerns, and emotional context. External factors included: resource availability, in-clinic experience, cues to action, and knowledge about diabetes (Fig. 1). The most frequently reported individual factors were the need for glasses and visual symptoms. The most frequently reported external factors were prompting by a primary care provider, diabetic education by a provider, insurance, and transportation.
Visual symptoms and the need for glasses are important facilitators of DR screening. Providers may influence screening adherence by educating patients. These data combined with interviews with diabetic patients not screened may provide the basis for a decision-model for DR screening in a high-risk population.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Theoretical framework of factors affecting utilization of eye exams in diabetic patients, and exemplary quotes from participants.
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