July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Towards a More Comprehensive Understanding of Barriers to and Facilitators of Diabetic Retinopathy Screening Utilization in a High-risk Population: A Qualitative Study
Author Affiliations & Notes
  • Amber Loren Ong King
    Ophthalmology, Yale School of Medicine, New Haven, Connecticut, United States
  • Elizabeth Fairless
    Ophthalmology, Yale School of Medicine, New Haven, Connecticut, United States
  • Kristen Harris Nwanyanwu
    Ophthalmology, Yale School of Medicine, New Haven, Connecticut, United States
  • Footnotes
    Commercial Relationships   Amber Loren King, None; Elizabeth Fairless, None; Kristen Nwanyanwu, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 1096. doi:
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      Amber Loren Ong King, Elizabeth Fairless, Kristen Harris Nwanyanwu; Towards a More Comprehensive Understanding of Barriers to and Facilitators of Diabetic Retinopathy Screening Utilization in a High-risk Population: A Qualitative Study. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1096.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Diabetic retinopathy (DR) remains a leading cause of vision loss in the U.S., and patients of low socioeconomic status and racial/ethnic minorities are among the most vulnerable. Over 50% of diabetic patients do not receive annual eye exams to screen for DR. We previously formulated a theoretical framework characterizing barriers and motivating factors for seeking eye care among diabetic patients. Towards a more comprehensive representation of these influencing factors, we present insights from additional interviews with patients not undergoing annual screening.

Methods : Semi-structured interviews were conducted with 9 diabetic patients. Participants discussed factors that influenced whether they underwent annual screening for DR. The interviews were transcribed using Trint transcription platform. The NVivo software was used to analyze responses for incorporation into a theoretical framework (Figure 1).

Results : In contrast to our previous study cohort in which 23 out of 24 patients had received an eye exam within the past year, less than half of these patients received an eye exam within the past year. Overall, as was seen in the previous study cohort, vision status was the most frequently reported individual-level factor, and resource availability, cues to action, and knowledge-creating experiences were the most commonly reported institutional/structural-level factors for receiving eye exams (Figure 1). Among the patients who had not received an eye exam within the past year, finances/insurance and lack of prompting by a health provider were the most frequently reported reasons for not pursuing eye screenings. Conflicting concerns, particularly other health issues perceived to be more life-threatening, were reported barriers.

Conclusions : The overall themes observed within this cohort align with our previously proposed decision-model for DR screening in a high-risk population. Knowledge-sharing and prompting by a health care provider is powerful facilitator for DR screening, and lack thereof presents as a missed opportunity to improve screening adherence and reduce DR-related visual loss.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

Figure 1. Theoretical framework of factors affecting utilization of eye exams in diabetic patients, and exemplary quotes from participants.

Figure 1. Theoretical framework of factors affecting utilization of eye exams in diabetic patients, and exemplary quotes from participants.

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