June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Factors influencing eye screening adherence among urban Black patients with diabetes: a qualitative study
Author Affiliations & Notes
  • CHRISTIANA FOWLKES
    Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
  • Loren Lock
    Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
  • Johnson Hoang
    Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
  • Olayinka O Shiyanbola
    Social and Administrative Sciences Division, University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin, United States
  • Nora Jacobson
    Institute for Clinical and Translational Research, University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, United States
  • Yao Liu
    Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
  • Footnotes
    Commercial Relationships   CHRISTIANA FOWLKES None; Loren Lock None; Johnson Hoang None; Olayinka Shiyanbola None; Nora Jacobson None; Yao Liu None
  • Footnotes
    Support  NIH/NEI UG1 EY032446, UW-Madison Baldwin Wisconsin Idea Endowment Grant, Research to Prevent Blindness, Inc., NIH National Center for Advancing Translational Sciences (NCATS) grant UL1TR002373
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 562 – A0127. doi:
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      CHRISTIANA FOWLKES, Loren Lock, Johnson Hoang, Olayinka O Shiyanbola, Nora Jacobson, Yao Liu; Factors influencing eye screening adherence among urban Black patients with diabetes: a qualitative study. Invest. Ophthalmol. Vis. Sci. 2022;63(7):562 – A0127.

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

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Abstract

Purpose : Black adults are twice as likely as non-Hispanic whites to become blind and are 50% more likely to develop diabetic eye disease. As few as 30% of Black adults with diabetes obtain yearly eye screening. Thus, there is an urgent need to increase screening to prevent vision loss. We aimed to identify factors influencing eye screening adherence among Black patients with diabetes at an urban federally qualified health center (FQHC) in Milwaukee, WI.

Methods : We conducted semi-structured individual interviews with 25 participants (14 patients with diabetes who self-identified as Black or African-American and 11 clinical personnel). Both inductive and deductive content analysis was performed. All interviews were transcribed verbatim and analyzed using QSR NVivo software.

Results : Patients had a mean age of 54 years (range: 27-72 years) and 57% were female. Clinical personnel included 3 primary care clinicians, 3 medical staff, and 5 administrators. We developed a model to understand factors influencing eye screening adherence among urban Black patients with diabetes adapted from the Socio-Ecological Model of Health and National Institutes of Minority Health and Disparities Research Framework. Factors were categorized as individual, social, and environmental. Many factors, such as limited access to healthcare and transportation, financial tradeoffs, anxiety about diabetes complications, and the burden of diabetes management, were similar to those from our prior qualitative study in a rural FQHC serving predominantly non-Hispanic white patients with diabetes. However, urban Black patients with diabetes reported many additional factors influencing diabetic eye screening adherence, including mistrust and discomfort with healthcare providers, experiences of racism and discrimination in healthcare settings, intergenerational trauma from healthcare experiences, and housing instability. Patients also emphasized the importance of patient self-advocacy in navigating the health care system to manage their medical conditions.

Conclusions : Urban Black patients with diabetes and clinical personnel reported several factors influencing patient adherence with eye screening. The effectiveness of interventions targeting eye screening disparities among urban Black patients with diabetes may be enhanced by addressing these factors.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

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