Telephone intervention to promote diabetic retinopathy screening among the urban poor

Abstract

Background: Participation in diabetic retinopathy screening is suboptimal. The Vision is Precious study (2001-2005) tested the hypothesis that a tailored telephone intervention in urban minority diabetes populations, offered in English or Spanish, would result in greater screening for retinopathy than a standard print intervention.

Design: Randomized controlled trial

Setting/participants: Subjects (N=598) were adults with diabetes without a dilated fundus examination (DFE) in >1 year from three healthcare centers in Bronx NY.

Intervention: A tailored telephone intervention to promote retinopathy screening compared to a standard print intervention over a 6-month period.

Main outcome measures: Documentation of a DFE within 6 months was the main outcome. Data on risk perceptions using the Risk Perception Survey for Diabetes were collected pre- and post-intervention. Electronic databases were used to obtain hemoglobin A1c information.

Results: Subjects were 40% men, mean age 57 years; 39% reported household incomes as <$15K; 45% reported their race as black, and 42% reported ethnicity as Hispanic/Latino; 23% chose Spanish as their preferred language. Data were analyzed in 2006. There was a 74% increase in retinopathy screening in the telephone versus print group (p<0.0005), with no differences by intervention language or by gender. Predictors of undergoing a DFE included: telephone intervention, baseline risk-perception scores indicating less worry and more realism about diabetes complications, and the interaction of self-reported worry and being in the telephone intervention. Subjects who had poor diabetes control responded with greater success to telephone interventions.

Conclusions: A limited telephone intervention can improve significantly participation in retinopathy screening in a minority, low-income population. This intervention influenced risk perceptions about diabetes complications. Further research is needed to develop effective risk communications to prevent the complications of diabetes.

Figure 1. Flow of subjects through the “Vision is Precious” study, from eligibility assessment to analysis

^a All exclusions after randomization were due to belated discovery of failure to meet eligibility requirements, specifically these excluded subjects turned out to have had a dilated fundus exam (DFE) within the year preceding randomization, though they did not report this at the time of enrollment. ^b One subject died within the 6-month follow-up period for the primary study outcome. ^c Subjects who withdrew consent or died were not excluded from analysis; rather, the DFE status as of the time of withdrawal/death was used as their study outcome.