Divergent Perceptions of Barriers to Diabetic Retinopathy Screening Among Patients and Care Providers, Los Angeles, California, 2014-2015

Abstract

Introduction: Despite availability of screening for diabetic retinopathy, testing is underused by many low-income and racial/ethnic minority patients with diabetes. We examined perceived barriers to diabetic retinopathy screening among low-income patients and their health care providers and provider staffers.

Methods: We collected survey data from 101 patients with diabetes and 44 providers and staffers at a safety-net clinic where annual diabetic retinopathy screening rates were low. Barriers specified in the survey were derived from the literature.

Results: Patients surveyed (mean [standard deviation] age, 54.0 [7.7] y; 41% were male) were primarily Hispanics (70%) and African Americans (27%) of low socioeconomic status. Overall, 55% of patients received diabetic retinopathy screening in the previous year. Patients who could not explain why this screening is needed reported more barriers than patients who could (2.5 vs 1.4 barriers, P = .02). Fewer patients reported that they experienced barriers such as transportation (15%), language issues (15%), cultural beliefs or myths (4%), denial (8%), and fear (5%), which providers and staffers considered very or extremely important (all P < .001). Financial burdens (26%) and depression (22%) were most commonly reported by patients as barriers, yet providers and staffers did not rate these barriers as important, P < .001.

Conclusion: Patients and health care providers had markedly divergent perceptions of barriers to diabetic retinopathy screening. Patients with poor understanding of the need for screening were more likely to report such barriers. These results suggest a need for active community engagement to find key elements for education programs and other interventions to increase rates of diabetic retinopathy screening, particularly among low-income, minority populations.

Figure 1

Perceived logistic and external barriers to diabetic retinopathy screening, Los Angeles, California, 2014–2015. Patients were asked to rate reasons that “would delay or prevent you from getting your screening/test for diabetic eye disease.” Health care providers and their staffers were asked to rate “how important it is to address the following potential barriers for patients to receive retinal eye screening” at the clinic. All P < .001. Barriers are ordered in descending order by how frequently they were identified by patients [Table: see text]

Figure 2

Perceived potential internal barriers to diabetic retinopathy screening, Los Angeles, California, 2014–2015. Patients were asked to rate reasons that “would delay or prevent you from getting your screening/test for diabetic eye disease.” Health care providers and their staffers were asked to rate “how important it is to address the following potential barriers for patients to receive retinal eye screening” at the clinic. All P < .001. Barriers are ordered in descending order by how frequently they were identified by patients. Abbreviation: DR, diabetic retinopathy. [Table: see text]