. 2021 Nov;9(2):e002436.

doi: 10.1136/bmjdrc-2021-002436.

Perceived barriers and enablers to the provision of diabetic retinopathy screening for young adults: a cross-sectional survey of healthcare professionals working in the UK National Diabetic Eye Screening Programme

Louise Prothero¹, Fabianna Lorencatto², Martin Cartwright¹, Jennifer M Burr³, Philip Gardner⁴, John Anderson^{5

6}, Justin Presseau^{7

8}, Noah Ivers^{9

10}, Jeremy M Grimshaw^{7

11}, John G Lawrenson¹²; EROS Study Investigators

Collaborators, Affiliations

Collaborators

EROS Study Investigators:
John Anderson, Elli Bourmpaki, Catey Bunce, Jennifer Burr, Martin Cartwright, Philip Gardner, Jeremy Grimshaw, Martin Gulliford, Noah Ivers, John Lawrenson, Fabianna Lorencatto, Tunde Peto, Justin Presseau, Louise Prothero, Irene Stratton

Affiliations

¹ School of Health Sciences, City, University of London, London, UK.
² Centre for Behaviour Change, University College London, London, UK.
³ School of Medicine, University of St Andrews, St Andrews, UK.
⁴ Public Health England, London, UK.
⁵ Diabetes and Endocrinology, Homerton University Hospital, London, UK.
⁶ Barts and The London School of Medicine and Dentistry, Blizard Institute, London, UK.
⁷ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
⁸ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
⁹ Women's College Research Institute, Toronto, Ontario, Canada.
¹⁰ Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
¹¹ Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
¹² School of Health Sciences, City, University of London, London, UK j.g.lawrenson@city.ac.uk.

PMID: 34740918
PMCID: PMC8573632
DOI: 10.1136/bmjdrc-2021-002436

Perceived barriers and enablers to the provision of diabetic retinopathy screening for young adults: a cross-sectional survey of healthcare professionals working in the UK National Diabetic Eye Screening Programme

Louise Prothero et al. BMJ Open Diabetes Res Care. 2021 Nov.

. 2021 Nov;9(2):e002436.

doi: 10.1136/bmjdrc-2021-002436.

Authors

Collaborators

EROS Study Investigators:
John Anderson, Elli Bourmpaki, Catey Bunce, Jennifer Burr, Martin Cartwright, Philip Gardner, Jeremy Grimshaw, Martin Gulliford, Noah Ivers, John Lawrenson, Fabianna Lorencatto, Tunde Peto, Justin Presseau, Louise Prothero, Irene Stratton

Affiliations

¹ School of Health Sciences, City, University of London, London, UK.
² Centre for Behaviour Change, University College London, London, UK.
³ School of Medicine, University of St Andrews, St Andrews, UK.
⁴ Public Health England, London, UK.
⁵ Diabetes and Endocrinology, Homerton University Hospital, London, UK.
⁶ Barts and The London School of Medicine and Dentistry, Blizard Institute, London, UK.
⁷ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
⁸ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
⁹ Women's College Research Institute, Toronto, Ontario, Canada.
¹⁰ Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
¹¹ Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
¹² School of Health Sciences, City, University of London, London, UK j.g.lawrenson@city.ac.uk.

PMID: 34740918
PMCID: PMC8573632
DOI: 10.1136/bmjdrc-2021-002436

Abstract

Introduction: Diabetic retinopathy screening (DRS) attendance in young adults is consistently below recommended levels. The aim of this study was to conduct a survey of screening providers in the UK Diabetic Eye Screening Programme (DESP) to identify perceived barriers and enablers to DRS attendance in young adults and elicit views on the effectiveness of strategies to improve screening uptake in this population.

Research design and methods: Members of the British Association of Retinal Screening (n=580) were invited to complete an anonymous online survey in July 2020 assessing agreement with 37 belief statements, informed by the Theoretical Domains Framework (TDF) of behavior change, describing potential barrier/enablers to delivering DRS for young adults and further survey items exploring effectiveness of strategies to improve uptake of DRS.

Results: In total, 140 (24%) responses were received mostly from screener/graders (67.1%). There was a high level of agreement that the DESP had a role in improving attendance in young adults (96.4%) and that more could be done to improve attendance (90.0%). The most commonly reported barriers related to TDF domains Social influences and Environmental context and resources including lack of integration of DRS with other processes of diabetes care, which limited the ability to discuss diabetes self-management. Other barriers included access to screening services and difficulties with scheduling appointments. Less than half (46.4%) of respondents reported having a dedicated strategy to improve screening uptake in young adults. Strategies perceived to be effective included: screening within the community; prompts/reminders and integrating eye screening with other diabetes services.

Conclusions: Screening providers were concerned about screening uptake in young adults, although many programs lacked a dedicated strategy to improve attendance. Problems associated with a lack of integration between DRS with other diabetes care processes were identified as a major barrier to providing holistic care to young adults and supporting diabetes self-management.

Keywords: diabetic retinopathy; qualitative research; young adult.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

References

1. Mathur R, Bhaskaran K, Edwards E, et al. . Population trends in the 10-year incidence and prevalence of diabetic retinopathy in the UK: a cohort study in the clinical practice research Datalink 2004-2014. BMJ Open 2017;7:e014444. 10.1136/bmjopen-2016-014444 - DOI - PMC - PubMed
1. Yau JWY, Rogers SL, Kawasaki R, et al. . Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care 2012;35:556–64. 10.2337/dc11-1909 - DOI - PMC - PubMed
1. Wong TY, Sun J, Kawasaki R, et al. . Guidelines on diabetic eye care: the International Council of ophthalmology recommendations for screening, follow-up, referral, and treatment based on resource settings. Ophthalmology 2018;125:1608–22. 10.1016/j.ophtha.2018.04.007 - DOI - PubMed
1. Scanlon PH. The English national screening programme for diabetic retinopathy 2003-2016. Acta Diabetol 2017;54:515–25. 10.1007/s00592-017-0974-1 - DOI - PMC - PubMed
1. Scanlon PH, Stratton IM, Leese GP, et al. . Screening attendance, age group and diabetic retinopathy level at first screen. Diabet Med 2016;33:904–11. 10.1111/dme.12957 - DOI - PMC - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Perceived barriers and enablers to the provision of diabetic retinopathy screening for young adults: a cross-sectional survey of healthcare professionals working in the UK National Diabetic Eye Screening Programme

Collaborators

Affiliations

Perceived barriers and enablers to the provision of diabetic retinopathy screening for young adults: a cross-sectional survey of healthcare professionals working in the UK National Diabetic Eye Screening Programme

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical