Perspectives on eye care access and telemedicine-based glaucoma screening among Latine individuals with limited English proficiency

Abstract

Purpose: Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine Program (MI-SIGHT) was developed to facilitate access to glaucoma and eye disease screening and improve attendance at recommended follow-up in underserved communities. MI-SIGHT offered free eye disease screenings, low-cost glasses and for those who screened positive for glaucoma, personalized education, and language-concordant coaching grounded in motivational interviewing. The primary aims of this study were 1) To explore barriers to eye care among Latine participants with limited English proficiency (LEP) who screened positive for glaucoma, 2) to understand whether and how the MI-SIGHT program facilitated access to care and 3) to understand participant experience in MI-SIGHT to inform the development of future interventions.

Design: Qualitative study.

Subjects: 21 participants who identified as Latine with low English proficiency (LEP) who screened positive for glaucoma during the MI-SIGHT program and received personalized health education about their screening results, motivational-interviewing based health coaching, and care navigation all in Spanish.

Methods: Participants were recruited from the two MI-SIGHT sites, a Federally Qualified Health Center (FQHC) and a free clinic. Semi-structured interviews were conducted in Spanish by a native Spanish speaker. Interviews were audio-recorded and transcribed verbatim in Spanish. Grounded theory was used to guide qualitative analysis. Thematic saturation was achieved after analyzing 16 interviews.

Main outcome measures: Themes regarding barriers to eye care access and facilitators to eye care access through MI-SIGHT.

Results: Between 7/11/23-12/19/23, 154 MI-SIGHT participants identified as Latine and had LEP, 22 screened positive for glaucoma and 21 agreed to be interviewed. Interviews revealed that the primary obstacles to accessing eye care among Latine participants with LEP were language barriers, financial constraints due to lack of insurance, insufficient social support, and difficulty with transportation. Additional challenges included immigration-related fears and complexities in healthcare system navigation. Participants identified key facilitators of the MI-SIGHT program as language concordance with providers, availability of interpreters, affordable eye care and glasses, and transportation services. Personalized coaching in their native language further enhanced their understanding of their eye disease and participation. High satisfaction was evident, with nearly all participants willing to recommend the program to others.

Conclusions: Eye care access for Latine participants with LEP is shaped by interconnected structural, socioeconomic, and cultural barriers. Language-concordant interventions, like the MI-SIGHT program, improve care engagement with unanimously positive feedback and willingness of participants to recommend the program. Integrated strategies targeting multiple barriers are critical for advancing eye health equity.

Keywords: Adherence; Glaucoma; Health equity; Limited English proficiency; Screening; Telemedicine.

Fig. 1.

Venn diagram illustrating three major themes from participant responses. (A) Barriers to eye care access, (B) Facilitators to eye care access. In both diagrams, text size and boldness indicate frequency of mention. Subthemes are conceptually grouped within and across the main categories. Surrounding participant quotes point to the themes they exemplify, demonstrating how these themes emerged from shared experiences.