Barriers and enablers to diabetic retinopathy screening: a cross-sectional survey of young adults with type 1 and type 2 diabetes in the UK

Louise Prothero; Martin Cartwright; Fabiana Lorencatto; Jennifer M Burr; John Anderson; Philip Gardner; Justin Presseau; Noah Ivers; Jeremy M Grimshaw; John G Lawrenson; EROS Study Investigators

doi:10.1136/bmjdrc-2022-002971

Barriers and enablers to diabetic retinopathy screening: a cross-sectional survey of young adults with type 1 and type 2 diabetes in the UK

BMJ Open Diabetes Res Care. 2022 Nov;10(6):e002971. doi: 10.1136/bmjdrc-2022-002971.

Authors

Affiliations

¹ Anglia Ruskin University - Rivermead Campus, Chelmsford, UK.
² City, University of London, London, UK.
³ University College London, London, UK.
⁴ University of St Andrews, St Andrews, UK.
⁵ Homerton University Hospital, London, UK.
⁶ United Kingdom Department of Health and Social Care, London, UK.
⁷ University of Ottawa, Ottawa, Ontario, Canada.
⁸ University of Toronto, Toronto, Ontario, Canada.
⁹ City, University of London, London, UK j.g.lawrenson@city.ac.uk.

Abstract

Introduction: Diabetic retinopathy screening (DRS) attendance in young adults (YAs) is consistently below recommended levels. The aim of this study was to identify barriers and enablers of DRS attendance among YAs in the UK living with type 1 (T1D) and type 2 diabetes (T2D).

Research design and methods: YAs (18-34 years) were invited to complete an anonymous online survey in June 2021 assessing agreement with 30 belief statements informed by the Theoretical Domains Framework (TDF) of behavior change describing potential barriers/enablers to DRS.

Results: In total, 102 responses were received. Most had T1D (65.7%) and were regular attenders for DRS (76.5%). The most salient TDF domains for DRS attendance were 'Goals', with 93% agreeing that DRS was a high priority, and 'Knowledge', with 98% being aware that screening can detect eye problems early.Overall, 67.4% indicated that they would like greater appointment flexibility (Environmental context/resources) and 31.3% reported difficulties getting time off work/study to attend appointments (Environmental context/resources). This was more commonly reported by occasional non-attenders versus regular attenders (59.1% vs 23.4%, p=0.002). Most YAs were worried about diabetic retinopathy (74.3%), anxious when receiving screening results (63%) (Emotion) and would like more support after getting their results (66%) (Social influences). Responses for T1D and T2D were broadly similar, although those with T2D were more likely have developed strategies to help them to remember their appointments (63.6% vs 37.9%, p=0.019) (Behavioral regulation).

Conclusions: Attendance for DRS in YAs is influenced by complex interacting behavioral factors. Identifying modifiable determinants of behavior will provide a basis for designing tailored interventions to improve DRS in YAs and prevent avoidable vision loss.

Keywords: diabetic retinopathy; health behavior; health services research.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Diabetes Mellitus, Type 1* / complications
Diabetes Mellitus, Type 1* / diagnosis
Diabetes Mellitus, Type 1* / epidemiology
Diabetes Mellitus, Type 2* / complications
Diabetes Mellitus, Type 2* / diagnosis
Diabetes Mellitus, Type 2* / epidemiology
Diabetic Retinopathy* / diagnosis
Diabetic Retinopathy* / epidemiology
Humans
United Kingdom / epidemiology
Young Adult