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Diabetic retinopathy screening barriers among Palestinian primary health care patients: a qualitative study

Journal of Diabetes & Metabolic Disorders volume 19, pages 875–881 (2020)Cite this article

Abstract

Purpose

Diabetic Retinopathy (DR) screening among Palestinian diabetic patients is limited. To improve the care of our patients, we explored the barriers to DR screening with a qualitative study.

Methods

Three focus groups were conducted in the northern West Bank. Patients noncompliant with DR screening were recruited from Primary Health Care clinics. Questions were adapted from similar published studies. Informed consent was obtained and group discussions were audio recorded, transcribed, and analyzed for themes by three researchers.

Results

Most patients reported financial barriers including the costs of the exam and additional treatments, and transportation to the referral clinic. System related issues were the difficulty of getting appointments and long wait times due to inadequate numbers of ophthalmologists or screening facilities, and physicians failing to recommend screening. Personal concerns related to patients having other priorities, fears about the results, and the negative experiences of family members. Finally, cultural aspects included the stigma of wearing glasses and not doing a test for a condition without symptoms.

Conclusions

Barriers to completing retinopathy screening are multidimensional with financial, personal, educational, health system, and cultural factors. These should be taken into consideration by policy makers in order to increase the uptake and quality of service.

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Data Availability

Data, transcripts (in Arabic language) are available for sharing upon a request to the corresponding author ZN.

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Acknowledgements

We would like to thank the team of Family and Community Medicine Department at AL–Najah National University (ANU) for this opportunity to conduct this study, and for their assistance. Researchers are grateful to Ministry of Health and ANU for support and facilitation our access to primary health care centers. A special thank for those who facilitated our fieldwork, and data collection, specially our colleague Dr. Layali Qaddoumi for her support in the second focus group conduction at Nablus, the research participants for cooperation, encouragement, and kindly welcome.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Affiliations

  1. Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine

    Tasneem Yahya, Abdul-Rahman Abdul-Hadi & Alaa Fuqaha

  2. Department of Family and Community Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Box 7, 707, Nablus, Palestine

    Zaher Nazzal & Souad Belkebir

  3. Palestine Diabetes Institute, Al-Bireh, West-Bank, Palestine

    Mohammad Hamarshih

  4. Department of Family Medicine & School of Public Health, Brown University, Providence, RI, USA

    Therese Zink

Authors
  1. Tasneem Yahya
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  2. Zaher Nazzal
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  3. Abdul-Rahman Abdul-Hadi
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  4. Souad Belkebir
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  5. Mohammad Hamarshih
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  6. Alaa Fuqaha
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  7. Therese Zink
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Contributions

ZN conceived of the presented idea, all authors contributed to study design, data analysis, data interpretation, the writing and revision of the abstract, and developed the manuscript drafting. TY, AA and A AF contributed to data collection. All authors have seen and approved the final version of the abstract for submission.

Corresponding author

Correspondence to Zaher Nazzal.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

Ethics approval was obtained from the Institutional Review Board of An-Najah National University, Nablus, Palestine.

Consent to participate

Verbal informed consent was obtained from all participants after explaining the aims of the study, including the use of audio recording.

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Not applicable.

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Cite this article

Yahya, T., Nazzal, Z., Abdul-Hadi, AR. et al. Diabetic retinopathy screening barriers among Palestinian primary health care patients: a qualitative study. J Diabetes Metab Disord 19, 875–881 (2020). https://doi.org/10.1007/s40200-020-00575-4

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  • DOI: https://doi.org/10.1007/s40200-020-00575-4

Keywords

  • Barriers
  • Diabetic retinopathy screening
  • Primary health care