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Barriers to and Facilitators of Diabetic Retinopathy Screening Utilization in a High-Risk Population

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Abstract

Background

Diabetic retinopathy (DR) is among the leading causes of vision loss in the USA, yet an estimated 50% of patients with diabetes do not receive recommended annual screening eye exams. Patients with diabetes and low socioeconomic status or who are racial/ethnic minorities are at increased risk for vision loss.

Methods

Qualitative interviews were conducted with 24 patients with diabetes at a federally qualified community health center in an urban area regarding factors influencing their use of screening. The interviews were recorded, transcribed, and analyzed line by line to identify themes. The themes were organized in a theoretical framework of factors influencing receipt of screening.

Results

The median age of participants was 57.5 (range 44–73). Ten participants identified as female and 14 as male. Participants identified as Black (14), White (4), Hispanic (3), and other/no answer (3). Twenty-three had health insurance. Twenty-three had received an eye exam within in the past year, and 17 reported that they receive eye exams at least yearly. Four hundred fifteen comments were analyzed, and 22 concepts were identified under 7 broader themes and two overarching categories of individual and structural factors. Themes included vision status, competing concerns, emotional context, resource availability, in-clinic experience, cues to action, and knowledge about diabetes.

Conclusions

The factors that influence diabetic retinopathy screening utilization are complex. Visual symptoms and the need for glasses are important facilitators of screening. Many patients lack knowledge about diabetic retinopathy and the utility of preventative eye care. New strategies for engaging high-risk populations are necessary.

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Acknowledgments

We would like to thank the participants for giving their time and sharing their experiences, the Cornell Scott Hill Health Center for accommodating us, and the Yale Center for Research and Engagement for their insight into the greater New Haven community.

Data Access, Responsibility, and Analysis

Both authors E.F. and K.N. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Funding

This work was financially supported by the National Center for Advancing Translational Science (CTSA Grant Number UL1 TR001863) and National Institute of Diabetes and Digestive and Kidney Diseases (Award Number T35DK104689).

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Authors and Affiliations

  1. Yale School of Medicine, 265 Saint John St., New Haven, CT, 06511, USA

    Elizabeth Fairless

  2. Department of Ophthalmology and Visual Science, Yale School of Medicine, 40 Temple Street, New Haven, CT, 06510, USA

    Kristen Nwanyanwu

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  1. Elizabeth Fairless
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Contributions

Author E.F. collected, analyzed, and interpreted the data and prepared the article. Author K.N. conceived and designed the study, interpreted the data, and provided critical revision of the article.

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Correspondence to Kristen Nwanyanwu.

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Fairless, E., Nwanyanwu, K. Barriers to and Facilitators of Diabetic Retinopathy Screening Utilization in a High-Risk Population. J. Racial and Ethnic Health Disparities 6, 1244–1249 (2019). https://doi.org/10.1007/s40615-019-00627-3

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  • DOI: https://doi.org/10.1007/s40615-019-00627-3

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