Barriers and enablers to diabetic eye screening: a cross sectional survey of young adults with type 1 and type 2 diabetes in the UK
Authors: Prothero Louise , Cartwright Martin , Lorencatto Fabiana , Burr Jennifer M , Anderson John , Gardner Philip , Presseau Justin , Ivers Noah , Grimshaw Jeremy M , Lawrenson John G ,   the EROS Study Investigators
Published: May 2022

Introduction

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

Research design and methods

YAs (18-34yrs) were invited to complete an anonymous online survey in June 2021 assessing agreement with 30 belief statements informed by the Theoretical Domains Framework of behaviour change (TDF) 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) [Behavioural regulation].

Conclusions

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

Significance of this study

What is already known about this subject?

Younger adults (<35 years) with diabetes have been identified as having longer time intervals before attending initial diabetic retinopathy screening (DRS) and are more likely to miss successive screening appointments.

Previous studies have explored modifiable influences on DRS attendance, but often do not differentiate between population groups, particularly young adults.

What are the new findings?

One of the main reported barriers to attending DRS was the lack of appointment flexibility and difficulty getting time off work/study to attend appointments. This was compounded by the lack of integration of DRS with other diabetes appointments.

Most young adults were worried about diabetic retinopathy, anxious when receiving screening results and would like more support

How might these results change the focus of research or clinical practice?

A more tailored approach is needed to support young adults to attend DRS. The findings of this research provide a basis for developing tailored interventions to increase screening uptake in this age group