Abstract
BackgroundYoung adults (18–39 years) with type 2 diabetes are at risk of early development and rapid progression of diabetic retinopathy, a leading cause of vision loss and blindness in working-age adults. Retinal screening is key to the early detection of diabetic retinopathy, with risk of vision loss significantly reduced by timely treatment thereafter. Despite this, retinal screening rates are low among this at-risk group. The objective of this study was to develop a theoretically-grounded, evidence-based retinal screening promotion leaflet, tailored to young adults with type 2 diabetes.MethodsUtilising the six steps of Intervention Mapping, our multidisciplinary planning team conducted a mixed-methods needs assessment (Step 1); identified modifiable behavioural determinants of screening behaviour and constructed a matrix of change objectives (Step 2); designed, reviewed and debriefed leaflet content with stakeholders (Steps 3 and 4); and developed program implementation and evaluation plans (Steps 5 and 6).ResultsStep 1 included in-depth qualitative interviews (N = 10) and an online survey that recruited a nationally-representative sample (N = 227), both informed by literature review. The needs assessment highlighted the crucial roles of knowledge (about diabetic retinopathy and screening), perception of personal risk, awareness of the approval of significant others and engagement with healthcare team, on retinal screening intentions and uptake. In Step 2, we selected five modifiable behavioural determinants to be targeted: knowledge, attitudes, normative beliefs, intention, and behavioural skills. In Steps 3 and 4, the “Who is looking after your eyes?” leaflet was developed, containing persuasive messages targeting each determinant and utilising engaging, cohort-appropriate imagery. In Steps 5 and 6, we planned Statewide implementation and designed a randomised controlled trial to evaluate the leaflet.ConclusionsThis research provides an example of a systematic, evidence-based approach to the development of a simple health intervention designed to promote uptake of screening in accordance with national guidelines. The methods and findings illustrate how Intervention Mapping can be employed to develop tailored retinal screening promotion materials for specific priority populations. This paper has implications for future program planners and is intended to assist those wishing to use Intervention Mapping to create similar theoretically-driven, tailored resources.
Highlights
Young adults (18–39 years) with type 2 diabetes are at risk of early development and rapid progression of diabetic retinopathy, a leading cause of vision loss and blindness in working-age adults
To achieve Change Objective A.3.4 (View retinal screening as a personal responsibility), four potential leaflet heading messages were developed: ‘Eyes: they’re important any way you look at it’, ‘The only way to know is to go...’, ‘Who is looking after your eyes?’, and ‘Looking at the facts’
We undertook the systematic development of an evidencebased health behaviour change intervention tailored to the needs of a priority population, young adults with type 2 diabetes (T2D), who are at risk of low retinal screening uptake and vision loss from diabetic retinopathy (DR)
Summary
Young adults (18–39 years) with type 2 diabetes are at risk of early development and rapid progression of diabetic retinopathy, a leading cause of vision loss and blindness in working-age adults. Young adults (aged 18–39 years) are the least likely to initiate retinal screening in accordance with national guidelines and have lower overall screening rates than older adults (aged ≥40 years) or young adults with type 1 diabetes [15,16,17] In addition to their low engagement with existing diabetes services [18], additional communication challenges exist due to the lack of dedicated programs, hubs or services for young adults with T2D. There is need for the development of tailored, evidence-based health promotion resources, using an application appropriate to the culture and context, in order to encourage screening uptake among this priority population [19,20,21,22,23]
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