Abstract
AimThe aim of this study was to identify barriers and enablers of diabetic eye screening (DES) attendance amongst young adults with diabetes living in the United Kingdom.MethodsSemistructured qualitative interviews with adults aged 18–34 years with diabetes. Participants were purposively sampled to aim for representation across gender, geographical locations, diabetes type, years since diabetes diagnosis and patterns of attendance (i.e. regular attenders, occasional non‐attenders, regular non‐attenders). Data were collected and analysed using the Theoretical Domains Framework (TDF) to explore potential individual, sociocultural and environmental influences on attendance. Data were analysed using a combined deductive and inductive thematic analysis approach. Barriers/enablers were mapped to behaviour change techniques (BCTs) to identify potential strategies to increase attendance.ResultsKey barriers to attendance reported by the sample of 29 study participants with type 1 diabetes, fell within the TDF domains: [Knowledge] (e.g. not understanding reasons for attending DES or treatments available if diabetic retinopathy is detected), [Social Influences] (e.g. lack of support following DES results), [Social role and Identity] (e.g. not knowing other people their age with diabetes, feeling ‘isolated’ and being reluctant to disclose their diabetes) and [Environmental Context and Resources] (e.g. lack of appointment flexibility and options for rescheduling). Enablers included: [Social Influences] (e.g. support of family/diabetes team), [Goals] (e.g. DES regarded as ‘high priority’). Many of the reported barriers/enablers were consistent across groups. Potential BCTs to support attendance include Instructions on how to perform the behaviour; Information about health consequences; Social support (practical) and Social comparison.ConclusionsAttendance to diabetic eye screening in young adults is influenced by a complex set of interacting factors. Identification of potentially modifiable target behaviours provides a basis for designing more effective, tailored interventions to help young adults regularly attend eye screening and prevent avoidable vision loss.
Highlights
In the United Kingdom, diabetic eye screening (DES) is managed by the National Screening Committee.[1]
We applied the Theoretical Domains Framework to identify modifiable barriers and enablers to screening attendance in young adults with type 1 diabetes living in the United Kingdom
Interventions directed at healthcare professionals (HCPs) (e.g. GPs, diabetes team) could include the development of a nationally approved training programme that includes specific recommendations for actions HCPs could take to support, encourage and enable young adults to attend DES
Summary
In the United Kingdom, diabetic eye screening (DES) is managed by the National Screening Committee.[1]. A recent retrospective analysis of attendance in three large screening programmes in England identified that the odds of attending annual screening were significantly lower amongst those aged 18–34 years compared to those ≥60, after controlling for other variables, for example, sex, ethnicity and socioeconomic deprivation.[4]. This raises questions as to how screening attendance can be increased in young adults to prevent complications and avoidable vision loss. We applied the Theoretical Domains Framework to identify modifiable barriers and enablers to screening attendance in young adults with type 1 diabetes living in the United Kingdom. Identify potential behaviour change intervention strategies to encourage attendance in this population group
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