Abstract
BackgroundDiabetic retinopathy is a serious complication of diabetes which, if left untreated, can result in blindness. Population screening among people with diabetes has been shown to be clinically effective; however, suboptimal attendance with wide demographic disparities has been reported. To develop quality improvement interventions to maximise attendance, it is important to understand the theoretical determinants (i.e. barriers and enablers) of screening behaviour. The aim of this systematic review is to identify and synthesise the modifiable barriers and enablers associated with diabetic retinopathy screening attendance.Methods/designPrimary and secondary studies will be included if they report perceived barriers/enablers of diabetic retinopathy screening attendance, from the perspectives of people with diabetes and healthcare providers. There will be no restrictions on study design. Studies will be identified from published and grey literature through multiple sources. Bibliographic databases will be searched using synonyms in four search domains: diabetic retinopathy; screening; barriers/enablers; and theoretical constructs relating to behaviour. Search engines and established databases of grey literature will be searched to identify additional relevant studies. Extracted data will include: participant quotations from qualitative studies, statistical analyses from questionnaire and survey studies, and interpretive descriptions and summaries of results from reports. All extracted data will be coded into domains from the Theoretical Domains Framework (TDF) and (for organisational level data) the Consolidated Framework of Implementation Research (CFIR); with domains representing theoretical barriers/enablers proposed to mediate behaviour change. The potential role of each domain in influencing retinopathy screening attendance will be investigated through thematic analysis of the TDF/ CFIR coding. Domain importance will be identified using pre-specified criteria: “frequency” and “expressed importance”. Variations in perceived barriers and enablers between demographic groups (e.g., socio-economic, ethnic) will be explored.DiscussionThis review will identify important barriers and enablers likely to influence attendance for diabetic retinopathy screening. The results will be used to assess the extent to which existing interventions targeting attendance address the theoretical determinants of attendance behaviour. Findings will inform recommendations for future intervention design.Systematic review registrationPROSPERO CRD42016032990Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0309-2) contains supplementary material, which is available to authorized users.
Highlights
Diabetic retinopathy is a serious complication of diabetes which, if left untreated, can result in blindness
Within the domain of the “inner setting”, for example, there are ten constructs including, but not limited to, the organisation’s “culture”, “structural characteristics” and “incentives and rewards”. Both the Theoretical Domains Framework (TDF) and Consolidated Framework of Implementation Research (CFIR) have been applied in a number of studies to systematically elicit and characterise barriers and enablers to behaviour change across a range of clinical contexts, primarily through interview and survey studies
Aim The current review will adopt a similar approach of applying the TDF/CFIR in a systematic review context to identify the modifiable barriers/enablers to diabetic retinopathy screening from the perspective of people diagnosed with type 1 or type 2 diabetes and their healthcare providers, and frame them in terms of theoretical domains/constructs
Summary
This review employs a systematic and replicable approach towards identifying barriers and enablers associated with diabetic retinopathy screening attendance from the perspective of both people with diabetes and healthcare providers. Phase 3 of the multi-phase programme of work will assess the extent to which QI interventions, designed to maximise retinopathy screening attendance, target the theoretical domains that are important in determining attendance. This will be achieved by mapping the BCTs identified in the phase 1 review against the theoretical domains identified in phase 2 (the current review), using an established mapping matrix [42]. Abbreviations AACODS, Authority, Accuracy, Coverage, Objectivity, Date, and Significance; BCT, behaviour change techniques; CASP, Critical Appraisal Skills Programme; CFIR, Consolidated Framework of Implementation Research; HMIC, The Healthcare Management Information Consortium; HTA, Health Technology AssessmentNIHR National Institute of Health Research; PRISMA-P, Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol; QI, quality improvement; TDF, Theoretical Domains Framework
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
