Comparing the Implementation of Different Diabetic Retinopathy Screening Models in Primary Health Care Settings in Northern India: Pragmatic Three-Arm Observational Study

Abstract

Introduction: Early screening is recommended to prevent vision impairment (VI) and blindness globally due to diabetic retinopathy (DR). We aim to analyze the factors influencing the implementation of DR screening models in primary healthcare facilities. Methods: A pragmatic three-arm observational study will be conducted in the district of Mohali in Punjab, India. The study will compare three equal-sized groups with type 2 diabetes mellitus (T2DM) at age 30 and above. The T2DM participants and healthcare providers (HCPs) will be interviewed to identify the barriers to retinal examinations in primary healthcare settings. The study includes a comprehensive economic evaluation to determine the cost-effectiveness of implementing different DR screening models in primary health settings. The present study will use the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance), to assess the implementation of two DR screening interventions and the extent of variation in outcomes. Qualitative and quantitative data collected from participants and research team observations will be examined to report on the five RE-AIM domains. Discussion: A screening program should ensure early detection and referral for DR treatment before it results in irreversible vision loss. However, understanding the problems of accessing DR screening and estimating the cost-effectiveness of such programs in a primary health setting is important before allocating public health resources.