Interventions to increase attendance for diabetic retinopathy screening: a systematic review and meta‐analysis

Abstract

PurposeStudy objectives were to: 1) determine the effectiveness of interventions to improve diabetic retinopathy screening (DRS) attendance; 2) specify intervention content in terms of behaviour change techniques (BCTs); 3) determine whether interventions that included particular BCTs were more effective in increasing attendance.MethodsWe searched the Cochrane Library, MEDLINE, EMBASE and clinical trials registers to February 2017 for randomised controlled trials (RCTs) that were designed to improve attendance for DRS or were evaluating general quality improvement (QI) strategies for diabetes care and reported the effect of the intervention on DRS attendance. We did not use any date or language restrictions in the searches. We identified and categorised component BCTs using an established BCT Taxonomy (BCTTv1).ResultsWe included 66 RCTs. QI interventions were multifaceted and targeted patients, healthcare professionals (HCPs) or healthcare systems. Overall, DRS attendance increased by 12% (risk difference (RD) 0.12 [95% CI 0.10‐0.14]) compared with usual care, with substantial heterogeneity in effect size. Both DRS‐targeted and general QI interventions were effective, particularly where baseline DRS attendance was low. All frequently identified BCTs were associated with significant improvements in attendance. Higher effect estimates were observed in sub‐group analyses for the BCTs ‘goal setting (outcome)’ (0.26 [0.16‐0.36]) and ‘feedback on outcomes of behaviour’ (RD 0.22 [0.15‐0.29]) in interventions targeting patients, and ‘restructuring the social environment’ (RD 0.19 [0.12‐0.26]) and ‘credible source’ (RD 0.16 [0.08‐0.24]) in interventions targeting HCPs.ConclusionsRCT evidence indicates that QI interventions incorporating specific BCT components are associated with meaningful improvements in DRS attendance compared to usual care.