Knowledge, attitude and practices on diabetes, hypertension and diabetic retinopathy and the factors that motivate screening for diabetes and diabolic retinopathy in a pyramidal model of eye health care

Introduction: To report the results of a knowledge, attitude and practice (KAP) study related to diabetes mellitus (DM), hypertension and diabetic retinopathy (DR) of patient populations in India at different levels (Tertiary (T), Secondary (S) and Primary (P)) of a pyramidal model of eye health care. Methods: In total, 202 participants, composed of equal numbers of diabetic and non-diabetic patients at a Tertiary urban facility (T), a Secondary rural facility (S) and a Primary (P) community-screening program, were surveyed on their knowledge, knowledge sources, attitudes, practices and factors that motivate use of eye health services. Results: People with diabetes had a higher mean knowledge and attitude score about DM, hypertension and DR (67.3% T, 59.4% S, 47.0% P) than non-diabetics (41.8% T, 29.0% S, 23.5% P; p<0.001). Awareness of DR was more 65.3% among diabetics compared with 22.0% among non-diabetics at all locations. Most participants in all locations were aware of hypertension (84.0% T, 65.3% S, 52.9% P), but few knew it could affect the eyes (30.0% T, 12.2% S, 13.7% P) or be associated with diabetic complications (30.0% T, 32.7% S, 21.8% P). Many participants had never previously had a dilated eye examination (2% T, 40% S, 50% P). Participants were motivated to visit an eye facility for a routine checkup (70.6%), poor vision (22.6%) or a glucose/blood pressure test (17.7%) at a Primary-level facility and for follow-up or poor vision at the other facilities (28% and 42% Tertiary, 50% and 30% Secondary). Conclusion: Practice-oriented education and advertising of facilities tailored for the relevant populations at each level of an eye health pyramid and continuation of fundus, glucose and blood pressure screening programs can help in creating awareness about diabetes, hypertension and diabetic retinopathy.