A qualitative study on barriers and enablers to uptake of diabetic retinopathy screening by people with diabetes in the Western Province of Sri Lanka

被引:24
|
作者
Piyasena, Mapa Mudiyanselage Prabhath Nishantha [1 ]
Murthy, Gudlavalleti Venkata S. [1 ]
Yip, Jennifer L. Y. [1 ]
Gilbert, Clare [1 ]
Peto, Tunde [2 ]
Premarathna, Mahesh [3 ]
Zuurmond, Maria [4 ]
机构
[1] London Sch Hyg & Trop Med, Int Ctr Eye Hlth, Dept Infect & Trop Dis, Clin Res Dept, London WC1E 7HT, England
[2] Queens Univ, Sch Med Dent & Biomed Sci, 97 Lisburn Rd, Belfast BT9 7BL, Antrim, North Ireland
[3] Univ Colombo, Dept Sociol, Reid Ave, Colombo 03, Colombo, Sri Lanka
[4] London Sch Hyg & Trop Med, Int Ctr Evidence Disabil, Dept Infect & Trop Dis, Dept Clin Res, London WC1E 7HT, England
关键词
Barriers; Diabetes mellitus; Diabetic retinopathy; Screening; Sri Lanka;
D O I
10.1186/s41182-019-0160-y
中图分类号
R188.11 [热带医学];
学科分类号
摘要
BackgroundBlindness and visual impairment from diabetic retinopathy (DR) are avoidable through early detection and timely treatment. The Western Province of Sri Lanka has the highest prevalence of diabetes mellitus (DM) (18.6%) in the country. A situational analysis identified a significant gap in DR screening services (DRSS) uptake in this region. Barriers that hinder people with DM (PwDM) from attending DRSS are poorly understood. The purpose of this study is to understand the factors which influence the uptake of DRSS and follow-up to inform health promotion strategies and improve the uptake of these services.MethodsEleven focus group discussions (FGDs) were conducted with PwDM who presented to medical, general eye and vitreoretinal services in three public sector institutions (two tertiary and one secondary level) in the Western Province between October 2016 and March 2017. We enrolled six groups (four Sinhala speaking, two Tamil) of women and five groups (three Sinhala and two Tamil) of men representing ethnicity and gender. We performed a thematic analysis and described the main themes and subthemes using the socio-ecological model as a framework.ResultsWe identified lack of knowledge of both the condition and the need for screening as key barriers to access DRSS. Socio-cultural factors in the family environment, economic reasons and institutional factors were also important barriers. Additional reasons include long waiting time at eye clinics and poor referrals exacerbated by the lack of a systematic DRSS. In addition, attitudes to DRSS such as fear of discomfort from the procedure and the need for accompaniment following mydriasis were also deterrents to follow-up screening.ConclusionThis study has shown that there are inter-related user, family, and institutional factors which affect the uptake of DRSS. Understanding how DR is conceptualised by PwDM in this region is essential to refine strategies to improve access to DRSS. Strategies to improve knowledge need to be more culturally acceptable and relevant to PwDM and their families, with increased availability of DRSS at convenient locations may increase timely uptake of screening.
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