Barriers to and enablers of attendance at diabetic retinopathy screening experienced by immigrants to Canada from multiple cultural and linguistic minority groups

Abstract

Aim To identify barriers to/enablers of attendance at eye screening among three groups of immigrantsto Canada from cultural/linguistic minority groups living with diabetes. Methods Using a patient‐oriented research approach leveraging Diabetes Action Canada's patient engagement platform, we interviewed a purposeful sample of people with type 2 diabetes who had immigrated to Canada from: Pakistan (interviews in Urdu), China (interviews in Mandarin) and French‐speaking African and Caribbean nations (interviews in French). We collected and analysed data based on the Theoretical Domains Framework covering key modifiable factors that may operate as barriers to or enablers of attending eye screening. We used directed content analysis to code barrier/enabler domains. Barriers/enablers were mapped to behaviour change techniques to inform future intervention development. Results We interviewed 39 people (13 per group). Many barriers/enablers were consistent across groups, including views about harms caused by screening itself, practical appointment issues including forgetting, screening costs, wait times and making/getting to an appointment, lack of awareness about retinopathy screening, language barriers, and family and clinical support. Group‐specific barriers/enablers included a preference to return to one's country of birth for screening, the impact of winter, and preferences for alternative medicine. Conclusion Our results can inform linguistic and culturally competent interventions to support immigrants living with diabetes in attending eye screening to prevent avoidable blindness.

Barriers and enablers to diabetic eye screening attendance: An interview study with young adults with type 1 diabetes

“…Many of the same theoretical domains were identified as barriers/enablers to DES in two previous studies using the TDF, including a study of young adults with type 2 diabetes in Australia 7 and linguistic and cultural minority groups in Canada. 15 Study participants included regular DES attenders, unintentional non-attenders and those who had intentionally missed one or more screening appointments in the past. Many factors influencing behaviour were consistent across groups, for example, knowledge gaps regarding DES and its treatment (Knowledge), strong intentions to attend future DES appointments (Intention).…”

“…In the context of DES, the TDF has been recently used to explore barriers/enablers to DES in Australian young adults with type 2 diabetes 7 and Canadian adults from ethnic minority groups with diabetes. 15 The aim of the current study was to apply the aforementioned behavioural science frameworks to:…”

“…This facilitates the systematic progression from understanding what is driving behaviour to designing more targeted strategies to change behaviour and therefore linking barriers to solutions. In the context of DES, the TDF has been recently used to explore barriers/enablers to DES in Australian young adults with type 2 diabetes 7 and Canadian adults from ethnic minority groups with diabetes 15 …”

The integrated screening action model (I-SAM): A theory-based approach to inform intervention development

“…Psychological capability includes self-efficacy – the belief that you can do the action required – which is a fundamental component of behaviour change ( Bandura, 1986 ) and has been found to influence screening behaviour ( Cooke and French, 2008 , Duncan et al, 2014 ). Psychological capability also includes having language and health literacy skills to engage with screening ( Graham-Rowe et al, 2018 , van Allen et al, 2021 , von Wagner et al, 2009 ). Physical capability to perform screening includes people having other priorities (e.g.…”

“…Convenience can also influence the physical opportunity to access screening including design of the test – such that the easier the test is to do, the more likely people are to do it, location of screening (e.g. rurality, access to public transport), opening hours, waiting time on day of appointment, one-stop-shops and side effects ( Robb and O'Carroll, 2019 , Sabatino et al, 2012 , Graham-Rowe et al, 2018 , Piyasena et al, 2019 , Cavan et al, 2017 , van Allen et al, 2021 , Hipwell et al, 2014 ). Opportunity is further influenced by the invitation and reminder strategy offered by the screening provider ( Duffy et al, 2017 , Graham-Rowe et al, 2018 , Hipwell et al, 2014 , Chaudhry et al, 2012 ), and whether providers are incentivized or receive prompts or skills training to engage people in screening ( Sabatino et al, 2012 , Brouwers et al, 2011 ).…”