Effect of a tailored leaflet to promote diabetic retinopathy screening among young adults with type 2 diabetes: a randomised controlled trial

Abstract

Background: Young adults with type 2 diabetes (aged 18-39 years) are at risk of early onset and rapid progression of diabetic retinopathy, the leading cause of blindness and vision loss in working age adults. Early detection via retinal screening can prevent most vision loss, yet screening rates are consistently lower among this priority population than the general diabetes population. We aimed to test the effect of a tailored, evidence-based brief health behaviour change intervention (leaflet) on self-reported screening uptake, and previously identified social cognitive determinants of retinal screening. Methods: A pragmatic, two-arm randomised controlled trial was conducted from September 2014 to April 2015. Participants were stratified by prior screening uptake (Yes/No) and randomly allocated to intervention (leaflet) or 'usual care' control (no leaflet). Primary outcome was self-reported screening uptake four weeks post-intervention for 'No' participants who had not previously screened for diabetic retinopathy. Secondary outcome variables were changes in knowledge, attitudes, normative beliefs, intention and behavioural skills for all participants, irrespective of prior screening behaviour. To assess intervention effects on secondary outcome variables, we conducted independent samples t-tests (two-tailed) on pre-post change scores. Results: 129 young adults (26% no prior retinal screen) completed baseline; 101 completed post-intervention. Power to determine effect on the primary outcome was curtailed by low recruitment of individuals with no prior retinal screen and loss to follow-up. Attrition was associated significantly with country of birth, language spoken at home, and marital status. Significant intervention effect was observed for one secondary outcome variable: knowledge of diabetic retinopathy (p = .03) with moderate effect (partial eta squared η 2 = .05); no adverse effects were reported. Control group participants received the leaflet at study completion. Conclusions: This study confirms that a well-designed eye health and retinal screening promotion leaflet can increase knowledge of diabetic retinopathy, an important screening predictor. The study highlights the challenges of conducting 'real-world' health behaviour change research with this priority population, providing insights for clinicians and researchers. Strategies to recruit, engage and retain hard-to-reach populations are discussed including nonconventional alternatives to randomised controlled trial designs. Trial registration: ACTRN12614001110673, UTN No.

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

“…A previous study investigating the effectiveness of a tailored evidence‐based information leaflet to promote uptake of DES in young adults with type 2 diabetes, found that this simple intervention significantly increased knowledge of diabetic retinopathy, an important predictor of DES uptake. 22 …”

Diabetic Retinopathy Screening Programme: Attendance, Barriers and Enablers amongst Young People with Diabetes Mellitus Aged 12–26 Years

“…Further appropriate, informative and not merely frightening education was requested by many respondents. While Lake et al in 2020 suggested that well-designed eye health and retinal screening leaflets might promote better attendance it was clear from our study that the young people wanted this in a digital format that is easily accessible and well designed [16]. The importance of attending both their annual DESP appointment and their high street optometrists needs to be emphasised [14].…”

Perceived barriers and enablers to the provision of diabetic retinopathy screening for young adults: a cross-sectional survey of healthcare professionals working in the UK National Diabetic Eye Screening Programme

“… 4 In 2014, a study of the causes of blindness in England revealed that for the first time in five decades, diabetic eye disease was no longer the most common cause of blindness in the working age population. 29 30 However, there is considerable variation in screening uptake among age groups. People with diabetes younger than 35 years have been identified as having longer time intervals from registration with the screening program to first screening event, 5 7 lower uptake of annual screening 6 7 and an increased likelihood of missing three successive screening appointments.…”

“…Classifying these using the BCW helped identify alignment of strategies with the barriers/enablers identified within TDF domains. These frameworks have recently been applied to design an intervention to improve self-management in young adults with type 2 diabetes28 29 and to increase the uptake of DRS in Ireland 12…”

“…The National DESPs in the UK have been very successful in ensuring that the vast majority of the eligible population of people with diabetes receive retinopathy screening in a timely manner 4. In 2014, a study of the causes of blindness in England revealed that for the first time in five decades, diabetic eye disease was no longer the most common cause of blindness in the working age population 29 30. However, there is considerable variation in screening uptake among age groups.…”