Exploring factors affected timely receiving intravitreal anti-VEGF treatment in patients with Diabetic Macular Edema: a qualitative interview study analyzed with COM-B model

Abstract

Objectives To explore factors affected untimely receiving intravitreal anti-Vascular endothelial growth factor (VEGF) injection based on the Capability, Opportunity and Motivation-Behavior (COM-B) model in patients with Diabetic Macular Edema (DME) and regard these factors as main targets for interventions. Design An exploratory qualitative study was conducted using semi-structured interviews with patients with DME. The COM-B model was used to guide data collection and analysis. Setting The study was carried out in outpatient department of ophthalmology in China. Participants 24 patients with DME who experienced anti-VEGF treatment at least one injection within one year were recruited using convenience and purposed sampling. Results The themes and subthemes were identified. Physical capability included (1) lack of knowledge, (2) high treatment expenditure, and psychological capability included prioritized glycemic control rather than anti-VEGF. Social opportunity included (1) no anti-VEGF available, (2) Recommended eyedrops, laser and oral drug but not mentioned intravitreal anti-VEGF injection, (3) As an optional therapy, selected more convenient treatment rather than anti-VEGF agents, and physical opportunity included (1) no confidence in treatment from doctor, (2) communication between doctors and patients. Reflective motivation included (1) outcome expectancies, and automatic motivation included (1) fear of injection, (2) fear of blindness. Conclusion We should attach importance to these eleven factors, especially to effective interaction between doctors and patients, and doctor's authoritative treatment advice, which interventions were based on in the future.