Factors Affecting Compliance with Diabetic Retinopathy Screening: A Qualitative Study Comparing English and Spanish Speakers

Abstract

The purpose of this study was to understand individual-, social-, and system-level factors that affect compliance with recommended diabetic retinopathy (DR)-evaluations, and how these factors vary between English and Spanish speakers. Patients and Methods:We conducted a qualitative study using semi-structured interviews. Study subjects included Kaiser Permanente Southern California members with type II diabetes mellitus at least aged 26 years who spoke English or Spanish. Patients were divided into groups based on their adherence with DR evaluations. Our main outcome measure was the major themes expressed by patients that explained their compliance with DR evaluation. Results: Fifty-one participants were enrolled: 30 English speakers (11 nonadherent, 19 adherent) and 21 Spanish speakers (8 nonadherent, 13 adherent). Adherent patients were more likely to have had experience with diabetes and identify as being responsible for their own care. Substantially more non-adherent patients suggested that beliefs and attitudes were the reasons people missed retinopathy appointments. More English-speaking participants tended to be self-directed in managing their healthcare, whereas more Spanish speakers relied on others for help. English speakers also noted better relationships with their physicians. Spanish speakers outlined problems with insurance coverage and costs as barriers. Conclusion: These data suggest two specific intervention strategies that eye care providers could implement to improve adherence with diabetic retinopathy screening and follow up: incorporating a person with DR-related visual loss into the team of staff delivering diabetes support programs and communication campaigns including specific messaging to address fears related to vision loss.

Social Determinants of Health and Perceived Barriers to Care in Diabetic Retinopathy Screening

“…Similarly, Owsley et al reported that transportation, trusting the physician, and communicating with the physician were perceived barriers to care for African American individuals. Hispanic individuals with diabetes are also more likely to face language barriers and struggles with health care costs . In previous studies, as well as in ours, the quality of communication with the physician was a key factor.…”

“…Hispanic individuals with diabetes are also more likely to face language barriers and struggles with health care costs . In previous studies, as well as in ours, the quality of communication with the physician was a key factor. Our results demonstrated the importance of practitioner concordance in relation to delaying eye care, suggesting the potential importance of enhancing workforce diversity and implementing cultural competency training to bridge the gap between patient-physician discordance …”

Influence of continuous 4C nursing on quality of life and self-care ability of patients with diabetes retinopathy: An observational study

“…These results highlight the importance of continuity nursing based on the 4C model in improving daily quality of life and gaining patient recognition, consistent with the continuity nursing theory proposed by Boucher et al [22,23] Previous studies by Boucher Marie Carole et al have also demonstrated that nursing models can improve patient compliance, enhance patient quality of life, and ultimately improve patient recovery after surgery. [23,24] This study fills knowledge gaps in the existing literature and provides an important theoretical and practical foundation for further research in this field. It is of significant importance for improving patient treatment outcomes and quality of life, reducing complication rates, and enhancing overall patient health.…”

“…These results highlight the importance of continuity nursing based on the 4C model in improving daily quality of life and gaining patient recognition, consistent with the continuity nursing theory proposed by Boucher et al [ 22 , 23 ] Previous studies by Boucher Marie Carole et al have also demonstrated that nursing models can improve patient compliance, enhance patient quality of life, and ultimately improve patient recovery after surgery. [ 23 , 24 ]…”

Factors Associated with Ophthalmology Referral and Adherence in a Teleretinal Screening Program: Insights from a Federally Qualified Health Center

“…A prior study showed that Spanish-speaking patients experienced difficulty communicating with eye care professionals in diabetic retinopathy evaluations. 26 These challenges and other unmeasured variables, such as level of education, literacy, or perceptions of implicit bias, may create additional barriers for Spanish-speaking patients receiving a recommendation to schedule an inperson DFE with an ophthalmologist. [27][28][29] For example, low disease knowledge has been identified as an important Clinical Ophthalmology 2022:16 https://doi.org/10.2147/OPTH.S380629 DovePress 3027 barrier to follow-up in patients with chronic eye diseases, 30 and may contribute to low adherence to follow-up appointments after teleretinal screening as well.…”