What works to increase attendance for diabetic retinopathy screening? An evidence synthesis and economic analysis

Lawrenson, John G; Graham-Rowe, Ella; Lorencatto, Fabiana; Rice, Stephen; Bunce, Catey; Francis, Jill J; Burr, Jennifer; Aluko, Patricia; Vale, Luke; Presseau, Justin; Ivers, Noah; Grimshaw, Jeremy

doi:10.3310/hta22290

Cited by 41 publications

(52 citation statements)

References 185 publications

(746 reference statements)

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“…The second study used an extended screening interval of 3 years, and an adherence rate of 91% was observed [ 16 ], which is close to that noted in our investigation. The high adherence rates we report from the screening program in our study may also be explained by having implemented a panel of interventions reported to be favorable for DR screening [ 22 ]. These interventions include facilitating retinal examinations by multiple access points, using telemedicine, giving feedback to diabetologists and general practitioners and sending reminders to patients who failed to attend their follow-up visit.…”

Section: Discussionmentioning

confidence: 99%

Screening for Diabetic Retinopathy with Extended Intervals, Safe and Without Compromising Adherence: A Retrospective Cohort Study

2020

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Section: Discussionmentioning

confidence: 99%

Screening for Diabetic Retinopathy with Extended Intervals, Safe and Without Compromising Adherence: A Retrospective Cohort Study

2020

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“…First, considering that most interventions to promote screening achieve statistically significant increases in screening rates, and that QBE effects have been demonstrated in other socially desirable behaviours (44), we recommend utilisation of QBE as a strategy for policy and practice. The simple act of asking questions about uptake has been used for other health-related behaviours, such as health check attendance and influenza vaccination (44) and may be sufficient to prompt screening, particularly if content and delivery are designed to engage low-attending groups such young adults with T2D (15). Second, 'number of cues' has been identified as a predictor of uptake of pre-pregnancy care for young adult women with T2D (45).…”

Section: Implications For Policy and Practicementioning

confidence: 99%

“…A range of demographic, clinical and psychosocial barriers to retinal screening have been identified for this group (12), including low general and health literacy, a key issue for ophthalmic education materials which are "consistently" written above recommended levels (13,14). Consequently, healthcare professionals and policymakers have called for development of evidence-based health behaviour change interventions and tailored, age-appropriate messaging which addresses screening barriers and enablers for this group (15,16). Effective interventions to promote health behaviour change have shared elements: content grounded in evidence and underpinned by theoretical constructs; targeting modifiable behavioural and psychosocial determinants of the behaviour, and tailored to the priority population (17).…”

Section: Introductionmentioning

confidence: 99%

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

Lake

Browne

Rees

et al. 2019

Preprint

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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 uptake for this priority population is consistently lower 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 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. Country of birth, language spoken at home, and relationship status were significantly associated with study attrition. 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.: U1111-1161-9803. Registered 20 October 2014 - retrospectively registered https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367127.

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“…In Australia, screening rates in this priority population are estimated to be 55%, compared with 78% in the general diabetes population [10,11]. A range of barriers to retinal screening have been identified among this group [12][13][14], leading to calls for tailored, age-appropriate intervention [15,16].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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What works to increase attendance for diabetic retinopathy screening? An evidence synthesis and economic analysis

Abstract: The National Institute for Health Research Health Technology Assessment programme.

Cited by 41 publications

References 185 publications

Screening for Diabetic Retinopathy with Extended Intervals, Safe and Without Compromising Adherence: A Retrospective Cohort Study

Screening for Diabetic Retinopathy with Extended Intervals, Safe and Without Compromising Adherence: A Retrospective Cohort Study

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

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

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