Improving diabEtic RetinOpathy screening aTtendancE in non-attenderS
Research type
Research Study
Full title
Improving diabetic retinopathy screening attendance in non-attenders aged ≥30 years: mixed methods study
IRAS ID
286651
Contact name
Roxanne Crosby-Nwaobi
Contact email
Clinicaltrials.gov Identifier
CROR1010, Sponsors reference number
Duration of Study in the UK
2 years, 3 months, 29 days
Research summary
Research Summary:
People with diabetes may develop severe vision loss because of the damaging effects of the disease on small blood vessels at the back of the eye (diabetic retinopathy). In the UK, everyone with diabetes aged 12 years and over is offered annual screening, consisting of taking photographs of the back of the eye (retina) to look for early signs of diabetic retinopathy that might need treatment. Treatment of sight-threatening retinopathy with lasers or injections can avoid vision loss, so it is important that people with diabetes regularly attend their screening appointments. However, across the UK, regular attendance for screening varies. This can have major consequences for identifying sight-threatening disease in good time. There are also financial consequences to the NHS, as the costs of missed appointments is high.
Previous research shows that certain groups are more likely to miss their annual appointment. For example, attendance may be lower in those living in deprived areas or among certain ethnic groups. I plan to invite people with diabetes to tell us what stops or would encourage them attend screening. We will use detailed one-to-one interviews (by MS Teams or phone) to record the views of people with diabetes who go or do not go to their screening appointment. I will also interview healthcare professionals(HCPs), asking for their views about how systems could be changed to improve
attendance.I will work with a group of people with diabetes, who will help me design questions that feel relevant and easy to answer. The findings will tell us how best to organise the screening programme and to develop specific advice to help change the behaviour of those who miss their screening appointments. I also plan to test one of the interventions in a group of people who do not attend their screening appointment and HCPs.
Summary of Results:
The EROTES Study: Helping People with Diabetes Protect Their Eyesight
People with diabetes can sometimes develop a complication called diabetic retinopathy, which can damage their eyesight. To prevent this, they are invited to regular eye screening appointments. However, many adults miss these vital check-ups.
The EROTES study was designed to understand why people miss these appointments and to test some potential solutions.
How Did We Investigate the Problem?
We interviewed 31 patients with diabetes and 7 healthcare professionals (primary care doctors and nurses). We asked them about the barriers that stop people from attending their eye screenings, and what could be done to make the process easier.
What Were the Main Barriers?
The interviews revealed several reasons why appointments were being missed:
For Patients: Many lacked awareness about how diabetes affects the eyes. The medical leaflets they received were often confusing and hard to read. Additionally, some patients struggled to get time off work because their employers didn't understand that diabetes can be a serious "hidden disability."
For Medical Staff: Primary care doctors and nurses said that their standard appointments are too short, leaving them with no time to discuss eye screenings. Some also admitted they didn't know enough about the screening process themselves and were not confident to speak to patients about their results and management.
Testing the Solutions
To help solve these issues, we designed and tested two new ideas:
A short, informative video: This was sent via text message or letter to patients who had recently missed an eye appointment.
An online training course: A self-paced educational program designed specifically for doctors and nurses to learn more about diabetic eye disease and screening.
Did the Solutions Work?
Yes, the results were very positive!
The Video: The video was a huge success. In just one month, it was viewed over 4,000 times. Most importantly, it led to a 25% increase in patients calling to re-book their missed eye tests.
The Training Course: The primary care doctors and nurses who completed the online program showed a significant increase in their knowledge and reported that they felt much more confident discussing diabetic eye disease and screening with their patients.
Conclusion
The study showed that a lack of clear information, a lack of support at work and lack of information from primary care doctors and nurses are major reasons why people miss their eye screenings. However, by making information more accessible —like text-message videos for patients and online training for primary care staff, we can successfully encourage more people to engage with the diabetic eye disease screening programme and protect their eyesight
REC name
South Central - Hampshire A Research Ethics Committee
REC reference
23/SC/0117
Date of REC Opinion
30 Mar 2023
REC opinion
Favourable Opinion