Factors Influencing The Receipt Of Diabetic Retinopathy Screening In A High-Risk Population

Diabetic retinopathy (DR) is among the leading causes of vision loss in the US, yet an estimated 50% of patients with diabetes do not receive recommended annual screening eye exams for reasons that are incompletely understood. Patients with diabetes and low socioeconomic status or who are racial/ethnic minorities are at increased risk for vision loss. Qualitative interviews were conducted with 30 patients with diabetes at a federally qualified community health center and a primary care clinic in New Haven, CT regarding factors influencing their use of screening exams. The interviews were recorded, transcribed, and analyzed line by line to identify themes. The themes were organized in a theoretical framework of factors influencing receipt of screening. Participants identified as black (16), white (5), Hispanic (5), Asian (1), and other/no answer (3). Twenty-eight had health insurance. Twenty-four had received an eye exam within in the past year, but one-third of participants reported they did not receive eye exam yearly. 415 comments were coded at 22 nodes under 7 broader themes and two overarching categories of individual factors and institutional/structural factors. Themes included vision status, competing concerns, emotional context, resource availability, in-clinic experience, cues to action, and knowledge about diabetes. Among the patients who had not received an eye exam within the past year, the cost of an exam, lack of insurance coverage, and lack of prompting by a health provider were among the reported reasons for not pursuing eye screenings. Many patients lack knowledge about diabetic retinopathy and the utility of preventative eye care. New strategies for engaging high-risk populations are necessary