How to Improve Attendance for Diabetic Retinopathy Screening: Ideas and Perspectives From People With Type 2 Diabetes and Health-care Professionals

Gabriela B Petersen; Lene E Joensen; Jette K Kristensen; Henrik Vorum; Stine Byberg; Mia V Fangel; Bryan Cleal

doi:10.1016/j.jcjd.2024.11.004

How to Improve Attendance for Diabetic Retinopathy Screening: Ideas and Perspectives From People With Type 2 Diabetes and Health-care Professionals

Can J Diabetes. 2024 Nov 29:S1499-2671(24)00400-3. doi: 10.1016/j.jcjd.2024.11.004. Online ahead of print.

Authors

Gabriela B Petersen¹, Lene E Joensen², Jette K Kristensen³, Henrik Vorum⁴, Stine Byberg², Mia V Fangel³, Bryan Cleal²

Affiliations

¹ Center for General Practice at Aalborg University, Gistrup, Denmark; Steno Diabetes Center Copenhagen, Herlev, Denmark. Electronic address: gabriela.byskov.petersen@regionh.dk.
² Steno Diabetes Center Copenhagen, Herlev, Denmark.
³ Center for General Practice at Aalborg University, Gistrup, Denmark.
⁴ Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

PMID: 39617266
DOI: 10.1016/j.jcjd.2024.11.004

Abstract

Objectives: Our aim in this study was to identify how to improve diabetic retinopathy screening from the perspectives of people with type 2 diabetes and health-care professionals and to elicit their thoughts on initiatives to increase attendance.

Methods: A total of 38 semistructured interviews were conducted with people with type 2 diabetes (n=20), general practitioners (n=10), and ophthalmic staff (n=8). The interviews examined ideas for improving screening and elicited feedback on 3 initiatives: getting a fixed appointment; same-day screening; and outsourcing screening to general practice, including the use of artificial intelligence (AI). Data analysis was guided by content analysis approaches.

Results: Ideas for improving screening were centred around reducing the inconvenience of attendance, making appointment scheduling easier, and improving health-care professionals' communication. Participants recognized the potential benefits of the initiatives but expressed important reservations to consider. Concerns included the following: that a fixed appointment would cause less active patient involvement and negatively affect attendance; that same-day screening may result in loss of patient-provider communication; that people with type 2 diabetes may be uneasy with having the screening performed outside the eye clinic; and that health-care professionals were concerned about the finances, validity, and examination quality associated with outsourcing screening and using AI.

Conclusions: Participants' thoughts on how to improve diabetic retinopathy screening should be seen as starting points for potential future interventions. Although outsourcing screening and the use of AI have gained traction, our study indicates that the target population has reservations that are important to consider in future development and implementation of such strategies.

Keywords: Diabète de type 2; Dépistage de la rétinopathie diabétique; Entretiens; Interventions; Participation au dépistage; Recherche qualitative; diabetic retinopathy screening; interventions; interviews; qualitative research; screening attendance; type 2 diabetes.