Hipwell, Alison, Sturt, Jackie, Lindenmeyer, Antje, Stratton, Irene, Gadsby, Roger, O'Hare, J. Paul and Scanlon, Peter H. (2014) Attitudes, access and anguish : a qualitative interview study of staff and patients' experiences of diabetic retinopathy screening. BMJ Open, Volume 4 (Number 12). Article number e005498. doi:10.1136/bmjopen-2014-005498

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Abstract

Objective To examine the experiences of patients, health professionals and screeners; their interactions with and understandings of diabetic retinopathy screening (DRS); and how these influence uptake.

Design Purposive, qualitative design using multiperspectival, semistructured interviews and thematic analysis.

Setting Three UK Screening Programme regions with different service-delivery modes, minority ethnic and deprivation levels across rural, urban and inner-city areas, in general practitioner practices and patients’ homes.

Participants 62 including 38 patients (22 regular-screening attenders, 16 non-regular attenders) and 24 professionals (15 primary care professionals and 9 screeners).

Results Antecedents to attendance included knowledge about diabetic retinopathy and screening; antecedents to non-attendance included psychological, pragmatic and social factors. Confusion between photographs taken at routine eye tests and DRS photographs was identified. The differing regional invitation methods and screening locations were discussed, with convenience and transport safety being over-riding considerations for patients. Some patients mentioned significant pain and visual disturbance from mydriasis drops as a deterrent to attendance.

Conclusions In this, the first study to consider multiperspectival experiential accounts, we identified that proactive coordination of care involving patients, primary care and screening programmes, prior to, during and after screening is required. Multiple factors, prior to, during and after screening, are involved in the attendance and non-attendance for DRS. Further research is needed to establish whether patient self-management educational interventions and the pharmacological reformulation of shorter acting mydriasis drops, may improve uptake of DRS. This might, in turn, reduce preventable vision loss and its associated costs to individuals and their families, and to health and social care providers, reducing current inequalities.

Item Type:	Journal Article
Subjects:	R Medicine > RE Ophthalmology
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > ( - July 2016) Health Education Hub Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine > Metabolic and Vascular Health (- until July 2016) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Diabetic retinopathy -- Medical examinations
Journal or Publication Title:	BMJ Open
Publisher:	BMJ
ISSN:	2044-6055
Official Date:	15 November 2014
Dates:	Date Event 15 November 2014 Published 21 August 2014 Accepted 16 April 2014 Submitted
Volume:	Volume 4
Number:	Number 12
Article Number:	Article number e005498
DOI:	10.1136/bmjopen-2014-005498
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access
Funder:	National Institute for Health Research (Great Britain) (NIHR), Gloucestershire Hospitals NHS Foundation Trust
Grant number:	PB-PG-1208-18043 (NIHR)

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