Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, United Kingdom.
PLoS One. 2019 Apr 23;14(4):e0198979. doi: 10.1371/journal.pone.0198979. eCollection 2019.
Diabetic retinopathy (DR) can lead to visual impairment and blindness if not detected and treated in time. Knowing the barriers/enablers in advance in contrasting different country income settings may accelerate development of a successful DR screening (DRS) program. This would be especially applicable in the low-income settings with the rising prevalence of DR.
The aim of this systematic review is to identify and contrast the barriers/enablers to DRS for different contexts using both consumers i.e., people with diabetes (PwDM) and provider perspectives and system level factors in different country income settings.
We searched MEDLINE, Embase, CENTRAL in the Cochrane Library from the databases start date to December 2018. We included the studies reported on barriers and enablers to access DRS services based at health care facilities. We categorised and synthesized themes related to the consumers (individuals), providers and the health systems (environment) as main dimensions according to the constructs of social cognitive theory, supported by the quantitative measures i.e., odds ratios as reported by each of the study authors.
We included 77 studies primarily describing the barriers and enablers. Most of the studies were from high income settings (72.7%, 56/77) and cross sectional in design (76.6%, 59/77). From the perspectives of consumers, lack of knowledge, attitude, awareness and motivation were identified as major barriers. The enablers were fear of blindness, proximity of screening facility, experiences of vision loss and being concerned of eye complications. In providers' perspectives, lack of skilled human resources, training programs, infrastructure of retinal imaging and cost of services were the main barriers. Higher odds of uptake of DRS services was observed when PwDM were provided health education (odds ratio (OR) 4.3) and having knowledge on DR (OR range 1.3-19.7).
Knowing the barriers to access DRS is a pre-requisite in development of a successful screening program. The awareness, knowledge and attitude of the consumers, availability of skilled human resources and infrastructure emerged as the major barriers to access to DRS in any income setting.
如果不能及时发现和治疗，糖尿病视网膜病变（DR）可导致视力损害和失明。在不同国家收入背景下，预先了解DR 筛查（DRS）的障碍/促进因素可能会加速成功的 DRS 项目的发展。这在 DR 患病率不断上升的低收入环境中尤其适用。
本系统综述的目的是从消费者（即糖尿病患者）和提供者的角度，并从系统层面，确定并比较不同国家收入背景下 DRS 的障碍/促进因素。
我们检索了 MEDLINE、Embase 和 Cochrane 图书馆中的 CENTRAL，检索时间从数据库建立开始到 2018 年 12 月。我们纳入了基于医疗机构的 DRS 服务获取障碍和促进因素的研究报告。我们根据社会认知理论的结构，将与消费者（个体）、提供者和卫生系统（环境）相关的主题分类并综合为主要维度，并辅以各研究作者报告的定量指标，如比值比。
我们纳入了 77 项主要描述障碍和促进因素的研究。大多数研究来自高收入环境（72.7%，56/77），且设计为横断面研究（76.6%，59/77）。从消费者的角度来看，缺乏知识、态度、意识和动机被认为是主要障碍。促进因素包括对失明的恐惧、筛查设施的便利性、视力丧失的经历和对眼部并发症的担忧。在提供者的角度来看，缺乏熟练的人力资源、培训计划、视网膜成像基础设施和服务成本是主要障碍。当为糖尿病患者提供健康教育（比值比 4.3）和有关 DR 的知识（比值比范围 1.3-19.7）时，DRS 服务的接受度更高。
了解 DRS 的障碍是制定成功筛查计划的前提。在任何收入环境下，消费者的意识、知识和态度、熟练人力资源的可用性以及基础设施都成为 DRS 可及性的主要障碍。
