School of Health Sciences, City, University of London, London, UK.
NIHR Moorfields Biomedical Research Centre, London, UK.
Diabet Med. 2022 Mar;39(3):e14751. doi: 10.1111/dme.14751. Epub 2021 Dec 29.
The aim of this study was to identify barriers and enablers of diabetic eye screening (DES) attendance amongst young adults with diabetes living in the United Kingdom.
Semistructured qualitative interviews with adults aged 18-34 years with diabetes. Participants were purposively sampled to aim for representation across gender, geographical locations, diabetes type, years since diabetes diagnosis and patterns of attendance (i.e. regular attenders, occasional non-attenders, regular non-attenders). Data were collected and analysed using the Theoretical Domains Framework (TDF) to explore potential individual, sociocultural and environmental influences on attendance. Data were analysed using a combined deductive and inductive thematic analysis approach. Barriers/enablers were mapped to behaviour change techniques (BCTs) to identify potential strategies to increase attendance.
Key barriers to attendance reported by the sample of 29 study participants with type 1 diabetes, fell within the TDF domains: [Knowledge] (e.g. not understanding reasons for attending DES or treatments available if diabetic retinopathy is detected), [Social Influences] (e.g. lack of support following DES results), [Social role and Identity] (e.g. not knowing other people their age with diabetes, feeling 'isolated' and being reluctant to disclose their diabetes) and [Environmental Context and Resources] (e.g. lack of appointment flexibility and options for rescheduling). Enablers included: [Social Influences] (e.g. support of family/diabetes team), [Goals] (e.g. DES regarded as 'high priority'). Many of the reported barriers/enablers were consistent across groups. Potential BCTs to support attendance include Instructions on how to perform the behaviour; Information about health consequences; Social support (practical) and Social comparison.
Attendance to diabetic eye screening in young adults is influenced by a complex set of interacting factors. Identification of potentially modifiable target behaviours provides a basis for designing more effective, tailored interventions to help young adults regularly attend eye screening and prevent avoidable vision loss.
本研究旨在确定英国年轻成年糖尿病患者参加糖尿病眼病筛查（DES）的障碍和促进因素。
对 18-34 岁的成年糖尿病患者进行半结构化定性访谈。参与者是有目的抽样的，以确保在性别、地理位置、糖尿病类型、糖尿病诊断年限和就诊模式（即定期就诊者、偶尔不就诊者、定期不就诊者）方面具有代表性。使用理论领域框架（TDF）收集和分析数据，以探讨对就诊率有潜在影响的个人、社会文化和环境因素。使用综合演绎和归纳主题分析方法进行数据分析。将障碍/促进因素映射到行为改变技术（BCT），以确定增加就诊率的潜在策略。
29 名 1 型糖尿病患者报告的就诊障碍主要属于 TDF 领域：[知识]（例如，不了解参加 DES 的原因或如果发现糖尿病视网膜病变可提供的治疗方法），[社会影响]（例如，DES 结果后缺乏支持），[社会角色和身份]（例如，不知道同龄人中有糖尿病患者，感到“孤立”，不愿透露自己的糖尿病）和[环境背景和资源]（例如，预约灵活性和重新安排选项不足）。促进因素包括：[社会影响]（例如，家庭/糖尿病团队的支持），[目标]（例如，DES 被视为“高度优先”）。许多报告的障碍/促进因素在各群体中是一致的。支持就诊的潜在 BCT 包括如何执行行为的指导；关于健康后果的信息；实际的社会支持和社会比较。
年轻成年糖尿病患者参加糖尿病眼病筛查的情况受到一系列相互作用的因素影响。确定潜在的可改变的目标行为为设计更有效的、量身定制的干预措施提供了依据，以帮助年轻成年人定期接受眼部筛查并预防可避免的视力丧失。
