Article type
Abstract
"Background - Diabetes is rising globally. Diabetic Retinopathy is a common microvascular complication of diabetes that can lead to sight loss, if not detected and treated early. Knowing the barriers and enablers to access diabetic retinopathy eye care services is important in improving the uptake of services.
Objectives: The aim of this systematic review is to explore the barriers as well as enablers to uptake diabetic retinopathy screening services by the people with diabetes in different country income settings.
Methods: Methods: We searched MEDLINE All (Ovid), Embase and Cochrane Library from the databases start date to December 2018. We included the studies reported on barriers and enablers to access diabetic retinopathy services based at health care facilities. We categorised and synthesized themes related to the service users, services providers and the health systems as main dimensions according to the constructs of social cognitive theory, supported by narrative descriptions of quantitative measures.
Main results: 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 diabetic retinopathy screening services was observed when people with diabetes were provided health education (odds ratio (OR) 4.3) and having knowledge on DR (OR range 1.3-19.7).
Conclusion: Knowing the barriers to access diabetic retinopathy screening 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 diabetic retinopathy screening in any income setting.
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Objectives: The aim of this systematic review is to explore the barriers as well as enablers to uptake diabetic retinopathy screening services by the people with diabetes in different country income settings.
Methods: Methods: We searched MEDLINE All (Ovid), Embase and Cochrane Library from the databases start date to December 2018. We included the studies reported on barriers and enablers to access diabetic retinopathy services based at health care facilities. We categorised and synthesized themes related to the service users, services providers and the health systems as main dimensions according to the constructs of social cognitive theory, supported by narrative descriptions of quantitative measures.
Main results: 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 diabetic retinopathy screening services was observed when people with diabetes were provided health education (odds ratio (OR) 4.3) and having knowledge on DR (OR range 1.3-19.7).
Conclusion: Knowing the barriers to access diabetic retinopathy screening 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 diabetic retinopathy screening in any income setting.
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