Factors influencing patient adherence with diabetic eye screening in rural communities: A qualitative study.

Kleins Lab // Publications // Nov 06 2018

PubMed ID: 30388172

Author(s): Liu Y, Zupan NJ, Shiyanbola OO, Swearingen R, Carlson JN, Jacobson NA, Mahoney JE, Klein R, Bjelland TD, Smith MA. Factors influencing patient adherence with diabetic eye screening in rural communities: A qualitative study. PLoS One. 2018 Nov 2;13(11):e0206742. doi: 10.1371/journal.pone.0206742. eCollection 2018.

Journal: Plo S One, Volume 13, Issue 11, 2018

OBJECTIVE Diabetic retinopathy remains the leading cause of blindness among working-age U.S. adults largely due to low screening rates. Rural populations face particularly greater challenges to screening because they are older, poorer, less insured, and less likely to receive guideline-concordant care than those in urban areas. Current patient education efforts may not fully address multiple barriers to screening faced by rural patients. We sought to characterize contextual factors affecting rural patient adherence with diabetic eye screening guidelines.

RESEARCH DESIGN AND METHODS We conducted semi-structured interviews with 29 participants (20 adult patients with type 2 diabetes and 9 primary care providers) in a rural, multi-payer health system. Both inductive and directed content analysis were performed.

RESULTS Factors influencing rural patient adherence with diabetic eye screening were categorized as environmental, social, and individual using the Ecological Model of Health. Major themes included limited access to and infrequent use of healthcare, long travel distances to obtain care, poverty and financial tradeoffs, trusting relationships with healthcare providers, family members’ struggles with diabetes, anxiety about diabetes complications, and the burden of diabetes management.

CONCLUSIONS Significant barriers exist for rural patients that affect their ability to adhere with yearly diabetic eye screening. Many studies emphasize patient education to increase adherence, but current patient education strategies fail to address major environmental, social, and individual barriers. Addressing these factors, leveraging patient trust in their healthcare providers, and strategies targeted specifically to environmental barriers such as long travel distances (e.g. teleophthalmology) may fill crucial gaps in diabetic eye screening in rural communities.