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Systematic review on barriers and enablers for access to diabetic retinopathy screening services in different income settings

Author

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  • Mapa Mudiyanselage Prabhath Nishantha Piyasena
  • Gudlavalleti Venkata S Murthy
  • Jennifer L Y Yip
  • Clare Gilbert
  • Maria Zuurmond
  • Tunde Peto
  • Iris Gordon
  • Suwin Hewage
  • Sureshkumar Kamalakannan

Abstract

Background: 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. Objectives: 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. Methods: 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. 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 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). Conclusion: 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.

Suggested Citation

  • Mapa Mudiyanselage Prabhath Nishantha Piyasena & Gudlavalleti Venkata S Murthy & Jennifer L Y Yip & Clare Gilbert & Maria Zuurmond & Tunde Peto & Iris Gordon & Suwin Hewage & Sureshkumar Kamalakannan, 2019. "Systematic review on barriers and enablers for access to diabetic retinopathy screening services in different income settings," PLOS ONE, Public Library of Science, vol. 14(4), pages 1-29, April.
  • Handle: RePEc:plo:pone00:0198979
    DOI: 10.1371/journal.pone.0198979
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    References listed on IDEAS

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    1. Hofer, T.P. & Katz, S.J., 1996. "Healthy behaviors among women in the United States and Ontario: The effect on use of preventive care," American Journal of Public Health, American Public Health Association, vol. 86(12), pages 1755-1759.
    2. Basch, C.E. & Walker, E.A. & Howard, C.J. & Shamoon, H. & Zybert, P., 1999. "The effect of health education on the rate of ophthalmic examinations among African Americans with diabetes mellitus," American Journal of Public Health, American Public Health Association, vol. 89(12), pages 1878-1882.
    3. Daniel Kreft & Myra B McGuinness & Gabriele Doblhammer & Robert P Finger, 2018. "Diabetic retinopathy screening in incident diabetes mellitus type 2 in Germany between 2004 and 2013 - A prospective cohort study based on health claims data," PLOS ONE, Public Library of Science, vol. 13(4), pages 1-14, April.
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    Cited by:

    1. Mar Blasco-Blasco & Marta Puig-García & Nora Piay & Blanca Lumbreras & Ildefonso Hernández-Aguado & Lucy Anne Parker, 2020. "Barriers and facilitators to successful management of type 2 diabetes mellitus in Latin America and the Caribbean: A systematic review," PLOS ONE, Public Library of Science, vol. 15(9), pages 1-19, September.
    2. Stevens Bechange & Anne Roca & Elena Schmidt & Munazza Gillani & Leena Ahmed & Robina Iqbal & Imran Nazir & Anna Ruddock & Muhammed Bilal & Itfaq Khaliq Khan & Sandeep Buttan & Emma Jolley, 2021. "Diabetic retinopathy service delivery and integration into the health system in Pakistan—Findings from a multicentre qualitative study," PLOS ONE, Public Library of Science, vol. 16(12), pages 1-20, December.

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