A qualitative study on barriers and enablers to uptake of diabetic retinopathy screening by people with diabetes in the Western Province of Sri Lanka

Mapa Mudiyanselage Prabhath Nishantha Piyasena; Gudlavalleti Venkata S Murthy; Jennifer L Y Yip; Clare Gilbert; Tunde Peto; Mahesh Premarathna; Maria Zuurmond

doi:10.1186/s41182-019-0160-y

A qualitative study on barriers and enablers to uptake of diabetic retinopathy screening by people with diabetes in the Western Province of Sri Lanka

Trop Med Health. 2019 May 17:47:34. doi: 10.1186/s41182-019-0160-y. eCollection 2019.

Authors

Mapa Mudiyanselage Prabhath Nishantha Piyasena¹, Gudlavalleti Venkata S Murthy¹, Jennifer L Y Yip¹, Clare Gilbert¹, Tunde Peto², Mahesh Premarathna³, Maria Zuurmond⁴

Affiliations

¹ 1Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK.
² 2School of Medicine, Dentistry and Biomedical Sciences, Queen's University, 97 - Lisburn Rd, Belfast, BT9 7BL Northern Ireland.
³ 3Department of Sociology, University of Colombo, Reid Avenue, Colombo 03, Colombo, Sri Lanka.
⁴ 4Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK.

Abstract

Background: Blindness and visual impairment from diabetic retinopathy (DR) are avoidable through early detection and timely treatment. The Western Province of Sri Lanka has the highest prevalence of diabetes mellitus (DM) (18.6%) in the country. A situational analysis identified a significant gap in DR screening services (DRSS) uptake in this region. Barriers that hinder people with DM (PwDM) from attending DRSS are poorly understood. The purpose of this study is to understand the factors which influence the uptake of DRSS and follow-up to inform health promotion strategies and improve the uptake of these services.

Methods: Eleven focus group discussions (FGDs) were conducted with PwDM who presented to medical, general eye and vitreoretinal services in three public sector institutions (two tertiary and one secondary level) in the Western Province between October 2016 and March 2017. We enrolled six groups (four Sinhala speaking, two Tamil) of women and five groups (three Sinhala and two Tamil) of men representing ethnicity and gender. We performed a thematic analysis and described the main themes and subthemes using the socio-ecological model as a framework.

Results: We identified lack of knowledge of both the condition and the need for screening as key barriers to access DRSS. Socio-cultural factors in the family environment, economic reasons and institutional factors were also important barriers. Additional reasons include long waiting time at eye clinics and poor referrals exacerbated by the lack of a systematic DRSS. In addition, attitudes to DRSS such as fear of discomfort from the procedure and the need for accompaniment following mydriasis were also deterrents to follow-up screening.

Conclusion: This study has shown that there are inter-related user, family, and institutional factors which affect the uptake of DRSS. Understanding how DR is conceptualised by PwDM in this region is essential to refine strategies to improve access to DRSS. Strategies to improve knowledge need to be more culturally acceptable and relevant to PwDM and their families, with increased availability of DRSS at convenient locations may increase timely uptake of screening.

Keywords: Barriers; Diabetes mellitus; Diabetic retinopathy; Screening; Sri Lanka.