What works to Increase attendance for Diabetic Retinopathy screening? An Evidence sYnthEsiS (WIDeR-EyeS)

Lawrenson JG, Graham-Rowe E, Lorencatto F, Rice S, Bunce C, Francis JJ, Burr JM, Aluko P, Vale L, Peto T, Presseau J, Ivers NM, Grimshaw JM
Record ID 32015001004
Authors' objectives: Diabetes is a common condition, affecting over 3 million people in the UK. People with diabetes are much more likely than the general population to have sight loss due to the damaging effects of diabetes on small blood vessels at the back of the eye (known as diabetic retinopathy). Screening of people with diabetes by photographing the back of the eye and thus identifying and treating retinopathy at an early stage saves significant numbers from sight loss. It is therefore very important that people regularly attend their appointment. Within the UK, regular attendance to the screening service is variable. Certain groups are more likely to miss their annual appointment, for example, younger patients, those living in areas of high social deprivation and patients belonging to certain ethnic groups. This can have major consequences for catching sight-threatening diabetic changes in good time and the costs associated with non-attendance or missed appointments are high. The aim of this study is to investigate the available literature to find out how well current retinopathy screening services perform in terms of regular attendance to the service In particular we are exploring which interventions, designed to motivate patients to attend, do work. Our initial findings have shown that the various interventions to improve attendance are not described well and are made up of many elements, making it difficult to know which element of the intervention works best. Also, the impact of the various interventions used in studies to improve screening uptake is associated with varying degrees of success. We plan to use a novel approach which will provide a fuller description of each intervention used, identify which is the most effective and use statistical methods to explain the variability in success between studies. These differences may relate to the techniques used to raise awareness of diabetes and encourage behaviour change in patients who are known to miss their screening appointments. Reliable classification systems for describing interventions in terms of the behaviour change technique used have recently been developed. We plan to apply these to label each intervention. We can then assess whether the presence or absence of a particular behaviour change technique is associated with the effectiveness of the intervention. In parallel, we will use similar frameworks to describe what stops or encourages patients to regularly attend screening and treatment if required. We will map the alignment between the behavioural characteristics of the intervention and the behaviours which affect regular attendance. We will also assess the cost-effectiveness of interventions that appear to work to determine value for money. The study team consists of researcher s with expertise in methods for collating and analysing the research literature, health psychologists with expertise in describing behaviour change, a health economist and eye care professionals with expertise in diabetic retinopathy screening. In addition we will draw upon the views of people with diabetes and patient organisations. The results of the study will be used to inform how best the screening programme might be organised to improve regular attendance and patient outcomes for the UK eye screening service and to highlight any areas that require further study.
Project Status: Completed
Year Published: 2018
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England, United Kingdom
MeSH Terms
  • Diabetic Retinopathy
  • Mass Screening
  • Diabetes Mellitus, Type 1
  • Diabetes Mellitus, Type 2
  • Patient Compliance
Organisation Name: NIHR Health Technology Assessment programme
Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
Contact Name: journals.library@nihr.ac.uk
Contact Email: journals.library@nihr.ac.uk
Copyright: Queen's Printer and Controller of HMSO
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