Barriers and enablers to diabetic retinopathy screening attendance: a theory-based systematic review

Abstract

Background: Diabetic retinopathy is a sight-threatening complication of diabetes. Population screening among people with diabetes has been shown to be clinically effective; however, suboptimal screening attendance with wide geographic disparities has been reported. To develop and evaluate quality improvement interventions to maximise retinopathy screening attendance, it is important to understand the theoretical determinants of screening behaviour. This systematic review aims to identify modifiable barriers/enablers associated with screening attendance. Methods: Studies will be identified from published and grey literature through multiple sources. Primary/secondary studies will be included if they report perceived barriers/enablers to diabetic retinopathy screening, elicited from the perspective of adults diagnosed with diabetes and healthcare providers. Data may include: participant quotations, statistical analyses from questionnaire studies, interpretive descriptions and summaries of results in published reports. Extracted data will be coded into domains (i.e. groups of explanatory factors proposed to mediate change) using the Theoretical Domains Framework and, for organisational level data, the Consolidated Framework of Implementation Research. The importance of each domain in influencing behaviour will be considered in terms of: frequency with which beliefs emerge across included studies; presence of conflicting beliefs; perceived strength of the themes impacting screening attendance. Expected results: There is likely to be a core number of domains important in determining attendance. However, some variation according to demographics (e.g. socio-economic status, ethnicity) and between patient/provider perspective, is expected. Current stage of work: The review protocol is registered on PROSPERO (CRD42016032990). Discussion: The results will form the basis for developing targeted interventions to increase attendance.