Investigation of Factors in Diabetic Retinopathy Screening (DRS) Attendance at the Diabetic Centres in Saudi Arabia
Abstract
Diabetes Mellitus (DM) affects more than 463 million adults worldwide and will affect 700
million patients by 2045 (International Diabetes Federation (IDF), 2019). Diabetic Retinopathy
(DR) is one of the manifestations of its complications, which affects 35% of the diabetes
population worldwide and is acknowledged to be one of the five causes of global blindness.
Around 50 -73% of blindness and visual impairment caused by DR can be prevented by early
detection and appropriate treatment. Therefore, early detection of this complication through
regular Diabetic Retinopathy screening (DRS) is recommended by the IDF guidelines.
Links between the attendance outcomes and socio-demographic, clinical, behavioural, and
organisational factors influencing DRS attendance have been indicated in the previous studies,
however, investigated the factors at multi-levels in one study, as well understand the
behavioural factors under sub-groups with the risk of low attendance, have yet to investigate.
This study aimed to investigate factors impacting patients' choice to (DRS), and to develop
evidence-based and theory-informed intervention recommendation accordingly; that help
improves and success DRS attendance rates in Saudi Arabia (SA).
To achieve this aim, three empirical studies conducted by adopting the mixed methods approach
involving both inductive and deductive approaches; and qualitative and quantitative analyses.
The data is proposed to be collected from two hospitals each in SA for patients who attended,
not regularly attended or never attended the DRS. The secondary data was collected from DM
centres’ documents and patients’ medical records, then was analysed quantitively by
conducting a multinomial logistic regression technique and SPSS software that tested the
hypotheses developed in this study. The primary data was collected from semi-structured
interviews of Patients and Healthcare Providers (HCPs), and qualitative data was analysed
through the thematic analysis of the transcripts. The results from the quantitative study, that
analysed 440 records, identified the predictors to the DRS based on the patients’ characteristics
and presented the patients’ sub-groups with different attendance outcomes accordingly. The
patients’ interview study found ten themes that reflect the key perceptions about DRS
attendance and linked that to the identified sub-groups. The HCPs’ findings recognised the
barriers and facilitators to the DRS attendance, at patients’ and HCPs’ behavioural level, in
addition to the DRS organisational level.