title: A qualitative study in the United Kingdom of factors influencing attendance by patients with diabetes at ophthalmic outpatient clinics.
abstract: BACKGROUND
  Many diabetics do not have regular eye examinations, although it is known that early diagnosis and treatment of sight-threatening retinopathy reduces the risk of blindness. The barriers that prevent diabetics from attending eye clinics are poorly understood.
  
  
  OBJECTIVE
  To determine what factors may influence diabetic patients' attendance at eye clinics.
  
  
  METHODS
  A qualitative survey of both patients and eye care providers was undertaken in a rural district general hospital and in an urban tertiary teaching hospital. Methods employed included semi-structured interviews, focus groups and non-participatory observations. All interviews and discussions were recorded and transcribed. The transcripts were then analyzed to detect emerging themes. Data collection continued until no new themes emerged.
  
  
  RESULTS
  Lack of awareness was seen as the greatest barrier by both patients and providers. Patients were aware that diabetes could affect the eye, but not that it could lead to blindness, nor that severe retinopathy could be asymptomatic. Patients reported that fundus images used for screening were a valuable educational resource. Fear, particularly of laser treatment, and guilt, about poor control causing retinopathy, deterred patients from attending. Both patients and providers recognized that regular attendance was inconvenient; however, providers underestimated the difficulties patients faced in obtaining time off work to attend clinics.
  
  
  CONCLUSIONS
  Providing more complete information about diabetic retinopathy, and making eye clinic attendance more convenient for patients, may increase the number of diabetics who have regular eye examinations.
authors.affiliation: International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, England.
authors.forename: Karinya
authors.initials: K
authors.lastname: Lewis
authors.forename: Daksha
authors.initials: D
authors.lastname: Patel
authors.forename: David
authors.initials: D
authors.lastname: Yorston
authors.forename: David
authors.initials: D
authors.lastname: Charteris
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D001766:Blindness / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D003695:Delivery of Health Care / Q000592:standards*; D003930:Diabetic Retinopathy / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D015995:Prevalence; D011785:Quality Assurance, Health Care / Q000592:standards*; D012307:Risk Factors; D012424:Rural Population; D011795:Surveys and Questionnaires; D006113:United Kingdom