title: Supports and barriers as experienced by individuals with vision loss from diabetes.
abstract: OBJECTIVE
  The purpose of this study was to explore the perceived environmental supports and barriers to daily functioning for people with low vision due to diabetic retinopathy and the adaptive strategies used by these individuals to improve person-environment fit.
  
  
  METHODS
  The researchers used a qualitative descriptive approach with eight participants with low vision as a result of diabetic retinopathy. Data collection methods included semi-structured interviews, observation of participants' home environments and focus group discussions.
  
  
  RESULTS
  Participants described aspects of the physical environment, the social environment and psychological adjustment as important in adapting to vision loss and diabetes. Four themes emerged from the data analysis: "It's a Complicated Life", "The World Isn't Accessible", "Making it Work" and "Learning to be Blind".
  
  
  CONCLUSIONS
  Physical and social environmental influences on functioning are complex. Adaptation to vision loss is an ongoing process that may be aided by peer interactions and more community-based rehabilitation. To best rehabilitate people with low vision due to diabetic retinopathy, the influence of both the physical and social environment along with psychological adaptation need to be considered. Periodic rehabilitation, interventions taking place in community settings and the formal inclusion of peers in the rehabilitation process may be indicated. Implications for Rehabilitation Consideration of the social as well as the physical environment is essential in the rehabilitation of people with low vision due to diabetic retinopathy. Adaptation to vision loss by those with diabetic retinopathy is complicated by the fact that diabetes is a systemic disease that affects multiple body systems. Psychological adaptation to vision loss is characterized by cycles of grieving and acceptance, which affects readiness for rehabilitation. Alternative approaches to rehabilitation may be indicated for people with low vision due to diabetic retinopathy, including periodic intervention over time and the inclusion of peers in the rehabilitation process.
authors.affiliation: School of Occupational and Physical Therapy, University of Puget Sound, Tacoma , Washington , USA .
authors.forename: Tatiana A
authors.initials: TA
authors.lastname: Kaminsky
authors.forename: Pamela H
authors.initials: PH
authors.lastname: Mitchell
authors.forename: Elaine A
authors.initials: EA
authors.lastname: Thompson
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Dudgeon
authors.forename: Janet M
authors.initials: JM
authors.lastname: Powell
mesh_terms: D000203:Activities of Daily Living; D000222:Adaptation, Physiological; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D003625:Data Collection / Q000379:methods; D003930:Diabetic Retinopathy / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D004779:Environment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012931:Social Environment