title: Attitudes, access and anguish: a qualitative interview study of staff and patients' experiences of diabetic retinopathy screening.
abstract: OBJECTIVE
  To examine the experiences of patients, health professionals and screeners; their interactions with and understandings of diabetic retinopathy screening (DRS); and how these influence uptake.
  
  
  METHODS
  Purposive, qualitative design using multiperspectival, semistructured interviews and thematic analysis.
  
  
  METHODS
  Three UK Screening Programme regions with different service-delivery modes, minority ethnic and deprivation levels across rural, urban and inner-city areas, in general practitioner practices and patients' homes.
  
  
  METHODS
  62 including 38 patients (22 regular-screening attenders, 16 non-regular attenders) and 24 professionals (15 primary care professionals and 9 screeners).
  
  
  RESULTS
  Antecedents to attendance included knowledge about diabetic retinopathy and screening; antecedents to non-attendance included psychological, pragmatic and social factors. Confusion between photographs taken at routine eye tests and DRS photographs was identified. The differing regional invitation methods and screening locations were discussed, with convenience and transport safety being over-riding considerations for patients. Some patients mentioned significant pain and visual disturbance from mydriasis drops as a deterrent to attendance.
  
  
  CONCLUSIONS
  In this, the first study to consider multiperspectival experiential accounts, we identified that proactive coordination of care involving patients, primary care and screening programmes, prior to, during and after screening is required. Multiple factors, prior to, during and after screening, are involved in the attendance and non-attendance for DRS. Further research is needed to establish whether patient self-management educational interventions and the pharmacological reformulation of shorter acting mydriasis drops, may improve uptake of DRS. This might, in turn, reduce preventable vision loss and its associated costs to individuals and their families, and to health and social care providers, reducing current inequalities.
authors.affiliation: CLAHRC-WM, Warwick Business School, University of Warwick, Coventry, UK.
authors.forename: A E
authors.initials: AE
authors.lastname: Hipwell
authors.affiliation: Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Sturt
authors.affiliation: Department of Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
authors.forename: A
authors.initials: A
authors.lastname: Lindenmeyer
authors.affiliation: Gloucester Diabetic Retinopathy Research Group, Cheltenham General Hospital, Gloucester, UK.
authors.forename: I
authors.initials: I
authors.lastname: Stratton
authors.affiliation: Warwick Medical School Education & Development, University of Warwick, Coventry, UK.
authors.forename: R
authors.initials: R
authors.lastname: Gadsby
authors.affiliation: Division of Metabolic & Vascular Health, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: P
authors.initials: P
authors.lastname: O'Hare
authors.affiliation: Diabetic Retinopathy Screening Programme (England), Gloucestershire Eye Unit and Oxford Eye Hospital, Cheltenham General Hospital, Gloucester, UK.
authors.forename: P H
authors.initials: PH
authors.lastname: Scanlon
mesh_terms: D003920:Diabetes Mellitus / Q000473:pathology; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008403:Mass Screening; D008875:Middle Aged; D009184:Mydriatics / Q000009:adverse effects; D010146:Pain / Q000209:etiology; D010342:Patient Acceptance of Health Care; D010781:Photography; D011320:Primary Health Care; D036301:Qualitative Research; D012424:Rural Population; D013315:Stress, Psychological; D014186:Transportation; D006113:United Kingdom; D014786:Vision Disorders / Q000209:etiology
chemical_list: D009184:Mydriatics
keywords: PRIMARY CARE; QUALITATIVE RESEARCH; SOCIAL MEDICINE; Screening