title: Perception of care and barriers to treatment in individuals with diabetic retinopathy in India: 11-city 9-state study.
abstract: BACKGROUND
  Diabetic retinopathy is a leading cause of visual impairment. Low awareness about the disease and inequitable distribution of care are major challenges in India.
  
  
  OBJECTIVE
  Assess perception of care and challenges faced in availing care among diabetics.
  
  
  METHODS
  The cross-sectional, hospital based survey was conducted in eleven cities. In each city, public and private providers of eye-care were identified. Both multispecialty and standalone facilities were included. Specially designed semi-open ended questionnaires were administered to the clients.
  
  
  RESULTS
  376 diabetics were interviewed in the eye clinics, of whom 62.8% (236) were selected from facilities in cities with a population of 7 million or more. The mean duration of known diabetes was 11.1 (±7.7) years. Half the respondents understood the meaning of adequate glycemic control and 45% reported that they had visual loss when they first presented to an eye facility. Facilities in smaller cities and those with higher educational status were found to be statistically significant predictors of self-reported good/adequate control of diabetes. The correct awareness of glycemic control was significantly high among attending privately-funded facilities and higher educational status. Self-monitoring of glycemic status at home was significantly associated with respondents from larger cities, privately-funded facilities, those who were better educated and reported longer duration of diabetes. Duration of diabetes (41%), poor glycemic control (39.4%) and age (20.7%) were identified as the leading causes of DR. The commonest challenges faced were lifestyle/behavior related.
  
  
  CONCLUSIONS
  The findings have significant implications for the organization of diabetes services in India.
authors.affiliation: South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India.
authors.forename: Rajan
authors.initials: R
authors.lastname: Shukla
authors.affiliation: South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India; Department of Clinical Research, International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Murthy V S
authors.initials: MV
authors.lastname: Gudlavalleti
authors.affiliation: South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India.
authors.forename: Souvik
authors.initials: S
authors.lastname: Bandyopadhyay
authors.affiliation: South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India.
authors.forename: Raghupathy
authors.initials: R
authors.lastname: Anchala
authors.affiliation: South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India.
authors.forename: Aashrai Sai Venkat
authors.initials: AS
authors.lastname: Gudlavalleti
authors.affiliation: South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India.
authors.forename: A T
authors.initials: AT
authors.lastname: Jotheeswaran
authors.affiliation: South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India.
authors.forename: Srikrishna S
authors.initials: SS
authors.lastname: Ramachandra
authors.affiliation: South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Singh
authors.affiliation: Department of Community Ophthalmology, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Praveen
authors.initials: P
authors.lastname: Vashist
authors.affiliation: South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India.
authors.forename: Komal
authors.initials: K
authors.lastname: Allagh
authors.affiliation: South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India.
authors.forename: Hira Pant
authors.initials: HP
authors.lastname: Ballabh
authors.affiliation: Department of Clinical Research, International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Clare E
authors.initials: CE
authors.lastname: Gilbert
keywords: Clients; India; diabetic retinopathy; health care utilization; perceptions; risk factors