title: What do patients with diabetes and providers think of an innovative Australian model of remote diabetic retinopathy screening? A qualitative study.
abstract: Diabetic retinopathy (DR) is the commonest cause of preventable blindness in working age populations, but up to 98% of visual loss secondary to DR can be prevented with early detection and treatment. In 2012, an innovative outreach DR screening model was implemented in remote communities in a state of Australia. The aim of this study was to explore the acceptability of this unique DR screening model to patients, health professionals and other key stakeholders.
  
  
  
  This descriptive qualitative study used semi-structured interviews with patients opportunistically recruited whilst attending DR screening, and purposefully selected health care professionals either working within or impacted by the programme. Interviews were audiotaped, transcribed and analysed using NVIVO. An iterative process of thematic analysis was used following the principles of grounded theory.
  
  
  
  Interviews were conducted with fourteen patients with diabetes living in three remote communities and nine health professionals or key stakeholders. Nine key themes emerged during interviews with health professionals, key stakeholders and patients: i) improved patient access to DR screening; ii) efficiency, financial implications and sustainability; iii) quality and safety; iv) multi-disciplinary diabetes care; v) training and education; vi) operational elements of service delivery; vii) communication, information sharing and linkages; viii) coordination and integration of the service and ix) suggested improvements to service delivery.
  
  
  
  The Remote Outreach DR Screening Service is highly acceptable to patients and health professionals. Challenges have primarily been encountered in communication and coordination of the service and further development in these areas could improve the programme's impact and sustainability in remote communities. The service is applicable to other remote communities nationally and potentially internationally.
authors.affiliation: College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville City, QLD, 4811, Australia. nicola.glasson@my.jcu.edu.au.
authors.forename: Nicola M
authors.initials: NM
authors.lastname: Glasson
authors.affiliation: College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville City, QLD, 4811, Australia.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Larkins
authors.affiliation: Discipline of General Practice, University of Queensland, Royal Brisbane Hospital, Level 8 Health Sciences Building, Herston, QLD, 4029, Australia.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Crossland
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001315:Australia / Q000453:epidemiology; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000208:ethnology; D042241:Early Diagnosis; D005260:Female; D006282:Health Personnel / Q000523:psychology; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D015397:Program Evaluation; D036301:Qualitative Research; D019035:Rural Health Services / Q000458:organization & administration*; D055815:Young Adult
keywords: Diabetic retinopathy; Qualitative study; Rural and remote; Screening