title: What factors influence uptake of retinal screening among young adults with type 2 diabetes? A qualitative study informed by the theoretical domains framework.
abstract: OBJECTIVE
  Young adults with type 2 diabetes (T2D, 18-39years) face increased risk of vision loss from diabetic retinopathy (DR). Retinal screening is essential to detect DR, yet screening rates for this group are low and little is known about the underlying factors influencing this important behavior. Using the theoretical domains framework (TDF) to guide data collection and analysis, we explored screening barriers and facilitator, contrasting them with a comparator group of older adults with T2D (40+ years).
  
  
  METHODS
  Thirty semi-structured telephone interviews (10 younger, 20 older adults) were conducted. Data were coded into TDF domains with salience identified by "frequency" of reference. Screening facilitators and barriers were systematically compared between groups.
  
  
  RESULTS
  Although many screening facilitators and barriers were shared by younger and older adults, additional factors highly relevant to the former included: social comparison with others ('social influences'); concern for the impact on the family unit, unrealistic optimism and perceived invulnerability ('beliefs about consequences'); lack of time and financial resources ('environmental context and resources'), and DR misconceptions ('knowledge').
  
  
  CONCLUSIONS
  This study demonstrated that young adult retinal screening behavior was influenced by additional social cognitive factors compared to older adults, providing a first-step evidence base for clinicians and other health professionals, and potential targets for future eye health and retinal screening interventions.
authors.affiliation: School of Psychology, Deakin University, Geelong, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Melbourne, VIC, Australia. Electronic address: alake@acbrd.org.au.
authors.forename: Amelia J
authors.initials: AJ
authors.lastname: Lake
authors.affiliation: School of Psychology, Deakin University, Geelong, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Melbourne, VIC, Australia.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Browne
authors.affiliation: Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, 3002, Australia; Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, 3010, Australia.
authors.forename: Gwyneth
authors.initials: G
authors.lastname: Rees
authors.affiliation: School of Psychology, Deakin University, Geelong, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Melbourne, VIC, Australia; AHP Research, Hornchurch, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Speight
mesh_terms: D000293:Adolescent; D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D010358:Patient Participation / Q000706:statistics & numerical data; D010465:Perception; D010818:Practice Patterns, Physicians'; D012160:Retina / Q000473:pathology; D012164:Retinal Diseases / Q000175:diagnosis* / Q000209:etiology; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Diabetic retinopathy; Qualitative research; Theoretical domains framework; Type 2 diabetes; Young adults