Factors influencing patient adherence with diabetic eye screening in rural communities: A qualitative study

Yao Liu, Nicholas J. Zupan, Olayinka O. Shiyanbola, Rebecca Swearingen, Julia N. Carlson, Nora A. Jacobson, Jane E. Mahoney, Ronald Klein, Timothy D. Bjelland, Maureen A. Smith, Denis Bourgeois
2018 PLoS ONE  
Objective Diabetic retinopathy remains the leading cause of blindness among working-age U.S. adults largely due to low screening rates. Rural populations face particularly greater challenges to screening because they are older, poorer, less insured, and less likely to receive guidelineconcordant care than those in urban areas. Current patient education efforts may not fully address multiple barriers to screening faced by rural patients. We sought to characterize contextual factors affecting
more » ... ctors affecting rural patient adherence with diabetic eye screening guidelines. Research design and methods We conducted semi-structured interviews with 29 participants (20 adult patients with type 2 diabetes and 9 primary care providers) in a rural, multi-payer health system. Both inductive and directed content analysis were performed. Results Factors influencing rural patient adherence with diabetic eye screening were categorized as environmental, social, and individual using the Ecological Model of Health. Major themes included limited access to and infrequent use of healthcare, long travel distances to obtain care, poverty and financial tradeoffs, trusting relationships with healthcare providers, family members' struggles with diabetes, anxiety about diabetes complications, and the burden of diabetes management.
doi:10.1371/journal.pone.0206742 fatcat:i4ueouwaq5bwhjzvdngvm5snpi