What factors prevent young people with T2D attending retinal screening?

The incidence of T2D in young adults continues to grow worldwide and we know that this group differs in many ways to their older counterparts. They face unique challenges in the management of their diabetes and may not engage fully with the current diabetes support services. A fascinating paper from Australia by Lake and colleagues (summarised alongside) recently investigated the barriers and facilitators to diabetic eye disease screening in young adults (aged 18–39 years) with T2D. 

The study comprised semi-structured telephone interviews with 10 young adults (YA) and 20 older (aged 40+ years) adults (OA). A specially developed and validated interview guide, informed by the Theoretical Domains Framework (TDF), was used to explore screening facilitators and barriers. 

The final validated guide comprised 39 TDF-based questions and covered social influences, beliefs about consequences, reinforcement, intentions, emotion, knowledge, environmental context and resources, goals, beliefs about capabilities, social professional role and identity, behaviour regulation, skills, memory, attention and decision making, and optimism.

An interesting side aspect of the study was the difficulty in recruiting YA to the study, despite wide advertisement on social media.

The study explored the individual facilitators and barriers to screening. The responses provide a fascinating insight into the beliefs and thought processes in both age groups. More than 80% of all facilitator references for both groups were captured by six TDF domains: “social influences” (reminders from healthcare providers and family members); “beliefs about consequences” (the reassurance gained from a clear screen or early detection outweighed the cost or discomfort due to mydriasis); “reinforcement” (avoiding negative outcomes, such as visual impairment); “intentions”; “emotion”; and “knowledge” (most study participants understood the connection between diabetes and eye health, but detailed knowledge was lacking). 

Similarly, more than 80% of all barrier references for both groups fell under the following domains: “environmental context and resource” (financial stress and work constraints were prominent barriers in the young group, and the inconvenience of mydriasis in both groups); “knowledge” (lack of symptoms combined with perceptions of invulnerability in the young group); “social influences and beliefs” about consequences. In addition, an “emotion” barrier existed for YA (negative emotions and fear about their diagnosis of diabetes) and the older group reported behavioural regulation (missing or forgetting appointments).

It is clear from this study that there are many challenges when encouraging individuals to take part in diabetic eye screening and that specific tailored strategies may need to be developed, especially with regard to young adults with T2D. These approaches are likely to be applicable to all aspects of diabetes care.

To read the article summaries, please download the PDF