Article Text

Attitudes, access and anguish: a qualitative interview study of staff and patients’ experiences of diabetic retinopathy screening
  1. A E Hipwell1,
  2. J Sturt2,
  3. A Lindenmeyer3,
  4. I Stratton4,
  5. R Gadsby5,
  6. P O'Hare6,
  7. P H Scanlon7
  1. 1CLAHRC-WM, Warwick Business School, University of Warwick, Coventry, UK
  2. 2Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK
  3. 3Department of Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
  4. 4Gloucester Diabetic Retinopathy Research Group, Cheltenham General Hospital, Gloucester, UK
  5. 5Warwick Medical School Education & Development, University of Warwick, Coventry, UK
  6. 6Division of Metabolic & Vascular Health, Warwick Medical School, University of Warwick, Coventry, UK
  7. 7Diabetic Retinopathy Screening Programme (England), Gloucestershire Eye Unit and Oxford Eye Hospital, Cheltenham General Hospital, Gloucester, UK
  1. Correspondence to Professor J Sturt; jackie.sturt{at}


Objective To examine the experiences of patients, health professionals and screeners; their interactions with and understandings of diabetic retinopathy screening (DRS); and how these influence uptake.

Design Purposive, qualitative design using multiperspectival, semistructured interviews and thematic analysis.

Setting Three UK Screening Programme regions with different service-delivery modes, minority ethnic and deprivation levels across rural, urban and inner-city areas, in general practitioner practices and patients’ homes.

Participants 62 including 38 patients (22 regular-screening attenders, 16 non-regular attenders) and 24 professionals (15 primary care professionals and 9 screeners).

Results Antecedents to attendance included knowledge about diabetic retinopathy and screening; antecedents to non-attendance included psychological, pragmatic and social factors. Confusion between photographs taken at routine eye tests and DRS photographs was identified. The differing regional invitation methods and screening locations were discussed, with convenience and transport safety being over-riding considerations for patients. Some patients mentioned significant pain and visual disturbance from mydriasis drops as a deterrent to attendance.

Conclusions In this, the first study to consider multiperspectival experiential accounts, we identified that proactive coordination of care involving patients, primary care and screening programmes, prior to, during and after screening is required. Multiple factors, prior to, during and after screening, are involved in the attendance and non-attendance for DRS. Further research is needed to establish whether patient self-management educational interventions and the pharmacological reformulation of shorter acting mydriasis drops, may improve uptake of DRS. This might, in turn, reduce preventable vision loss and its associated costs to individuals and their families, and to health and social care providers, reducing current inequalities.

  • Screening

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