Article Text

Download PDFPDF

System-level and patient-level explanations for non-attendance at diabetic retinopathy screening in Sutton and Merton (London, UK): a qualitative analysis of a service evaluation
  1. R Strutton1,
  2. A Du Chemin2,3,
  3. I M Stratton4,
  4. A S Forster5,6
  1. 1Sutton and Merton Diabetic Eye Screening Programme, London, UK
  2. 2NHS England (London), London, UK
  3. 3Sutton and Merton Diabetic Eye Screening Programme, London, UK
  4. 4Gloucestershire Retinal Research Group, Gloucester Hospitals NHS Foundation Trust, Cheltenham, UK
  5. 5Health Behaviour Research Centre, London, UK
  6. 6Department of Primary Care and Public Health Sciences, King's College London, London, UK
  1. Correspondence to Dr A S Forster; alice.forster{at}


Objectives Non-attendance at diabetic retinopathy screening has financial implications for screening programmes and potential clinical costs to patients. We sought to identify explanations for why patients had never attended a screening appointment (never attendance) in one programme.

Design Qualitative analysis of a service evaluation.

Setting One South London (UK) diabetic eye screening programme.

Participants and procedure Patients who had been registered with one screening programme for at least 18 months and who had never attended screening within the programme were contacted by telephone to ascertain why this was the case. Patients’ general practices were also contacted for information about why each patient may not have attended. Framework analysis was used to interpret responses.

Results Of the 296 patients, 38 were not eligible for screening and of the 258 eligible patients, 159 were not contactable (31 of these had phone numbers that were not in use). We obtained reasons from patients/general practices/clinical notes for non-attendance for 146 (57%) patients. A number of patient-level and system-level factors were given to explain non-attendance. Patient-level factors included having other commitments, being anxious about screening, not engaging with any diabetes care and being misinformed about screening. System-level factors included miscommunication about where the patient lives, their clinical situation and practical problems that could have been overcome had their existence been shared between programmes.

Conclusions This service evaluation provides unique insight into the patient-level and system-level reasons for never attendance at diabetic retinopathy screening. Improved sharing of relevant information between providers has the potential to facilitate increased uptake of screening. Greater awareness of patient-level barriers may help providers offer a more accessible service.

  • utilization of health care

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

View Full Text

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.