How to improve attendance for diabetic retinopathy screening? Ideas and perspectives from people with type 2 diabetes and healthcare professionals

Objectives
Our aim in this study was to identify how to improve diabetic retinopathy screening from the perspectives of people with type 2 diabetes and health-care professionals and to elicit their thoughts on initiatives to increase attendance.

Methods
A total of 38 semistructured interviews were conducted with people with type 2 diabetes (n=20), general practitioners (n=10), and ophthalmic staff (n=8). The interviews examined ideas for improving screening and elicited feedback on 3 initiatives: getting a fixed appointment; same-day screening; and outsourcing screening to general practice, including the use of artificial intelligence (AI). Data analysis was guided by content analysis approaches.

Results
Ideas for improving screening were centred around reducing the inconvenience of attendance, making appointment scheduling easier, and improving health-care professionals’ communication. Participants recognized the potential benefits of the initiatives but expressed important reservations to consider. Concerns included the following: that a fixed appointment would cause less active patient involvement and negatively affect attendance; that same-day screening may result in loss of patient–provider communication; that people with type 2 diabetes may be uneasy with having the screening performed outside the eye clinic; and that health-care professionals were concerned about the finances, validity, and examination quality associated with outsourcing screening and using AI.

Conclusions
Participants’ thoughts on how to improve diabetic retinopathy screening should be seen as starting points for potential future interventions. Although outsourcing screening and the use of AI have gained traction, our study indicates that the target population has reservations that are important to consider in future development and implementation of such strategies.