Date of Award
January 2020
Document Type
Open Access Thesis
Degree Name
Medical Doctor (MD)
Department
Medicine
First Advisor
Kristen H. Nwanyanwu
Abstract
Diabetic retinopathy (DR) is among the leading causes of vision loss in the US,
yet an estimated 50% of patients with diabetes do not receive recommended annual
screening eye exams for reasons that are incompletely understood. Patients with diabetes
and low socioeconomic status or who are racial/ethnic minorities are at increased risk for
vision loss. Qualitative interviews were conducted with 30 patients with diabetes at a
federally qualified community health center and a primary care clinic in New Haven, CT
regarding factors influencing their use of screening exams. The interviews were recorded,
transcribed, and analyzed line by line to identify themes. The themes were organized in a
theoretical framework of factors influencing receipt of screening. Participants identified
as black (16), white (5), Hispanic (5), Asian (1), and other/no answer (3). Twenty-eight
had health insurance. Twenty-four had received an eye exam within in the past year, but
one-third of participants reported they did not receive eye exam yearly. 415 comments
were coded at 22 nodes under 7 broader themes and two overarching categories of
individual factors and institutional/structural factors. Themes included vision status,
competing concerns, emotional context, resource availability, in-clinic experience, cues
to action, and knowledge about diabetes. Among the patients who had not received an
eye exam within the past year, the cost of an exam, lack of insurance coverage, and lack
of prompting by a health provider were among the reported reasons for not pursuing eye
screenings. Many patients lack knowledge about diabetic retinopathy and the utility of
preventative eye care. New strategies for engaging high-risk populations are necessary.
Recommended Citation
Fairless, Elizabeth Ann, "Factors Influencing The Receipt Of Diabetic Retinopathy Screening In A High-Risk Population" (2020). Yale Medicine Thesis Digital Library. 3897.
https://elischolar.library.yale.edu/ymtdl/3897
Comments
This is an Open Access Thesis.