Date of Award

January 2020

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)



First Advisor

Kristen H. Nwanyanwu


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.


This is an Open Access Thesis.

Open Access

This Article is Open Access