Interrogating a framework for diabetic retinopathy screening adherence

Qualitative insights from a severely affected and under-adherent population

Bibliographic Data

ID19591417
AuthorsJulia Fu (0000-0003-4351-9534, Yale University), Joana Andoh (0000-0001-6750-4113, Johns Hopkins University), Elizabeth Fairle (0000-0002-1028-7610, University of Utah), June Weiss (Yale University), Althea Norcott (Melinta Therapeutics (United States)), Kristen Nwanyanwu (0000-0003-1146-7733, Yale University, corresponding author)
EditorsJulia Robinson (0000-0003-0719-3995)
Year2026
Volume6
Issue4
Pagese0006230
Publication date2026-04-02
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0006230
PMID41926436
OpenAlexW7148567436
LanguageEN
References cited34

To validate and expand upon a framework of diabetic retinopathy (DR) screening adherence by examining barriers and facilitators among individuals with severe DR and those under-adherent to screening. From March 2021 to February 2022, we conducted eight remote semi-structured interviews with adults with diabetes across two participant populations: (1) participants with severe DR who had undergone procedures (n = 4) and (2) participants under-adherent to screening, defined as no eye exam in >1 year (n = 4). We recruited participants from the Yale Eye Center and community referrals. During the interviews, we collected demographic data and presented participants with a DR screening adherence framework previously developed by our group. We transcribed all interviews and conducted analyses using a hybrid deductive-inductive analytic approach informed by grounded theory techniques to identify recurring themes. Themes across both participant populations aligned with the existing framework, including vision status , emotional context , competing concerns , resource availability , cues to action , knowledge-creating experiences , and in-clinic experiences . The patient-doctor relationship emerged as a sub-theme of in-clinic experiences, highlighting the role of trust and communication in supporting sustained eye care engagement. At the individual level, participants with stable vision often perceived no need for screening. At the institutional and structural level, participants identified lack of insurance and transportation as significant barriers. These findings support the robustness of the DR screening adherence framework across varying levels of disease severity and engagement. Interventions that improve patient education, address structural barriers, and strengthen patient-doctor relationships may enhance screening adherence among populations at high risk for vision loss

Diabetes mellitus · Diabetic retinopathy · Disease · Eye care · Grounded theory · Population · Psychological intervention · Qualitative research · Diabetes Management and Education · Ophthalmology and Visual Impairment Studies · Retinal Diseases and Treatments