INCENTIVES AND BARRIERS TO RETINOPATHY SCREENING AMONG AFRICAN-AMERICANS WITH DIABETES

Diabetes-related ophthalmic complications are the leading cause of new ly diagnosed blindness among adults, These eye complications are often asymptomatic in the early stages, yet the majority of diabetes patien ts are not screened yearly. To develop a health promotion intervention to increase the rate of screening for diabetic retinopathy by dilated fundus exam (DFE), we assessed the knowledge and health beliefs relat ed to preventing diabetic eye complications among a sample of African- Americans with diabetes. The study design was cross-sectional, using a telephone interview to collect data, From a random sample of 104 Afri can-Americans with diabetes, 67 (64%) were completed: 54 women; mean a ge of 58 years. The telephone interview schedule contained items group ed into subscales for Perceived Incentives, Perceived Barriers to gett ing a DFE, Causes of Eye Problems, Risk of Eye Problems, and Effective Treatments for Eye Problems. Descriptive statistics were used to anal yze the quantitative data. Transcribed qualitative responses to the op en-ended questions were analyzed for themes, The incentives ''having e ye problems'' and ''doctor said it was important to go'' each had 91% responding it was an incentive to go for a DFE. Only about one-third a greed that any particular item was a barrier to receiving a DFE (e.g., economic factors). In the subscale for Risk of Eye Problems, ''retino pathy'' had the lowest level of perceived risk (30%), Only 21% of the sample reported there were effective treatments for retinopathy, Eight y-seven percent reported the faulty belief that ''diabetic eye problem s have symptoms.'' Only 36% of the sample said they had heard of retin opathy and of those, only 8% could describe it correctly, Among genera l response themes were: fear, spirituality (faith and hope), prioritie s, economic or logistical factors, and external/internal motivation. P erceived incentives for receiving a DFE were acknowledged at far great er rates than perceived barriers. Having a yearly DFE in the absence o f symptoms must be emphasized in health promotion materials. There are effective, early treatments for diabetic Eye problems, and this infor mation should be used to counter the fear of a dreaded diagnosis with the hope of treatment and cure, Ways of coping with fear of having the exam should be included in health education, DFEs must become a routi ne yearly exam and not just a reaction to recognized problems. Health education must address the specific needs of high-risk minority popula tions. (C) 1997 Elsevier Science Inc.