ABSTRACT
Purpose: In India, people with diabetes (PwDM) often seek care in the government-approved alternative medicine system, AYUSH (Ayurveda, Yoga and naturopathy, Unani, Siddha and Homeopathy). The purpose of this pilot study was to assess whether health education plus retinal imaging for diabetic retinopathy (DR) within an AYUSH hospital increased the uptake of screening for DR compared with health education and referral. Methods: The study was a nonrandomized pilot conducted in two AYUSH hospitals. Both hospitals received intervention on educating the AYUSH practitioners about DR screening and distributing health education materials to diabetic patients. In one hospital in addition to education, retinal imaging by a trained technician with remote grading by an ophthalmologist was provided, while in another hospital PwDM were referred to nearby eye hospitals for screening. The uptake of screening was assessed through registers and phone calls. Results: At baseline, only 10.7% of 178 PwDM were aware of DR and only 8% had undergone DR screening. After the intervention, in the hospital where screening was provided, all (100%) eligible patients (101) underwent digital imaging, whereas in the other hospital only 25% of 77 eligible patients underwent screening in eye hospitals (P < 0.001). Conclusion: AYUSH hospitals could provide a feasible and acceptable location for providing DR screening services. Further studies are required to assess scale-up of such intervention.
ABSTRACT
Purpose: The effectiveness of Accredited Social Health Activists (ASHAs) with and without monetary incentive in uptake of diabetic retinopathy (DR) screening at community health center (CHC) was compared in South Gujarat, India. Methods: In this non-randomized controlled trial, ASHAs were incentivized to refer people with diabetes mellitus (PwDM) from their respective villages for DR screening after people were sensitized to DM and DR. The minimum sample size was 63 people in each arm. Results: Of 162, 50.6% were females, 80.2% were literate, 56.2% were >50 years, 54.3% had increased random blood sugar (RBS), and 59.9% had diabetes for 5 years. The percentage of screening was significantly higher [relative risk (RR) = 4.37, 95% confidence interval (CI) 2.79, 6.84] in ASHA incentive group and health education (HE) group (RR = 3.67, 95% CI 2.35, 5.75) compared with baseline. Providing incentive to ASHAs was not found to be of extra advantage (RR = 1.19, 95% CI 0.89, 1.57). The likelihood of uptake of screening was higher among uncontrolled PwDM, poor literacy, and higher duration of diabetes in incentive phase (P < 0.001) compared with HE. The results show that age (P = 0.017), education (P = 0.015) and level of RBS (P = 0.001) of those referred were significantly associated with incentives to ASHAs. Conclusion: ASHAs can be used effectively to refer known PwDM for DR screening especially when DR screening program is introduced in population with low awareness and poor accessibility. When incentives are planned, additional burden on resources should be kept in mind before adapting this model of care.
ABSTRACT
Purpose: A community-based intervention to compare the effectiveness of pamphlets and videos as education material to promote diabetic retinopathy (DR) screening in urban slums of Hyderabad and to identify barriers/facilitators for compliance with DR screening. Methods: A cross-sectional survey among people with diabetes (sample of 267) was followed by a health education intervention where patients were allocated into two groups (121 received pamphlets and 102 attended video sessions). The effectiveness of the intervention was assessed based on the uptake of DR screening. The facilitating factors and barriers to DR screening were explored through semi-structured interviews and focus group discussions with participants and health workers. Data analysis included Chi-square test for quantitative data and thematic analysis for qualitative data. Results: Among the 235 people in the health education intervention study, 131 (55.7%) received the pamphlet and 104 (44.3%) watched the educational videos. The uptake of DR screening within 2 months was higher in the group shown the educational video than who received the pamphlet (32.7% vs 11.45%; P < 0.05). Absence of an accompanying person and good vision were barriers that prevented patients from screening. Realization of consequences of DR and proximity of the screening facility were identified as motivators. The major results we found in the initial survey of 267 people were that 74.5% had never had HbA1c test and locals underwent health check-ups more regularly than migrants (62.2% versus 34%; P < 0.05). Conclusion: Educational videos led to greater behavior change than pamphlets in motivating diabetics for DR screening.