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Impact of Intersecting Systems of Oppression on Diabetic Retinopathy Screening Among Those Who Identify as Women of Low Socioeconomic Status: Protocol for a Convergent Mixed Methods Study.
Stanimirovic, Aleksandra; Francis, Troy; Cooper Reed, Anna; Meerai, Sonia; Sutakovic, Olivera; Merritt, Rebecca; Brent, Michael; Rac, Valeria.
  • Stanimirovic A; Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
  • Francis T; Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
  • Cooper Reed A; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
  • Meerai S; Diabetes Action Canada, CIHR SPOR Network, Toronto, ON, Canada.
  • Sutakovic O; Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
  • Merritt R; Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
  • Brent M; Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
  • Rac V; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
JMIR Res Protoc ; 10(3): e23492, 2021 Mar 05.
Article in English | MEDLINE | ID: covidwho-1167217
Semantic information from SemMedBD (by NLM)
1. Diabetes PROCESS_OF Canadian
Subject
Diabetes
Predicate
PROCESS_OF
Object
Canadian
2. Diabetic Retinopathy CAUSES Blindness
Subject
Diabetic Retinopathy
Predicate
CAUSES
Object
Blindness
3. Blindness PROCESS_OF Adult
Subject
Blindness
Predicate
PROCESS_OF
Object
Adult
4. Gender ASSOCIATED_WITH Blindness
Subject
Gender
Predicate
ASSOCIATED_WITH
Object
Blindness
5. Community Health Centers LOCATION_OF Diabetic retinopathy screening
Subject
Community Health Centers
Predicate
LOCATION_OF
Object
Diabetic retinopathy screening
6. Patient referral USES Diabetic retinopathy screening
Subject
Patient referral
Predicate
USES
Object
Diabetic retinopathy screening
7. Decision PROCESS_OF Maker (occupation)
Subject
Decision
Predicate
PROCESS_OF
Object
Maker (occupation)
8. Practice Experience PROCESS_OF Woman
Subject
Practice Experience
Predicate
PROCESS_OF
Object
Woman
9. Diabetes PROCESS_OF Canadian
Subject
Diabetes
Predicate
PROCESS_OF
Object
Canadian
10. Diabetic Retinopathy CAUSES Blindness
Subject
Diabetic Retinopathy
Predicate
CAUSES
Object
Blindness
11. Blindness PROCESS_OF Adult
Subject
Blindness
Predicate
PROCESS_OF
Object
Adult
12. Gender ASSOCIATED_WITH Blindness
Subject
Gender
Predicate
ASSOCIATED_WITH
Object
Blindness
13. Community Health Centers LOCATION_OF Diabetic retinopathy screening
Subject
Community Health Centers
Predicate
LOCATION_OF
Object
Diabetic retinopathy screening
14. Patient referral USES Diabetic retinopathy screening
Subject
Patient referral
Predicate
USES
Object
Diabetic retinopathy screening
15. Decision PROCESS_OF Maker (occupation)
Subject
Decision
Predicate
PROCESS_OF
Object
Maker (occupation)
16. Practice Experience PROCESS_OF Woman
Subject
Practice Experience
Predicate
PROCESS_OF
Object
Woman
ABSTRACT

BACKGROUND:

By 2025, 5 million Canadians will be diagnosed with diabetes, and women from lower socioeconomic groups will likely account for most new diagnoses. Diabetic retinopathy is a primary vision complication of diabetes and a leading cause of blindness among adults, with 26% prevalence among women. Tele-retina is a branch of telemedicine that delivers eye care remotely. Screening for diabetic retinopathy has great potential to reduce the incidence of blindness, yet there is an adverse association among screening, income, and gender.

OBJECTIVE:

We aim to explore gender disparity in the provision of tele-retina program services for diabetic retinopathy screening in a cohort of women of low socioeconomic status (SES) receiving services in South Riverdale Community Health Centre (SRCHC) between 2014 and 2019.

METHODS:

Using a convergent mixed methods design, we want to understand patients', providers', administrators', and decision makers' perceptions of the facilitators and barriers associated with the implementation and adoption of tele-retina. Multivariate logistic regression will be utilized to assess the association among client characteristics, referral source, and diabetic retinopathy screening. Guided by a grounded theory approach, systematic coding of data and thematic analysis will be utilized to identify key facilitators and barriers to the implementation and adoption of tele-retina.

RESULTS:

For the quantitative component, we anticipate a cohort of 2500 patients, and we expect to collect data on the overall patterns of tele-retina program use, including descriptions of program utilization rates (such as data on received and completed diabetic retinopathy screening referrals) along the landscape of patient populations receiving these services. For the qualitative component, we plan to interview up to 21 patients and 14 providers, administrators, and decision makers, and to conduct up to 14 hours of observations alongside review of relevant documents. The interview guide is being developed in collaboration with our patient partners. Through the use of mixed methods research, the inquiry will be approached from different perspectives. Mixed methods will guide us in combining the rich subjective insights on complex realities from qualitative inquiry with the standard generalizable data that will be generated through quantitative research. The study is under review by the University Health Network Research Ethics Board (19-5628). We expect to begin recruitment in winter 2021.

CONCLUSIONS:

In Ontario, the screening rate for diabetic retinopathy among low income groups remains below 65%. Understanding the facilitators and barriers to diabetic retinopathy screening may be a prerequisite in the development of a successful screening program. This study is the first Ontario study to focus on diabetic retinopathy screening practices in women of low SES, with the aim to improve their health outcomes and revolutionize access to quality care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/23492.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Diagnostic study / Prognostic study / Qualitative research / Randomized controlled trials / Risk factors / Screening study Language: English Journal: JMIR Res Protoc Year: 2021 Document Type: Article Affiliation country: 23492

Full text: Available Collection: International databases Database: MEDLINE Type of study: Diagnostic study / Prognostic study / Qualitative research / Randomized controlled trials / Risk factors / Screening study Language: English Journal: JMIR Res Protoc Year: 2021 Document Type: Article Affiliation country: 23492