Barriers to and enablers of attendance at diabetic retinopathy screening experienced by immigrants to Canada from multiple cultural and linguistic minority groups.

AIM: To identify barriers to/enablers of attendance at eye screening among three groups of immigrantsto Canada from cultural/linguistic minority groups living with diabetes. METHODS: Using a patient-oriented research approach leveraging Diabetes Action Canada's patient engagement platform, we interviewed a purposeful sample of people with type 2 diabetes who had immigrated to Canada from: Pakistan (interviews in Urdu), China (interviews in Mandarin) and French-speaking African and Caribbean nations (interviews in French). We collected and analysed data based on the Theoretical Domains Framework covering key modifiable factors that may operate as barriers to or enablers of attending eye screening. We used directed content analysis to code barrier/enabler domains. Barriers/enablers were mapped to behaviour change techniques to inform future intervention development. RESULTS: We interviewed 39 people (13 per group). Many barriers/enablers were consistent across groups, including views about harms caused by screening itself, practical appointment issues including forgetting, screening costs, wait times and making/getting to an appointment, lack of awareness about retinopathy screening, language barriers, and family and clinical support. Group-specific barriers/enablers included a preference to return to one's country of birth for screening, the impact of winter, and preferences for alternative medicine. CONCLUSION: Our results can inform linguistic and culturally competent interventions to support immigrants living with diabetes in attending eye screening to prevent avoidable blindness.

Identifying Barriers and Enablers to Attending Diabetic Retinopathy Screening in Immigrants to Canada From Ethnocultural Minority Groups: Protocol for a Qualitative Descriptive Study.

BACKGROUND: Immigrants to Canada belonging to ethnocultural minority groups are at increased risk of developing diabetes and complications, including diabetic retinopathy, and they are also less likely to be screened and treated. Improved attendance to retinopathy screening (eye tests) has the potential to reduce permanent complications, including blindness. OBJECTIVE: This study aims to identify the barriers and enablers of attending diabetic retinopathy screening among ethnocultural minority immigrants living with diabetes in Quebec and Ontario, Canada, to inform the development of a behavior change intervention to improve diabetic retinopathy screening attendance. METHODS: The research question draws on the needs of patients and clinicians. Using an integrated knowledge translation approach, the research team includes clinicians, researchers, and patient partners who will contribute throughout the study to developing and reviewing materials and procedures, helping to recruit participants, and disseminating findings. Using a convenience snowball strategy, we will recruit participants from three target groups: South Asian and Chinese people, and French-speaking people of African descent. To better facilitate reaching these groups and support participant recruitment, we will partner with community organizations and clinics serving our target populations in Ontario and Quebec. Data will be collected using semistructured interviews, using topic guides developed in English and translated into French, Mandarin, Hindi, and Urdu, and conducted in those languages. Data collection and analysis will be structured according to the Theoretical Domains Framework (TDF), which synthesizes predominant theories of behavior change into 14 domains covering key modifiable factors that may operate as barriers or enablers to attending eye screening. We will use directed content analysis to code barriers and enablers to TDF domains, then thematic analysis to define key themes within domains. RESULTS: This study was approved for funding in December 2017, and the research ethics board approved the conduct of the study as of January 13, 2018. Data collection then began in April 2018. As of August 28, 2018, we have recruited 22 participants, and analysis is ongoing, with results expected to be published in 2020. CONCLUSIONS: Findings from this study will inform the codevelopment of theory-informed, culturally- and linguistically-tailored interventions to support patients in attending retinopathy screening. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/15109.

Direct and indirect interactions between ants (Pheidole megacephala), scales (Coccus viridis) and plants (Pluchea indica).

This study investigated direct and indirect interactions between the ant, Pheidole megacephala (Fabr.), the green scale, Coccus viridis (Green), and the scale's host plant, Pluchea indica (L.). To examine the influence of ants on scales and host plants, scale population densities, scale mortality rates, and plant performance were studied on control host plants with ants and host plants from which ants had been removed. Plants with ants present had significantly greater scale population densities and scale reproductive rates than did plants without ants. Scale mortality from both parasitism and other causes was increased on plants without ants relative to plants with ants. Predator introduction experiments showed that P. megacephala removes predatory coccinellid larvae, even when they are covered with a protective coating. Host plants from which ants had been removed had significantly higher degrees of honeydew accumulation, which resulted in greater colonization by sooty mold and greater rates of leaf death and abscission. Ants also removed herbivorous lepidopteran larvae from plants. Results are discussed in terms of the potential of P. megacephala to exert direct and indirect positive effects on scale populations and an indirect positive effect on Pluchea indica.

A comparison of the responses of two tropical specialist herbivores to host plant patch size.

The effects of host plant patch size on the abundances of two specialist herbivores (the chrysomelid beetle, Acalymma innubum and the pentatomid bug, Piezosternum subulatum) were investigated in a natural forest community in the Virgin Islands. Abundances were compared early and late in the season in different sized patches of the cucurbit host plant (Cayaponia americana) growing in open habitat (with no surrounding plant community) and forest habitat (with diverse surrounding plant community). For both herbivore species, adult abundances per patch were positively correlated with patch leaf area, but there was a significant patch size effect (i.e., correlation between herbivore density per unit plant and patch leaf area) only for beetles in the forest habitat. Both herbivore species were significantly affected by surrounding plant diversity, but in opposite ways: beetles were more abundant in open patches whereas bugs were more abundant in forest patches. Relationships between abundance and patch size in open and forest patches changed through the season for both herbivore species. These changing abundance patterns are discussed with respect to (1) increases in the diversity of the plant community surrounding host plant patches, and (2) differences in herbivore movement patterns.

Host plant growth form and diversity: Effects on abundance and feeding preference of a specialist herbivore, Acalymma vittata (Coleoptera: Chrysomelidae).

Abundances of the specialist herbivore, Acalymma vittata (Fab.) (Coleoptera: Chrysomelidae), were assessed in small experimental plots with three levels of plant diversity (cucumber monoculture, cucumber/corn, and cucumber/tomato) and two levels of host plant growth form (horizontal on the ground and vertical, staked up or growing up other plant species). Host plant growth form more strongly affected beetle abundances than did plant diversity; greater numbers were found on vertically growing than on horizontally growing cucumber plants. The combination of cucumber monoculture and vertical growth form supported significantly greater herbivore abundances than did any other type of plot, emphasizing a strong interaction between diversity and growth form. Beetles were not more common in monocultures with horizontal growth forms than in mixed species plots, and beetles did not respond differently to plots with corn and plots with tomatoes.Feeding experiments demonstrated that the plant diversity under which a host plant is grown strongly influenced herbivore feeding preference. Beetles given a choice of cucumber leaves grown in monoculture and in plots with tomatoes exhibited individual differences in their food selection behavior, however, a significantly greater number of beetles preferred monoculture leaves. Those individuals preferring monoculture leaves and those individuals preferring leaves from plots with tomatoes did not differ in either absolute or relative amounts of feeding damage per leaf.Neither plant size nor the date on which plots were colonized by beetles explained the differences in herbivore abundance. It is suggested that differences in movement patterns and plant quality contributed to the greater numbers of beetles on plants growing vertically in monocultures.

Effects of plant diversity and time of colonization on an herbivore-plant interaction.

Experimental field plantings showed that plant diversity strongly affected the population dynamics of a specialist herbivore, the striped cucumber beetle, Acalymma vittata (Fab.) (Coleoptera: Chrysomelidae). Population densities over time were characterized by two peaks in numbers (from colonization and reproduction, respectively) and were consistently higher in cucumber monocultures (Cucumis sativus L.) than in polycultures of cucumbers, corn (Zea mays L.), and broccoli (Brassica oleracea L.). Greater abundances in monocultures appear to result from two factors: (1) per individual reproductive rates were greater in monocultures than in polycultures, and (2) mark-recapture studies confirmed that beetles stay in monocultures for a longer period of time than in polycultures. Differences in predation did not appear to contribute to the overall differences in herbivore abundances.The primary impact of A. vittata on its host plant, C. sativus, is the dissemination of bacterial wilt disease, Erwinia tracheiphila (E.F.Sm.). Greater numbers of beetles led to greater plant mortality in monocultures. It is suggested that factors other than numbers of beetles (e.g., shading, allelopathy, microclimate) are more important in influencing plant reproduction, since cucumber plants in monocultures had greater yields than did plants grown in polycultures. However, time of beetle colonization strongly affected plant parameters, indicating that the length of time during which herbivores are interacting with plants is of critical importance to plant survivorship, and thus reproduction.