Data from: Systematic review on barriers and enablers for access to diabetic retinopathy screening services in different income settings

Background: Diabetic retinopathy (DR) can lead to visual impairment and
blindness if not detected and treated in time. Knowing the
barriers/enablers in advance in contrasting different country income
settings may accelerate development of a successful DR screening (DRS)
program. This would be especially applicable in the low-income settings
with the rising prevalence of DR. Objectives: The aim of this systematic
review is to identify and contrast the barriers/enablers to DRS for
different contexts using both consumers i.e., people with diabetes (PwDM)
and provider perspectives and system level factors in different country
income settings. Methods: We searched MEDLINE, Embase, CENTRAL in the
Cochrane Library from the databases start date to December 2018. We
included the studies reported on barriers and enablers to access DRS
services based at health care facilities. We categorised and synthesized
themes related to the consumers (individuals), providers and the health
systems (environment) as main dimensions according to the constructs of
social cognitive theory, supported by the quantitative measures i.e., odds
ratios as reported by each of the study authors. Main Results: We included
77 studies primarily describing the barriers and enablers. Most of the
studies were from high income settings (72.7%, 56/77) and cross sectional
in design (76.6%, 59/77). From the perspectives of consumers, lack of
knowledge, attitude, awareness and motivation were identified as major
barriers. The enablers were fear of blindness, proximity of screening
facility, experiences of vision loss and being concerned of eye
complications. In providers’ perspectives, lack of skilled human
resources, training programs, infrastructure of retinal imaging and cost
of services were the main barriers. Higher odds of uptake of DRS services
was observed when PwDM were provided health education (odds ratio (OR)
4.3) and having knowledge on DR (OR range 1.3-19.7). Conclusion: Knowing
the barriers to access DRS is a pre-requisite in development of a
successful screening program. The awareness, knowledge and attitude of the
consumers, availability of skilled human resources and infrastructure
emerged as the major barriers to access to DRS in any income setting.