<p>Qualitative codebook.</p>

To validate and expand upon a framework of diabetic retinopathy (DR) screening adherence by examining barriers and facilitators among individuals with severe DR and those under-adherent to screening. From March 2021 to February 2022, we conducted eight remote semi-structured interviews with adults with diabetes across two participant populations: (1) participants with severe DR who had undergone procedures (n = 4) and (2) participants under-adherent to screening, defined as no eye exam in >1 year (n = 4). We recruited participants from the Yale Eye Center and community referrals. During the interviews, we collected demographic data and presented participants with a DR screening adherence framework previously developed by our group. We transcribed all interviews and conducted analyses using a hybrid deductive-inductive analytic approach informed by grounded theory techniques to identify recurring themes. Themes across both participant populations aligned with the existing framework, including vision status, emotional context, competing concerns, resource availability, cues to action, knowledge-creating experiences, and in-clinic experiences. The patient-doctor relationship emerged as a sub-theme of in-clinic experiences, highlighting the role of trust and communication in supporting sustained eye care engagement. At the individual level, participants with stable vision often perceived no need for screening. At the institutional and structural level, participants identified lack of insurance and transportation as significant barriers. These findings support the robustness of the DR screening adherence framework across varying levels of disease severity and engagement. Interventions that improve patient education, address structural barriers, and strengthen patient-doctor relationships may enhance screening adherence among populations at high risk for vision loss.本研究旨在验证并拓展糖尿病视网膜病变（Diabetic Retinopathy, DR）筛查依从性框架，通过分析重度DR患者以及筛查依从性不佳人群的筛查阻碍因素与促进因素。2021年3月至2022年2月期间，本研究针对两类糖尿病成人受试者开展了8次远程半结构化访谈：① 接受过相关治疗的重度DR患者（n=4）；② 筛查依从性不佳者，定义为超过1年未接受眼部检查者（n=4）。研究受试者招募自耶鲁眼科中心（Yale Eye Center）以及社区转诊渠道。访谈过程中，我们收集了受试者的人口统计学资料，并向其展示了本团队此前开发的DR筛查依从性框架。我们对所有访谈内容进行了转录，并采用基于扎根理论技术的演绎-归纳混合分析方法开展编码分析，以识别重复出现的主题。两类受试者的访谈主题均与现有框架相契合，涵盖视力状况、情绪环境、优先级冲突、资源可及性、行动线索、知识获取体验以及临床就诊体验等维度。医患关系作为临床就诊体验的子主题被提炼出来，凸显了信任与沟通在维持长期眼部护理依从性中的重要作用。在个体层面，视力稳定的受试者通常认为无需进行筛查。在机构与结构层面，受试者将保险缺失与交通不便视为主要筛查阻碍因素。上述研究结果验证了DR筛查依从性框架在不同疾病严重程度与筛查参与度人群中的适用性与稳健性。针对患者开展健康教育、解决结构性阻碍因素以及强化医患关系的干预措施，或可提升视力丧失高风险人群的筛查依从性。