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Knowledge, attitudes and eye health-seeking behaviours in a population-based sample of people with diabetes in rural China
  1. Tingting Chen1,2,
  2. Ling Jin2,
  3. Wenhui Zhu1,2,
  4. Congyao Wang1,2,
  5. Guoshan Zhang2,
  6. Xiuqin Wang2,
  7. Jun Wang2,
  8. Ke Yang2,
  9. Gillian M Cochrane3,
  10. Ecosse Luc Lamoureux4,
  11. David S Friedman5,
  12. Suzanne Gilbert6,
  13. Van C Lansingh7,
  14. Serge Resnikoff8,
  15. Jialiang Zhao9,
  16. Baixiang Xiao2,
  17. Mingguang He2,10,
  18. Nathan Congdon2,11
  1. 1 The Ophthalmology Department, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
  2. 2 State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
  3. 3 Faculty of Health, School of Medicine (Optometry), Deakin University, Burwood, Australia
  4. 4 Health Services Research Unit, Singapore Eye Research Institute, Singapore, Singapore
  5. 5 Glaucoma Center of Excellence, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
  6. 6 Innovation & Sight Programs, Seva Foundation, Berkeley, California, USA
  7. 7 HelpMeSee, Inc, New York, New York, USA
  8. 8 Brien Holden Vision Institute, Sydney, Australia
  9. 9 Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Dongcheng-qu,China
  10. 10 Centre for Eye Research Australia; Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
  11. 11 Centre for Public Health, Queen’s University Belfast, Belfast, UK
  1. Correspondence to Professor Nathan Congdon, Centre for Public Health, Queen’s University Belfast, Grosvenor Rd, Belfast BT12 6BA, UK and State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, 54 S. Xianlie Road, Guangzhou, China; ncongdon1{at}gmail.com

Abstract

Aims To assess knowledge of diabetes and acceptance of eye care among people with diabetes in rural China, to improve service uptake.

Methods Population-based study of people in Guangdong, China, with glycosylated haemoglobin A1c≥6.5% and/or known history of diabetes. Between August and November 2014, participants answered a questionnaire (based on Delphi process/previous focus groups) on medical history, demographic characteristics, self-rated health and vision, knowledge about diabetes and diabetic retinopathy, quality of local healthcare, barriers to treatment, likely acceptance of eye exams and treatment, and interventions rated most likely to improve service uptake. Presenting visual acuity was assessed, fundus photography performed and images graded by trained graders. Potential predictors of accepting care were evaluated and confounders adjusted for using logistic regression.

Results A total of 562 people (9.6% (256/5825), mean age 66.2±9.84 years, 207 (36.8%) men) had diabetes, 118 (22.3%) previously diagnosed. ‘Very likely’ or ‘likely’ acceptance of laser treatment (140/530=26.4%) was lower than for eye exams (317/530=59.8%, p<0.001). Predictors of accepting both exams and laser included younger age (p<.001) and prior awareness of diabetes diagnosis (p=0.004 and p=0.035, respectively). The leading barrier to receiving diabetes treatment was unawareness of diagnosis (409/454, 97.2%), while interventions rated most likely to improve acceptance of eye exams included reimbursement of travel costs (387/562, 73.0%), video or other health education (359/562, 67.7%) and phone call reminders (346/562, 65.3%).

Conclusions Improving diagnosis of diabetes, along with incentives, education and communication strategies, is most likely to enhance poor acceptance of diabetic eye care in this setting.

  • Intraocular pressure
  • Optic Nerve
  • Clinical Trial
  • Child health (paediatrics)
  • Contact lens
  • Epidemiology
  • Public health
  • Low vision aid
  • Rehabilitation
  • Visual perception
  • Glaucoma
  • Lens and zonules
  • Retina
  • Infection
  • Medical Education
  • Vision
  • Eye (Globe)
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Footnotes

  • Contributors NC designed the study, obtained funding for the study, initiated the collaborative project, designed data collection tools and monitored data collection for the whole study, wrote the statistical analysis plan, drafted and revised the paper. TC designed the study, designed data collection tools and monitored data collection for the whole study, collected data, wrote the statistical analysis plan and drafted and revised the paper. LJ designed the study, monitored data collection for the whole study, wrote the statistical analysis plan and drafted and revised the paper. WZ, CW, GZ, XW, JW and KY designed the study and collected data. GMC, ELL, DSF, SG, WL and SR designed data collection tools and revised the paper. JZ and MH designed the study and designed data collection tools and monitored data collection for the whole study.

  • Funding This study was supported by Bayer, Leverkusen, Germany and Orbis International. Professor Congdon is supported by a 1000 Man Plan award from the Chinese government and by the Ulverscroft Foundation, UK. The sponsor or funding organisation had no role in the design or conduct of this research.

  • Competing interests NC works as the Director of Research for Orbis International, a non-governmental organization which carries out programs I eye health, including diabetic retinopathy, in China.

  • Data sharing statement Data are available upon reasonable request.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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