Accepted for/Published in: JMIR Research Protocols
Date Submitted: Aug 13, 2020
Date Accepted: Dec 30, 2020
Impact of intersecting systems of oppression on diabetic retinopathy screening among those who identify as women of lower socioeconomic status: convergent mixed-method protocol
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 (DR) is a primary vision complication of diabetes and a leading cause of blindness in adults, with a 26% prevalence among women. Tele-retina is a branch of Tele-medicine that delivers eye care remotely. Screening for DR has great potential to reduce the incidence of blindness, yet there is an adverse association between screening, income, and gender.
Objective:
To explore gender disparity in the provision of Tele-retina program services for DR 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-method design, we aim to understand patients’; providers’; administrators’; and decision makers’ perceptions of facilitators/barriers associated with Tele-retina’s implementation and adoption. Multivariate logistic regression will be utilized to assess association between client’s characteristics, referral source and DR screening. Guided by a Grounded Theory approach, systematic coding of data and thematic analysis will be utilized to identify key facilitators and barriers to Tele-retina`s implementation and adoption.
Results:
For the quantitative component we anticipate a cohort of 2,500 patients and we expect to collect data on overall patterns of Tele-retina program use, including description of program utilization rates (such as data on received and completed DR screening referrals) along landscape of patient population receiving these services. For the qualitative component we plan to interview up to 21 patients; 14 providers, administrators, and decision makers; and to conduct up to 14 hours of observations, alongside the review of relevant documents. 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 University Health Network (UHN) Research Ethics Board (REB) (19-5628).
Conclusions:
In Ontario, screening rates for DR among low income groups remains below 65%. Understanding facilitators and barriers to DR screening may be a pre-requisite in development of a successful screening program. This study is the first Ontario study to focus on DR screening practices in women of low SES aiming to improve their health outcomes and revolutionize access to quality care. Clinical Trial: Not applicable
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