JMIR Publications

ABSTRACT

Background:

By 2025, 5 million Canadians will be diagnosed with diabetes. Diabetes is more common among men, yet among lower socio-economic groups, majority of affected individuals are women. Diabetic retinopathy (DR) is a primary vision complication of diabetes and a leading cause of blindness in adults, with 26% prevalence among women. Canadian vision loss costs are projected to reach $30billion/year by 2032. 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. There is an adverse association between screening, gender, and income. Women within lower socio-economic groups may not be screened for breast, lung, and colorectal cancers. Similar to cancer screening, DR screening is essential for early detection and treatment of disease. Considering higher prevalence and greater diabetic morbidity and mortality associated with low socio-economic status, the need to address socioeconomic barriers for those who identify as women, must take precedence over simply ensuring the provision of diabetes medical management.

Objective:

1. To explore gender disparity in the provision of Tele-retina program for DR screening in cohort of women of low SES receiving services in SRCHC between 2014 and present, including but not limited to evaluation of the overall patterns of Tele-retina program use. 2. To conduct a qualitative study of patients, providers, administrators, and decision makers to understand their perceptions regarding facilitators/barriers associated with the Tele-retina program implementation and adoption in Anishnawabe Health Toronto, Flemingdon Health Centre, LAMP Community Health Centre, Parkdale Community Health Centre, Scarborough Academic Family Health Team, South Riverdale Community Health Centre, and Unison Health and Community Services. Using a multi-construct Intersectionality framework, reflective of the simultaneous and cumulative effects of gender, race, class, and geography, this study will explore facilitators and barriers, which drive the implementation and adoption of Tele-retina program.

Methods:

We will explore gender disparities in the provision of Tele-retina services for DR at South Riverdale Community Care Health Centre between 2014 and 2019. Guided by the theory of Intersectionality we aim to understand patients’; providers’; administrators’; and decision makers’ perceptions of facilitators/barriers associated with program’s implementation and adoption. Multivariate logistic regression will be utilized to assess association between client’s characteristics, referral source and screening. Systematic coding of data and theme abstraction will be utilized to identify key facilitators and barriers to program`s implementation and adoption.

Results:

Not applicable

Conclusions:

Worldwide the number of people with DR will reach 191 million by 2030, and an estimated 56.3 million will be diagnosed with vision-threatening diabetic retinopathy (VTDR), with the majority of cases remaining among low income populations. Current literature shows that proper DR screening and early identification and treatment will reduce progression of sight threatening DR In Ontario, screening rates for DR among low income groups remains below 65%. Understanding facilitators and barriers to access DR screening may be a pre-requisite in development of a successful screening program. Tele-retina screening may be a cost-effective strategy to increase accessibility to eye care services and reduce risk of undiagnosed sight-threatening eye disease. Low screening rates and gender differences result in women being less frequently screened, which may lead to blindness, reduced quality of life and productivity loss. This is the first Ontario study to focus on DR screening practices in women of low socio-economic status aiming to improve their health outcomes, and revolutionize their access to quality care. Clinical Trial: Not applicable