Identifying knowledge gap and adherence barriers for diabetic retinopathy screening: Findings from primary healthcare clinics in Pakistan.

Abstract

Diabetes is a leading cause of mortality globally, with a growing prevalence in low- and middle-income countries. The increasing burden of diabetes has led to a surge in diabetic retinopathy (DR), a major cause of preventable blindness, emphasizing the need to address poor screening practices. This study aims to assess the frequency of DR screening, patients' perceived knowledge, and barriers to adherence at two primary health care (PHC) clinics in Pakistan. This descriptive cross-sectional study was conducted at two PHCs. Data were collected using a validated electronic questionnaire on REDCap^®, covering sociodemographics, diabetes profile, DR screening knowledge, frequency, and adherence barriers. Descriptive analysis summarized participant characteristics, and site-specific comparisons used the Chi-square test to explore differences in clinical profiles, DR knowledge, treatment, prevention, and adherence using STATA/SE v18.0. Of 321 participants (<i>n</i> = 165 PHC-1 and <i>n</i> = 155 PHC-2), PHC-2 patients demonstrated higher knowledge of DR as a diabetes complication (76% vs 54%; <i>P</i> < 0.01), with its asymptomatic nature (74% vs 40%; <i>P</i> < 0.001). Additionally, 59% knew regular eye exams could prevent DR progression, with PHC-2 patients more informed than PHC-1 (73% vs 46%; <i>P</i> < 0.001). Across PHCs, 37% underwent routine eye exams every 6 months, although 70% preferred annual screening at their diabetes care facility. Despite good DR knowledge, participants did not adhere to yearly screenings. Integrating screenings into PHCs by equipping them with the necessary tools can enable timely detection and referral, address barriers, and reduce the DR burden on secondary and tertiary ophthalmology facilities.