Abstract/Summary

Diabetes Mellitus (DM) affects more than 463 million adults worldwide and will affect 700 million patients by 2045 (International Diabetes Federation (IDF), 2019). Diabetic Retinopathy (DR) is one of the manifestations of its complications, which affects 35% of the diabetes population worldwide and is acknowledged to be one of the five causes of global blindness. Around 50 -73% of blindness and visual impairment caused by DR can be prevented by early detection and appropriate treatment. Therefore, early detection of this complication through regular Diabetic Retinopathy screening (DRS) is recommended by the IDF guidelines. Links between the attendance outcomes and socio-demographic, clinical, behavioural, and organisational factors influencing DRS attendance have been indicated in the previous studies, however, investigated the factors at multi-levels in one study, as well understand the behavioural factors under sub-groups with the risk of low attendance, have yet to investigate. This study aimed to investigate factors impacting patients' choice to (DRS), and to develop evidence-based and theory-informed intervention recommendation accordingly; that help improves and success DRS attendance rates in Saudi Arabia (SA). To achieve this aim, three empirical studies conducted by adopting the mixed methods approach involving both inductive and deductive approaches; and qualitative and quantitative analyses. The data is proposed to be collected from two hospitals each in SA for patients who attended, not regularly attended or never attended the DRS. The secondary data was collected from DM centres’ documents and patients’ medical records, then was analysed quantitively by conducting a multinomial logistic regression technique and SPSS software that tested the hypotheses developed in this study. The primary data was collected from semi-structured interviews of Patients and Healthcare Providers (HCPs), and qualitative data was analysed through the thematic analysis of the transcripts. The results from the quantitative study, that analysed 440 records, identified the predictors to the DRS based on the patients’ characteristics and presented the patients’ sub-groups with different attendance outcomes accordingly. The patients’ interview study found ten themes that reflect the key perceptions about DRS attendance and linked that to the identified sub-groups. The HCPs’ findings recognised the barriers and facilitators to the DRS attendance, at patients’ and HCPs’ behavioural level, in addition to the DRS organisational level.