Adherence to Periodic Dilated Eye Examinations and Its Determinants Among Nepalese Patients With Diagnosed Diabetes: A Single-Center Hospital-Based Analysis Using Health Belief Model.

Abstract

Introduction: To find the adherence rate to periodic dilated eye examinations (DEEs) and its determinants among patients with diagnosed diabetes. Research Design and Methods: In this cross-sectional study of 165 participants with diagnosed diabetes (Type 1/2) attending a general hospital with a diabetes clinic, we explored perceptions of barriers and facilitators of DEE at the individual level using a framework adapted from the health belief model (HBM). Patients were compared using t tests for continuous data and chi-square tests for categorical data. Results: The rate of adherence to DEE (as defined by DEE within a year) was 62.4% (95% confidence interval [CI] = 55.0%-69.8%). The mean age of the patients was 56.81 (±13.29) years. We found that the mean benefit score was significantly higher, and the mean barrier score was significantly lower in those adhering to DEE (p < 0.001); but the susceptibility, severity, and self-efficacy scores were not significantly different. Furthermore, those under treatment for diabetes mellitus (DM), those with diabetic retinopathy (DR) in them or their family member, and those with DM duration of 1 year or less were significantly likely to adhere to DEE (p < 0.005). Additionally, those who had received advice for eye screening from their physicians were about 25 times more likely to adhere to DEE (95% CI =6.80-92.05) than those who were not advised. Conclusion: A larger proportion of people with diabetes did not adhere to periodic DEE. Benefits and barriers were found to be determinants in this population. Further exploration in a larger population and the use of HBM to increase adherence to periodic DEE can be tested by targeting behavioral counseling along with other traditional approaches.