Research article
Telephone Intervention to Promote Diabetic Retinopathy Screening Among the Urban Poor

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Background

Participation in diabetic retinopathy screening is suboptimal. The Vision is Precious study (2001–2005) tested the hypothesis that a tailored telephone intervention in urban minority diabetes populations, offered in English or Spanish, would result in greater screening for retinopathy than a standard print intervention.

Setting/Participants

Subjects (N=598) were adults with diabetes without a dilated fundus examination (DFE) in >1 year from three healthcare centers in Bronx NY.

Intervention

A tailored telephone intervention to promote retinopathy screening compared to a standard print intervention over a 6-month period.

Main Outcome Measures

Documentation of a DFE within 6 months was the main outcome. Data on risk perceptions using the Risk Perception Survey for Diabetes were collected pre- and post-intervention. Electronic databases were used to obtain hemoglobin A1c information.

Results

Subjects were 40% men, mean age 57 years; 39% reported household incomes as <$15K; 45% reported their race as black, and 42% reported ethnicity as Hispanic/Latino; 23% chose Spanish as their preferred language. Data were analyzed in 2006. There was a 74% increase in retinopathy screening in the telephone versus print group (p<0.0005), with no differences by intervention language or by gender. Predictors of undergoing a DFE included: telephone intervention, baseline risk-perception scores indicating less worry and more realism about diabetes complications, and the interaction of self-reported worry and being in the telephone intervention. Subjects who had poor diabetes control responded with greater success to telephone interventions.

Conclusions

A limited telephone intervention can improve significantly participation in retinopathy screening in a minority, low-income population. This intervention influenced risk perceptions about diabetes complications. Further research is needed to develop effective risk communications to prevent the complications of diabetes.

Section snippets

Background

Diabetic retinopathy is the primary cause of new-onset blindness in adults aged 20–64 years.1 Primary and secondary preventive measures for visual problems related to diabetes include both diabetes management and early ophthalmic screening. Improvements in metabolic control decrease the risk of retinopathy in both type 12, 3 and type 2 diabetes.4 Dilated fundus examinations (DFE) can detect retinal disease in the absence of symptoms and early enough for treatments to effectively prevent serious

Methods

The VIP study was a randomized controlled behavioral intervention study from 2001 to 2005, whose participants were primarily residents of Bronx NY recruited by telephone through three healthcare centers. To be eligible for the study, subjects had to be aged >18 years, diagnosed with diabetes, able to speak and read (or be read to in) English or Spanish, capable of providing informed consent, have access to a telephone, and report not having had a DFE in the previous 12 months. The study

Results

The results of this behavioral intervention study included: the flow of subjects through this study to the analysis of data, demographic characteristics of the sample, the primary outcome results, association of risk perceptions and other variables at pre- and post-intervention with the primary outcome, and the impact of each telephone call on obtaining a DFE.

Figure 1 portrays the flow of participants from the available pool of subjects for screening through study analyses. Of the 10,273 names

Conclusion

A limited telephone intervention delivered to a low-income, urban, minority population can significantly improve participation in diabetic retinopathy screening. A sample of 598 adults with diabetes was recruited to evaluate a tailored telephone intervention compared to a standard print intervention in both Spanish and English. These subjects are similar in their initial eligibility response to the almost 30% of respondents to the Behavioral Risk Factor Surveillance System survey for 2001 who

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