A qualitative study on barriers and enablers to uptake of diabetic retinopathy screening by people with diabetes in the Western Province of Sri Lanka

Mapa Mudiyanselage Prabhath Nishantha Piyasena*, Gudlavalleti Venkata S. Murthy, Jennifer L.Y. Yip, Clare Gilbert, Tunde Peto, Mahesh Premarathna, Maria Zuurmond

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Background: Blindness and visual impairment from diabetic retinopathy (DR) are avoidable through early detection and timely treatment. The Western Province of Sri Lanka has the highest prevalence of diabetes mellitus (DM) (18.6%) in the country. A situational analysis identified a significant gap in DR screening services (DRSS) uptake in this region. Barriers that hinder people with DM (PwDM) from attending DRSS are poorly understood. The purpose of this study is to understand the factors which influence the uptake of DRSS and follow-up to inform health promotion strategies and improve the uptake of these services. Methods: Eleven focus group discussions (FGDs) were conducted with PwDM who presented to medical, general eye and vitreoretinal services in three public sector institutions (two tertiary and one secondary level) in the Western Province between October 2016 and March 2017. We enrolled six groups (four Sinhala speaking, two Tamil) of women and five groups (three Sinhala and two Tamil) of men representing ethnicity and gender. We performed a thematic analysis and described the main themes and subthemes using the socio-ecological model as a framework. Results: We identified lack of knowledge of both the condition and the need for screening as key barriers to access DRSS. Socio-cultural factors in the family environment, economic reasons and institutional factors were also important barriers. Additional reasons include long waiting time at eye clinics and poor referrals exacerbated by the lack of a systematic DRSS. In addition, attitudes to DRSS such as fear of discomfort from the procedure and the need for accompaniment following mydriasis were also deterrents to follow-up screening. Conclusion: This study has shown that there are inter-related user, family, and institutional factors which affect the uptake of DRSS. Understanding how DR is conceptualised by PwDM in this region is essential to refine strategies to improve access to DRSS. Strategies to improve knowledge need to be more culturally acceptable and relevant to PwDM and their families, with increased availability of DRSS at convenient locations may increase timely uptake of screening.

Original languageEnglish
Article number34
JournalTropical Medicine and Health
Issue number1
Publication statusPublished - 17 May 2019

Bibliographical note

Funding Information:
The authors would like to acknowledge the following: 1. Queen Elizabeth Diamond Jubilee Trust and Commonwealth Eye Health Consortium-UK, funded the whole project from a PhD student grant to Dr. MMPN Piyasena. 2. Association of Vitreo-Retina Specialists of Sri Lanka for their role as the local collaborator in this research project. 3. Dr. Chandani Liyanage-Senior Lecturer at the Department of Sociology, University of Colombo-for coordinating the local sociologists team. 4. Dr.Charith Fonseka, Dr. Kapila Banduthilaka, Dr. Mangala Dhanapala, Dr. Aruna Kulathunga, Dr. Janaka Munasinghe and Dr. Udaya Dissanayaka for their constant support in conducting study in the Western Province of Sri Lanka 5. Suranga Lakmal (SL), Kathirgamarthmby Krishnaraj (KR), Dr.Subhangi Shanmugarajah (SB), Dr. Subhash Pathirana (SP) and Dr. Kanchana Gamage (KG) for field work, conducting FGDs in local languages, transcription and translation of FGDs. 6. The heads of the institutions of the Western Province, FGDs participants, my family and colleagues at London School of Hygiene and Tropical Medicine-UK, for their constant support.

Funding Information:
Funding was provided by the Queen Elizabeth Diamond Jubilee Trust through the Commonwealth Eye Health Consortium-UK, through a PhD student grant awarded to Dr. MMPN Piyasena.

Publisher Copyright:
© 2019 The Author(s).

Copyright 2019 Elsevier B.V., All rights reserved.


  • Barriers
  • Diabetes mellitus
  • Diabetic retinopathy
  • Screening
  • Sri Lanka

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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