Do intervention components target key barriers? Review and synthesis of interventions to increase diabetic-retinopathy screening attendance

Abstract

Background: Diabetic retinopathy screening attendance (DRSA) rates are suboptimal despite wide availability of screening programs and numerous interventions to increase attendance. Variation in intervention effectiveness is largely unexplained. Whether interventions target theoretical determinants (barriers/enablers) of screening behaviour is unknown. Aims: to identify and synthesise: component behaviour change techniques (BCTs) comprising interventions targeting DRSA; modifiable barriers/enablers to DRSA; and whether BCTs in existing interventions target key barriers/enablers. Methods: Three phases: 1-Cochrane systematic review of 66 randomised trials of interventions targeting DRSA. Intervention content was coded into BCTs. Meta-regression identified BCTs associated with higher attendance; 2- Systematic review of 62 published/grey literature studies reporting perceived barriers/enablers to DRSA. Extracted barriers/enablers classified using Theoretical Domains Framework (TDF); 3-Coherence between identified BCTs and key barriers/enablers investigated using TDF/taxonomy mapping matrices to examine proportion of BCTs mapped to each TDF domain. Results: 1- Interventions contained 0-30 BCTs (median 7). Eleven BCTs were associated with higher attendance, including: ‘goal setting’ [Risk Difference:0.26 (95%CI:0.16-0.36)], ‘Feedback’ [0.22(0.15-0.29)]. 2- Key barriers/enablers corresponded to TDF domains: ‘environmental context/resources,’ ‘social influences,’ ‘memory/attention/decision making,’ ‘knowledge,’ ‘beliefs about consequences,’ and ‘emotions.’ 3- On average, 33% (0%-75%) of BCTs mapped to key domains have been frequently used (≥10 interventions). Coherence was lowest for domains ‘emotions’ and ‘beliefs about consequences (0% BCTs mapped frequently used). Discussion: BCTs associated with increased DRSA and important determinants of DRSA were identified. However, existing interventions incorporate only a third of potentially relevant BCTs to target key barriers/enablers to DRSA. These findings may thus inform design/refinement of DRSA interventions.