A model of culturally-informed integration of diabetic retinopathy screening and diabetes education assessment in Indigenous primary care settings.

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Diabetic retinopathy is a major public health problem in Australia, particularly among Indigenous Australians. For this reason, national guidelines in Australia were first developed for diabetic retinopathy. Despite efforts over two decades aimed at timely detection and early treatment of diabetic retinopathy, about half the Indigenous population with diabetes in Australia is not screened in accordance with the guidelines. Novel approaches to screening for diabetic retinopathy are needed, particularly in Australia's remote, under-resourced and Indigenous communities.The aim of this project is to implement an imaging-based telehealth diabetic retinopathy screening program managed by a diabetes educator in Indigenous primary care clinics. Objectives 1) To develop a model of integrated DE and DRS assessment in regional Indigenous primary care services. 2) To develop culturally-informed DE and DRS programs with input from Indigenous stakeholders. 3) To improve DRS coverage in Indigenous primary health care services. 4) Use DRS images and vision status to reinforce importance of diabetes self-management for reducing risk of all diabetes complications. 5) Facilitate timely referral pathways to ophthalmic services and diabetes specialist services. Research Design Proof of concept trial using a qualitative and quantitative approach. Up to three rural/regional trial-sites and approximately 250 T2DM participants aged older than 18 years of age Pre-post trial design: diabetic retinopathy screening, assessing health literacy, clinical and lifestyle risk factors, social/emotional well-being, satisfaction with diabetes education, perceived barriers/motivators to access and follow-up services. Baseline visit: Diabetic retinopathy screening, Smoking, Nutrition, Alcohol, Physical (activity) and Emotional (well-being) [SNAPE] and Vision Impairment Questionnaires to will be administered. HbA1c, lipids and blood pressure will also be measured to gauge patient’s baseline diabetes self-management. Surveys will assess a patient’s diabetes knowledge and health literacy, Final visit: Diabetic retinopathy screening repeated to assess adherence to annual screening recommendation, administration of the Diabetes Knowledge Questionnaire to gauge if patient’s diabetes knowledge has increased and self-care has improved over the intervention period, repeat measurement of patient’s HbA1c, lipids and blood pressure to see if diabetes risk factor control has improved. Patients will also have administered the Diabetes Treatment Satisfaction Questionnaire that will gauge patient’s satisfaction with the intervention over time. With integration of diabetes education and diabetic retinopathy screening, it is expected that engagement with self-management [risk factor control and adherence to retinopathy screening recommendations] will improve.