Feasibility of an Intervention to Increase Diabetic Retinopathy Screening Attendance

Aims and objectives.

The current study will address uncertainties about feasibility, economic evaluation, and the study procedures. The feasibility pilot study is needed to determine whether a larger-scale trial would be viable. Specifically, it will address the questions:

• Are the intervention content, delivery and procedures acceptable to people with diabetes who will receive the intervention, and staff who will deliver the intervention?
• Are the data collection processes, including mode and duration of data collection and outcome measures used, acceptable to staff?
• Is the intervention feasible to deliver in primary care practice, in terms fidelity of delivery and receipt of the intervention?
• Is the study feasible in terms of recruitment and retention procedures and data collection?
• What are the costs associated with the intervention?

Intervention. The intervention involves components which target practice staff (1. brief training 2. electronic prompt, and 3. reimbursement) and components which target patients with type 1 or type 2 diabetes who have not attended screening (1. face-to-face reminder message and information leaflet; 2. phone reminder; 3. GP-endorsed reminder letter and information leaflet). The intervention will be delivered over 6 months. The practice will conduct an audit of their patients with diabetes at baseline and re-audit at 6 months. Only practice staff will access patient files for the purpose of the audit. Only practice staff will have contact with patients during intervention delivery; a member of the practice team will issue the face-to-face, phone and letter reminders.

Methods. IDEAs (Improving Diabetes Eye-screening Attendance) is a cluster randomised feasibility pilot trial, including an embedded process evaluation and economic evaluation. In the current study, general practices will be randomly allocated to intervention or wait-list control groups following stratification by practice size (i.e. single/two-handed or group practice (3 more or GPs). Practices in the wait-list control group will receive the same intervention at 6 months. A multi-method approach will be used to evaluate the trial and study procedures, and to examine the acceptability and feasibility of the intervention from the perspective of practice staff and patients. Quantitative and qualitative data will be collected on intervention delivery, research processes, and implementation outcomes. Data will be collected at the practice, health professional and patient level. Data will be collected by practice staff and study researchers during intervention delivery. An economic evaluation will be conducted to estimate the cost of delivering the intervention in general practice

Inclusion criteria

(practices):

• Computerised record system
• Practice nurse

Inclusion criteria

(patients)

• 18 years or over
• Diagnosed diabetes (type 1 or type 2)
• Has been audited as part of the practice-level intervention
• Eligible to attend the national screening programme but has not registered, consented to, and attended the programme.

Exclusion criteria

(patients):

• Has retinopathy and are currently under surveillance or receiving treatment