Factors influencing attendance by diabetic patients for their yearly opthalmic reviews at a private opthalmic practice in East London, South Africa

Abstract

Introduction: Diabetic retinopathies is a complication of diabetes mellitus causing blindness globally, and as patients live longer, cases of diabetic retinopathy increases. Despite efforts to educate patients at their eye visits, yearly follow up visits is still a major challenge. Key words: Diabetes, Diabetic retinopathy, health systems, non-attendance, knowledge, attitude, behaviour, gender, fear and anxiety Objectives: The objectives of the study were to investigate the reasons for non-compliance by determining the relationship among the selected factors (knowledge/ confidence/ fear and anxiety) and adherence to yearly reviews. Methods: Data were collected from adult diabetic patients who attended the private practice for an eye review by the ophthalmologist. The instrument used was a semi- structured questionnaire with sections covering demographics, statements regarding diabetes and diabetic eye care and one section with an open ended question to determine the reasons for non- attendance. Data analysis: Measures of central tendency were checked and expressed in terms of percentages and tables. The inferential statistics was also conducted to determine the relationship amongst variables. Chi square tests were used to determine the relationship amongst the categorical variables and eye reviews. Spearman’s correlation analysis was carried out to determine the association amongst variables, (behaviour, control, stigma and satisfaction). The open ended question was used to analyse the reason for non-compliance. Results: A total of 300 diabetic patients were randomly selected for the study. The participants were sampled in a stratified way such that each level of compliance is equally represented. The dataset was acceptably complete with very few missing values. The distribution of the participants across the different biographical variables was cross tabulated by compliance with annual reviews. Of the 300 participants, 151 (50.3 percent) were compliant. The results show that there were more females than males 166 (56.3 percent), more Africans than any other ethnic group 168 (57.1 percent), more married viii people than any other marital status group 183 (61.0 percent), more Christians than any other religion 227 (92.3 percent), and more living with their families than any other living arrangement 223 (74.8 percent). Of these variables 5 (1.7 percent) missing values were recorded for gender, 6 (2 percent) for ethnicity, and 2 (0.7 percent) for living arrangements, while marital status and religion were complete. The majority of the participants had a secondary school education 130 (43.3 percent), and most felt that they were in good health 148 (49.3 percent). As for payment of medical expenses, 255 (87 percent) had a medical aid, and yet 147 (51.6 percent) last visited a doctor more than a year from the date of data collection. Conclusion: Compliance with doctor’s visits was found to be associated with positive behaviour and more knowledge and control. Knowledgeable patients were more satisfied with the medical services. Fear of stigma associated with diabetes mellitus was found to be associated with demographic variables such as gender, race, marital status, employment status and educational level. The main reasons for non-compliance were lack of information, negligence, busy work schedules and lack of finance. These results suggested there is a need to raise awareness of eye health and access to affordable medical services.