Show simple item record

Files in this item


Item metadata

dc.contributor.authorLawrenson, John G
dc.contributor.authorGraham-Rowe, Ella
dc.contributor.authorLorencatto, Fabiana
dc.contributor.authorRice, Stephen
dc.contributor.authorBunce, Catey
dc.contributor.authorFrancis, Jill J
dc.contributor.authorBurr, Jennifer M
dc.contributor.authorAluko, Patricia
dc.contributor.authorVale, Luke
dc.contributor.authorPeto, Tunde
dc.contributor.authorPresseau, Justin
dc.contributor.authorIvers, Noah M
dc.contributor.authorGrimshaw, Jeremy M
dc.identifier.citationLawrenson , J G , Graham-Rowe , E , Lorencatto , F , Rice , S , Bunce , C , Francis , J J , Burr , J M , Aluko , P , Vale , L , Peto , T , Presseau , J , Ivers , N M & Grimshaw , J M 2018 , ' What works to increase attendance for diabetic retinopathy screening? An evidence synthesis and economic analysis ' , Health Technology Assessment , vol. 22 , no. 29 .
dc.identifier.otherPURE: 255554333
dc.identifier.otherPURE UUID: c5d58153-3b91-4c37-9b26-1bff1ef4852f
dc.identifier.otherPubMed: 29855423
dc.identifier.otherPubMedCentral: PMC6004544
dc.identifier.otherScopus: 85048467318
dc.identifier.otherORCID: /0000-0002-9478-738X/work/60196193
dc.identifier.otherWOS: 000433516800001
dc.descriptionFunding: The National Institute for Health Research Health Technology Assessment programme.en
dc.description.abstractBACKGROUND: Diabetic retinopathy screening (DRS) is effective but uptake is suboptimal. OBJECTIVES: To determine the effectiveness of quality improvement (QI) interventions for DRS attendance; describe the interventions in terms of QI components and behaviour change techniques (BCTs); identify theoretical determinants of attendance; investigate coherence between BCTs identified in interventions and determinants of attendance; and determine the cost-effectiveness of QI components and BCTs for improving DRS. DATA SOURCES AND REVIEW METHODS: Phase 1 - systematic review of randomised controlled trials (RCTs) evaluating interventions to increase DRS attendance (The Cochrane Library, MEDLINE, EMBASE and trials registers to February 2017) and coding intervention content to classify QI components and BCTs. Phase 2 - review of studies reporting factors influencing attendance, coded to theoretical domains (MEDLINE, EMBASE, PsycINFO and sources of grey literature to March 2016). Phase 3 - mapping BCTs (phase 1) to theoretical domains (phase 2) and an economic evaluation to determine the cost-effectiveness of BCTs or QI components. RESULTS: Phase 1 - 7277 studies were screened, of which 66 RCTs were included in the review. Interventions were multifaceted and targeted patients, health-care professionals (HCPs) or health-care systems. Overall, interventions increased DRS attendance by 12% [risk difference (RD) 0.12, 95% confidence interval (CI) 0.10 to 0.14] compared with usual care, with substantial heterogeneity in effect size. Both DRS-targeted and general QI interventions were effective, particularly when baseline attendance levels were low. All commonly used QI components and BCTs were associated with significant improvements, particularly in those with poor attendance. Higher effect estimates were observed in subgroup analyses for the BCTs of 'goal setting (outcome, i.e. consequences)' (RD 0.26, 95% CI 0.16 to 0.36) and 'feedback on outcomes (consequences) of behaviour' (RD 0.22, 95% CI 0.15 to 0.29) in interventions targeting patients and of 'restructuring the social environment' (RD 0.19, 95% CI 0.12 to 0.26) and 'credible source' (RD 0.16, 95% CI 0.08 to 0.24) in interventions targeting HCPs. Phase 2 - 3457 studies were screened, of which 65 non-randomised studies were included in the review. The following theoretical domains were likely to influence attendance: 'environmental context and resources', 'social influences', 'knowledge', 'memory, attention and decision processes', 'beliefs about consequences' and 'emotions'. Phase 3 - mapping identified that interventions included BCTs targeting important barriers to/enablers of DRS attendance. However, BCTs targeting emotional factors around DRS were under-represented. QI components were unlikely to be cost-effective whereas BCTs with a high probability (≥ 0.975) of being cost-effective at a societal willingness-to-pay threshold of £20,000 per QALY included 'goal-setting (outcome)', 'feedback on outcomes of behaviour', 'social support' and 'information about health consequences'. Cost-effectiveness increased when DRS attendance was lower and with longer screening intervals. LIMITATIONS: Quality improvement/BCT coding was dependent on descriptions of intervention content in primary sources; methods for the identification of coherence of BCTs require improvement. CONCLUSIONS: Randomised controlled trial evidence indicates that QI interventions incorporating specific BCT components are associated with meaningful improvements in DRS attendance compared with usual care. Interventions generally used appropriate BCTs that target important barriers to screening attendance, with a high probability of being cost-effective. Research is needed to optimise BCTs or BCT combinations that seek to improve DRS attendance at an acceptable cost. BCTs targeting emotional factors represent a missed opportunity to improve attendance and should be tested in future studies. STUDY REGISTRATION: This study is registered as PROSPERO CRD42016044157 and PROSPERO CRD42016032990.
dc.relation.ispartofHealth Technology Assessmenten
dc.rights© Queen’s Printer and Controller of HMSO 2018. This work was produced by Lawrenson et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.en
dc.subjectRA0421 Public health. Hygiene. Preventive Medicineen
dc.titleWhat works to increase attendance for diabetic retinopathy screening? An evidence synthesis and economic analysisen
dc.typeJournal articleen
dc.description.versionPublisher PDFen
dc.contributor.institutionUniversity of St Andrews.School of Medicineen
dc.contributor.institutionUniversity of St Andrews.Population and Behavioural Science Divisionen
dc.description.statusPeer revieweden

This item appears in the following Collection(s)

Show simple item record