Challenges to ophthalmic care for hispanic adults with diabetes
Trusty, Sharon Charlene Bridgeman
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It is estimated that in the United States one of every twenty people has diabetes mellitus. The reported prevalence of Type 2 diabetes is 12.1% in Texas with 340,000 Hispanic adults with diabetes (9.2% of reported Hispanic adults in Texas). Of the estimated eight million Americans who have been diagnosed with diabetes mellitus, less than half have had recommended ophthalmic care that included a dilated fundus examination. Diabetic retinopathy, a complication of diabetes, is the leading cause of new cases of blindness in adults who are 20 to 74 years old. This condition can be detected early in its development by dilated fundus examinations. Prevalence of diabetes in adults who are Hispanic and aged 40 to 74 years is almost twice that of non-Hispanic white adults of the same age range. Considering the high prevalence of diabetes in Hispanic adults and that diabetes is a leading cause of blindness, this study investigated the challenges that Hispanic adults face in obtaining dilated fundus examinations. The study compared the responses of 133 Hispanic adults with diabetes. One of two groups had kept appoints to obtain dilated fundus examinations (compliant, n = 95). The second group had not kept appointments to obtain dilated fundus examinations (noncomphant, n = 95). All of the subjects were living in a rural area of Texas. The interviews were conducted in an ophthalmology clinic and via home telephones using a questionnaire that incorporated demographic information (age, gender, language preference, etc.), information from the physicians diagnosing diabetes and eye care prior to the scheduled appointment, and challenges gathered from the research literature. The challenges most frequently identified by the study participants to obtaining dilated fundus examinations were financial concerns (67%), lack of eye problems (53%) not having been told to see an eye specialist by the physician who diagnosed their diabetes (32%), and lack transportation (28%). Family members offered to accompany 71% of the participants to their eye examinations. There were two challenges that were ranked differently by the two groups in this study. One of the differences was in the number of participants who indicated that the challenge of lacking transportation. Transportation was indicated by 24% of the compliant participants and by 37% of those who were non-compliant. Not having been told to see an eye specialist was identified as a challenge by 31% of the compliant group and by 34% of the non-compliant. The results for the chi-square tests showed that the responses for age, having access to an interpreter, and attendance at diabetes education class exceeded/? < .05. AH of the remaining groups of responses that were tested were significant at p < .001, with the exception of gender (which was significant at the/? < .05). The discriminant function analysis found that the set of data from the questions that concerned the challenges to obtaining dilated fundus examinations (both positive and negative responses) were indicators and that the set of data from the questions about receiving information from physicians who had diagnosed diabetes (positive responses only) was found to be a marginal indicator.