Telephone Intervention to Promote Diabetic Retinopathy Screening Among the Urban Poor

Background: Participation in diabetic retinopathy screening is suboptimal. The Vision is Precious study (2001-2005) tested the hypothesis that a tailored telephone intervention in urban minority diabetes populations, offered in English or Spanish, would result in greater screening for retinopathy than a standard print intervention.

Design: Randomized controlled trial

Setting/participants: Subjects (N=598) were adults with diabetes without a dilated fundus examination (DFE) in >1 year from three healthcare centers in Bronx NY.

Intervention: A tailored telephone intervention to promote retinopathy screening compared to a standard print intervention over a 6-month period.

Main Outcome Measures: Documentation of a DFE within 6 months was the main outcome. Data on risk perceptions using the Risk Perception Survey for Diabetes were collected pre- and post-intervention. Electronic databases were used to obtain hemoglobin A1c information.

Results: Subjects were 40% men, mean age 57 years; 39% reported household incomes as <$15K; 45% reported their race as black, and 42% reported ethnicity as Hispanic/Latino; 23% chose Spanish as their preferred language. Data were analyzed in 2006. There was a 74% increase in retinopathy screening in the telephone versus print group (p<0.0005), with no differences by intervention language or by gender. Predictors of undergoing a DFE included: telephone intervention, baseline risk-perception scores indicating less worry and more realism about diabetes complications, and the interaction of self-reported worry and being in the telephone intervention. Subjects who had poor diabetes control responded with greater success to telephone interventions.

Conclusions: A limited telephone intervention can improve significantly participation in retinopathy screening in a minority, low-income population. This intervention influenced risk perceptions about diabetes complications. Further research is needed to develop effective risk communications to prevent the complications of diabetes.