Discussion
diabetic retinopathy, DM, Diabetic retinopathy, ±, diabetes mellitus, SD, diabetic, diabetes
DIABETIC RETINOPATHY, DIABETIC RETINOPATHY, DIABETES MELLITUS, PCP, DIABETES
We conducted a non-randomized pre-post health education intervention study on health personnel with an objective to increase the referral of DM patients for DR screening. The health professionals were provided health education to create awareness and knowledge of DR using PPTs, posters, pamphlets, and referral slips. There was a significant increase in referral and attendance of DM patients in REMEH for DR screening after the intervention. There was also a significant increase in knowledge among the physicians after the intervention.Few studies in Nepal have mentioned the need of stakeholders to enhance and provide quality eye care services to diabetic people. The need to establish coordination between general medical service providers and the eye care service providers to develop a coordinated service system for diabetes and diabetic retinopathy care has also been discussed [Our study should be the first study involving stakeholders in health education session on DR aiming to increase the DR referral in Nepal. Piyasena et al. in their study involved patients with diabetes mellitus and stakeholders in health education intervention sessions to improve the uptake of screening for DR. They also developed strategies to improve knowledge on diabetic retinopathy in Sri Lanka, like our study [The male and female ratio in health care personnel was equal with overall average age of 35.8 years Ten (71.43%) were physicians with median experience of4.5 years and 4 (28.57%) were non physicians with median experience of 27.5 years. Anwar et al. in their study in Pakistan enrolled 36 physicians for DR related health education intervention. The mean age was33.10 ± 11.2 years and 64% were female and 36% were male. Most of the participating physicians, 61% (In our study, the mean score of the physicians DR knowledge and awareness increased at post intervention as compared to pre intervention. We did a follow up after 2 months by sending questionnaire via goggle forms. All the participants except the helpers responded and the overall mean score was 7.71 ± 2.30 not decreased for the physicians. Similarly other studies have also assessed the DR awareness of physicians by calculating Diabetic retinopathy awareness index (DRAI) and found the need of referral communication with the physicians and ophthalmologists/retina specialist [Similarly, we used a referral slip as a mode of communication between an ophthalmologist and health care personnel providing medical care to the patients with diabetes at Scheer Memorial hospital. Storey et al. also found that written communication between an ophthalmologist and a primary care physician (PCP) and referral vice versa was effective to change the behavior of the referring physicians [We also conducted a pilot before the health education intervention and there were only two physicians. Therefore, it was easy to compare the before and after score of the physicians. Pilot made us realize that pre post questionnaire needed to be written in Nepali language as well, to eliminate language barrier. We missed to distribute information sheet and consent form which we corrected during the final sessions. We used posters, pamphlets, videos and PPTs with diabetic retinopathy awareness message in our educational sessions which helped change the behavior of the physicians. Similarly, printed educational messages and posters increased behavior and change in attitude of primary care physicians and assistants of a multi-specialty hospital in Ireland and increased diabetic retinopathy screening like our study [There was a significant increase in the number of diabetic retinopathy patients attendance post intervention in our study. The use of printed educational messages like the use of pamphlets and referral slips also increased the number of referrals by primary health care professionals to ophthalmologist [Few studies have shown that lesser experienced primary health care professionals and internists could miss the diagnosis and refer a smaller number of diabetic retinopathy than the experienced health care professionals [In our study female patients attended for diabetic retinopathy screening more than males in both the pre and post intervention period. Similarly in other study females were found to be more than males for diabetic retinopathy screening [The mean age of pre intervention patients was 56.67 years (SD ± 17.30) while that of post intervention patients was 55.39 years (SD ± 12.51). Similarly in few other studies the mean age 55.43 ± 11.86 years [