# Barriers to Regular Eye Examination in Individuals with Diabetes at a Tertiary Diabetes Centre in Jordan: A Cross-Sectional Study

## TL;DR

This study identifies barriers to regular eye exams for diabetes patients in Jordan, finding that low awareness and accessibility are key issues.

## Contribution

The study combines previously researched barriers to diabetic retinopathy screening into a single analysis specific to Jordan.

## Key findings

- Lack of awareness and belief that being asymptomatic negates the need for screening are major barriers.
- Transportation difficulties and older age are also significant obstacles to regular eye exams.
- Public health strategies should focus on education and removing logistical barriers to improve screening compliance.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Diabetes is a worldwide disease that affects many people and could cause many complications such as diabetic retinopathy.

Diabetes is a worldwide disease that affects many people and could cause many complications such as diabetic retinopathy.

Public health significance—Why is this work of significance to public health?
This study highlights the importance of regular eye examination in the early recognition of diabetic retinopathy.The study aims to identify the barriers that affect adherence to regular diabetic retinopathy screening among people with diabetes. Although these barriers have been studied individually in other countries, this research combines them together.

This study highlights the importance of regular eye examination in the early recognition of diabetic retinopathy.

The study aims to identify the barriers that affect adherence to regular diabetic retinopathy screening among people with diabetes. Although these barriers have been studied individually in other countries, this research combines them together.

Public health implications—What are the key implications or messages for practitioners, policy makers, and/or researchers in public health?
The most prevalent barriers to diabetic retinopathy screening in Jordan are modifiable and rooted in low awareness and accessibility.Directing more focus towards modifiable barriers could help facilitate and ensure the early detection of diabetic retinopathy.

The most prevalent barriers to diabetic retinopathy screening in Jordan are modifiable and rooted in low awareness and accessibility.

Directing more focus towards modifiable barriers could help facilitate and ensure the early detection of diabetic retinopathy.

Background: Diabetic retinopathy is a leading cause of vision impairment and a significant complication of diabetes mellitus, especially in low- and middle-income countries. This study aimed to identify the barriers affecting diabetic retinopathy screening among people with diabetes mellitus. Methods: This cross-sectional study was conducted between April and October 2024 at the National Center for Diabetes, Endocrinology and Genetics. Data collection was performed using a structured, validated electronic questionnaire adapted from previous studies. Sample size calculation was carried out before data collection. Data were collected using a structured electronic questionnaire. A total of 998 responses were included in the study. The collected data incorporated sociodemographic characteristics, diabetes history, screening practices, and reported barriers. Descriptive and categorical data analyses were performed. Results: Of 998 participants, 82% were over 50 years old, 79% had type 2 diabetes mellitus, and 30% had never had an eye examination. Diabetic retinopathy was diagnosed in 12%. The main barriers to regular attendance among those previously screened (699) were as follows: lack of awareness of its importance (11%), believing that being asymptomatic made screening unnecessary (19%), and transportation difficulties (14%). Among those never screened (299), 56% lacked awareness, 62% believed being asymptomatic negates the need for screening, and 13% faced transportation difficulties. Age > 50 years, higher educational level, availability of health insurance, longer duration of diagnosis of diabetes mellitus, and HbA1c > 7% were significantly associated with prior screening (p < 0.05). Conclusions: Public health strategies should enhance the education provided to people and physician–person communication and remove logistical obstacles to improve screening compliance.