A new paper by the ACBRD outlines best practice development of a brief communication resource to reduce vision loss from diabetic retinopathy
By Dr Amelia Lake
The average age of onset of type 2 diabetes is decreasing, with more people developing the condition before 40 years of age. Younger adults with type 2 diabetes are at increased risk of early development and rapid progression of a range of diabetes-related complications. These include diabetic retinopathy, the leading cause of vision loss and blindness in working-age adults. Due to the fact that most people with diabetes are over 50 years of age, most educational resources for type 2 diabetes are designed for this older age group. This has led people with diabetes and health professionals to call for the development of age-appropriate resources and support services. So, Vision 2020 Australia commissioned Diabetes Victoria and the ACBRD to develop a resource for young adults with type 2 diabetes, designed to increase their uptake of retinal screening – the proven clinical pathway to prevention of vision loss from diabetic retinopathy.
Leaflets are widely used in health promotion to raise awareness and influence health behaviour. They have the combined benefits of low cost, broad reach, consistency of message and wide public acceptance. By its nature, a leaflet must be short, easy to read and understand; the format and content should be of interest, engage the target group, and influence the desired health behaviour. This paper, led by Dr Amelia Lake and Prof Jane Speight, outlines the theoretically-grounded and evidence-based development of an eye health leaflet, specifically tailored to the needs and characteristics of young adults with type 2 diabetes.
We used a process known as Intervention Mapping, a 6-step intervention development framework. Our multidisciplinary planning team conducted a comprehensive needs assessment to ensure that the leaflet content was grounded in the latest evidence. Through our literature review, in-depth interviews and a nationwide survey, we identified the crucial roles of knowledge (about diabetic retinopathy and screening), perception of personal risk, awareness of the approval of significant others and engagement with healthcare teams, on retinal screening intentions and uptake among young adults with type 2 diabetes.
With this information, we targeted five key areas: knowledge, attitudes, normative beliefs, intentions, and behavioural skills. Focusing on those areas, we developed a range of persuasive messages grounded in theory-based behaviour change techniques. Messages were selected by consensus, and the design of the leaflet including imagery showing young adults (pictured), with a targeted headline message: ‘Who is looking after your eyes?’. The paper also describes our comprehensive review and piloting process, which included with feedback from young adults with type 2 diabetes, ensuring that the leaflet was both engaging, and meets cultural and literacy standards.
This paper provides a blueprint for others wishing to use an evidence-based approach to developing a brief, print-based resource. Further, as there is relatively little research about young adults with type 2 diabetes (compared to the older age group), and few resources designed specifically for their needs, the paper also provides helpful insights into the psychosocial and eye health needs of this.
Finally, we would like to acknowledge that this project was a collaboration with representatives from Centre for Eye Research Australia, Diabetes Victoria, University of Exeter Medical School and Vision 2020 Australia.
Lake AJ, Browne JL, Abraham C, Tumino D, Hines C, Rees G, Speight J (2018) A tailored intervention to promote uptake of retinal screening among young adults with type 2 diabetes – an intervention mapping approach BMC Health Services Research, 18(1) doi:10.1186/s12913-018-3188-5.