Knowledge, attitudes, and beliefs about dilated eye examinations among African-Americans.

As the population of the United States continues to age, the public health impact of vision loss due to eye disease will continue to grow. Projections for the year 2020 are that 3.4 million people will be affected by glaucoma1 and between 6.1 and 7.2 million people in the United States will have diabetic retinopathy.2 African-Americans are at increased risk of glaucoma, with an estimated prevalence rate of 3.5% among African-Americans compared with 1.6% in whites.3 African-Americans are also at increased risk of diabetes, with a prevalence rate of 13.3% in African-American adults compared with 8.7% in adult whites,4 which puts them at increased risk of diabetic retinopathy. Although early detection and subsequent earlier treatment can prevent or delay eye disease,5–7 several studies have shown that people are not getting dilated fundus examinations (DFEs) according to recommended guidelines.8 –12 More than half the participants in a glaucoma screening program in Baltimore city reported not having an eye examination in the past 2 years.8 Studies have consistently shown that approximately one third of people with diabetes have not had an eye examination in the previous 2 years.8 –10 In addition, African-Americans have fewer eye examinations than do whites,10 –12 despite African-Americans’ increased prevalence of glaucoma1,3 and diabetes.2,4 Increasing the proportion of people who have a dilated eye examination, which is one of the vision goals in Healthy People 2010,13 can have a major impact on the prevalence of eye disease, as well as people’s quality of life. To achieve this goal, we need to develop, implement, and evaluate interventions to change people’s attitudes toward DFEs. The first step in this process is to understand the factors that influence people’s knowledge, attitudes, and beliefs about eye care. To date there has been limited research into the factors that are associated with African-Americans obtaining dilated eye examinations,14 –17 or the information needed by this population to promote informed decisions about preventive eye care.18 There has been a limited use of qualitative methodology in ophthalmology for understanding these issues from the patients’ perspective, in particular patients’ knowledge, attitudes, and beliefs about eye care.19 –22 Qualitative research is well-suited to providing understanding and insight into how perception, experience and culture shape medical decision-making among the research population, and can provide in-depth explorations of multifaceted issues. As such, qualitative methodologies are complementary to the use of quantitative methods, such as large-scale surveys that can less readily capture complex issues of context and subjective meaning which inform decision-making.23–25 Focus groups, in particular, are a time-efficient method to collect rich qualitative data through a “process of disciplined inquiry that is systematic and verifiable.”26 To address the gap in understanding the factors associated with getting dilated eye examinations, we conducted focus group interviews with African-Americans 40 years of age and older. The study was designed to elucidate knowledge, attitudes, and beliefs regarding dilated fundus examinations in this population. We were particularly interested in the barriers that keep people from getting DFEs and the perceived benefits that may serve as motivators for getting DFEs. In addition, because of the increased prevalence of glaucoma and diabetes among African-Americans, a secondary objective was to assess people’s knowledge about glaucoma, diabetes, and diabetic retinopathy.