The Role of Health Beliefs in Adherence to Diabetes Eye Examinations in Black/African-American Adults

Purpose: Sight-threatening diabetic retinopathy disproportionately affects Black/African-Americans at a rate 46% higher than that of non-Hispanic whites. Although screening for diabetic retinopathy through dilated eye exams (DEE) can decrease diabetes-related blindness, only 35% of Black/African-Americans receive a DEE each year compared to 50-60% of their white counterparts. The purpose of this study was to evaluate whether the six constructs of the Health Belief Model (HBM) (perceived severity, perceived susceptibility, perceived benefits, perceived barriers, cues to action, and self-efficacy) can be used to understand and predict adherence to annual DEE recommendations in the Black/African-American population. Methods: A cross-sectional survey study design and Rasch analysis were used to assess the psychometric properties of the revised Compliance with Annual Diabetic Eye Exam Survey (CADEES). One hundred and eighty-two Black/African-American adults who had a diagnosis of type 2 diabetes were enrolled. Participants were administered the revised CADEES, which employs the HBM framework, once at the time of enrollment. Results: Rasch analysis indicated the CADEES has acceptable psychometric properties to evaluate the six HBM constructs. Individuals who reported adherence to DEE recommendations demonstrated a significantly improved ability to endorse items related to higher perceived severity, perceived barriers, perceived benefits, cues to action, and self-efficacy compared to non-adherent individuals. Lastly, a multivariate logistic regression determined age, gender, clinical characteristic, perceived benefits, and self-efficacy to be predictors of adherence. Conclusions: The findings from this research reveal that health beliefs and attitudes are important factors to consider when attempting to increase DEE adherence in this high-risk population. In addition, assessing health beliefs can provide information about the most appropriate actions needed to promote early detection of diabetic retinopathy through regular DEEs leading to a reduction in the burden of visual impairment and blindness in the Black/African-American population.