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Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Study protocol

Effectiveness of peer support to increase uptake of retinal examination for diabetic retinopathy: study protocol for the DURE pragmatic cluster randomized clinical trial in Kirinyaga, Kenya

Authors: Nyawira Mwangi, Mark Ng’ang’a, Esbon Gakuo, Stephen Gichuhi, David Macleod, Consuela Moorman, Lawrence Muthami, Peter Tum, Atieno Jalango, Kibata Githeko, Michael Gichangi, Joseph Kibachio, Covadonga Bascaran, Allen Foster

Published in: BMC Public Health | Issue 1/2018

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Abstract

Background

All patients with diabetes are at risk of developing diabetic retinopathy (DR), a progressive and potentially blinding condition. Early treatment of DR prevents visual impairment and blindness. The natural history of DR is that it is asymptomatic until the advanced stages, thus annual retinal examination is recommended for early detection. Previous studies show that the uptake of regular retinal examination among people living with diabetes (PLWD) is low. In the Uptake of Retinal Examination in Diabetes (DURE) study, we will investigate the effectiveness of a complex intervention delivered within diabetes support groups to increase uptake of retinal examination.

Methods

The DURE study will be a two-arm pragmatic cluster randomized clinical trial in Kirinyaga County, Kenya. Diabetes support groups will be randomly assigned to either the intervention or usual care conditions in a 1:1 ratio. The participants will be 700 PLWD who are members of support groups in Kirinyaga. To reduce contamination, the unit of randomization will be the support group. Peer supporters in the intervention arm will receive training to deliver the intervention. The intervention will include monthly group education on DR and individual member reminders to take the eye examination. The effectiveness of this intervention plus usual care will be compared to usual care practices alone. Participant data will be collected at baseline. The primary outcome is the proportion of PLWD who take up the eye examination at six months. Secondary outcomes include the characteristics of participants and peer supporters associated with uptake of eye examination for DR. Intention-to-treat analysis will be used to evaluate the primary and secondary outcomes.

Discussion

Eye care programs need evidence of the effectiveness of peer supporter-led health education to improve attendance to retinal screening for the early detection of DR in an African setting. Given that the intervention combines standardization and flexibility, it has the potential to be adopted in other settings and to inform policies to promote DR screening.

Trial registration

Pan African Clinical Trial Registry PACTR20170700243​0195, registered 25 July 2017, www.​pactr.​org
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Metadata
Title
Effectiveness of peer support to increase uptake of retinal examination for diabetic retinopathy: study protocol for the DURE pragmatic cluster randomized clinical trial in Kirinyaga, Kenya
Authors
Nyawira Mwangi
Mark Ng’ang’a
Esbon Gakuo
Stephen Gichuhi
David Macleod
Consuela Moorman
Lawrence Muthami
Peter Tum
Atieno Jalango
Kibata Githeko
Michael Gichangi
Joseph Kibachio
Covadonga Bascaran
Allen Foster
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-5761-6

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