OPTIMISING THE APPROPRIATENESS OF DIABETIC EYECARE DELIVERY IN AUSTRALIA
Purpose: The thesis aims to explore any evidence-to-practice gaps in diabetic eyecare delivery and address these gaps by designing an intervention to support optometrists in the uptake of evidence-based practice. Methods: A multimethod approach with five exploratory studies was conducted. The first study analysed secondary data from a nationwide record card review from optometry practices to establish the current levels of appropriateness and benchmarks of care. The second study combined a systematic quality appraisal of the evidence and a modified Delphi process to update and validate diabetic eyecare clinical indicators. The third study explored the underlying determinants of suboptimal care delivery through focus group discussions and interviews with optometrists. The fourth study utilised the Behaviour Change Wheel model to conceptualise an improvement strategy to address the determinants of suboptimal care. In the final study, the strategy was co-designed, iteratively refined and tested with optometrists, stakeholders, and people with diabetes. Results: The first study showed the overall appropriateness to be 69%, established the benchmarks of care (overall care benchmark to be 85%) and identified the areas of suboptimal care (history taking and physical examination). The second study updated and validated a set of 32 updated clinical indicators. The third study revealed several interconnected factors related to optometrists' capability and motivation and the social and practice environment affecting their clinical practice behaviour. The fourth study identified education, persuasion, enablement, and environmental restructuring as part of a conceptual improvement strategy. The fifth study finalised the iCareTrack: optimising the Diabetic Eyecare Appropriateness in Australia (IDEA) program consisting of a self-assessment tool, peer support, education, and resources. The usability testing of the web application hosting the IDEA program showed high usability, acceptability and potential effectiveness in supporting optometrists to deliver appropriate diabetic eyecare. Conclusion: Optometrists in Australia deliver diabetic eyecare with high levels of appropriateness; however, several individual and contextual determinants result in some areas of suboptimal care. To address such gaps, the IDEA program was developed with a strong evidence-based theoretical underpinning and participatory design methods. As a result, the program is acceptable, usable, and likely effective in supporting optometrists in improving the uptake of evidence and optimising the appropriateness of diabetic eyecare delivery in Australia.
Gyawali, Rajendra ; https://orcid.org/0000-0003-3502-8022
iCareTrack study, Diabetes, Diabetic Retinopathy, Appropriate care, Evidence-based care, Behaviour change, Co-design, anzsrc-for: 321299 Ophthalmology and optometry not elsewhere classified
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