Diabetic retinopathy screening and referrals: Knowledge, attitudes and practices among community health workers in South Africa

Background: Community health workers (CHWs) play a crucial role in health promotion, particularly in rural areas. Diabetic retinopathy (DR) is a complication that can be prevented through timely screening. CHWs could assist in referring patients for DR screening, thereby reducing the burden of DR-associated vision loss. Aim: This study aimed to assess the knowledge, attitudes, and practices of DR among CHWs. Setting: The study was conducted at 10 primary healthcare clinics in Maruleng sub-district, Limpopo. Methods: A cross-sectional study was conducted among CHWs using a self-administered questionnaire. Knowledge was assessed using yes or no questions, attitudes were assessed using a five-point Likert scale, and one question was used to assess practice. Scores above the median were considered good knowledge and positive attitudes. Results: A total of 131 CHWs completed questionnaires. Over half (n = 76, 58%) of CHWs had not received training on DR. Just under two-thirds (n = 82, 62.6%) had good knowledge and were aware of several risk factors of DR. A similar proportion (n = 80, 61.1%) showed positive attitudes towards DR screening and referrals. Most CHWs (n = 113, 86.3%) reported referring patients for DR screening. Good knowledge was associated with positive attitudes and referral of patients for DR screening. Conclusion: Although many CHWs have good knowledge and attitudes towards DR, there were important gaps that can be addressed to increase the referral of patients for DR screening and enhance health promotion activities of CHWs. Contribution: The results of this study provide valuable information that can be used to develop training on DR specifically for CHWs to increase DR screening and preserve the vision of diabetic patients.