Delayed healthcare-seeking and treatment satisfaction among symptomatic patients presenting for initial specialist diabetic retinopathy care: a convergent parallel mixed-methods study

Delayed healthcare-seeking may adversely affect treatment experiences among patients with diabetic retinopathy (DR), but its associated factors and association with treatment satisfaction remain insufficiently understood. Using the Health Promotion Model (HPM) as an integrative framework, this study examined factors associated with delayed healthcare-seeking and explored its association with treatment satisfaction at 6 months among symptomatic patients with DR attending their first specialist ophthalmic consultation. A convergent parallel mixed-methods study was conducted at a regional public hospital in northern China from June 2024 to February 2025. The quantitative component included 235 symptomatic patients with DR. Delay was defined as an interval of ≥ 3 months between symptom onset and the first specialist ophthalmic consultation and was analyzed using hierarchical logistic regression. Treatment satisfaction was analyzed primarily as an exploratory continuous outcome using linear regression, with binary logistic regression as a sensitivity analysis. Nineteen participants completed semi-structured interviews at baseline and 6 months. Quantitative and qualitative findings were analyzed separately and integrated during interpretation guided by the HPM. Overall, 108 (46.0%) participants reported delayed healthcare-seeking. Other diabetes-related complications were associated with lower odds of delay, whereas no previous retinal screening and primary care referral were associated with higher odds (all P < 0.05). The mean treatment satisfaction score was 7.75 ± 1.93. No previous retinal screening and delayed healthcare-seeking were associated with lower satisfaction scores (both P < 0.05). Four qualitative themes were identified: interpreting visual symptoms and the need for care; appraising risks, treatment, and care feasibility; translating intention into action amid support and constraints; and reflecting on care timing and treatment experience. Integrated findings indicated that prior healthcare experiences, personal and situational factors, perceived barriers, referral context, interpersonal support, and competing demands were relevant to healthcare-seeking and subsequent treatment appraisal. Delayed healthcare-seeking was common among symptomatic patients with DR attending their first specialist ophthalmic consultation and was associated with lower treatment satisfaction. Repeated risk communication, supported referral navigation, and coordination between primary and specialist care may facilitate earlier ophthalmic assessment and better treatment experiences.