Diabetic Eye Screening Attendance Among Minority Ethnic and Other Inequality-Affected Populations in the United Kingdom: A Systematic Review of Associated Factors, Barriers, Facilitators and Interventions

Diabetic retinopathy is a leading cause of preventable sight loss. The United Kingdom achieves high overall uptake through organised diabetic eye screening programmes, but aggregate performance may conceal inequalities. This systematic review synthesised United Kingdom evidence on attendance-related associated factors, barriers, facilitators and interventions, with particular emphasis on minority ethnic communities and related inequalities. MEDLINE and Embase via Ovid, Web of Science, Scopus, the Cochrane Central Register of Controlled Trials, Google Scholar, citation searching and targeted United Kingdom grey-literature sources were searched and updated to 18 August 2026. Fourteen primary studies met the inclusion criteria. Younger age and socioeconomic deprivation showed the most consistent associations with lower or delayed attendance across multiple large routine-data analyses. Ethnicity-related associations varied by group and setting, and several datasets were limited by incomplete ethnicity recording. Qualitative, mixed-methods and survey evidence identified communication difficulties, competing work or education, appointment inflexibility, transport, inaccurate contact details and fragmentation with diabetes care as plausible barriers. One cluster-randomised trial in practices serving South Asian communities increased mean practice-level attendance from 74% to 89% (adjusted difference 12 percentage points, 95% confidence interval 7–17). Overall confidence was strongest for age- and deprivation-related associations and lower for specific mechanisms and interventions. Equity improvement should combine robust demographic monitoring with locally demonstrated barriers and the evaluation of intervention reach and sustained attendance.