Predictors of and barriers to follow-up uptake: analysis of factors and perceived barriers among high-risk individuals with diabetes after screening in China.

ABSTRACT

OBJECTIVE: The objective of this study was to identify variables that predict adherence to follow-up visits among people who are positive for diabetes during screening and to investigate barriers to follow-up. STUDY DESIGN: A retrospective cohort study linking individual-level registry data was performed. METHODS: First, we compared the characteristics of attenders and non-attenders. Second, we investigated perceived barriers using a questionnaire in a random sample of people who failed to attend the follow-up visit. RESULTS: A total of 27,806 (16.4%) patients attended the follow-up visits. Multiple logistic regression analysis revealed that individuals aged ≥75 years were more likely to attend follow-up than were those aged 35-45 years (odds ratio [OR] 1.97 [95% confidence interval {CI} 1.82-2.15]), male (OR 1.15 [95% CI 1.12-1.18]), obese (OR 1.36 [95% CI 1.29-1.43]), had positive family history of diabetes (OR 1.37 [95% CI 1.30-1.45]), hypertension (OR 1.05 [95% CI 1.01-1.09]), high glucose levels (OR 1.10 [95% CI 1.09-1.11]), and high diabetes risk scores (OR 1.02 [95% CI 1.02-1.03]) facilitated follow-up. However, overweight (OR 0.95 [95% CI 0.92-0.99]) and central obesity (OR 0.86 [95% CI 0.83-0.90]) predicted no follow-up. Among nonattenders, diabetes beliefs, time restrictions and distance from home to hospitals were the top three barriers hindering follow-up visits. CONCLUSIONS: Specific individual-level characteristics predicted adherence to follow-up visits, and some personal and sociocultural barriers hindered follow-up visits.