Confronting Unequal Eye Care in Pennsylvania
Diabetic Retinopathy, Diabetes Mellitus, Type 2, Glaucoma
About this trial
This is an interventional prevention trial for Diabetic Retinopathy focused on measuring Diabetic Complications, Intervention Studies, African Americans, Vision Screening, Vision, Low, Geriatric Assessment, Outcomes Assessment, Cultural Characteristics, Cultural Competency, Appointment Adherence, Cost-effectiveness, Personalization of care, Follow-up Care
Eligibility Criteria
Pt. 1
Inclusion Criteria:
- African-American race (self-identified)
- Age ≥ 65 years
- Type II Diabetes Mellitus (physician diagnosis) for at least 1 year
- No medical documentation of a DFE by an ophthalmologist or an optometrist within the past 12 months
- Self-report of no DFE within the past 12 months
Exclusion Criteria:
- Cognitive Impairment (Mini-Mental Status Examination ≤ 24)
- Current clinically significant psychiatric disorder other than depression
- Current medical disorder that limits life expectancy (≤ 12 months) or need for dialysis
- Hearing impairment that precludes research participation
Pt. 2
Inclusion Criteria:
- Glaucoma (physician diagnosis)
- Scheduled for a follow-up appointment that meets the American Academy of Ophthalmology (AAO) follow-up guidelines
- Attended the Wills Eye Glaucoma Clinic from September 1, 2012 to October 31, 2013
- Age ≥ 21 years old
- Able to understand and speak English
Exclusion Criteria:
- Diagnosed with a pre-existing medical condition that would preclude the subject from providing reliable and valid data
- Individual was asked to follow-up in less than a month.
Sites / Locations
- Thomas Jefferson University
- Wills Eye Health System
- Temple University
Arms of the Study
Arm 1
Arm 2
Experimental
Placebo Comparator
Pt. 1 Behavioral Activation
Pt. 1 Supportive Therapy
Behavioral Activation (BA) is a behavioral technique to help people overcome avoidant tendencies through goal setting, activity scheduling, and graded task assignment. The key component of BA involves developing an "Action Plan", and having the subject document each step of the plan as he or she implements it, reinforcing the steps towards goal attainment. "Action Plans" are easily applied to diabetes self-care tasks because the latter lend themselves to documentation of simple, step-by-step plans. In this study, a Community Health Educator (CHE) - interventionist will schedule and deliver four 45-60 minute in-home BA sessions within 3 months of randomization (i.e., one session every 2-3 weeks).
The purpose of Supportive Therapy (ST) is to explore the impact of aging and diabetes on the subject's life. In contrast to the BA intervention, the interventionist does not discuss the importance of dilated eye exams. In subsequent sessions, ST facilitates and deepens knowledge about the subject's life situation in relation to his or her health and other life difficulties. The ST therapist encourages this process and creates an accepting, nondirective, and supportive opportunity for discussion.