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Underserved populations often have difficulty accessing care for diabetic eye disease, including screening, referral, and treatment. Although barriers to diabetes care management have been well documented, less is understood about barriers specific to rural and underserved populations. In this study, we interviewed health care professionals to identify barriers to and facilitators of screening for diabetic eye disease and specialty care among underserved patients in Alabama.

We conducted 12 semistructured interviews with experts in ophthalmology, diabetes care management, and primary care in Alabama between November 2023 and January 2024. We used the Health Equity Implementation Framework to code interviews and identify key themes related to access barriers and other obstacles to care, as well as opportunities to improve access to screening and treatment.

Factors associated with access barriers for underserved populations include limited services in rural areas, insufficient referrals, cost, transportation, limited patient knowledge about diabetes and eye health, inadequate information provided during clinical encounters, and mistrust of clinicians. Several innovative approaches were identified to improve access to eye care services at the health system level and during clinical encounters.

Experts have suggested groundbreaking ways to improve access to care across several domains, including clinic mobility, teleophthalmology, and improved information dissemination to patients on disease. Further research is needed to establish an evidence base for additional innovations aimed at improving access to diabetic eye care and expanding their scope through quantitative research efforts, both in Alabama and nationwide.