Developing a leaflet intervention to promote retinal screening uptake among young adults with type 2 diabetes: an intervention mapping approach

Introduction and purpose: Young adults (18-39 years) with type 2 diabetes are at risk of early onset of diabetic retinopathy (DR), a leading cause of vision loss in working-age adults. Retinal screening is essential for early detection and prevention, yet screening rates are low in this cohort. We aimed to develop a tailored, evidence-based eye health promotion leaflet to increase screening uptake. Methods: Following the six steps of Intervention Mapping (IM), we: established a multidisciplinary reference group and conducted a mixed-methods needs assessment (Step 1); identified determinants of screening behaviour and specified performance objectives for behavioural and social-cognitive outcomes (Step 2); designed, reviewed and debriefed leaflet content with the reference and target groups (Steps 3 and 4); developed an implementation plan (Step 5), and an evaluation plan (Step 6). Results: Step 1 highlighted the crucial role of knowledge (DR and screening), awareness of personal risk and others’ screening behaviour, impact of DR on the family unit, and engagement with healthcare team. Step 2 identified five social cognitive determinants: knowledge, subjective norms, attitudes, behavioural skills, intention. In Steps 3 and 4, the “Who is looking after your eyes?” leaflet was created, containing persuasive messages targeting each determinant and cohort-specific imagery. In Steps 5 and 6, we planned statewide implementation (via Diabetes Victoria) and designed an RCT. Conclusion: This study illustrates how IM was employed to develop a health promotion resource tailored to a specific target group, and may assist future program planners who wish to use IM to create similar resources.