Exploring factors affected timely receiving intravitreal anti-VEGF treatment in patients with Diabetic Macular Edema: a qualitative interview study analyzed with COM-B model

ObjectivesTo explore factors affected untimely receiving intravitreal anti-Vascular endothelial growth factor (VEGF) injection based on the Capability, Opportunity and Motivation-Behavior (COM-B) model in patients with Diabetic Macular Edema (DME) and regard these factors as main targets for interventions. DesignAn exploratory qualitative study was conducted using semi-structured interviews with patients with DME. The COM-B model was used to guide data collection and analysis. SettingThe study was carried out in outpatient department of ophthalmology in China. Participants24 patients with DME who experienced anti-VEGF treatment at least one injection within one year were recruited using convenience and purposed sampling. ResultsThe themes and subthemes were identified. Physical capability included (1) lack of knowledge, (2) high treatment expenditure, and psychological capability included prioritized glycemic control rather than anti-VEGF. Social opportunity included (1) no anti-VEGF available, (2) Recommended eyedrops, laser and oral drug but not mentioned intravitreal anti-VEGF injection, (3) As an optional therapy, selected more convenient treatment rather than anti-VEGF agents, and physical opportunity included (1) no confidence in treatment from doctor, (2) communication between doctors and patients. Reflective motivation included (1) outcome expectancies, and automatic motivation included (1) fear of injection, (2) fear of blindness. ConclusionWe should attach importance to these eleven factors, especially to effective interaction between doctors and patients, and doctors authoritative treatment advice, which interventions were based on in the future. Strengths and limitations of this study{Rightarrow} The qualitative design was used to understand factors affecting timely intravitreal anti-VEGF injections in patients with DME and to explore the potential measures to change them. {Rightarrow}The study highlighted the importance of efficient communication between clinicians and patients. {Rightarrow}The study didnt consider other clinical variables, such as the severity and duration of diabetes, which should be included in the future studies.