Impact of diabetic retinopathy awareness training on community health workers' knowledge and referral practices in Fiji: a qualitative study.

Introduction: Community health workers (CHWs) are effective in raising awareness about diabetes mellitus and diabetic retinopathy (DR). In Fiji, CHWs were trained in a 1-day diabetic retinopathy (DR) awareness to provide communities with adequate basic knowledge about diabetes and DR to improve awareness and enhance referrals for DR screening and treatment. This study aimed to explore the impact of this training on CHWs' knowledge of DR and their referral practices related to DR screening in Fiji 2 years post-training.

Methods: This qualitative study was conducted in 2021 across three out of the four administrative divisions of Fiji, namely the Western, Northern and Central divisions. A total of 14 CHWs from the three divisions of Fiji participated in this study. All participants had attended a 1-day DR awareness training 2 years before this study. Participants were chosen purposively and were invited to participate in focus group discussion (FGD). The FGDs were audio-recorded and transcribed verbatim, and thematic analysis was conducted to identify and classify recurrent themes.

Results: CHWs indicated that their knowledge about both diabetes and DR improved significantly after the training. This boosted their confidence in talking about these issues and providing clarity regarding referrals for DR screening in their respective communities. Consequently, they have referred a significantly higher number of people for screening both in outreach and to health facilities. Challenges in referral included poverty, high transportation cost and social support needs, which hindered screening. Further, although CHWs felt some degree of integration within the health system, they thought more was needed.

Conclusion: Investing in scalable models such as training CHWs is an important first step in tackling diabetes and DR in communities, particularly at the grassroots level in low-resource settings by increasing the community's knowledge of DR and improving access to screening, diagnosis and treatment.