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The Effect of Health Education on Diabetic Retinopathy Screening Compliance: A Systematic Review and Meta-Analysis

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Abstract

Diabetic retinopathy (DR) is a common microvascular complication that can lead to visual impairment and blindness if it is not recognized and treated early. Lack of awareness of DR is the most commonly cited reason why many people with type 2 diabetes do not seek a referral for retinal screening. The current systematic review and meta-analysis aimed to investigate the effect of health education on DR screening compliance. PubMed, Scopus, Web of Science, and Google Scholar databases searched up to June 2025 to retrieve relevant articles based on titles, abstracts, and full-text screening. The quality of the included studies was assessed. Hence, data were extracted and analyzed. This study included a review of nine studies conducted in India, United States, China, Switzerland, Tanzania, Kenya, Bangladesh, and Canada with a total population of 2409 people. This current meta-analysis showed that health education increases DR screening compliance (odds ratio: 3.40, confidence interval 95% = 2.08–5.58). Also, the group whose reminder happened through a phone call compared to those who received other forms of reminders had higher compliance (odds ratio: 5.79, confidence interval 95% = 0.42–80.25). Data was associated with high heterogeneity (I2 = 72% for the first analysis and 75% for the second). The current study found a significant association between health education and DR screening compliance. Since the heterogeneity between the included studies was high, further large skilled studies are required.

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Data Availability

The data is available upon request from the corresponding author.

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Acknowledgements

The authors would like to thank the researchers whose works were included in this study.

Author information

Author notes

  1. Parisa Alsadat Dadkhah, Narges Norouzkhani, and Hassan Asadigandomani contributed equally to the article.

Authors and Affiliations

  1. Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

    Parisa Alsadat Dadkhah

  2. Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

    Narges Norouzkhani

  3. Department of Ophthalmology, University of California San Francisco, San Francisco, USA

    Hassan Asadigandomani

  4. Student Research Committee, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Mahsa Aslani Khiavi & Maryam Khanlari

  5. Department of Health Education & Promotion, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran

    Fateme Sedghi

  6. Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Seyyed Kiarash Sadat Rafiei & Niloofar Deravi

  7. School of Medicine, Babol University of Medical Sciences, Babol, Iran

    Fatemeh Ghasemi

  8. Student Research Committee, School of Medicine, Alborz University of Medical Science, Karaj, Iran

    Nazila Saffarian Zade

  9. School of Medicine, Isfahan University of Medical Science, Isfahan, Iran

    Farnaz Aghadavood

  10. School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Zahra Geshani

  11. Health Education and Promotion Department of Community Medicine, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran

    Fereshteh Sohrabivafa

  12. Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

    Reza Khademi

  13. Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran

    Seyyed-Ghavam Shafagh

  14. Student Research Committee, Faculty of Medicine, Tabriz Medical Sciences, Islamic Azad University, Tabriz, Iran

    Ata Akhtari Kohnehshahri

  15. Department of Social Determinant of Health Research Center, Yasuj University of Medical Sciences, Shahid Motahari Blvd, Yasuj, Kohgiluyeh and Boyer-Ahmad Province, Iran

    Parviz Aghaei Borzabad

  16. Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

    Alireza Mojarrad

  17. Faculty of Medicine, Tabriz Branch, Islamic Azad University, Tabriz, Iran

    Amin Magsudy

Contributions

Study concept, design, critical revision of the manuscript for important intellectual content, and study supervision: PAB. Acquisition of data: PaD, NN, HA, MAK, FS, and SKSR. Drafting of the manuscript: PaD, NN, HA, MAK, FS, SKSR, Fg, NSz, FA, ZG, FS, RK, SGS, AAk, and ND. Revision: Am.M, Al.M, PaD, NN, HA, and PAB. All authors contributed to the article and approved the submitted version.

Corresponding author

Correspondence to Parviz Aghaei Borzabad.

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Competing interests

The authors declare no competing interests.

Additional information

Supplementary Information

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Supplementary file 1 (PDF 1.98 MB)

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Cite this article

Dadkhah, P.A., Norouzkhani, N., Asadigandomani, H. et al. The Effect of Health Education on Diabetic Retinopathy Screening Compliance: A Systematic Review and Meta-Analysis. SN Compr. Clin. Med. 7, 217 (2025). https://doi.org/10.1007/s42399-025-01941-0

  • Received
  • Revised
  • Accepted
  • Published
  • DOI https://doi.org/10.1007/s42399-025-01941-0

Keywords

  • Compliance
  • Diabetic retinopathy
  • Health education
  • Screening

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