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Abstract

Age related Macular Degeneration (AMD) is progressive leading to irreversible blindness. The rate of progression can be reduced through lifestyle modifications such as stopping smoking, consumption of certain foods and vitamin supplementation. Eye Care Practitioners (ECPs) are recommended to provide lifestyle advice to patients, but studies show recommendations are not always followed, or patients cannot recall the advice. The aim of this PhD was to investigate the extent, nature and effectiveness of lifestyle modification advice given to patients with AMD, from a patient perspective.

Using themes from patient and practitioner co-design activities and literature, three surveys were created. The first survey was about patients’ experiences, and lifestyle advice received previously or at their most recent appointment. Consenting participants were sent a second survey three months later, following up on any changes that they made since their last appointment. Survey three was given to practitioners to investigate what barriers they perceive to effective lifestyle advice. As this was an exploratory study, the quantitative analysis comprised summary descriptive statistics obtained using Excel version 2407 (Microsoft) and SPSS Statistics 25 (IBM). Thematic analysis of qualitative data was conducted using NVivo 12 (Lumivero).

In total, 404 participants responded to survey one. Participants were mainly female (n=244; 60.4%) and between 71 and 80 years old (n=172; 42.6%). Out of the 371 participants that answered the question, 246 (66.3%) reported not receiving any advice previously. Of the 125 participants that did, 63% (n=79) made lifestyle changes. Most participants did not receive written advice at their most recent appointment (n=345; 85.4%). For survey two, 153 participants responded (38% response rate). Only 16.3% (n=25) received lifestyle advice at their most recent appointment, and 9 (36%) reported making changes. The most common reason for not making changes was not being given advice (n=36; 46.2%). The importance of making changes was rated 6 out of 10 (IQR=5-9.5). The most common reason for the rating was ‘uncertainty about whether changes are helpful’. For survey three, 54 ECPs responded. Most participants were nurses (n=22; 40.7%). In total, 47 (87%) participants reported providing patients with AMD with lifestyle advice. Most participants asked about smoking (n=31; 57.4%). A ‘lack of understanding/uncertainty’ was the most mentioned barrier to patients implementing lifestyle changes.

Most patients cannot recall lifestyle advice after appointments and are not being provided with written information. The importance of making changes and detailed advice would help patients implement changes. Further research and written information are needed with patient involvement to optimise advice provision.

Publication Type:	Thesis (Doctoral)
Subjects:	R Medicine > R Medicine (General) R Medicine > RE Ophthalmology
Departments:	School of Health & Medical Sciences > Optometry & Visual Sciences School of Health & Medical Sciences > School of Health & Medical Sciences Doctoral Theses Doctoral Theses

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