By Kathryn Meade, Senior Health Promotion Officer, National Screening Service
In 2024 and 2025, we worked in partnership with Pavee Point Traveller and Roma Centre to improve knowledge and awareness about diabetic eye screening among Travellers living with diabetes.
Nancy Collins is one of a team of 14 Traveller Community Health Workers in Pavee Point who provide health information to Traveller families. Nancy says: “A lot of people don’t know that diabetes is a very serious condition if you don’t mind yourself, and it can be especially serious to your eyes. The partnership work with the HSE National Screening Service, GPs and other healthcare professionals, plays an important role in promoting awareness of diabetic retina screening and encouraging people to attend.”
The project is part of our work to improve equity in screening - to make sure that everyone, including Travellers, has the same opportunity to access, participate and benefit from screening. For some marginalised groups, including Travellers, there can be systemic barriers to information and access to screening. By working directly with Traveller Community Health Workers (TCHWs), we’re helping to address some of these barriers, build trust and make screening more inclusive and accessible.
Why we did the project
Travellers are disproportionately affected by chronic diseases such as diabetes. The All-Ireland Traveller Health Study 2010 found that the rate of diabetes among Travellers was double that of the general population.
Diabetic eye screening is an important part of diabetes management and care. Diabetic retinopathy is a complication of diabetes. It’s an eye disease that affects the small blood vessels at the back of the eye and can cause sight loss.
We provide eye screening to everyone with type 1 or type 2 diabetes aged 12 and over. Diabetic RetinaScreen is free of charge and if treatment is needed, this is also free. When diabetic retinopathy is found early, treatment can reduce or prevent damage to a person’s eyesight.
What we did
We worked with TCHWs in Pavee Point. TCHWs are peer workers who provide health advocacy and signposting to Traveller families on the ground through the Traveller Primary Health Care project. There are approximately 27 of these projects around the country, alongside other Traveller health initiatives.
Dr Recie Davern, Consultant Endocrinologist at the Mater University Hospital, provided clinical and educational support for the project; with the TCHWs providing institutional knowledge and expertise. Dr Davern is part of a new initiative creating community hubs for managing chronic conditions such as diabetes. The aim is to bring care closer to people - especially those who haven’t been well served by mainstream hospital-based models.
Together, we educated and trained TCHWs about diabetes and diabetic eye screening so that they could deliver this information with Travellers in Finglas and Blanchardstown.
How we did it
Education
We provided education sessions for TCHWs. These sessions were co-designed and we adapted existing resources to make them accessible, relevant and culturally appropriate for the Travellers. We used videos, easy-to-read resources, storytelling and interactive discussions to deliver the information in a literacy-friendly and culturally-informed way.
Dr Davern said that many of the workers were well-informed about diabetes through their own training, family experience and community networks. “There was a good baseline knowledge”, she said. “A lot of the women actually knew the information - they just wanted it confirmed. They were aware of who in their community was at risk, or who might need to be approached.”
Fieldwork
TCHWs then carried out fieldwork within the community. They provided support, information and resources to people about diabetes and diabetic eye screening.
Speaking about her fieldwork, Nancy Collins said: “It’s not just about telling people what they should do. It’s more about supporting people where they are at and providing culturally appropriate information on how to lead a good life living with diabetes. A lot of people don’t know that diabetes is a very serious condition if you don’t mind yourself, and it can be especially serious to your eyes.”
Evaluation
We held focus groups with the Traveller CHWs to learn about their fieldwork, how they delivered information and the barriers they came across. Literacy was the main challenge to registering for screening and attending appointments.
Outcomes
About 75% of people contacted had already registered for screening. We worked with the TCHWs to address barriers and supported people to register for screening. We organised screening appointments for everyone eligible who wanted to take part.
Dr Davern says that the impact of the project was almost immediate. “Within 8 to 10 weeks of the session, I’d received about 10 new referrals. In a few of them, GPs mentioned that the person had attended one of our talks or had been encouraged to attend by one of the Traveller Community Healthcare Workers. This showed that the information was trusted. It meant the healthcare workers were meeting the right people and the message was getting through.”
Dr Davern explains that the education sessions were a two-way exchange of knowledge. She said: “A few of the Traveller women had experience of living with diabetes and shared their personal experiences. It was invaluable because you learn from them, and they learn from you. I could see where the barriers were to accessing diabetes services.
“It was a great opportunity to partner with Pavee Point and the TCHWs to co-design solutions, improve diabetes care, and not just to teach, but to learn. There’s a growing emphasis in medicine on cultural competence - to make sure that clinics and services follow principles that make care more accessible and appropriate for all communities.”
Storytelling
The TCHWs worked with us and an illustrator to tell the story of the project. The visually eye-catching infographic shows the process and results of the project using images that are culturally appropriate, such as showing the different types of Traveller accommodation.
The results show how equity in screening can be improved in practice - by using Traveller-proofing approaches in partnership with Traveller organisations, adapting information and meeting people where they are at. It demonstrates how community-led, culturally-informed approaches can make screening services more accessible for everyone.