Animesh Rai, Anandhi Ramachandran
Diabetes mellitus continues to be one of the fastest-growing non-communicable diseases worldwide and is accompanied by an increasing burden of long-term microvascular complications, among which diabetic retinopathy remains one of the leading causes of preventable blindness among working-age adults. Because early-stage diabetic retinopathy frequently progresses without noticeable visual symptoms, timely retinal screening remains essential for preventing irreversible vision loss. Nevertheless, awareness of diabetic retinopathy, knowledge of recommended retinal examinations, and participation in preventive eye care services remain inadequate, particularly among individuals living in rural and resource-constrained settings. The rapid expansion of digital technologies has created new opportunities for delivering health communication through mobile health (mHealth) interventions that are accessible, scalable, and capable of reaching geographically dispersed populations. Mobile-based communication strategies have demonstrated considerable potential for improving health knowledge, reinforcing preventive behaviors, supporting treatment adherence, and facilitating greater engagement with healthcare services. However, although the effectiveness of mHealth interventions has been demonstrated for several chronic diseases, evidence specifically addressing diabetic retinopathy awareness and retinal screening remains comparatively limited. This narrative review critically synthesizes the available evidence on diabetic retinopathy awareness, screening behavior, barriers to preventive eye care, behavior change theories, mHealth interventions, digital health ecosystems, technology adoption models, and implementation frameworks relevant to diabetic retinopathy prevention. Evidence from public health, ophthalmology, behavioral science, digital health, and implementation research was examined to provide a comprehensive understanding of the factors influencing awareness, preventive health behavior, and retinal screening among individuals living with diabetes. The available evidence indicates that preventive eye care practices are influenced by a complex interaction of cognitive, behavioral, social, cultural, socioeconomic, and healthcare system determinants. Behavioral theories provide important conceptual foundations for designing communication strategies that extend beyond information dissemination to strengthen motivation, improve perceived susceptibility, reduce behavioral barriers, and encourage sustained participation in retinal screening. Simultaneously, implementation science frameworks provide structured approaches for improving the adoption, implementation, scalability, and sustainability of mHealth interventions within existing healthcare systems. Overall, the available evidence suggests that mobile-based behavior change interventions represent a promising strategy for strengthening diabetic retinopathy awareness, improving retinal screening uptake, and supporting preventive eye care among individuals living with diabetes. Future research should focus on culturally appropriate, theory-informed, and implementation-oriented mHealth interventions that are rigorously evaluated for effectiveness, feasibility, scalability, sustainability, and integration within routine healthcare systems, particularly among rural populations and other underserved communities.