Table 5.

Individual factors.

Theme	Quote
State of health	“…her grandson was here at the time and I discussed it with the family and they said no rather not because they don’t want anyone poking around because P1 was quite sick at the time and they felt that she would not be able to handle much more” (Patient 1 carer).
	“…because I was in the hospitals for surgeries and other things, I never got around to it (eye examination) […] I struggled with my foot to heal. I was bedridden for months…” (Patient 4).
Medication-related burden	“Then eventually, to tell you the truth, I got fed up with having to struggle with the pills […] I decided to look at the pills that are important to me, in my life […] then I decided, over a period of time, that I’m tired of the Metformin I’m drinking, because it makes me very constipated and so on. And then I left it and I’ve been off it for over two months now. And the same with the Insulin, I don’t even use Insulin anymore […] then I just wondered if the pills were even worth taking? […] I drink cooldrink and all of those things. I’m living normally, like how I used to live […] I wondered whether the diabetes medication didn’t maybe have a negative impact on my life, because my eyes weakened so much.” (Patient 4).
Forgetfulness	“…And then I did go to the (NTSS) hospital. In May, June, July I was supposed to go for the injections in the eye. Then this month they would have checked to see, and then they would’ve maybe done the laser… But because I couldn’t find my day hospital card and didn’t know what dates I needed to go, I didn’t attend those three months…” (Patient 13).
Fear of vision loss	“The main thing, I think they (patients) are scared” (Key informant 1).
	“I was scared. I didn’t know what to expect” (Patient 8).
	“…if I don’t do it then I’ll eventually go blind” (Patient 3); “…probably my fear that I’ll go blind if I don’t go” (Patient 7).
Health literacy	“…so diabetes can affect your eyes, your eye health, uhm... can cause blurry vision… In severe cases it could cause blindness… that’s the extent I know about it” (Patient 9).
	“So it’s like they say, the sugar, it affects the veins in your eyes […] they explain to you” (Patient 3).
	“…they never said we must go for an eye test (annually)… They won’t tell you that you have to go for an eye test now” (Patient 10).
	“[…] as soon as they become diabetic, they should know the consequences. So, the main thing is patient education should be increased” (Key informant 1).
Financial trade-offs	“…to eat healthy, for a diabetic, is expensive… if the money isn’t there… and you only have pap and bread and not even vegetables really... I mean households are struggling (financially)” (Patient 3).
	“…look, you lose a day’s wages, but you don’t care, it’s for your own health. I will never skip an appointment. Even if I have to lose a day’s wages” (Patient 6).
	“I’m not working at the moment. They retrenched me 10 years ago already” (Patient 12).