Diabetic retinopathy (DR) in pregnancy can cause blindness. National guidelines recommend at least one eye examination in early pregnancy, then ideally 3-monthly, through to the postpartum for pregnant women with pregestational diabetes. Here we examined adherence rates, barriers and enablers to recommended DR screening guidelines.

Cross-sectional survey study, as part of a larger prospective cohort study.

Participants were recruited from two tertiary maternity hospitals in Melbourne, Australia.

Of the 173 pregnant women with type 1 (T1D) or type 2 diabetes (T2D) in the main cohort study, with an additional four who participated solely in this survey study, 130 (74.3%) completed the survey.

This study calculated rates of adherence to guideline-recommended DR screening schedules and collected data on the enablers and barriers to attendance using a modified Compliance with Annual Diabetic Eye Exams Survey. Each of the 5-point Likert-scale survey items was compared between adherent and non-adherent participants using the Wilcoxon rank-sum test and logistic regression models were constructed to quantify associations as ORs.

A retinal assessment was undertaken at least once during pregnancy in 86.3% of participants, but only 40.9% attended during their first trimester and only 21.2% attended the recommended number of examinations. Competing priorities were the main barriers to adherence, with eye examinations ranked as the fourth priority (IQR 4th–5th) among other health appointments during pregnancy. Meanwhile, knowledge of the benefits of eye screening examinations, eye-check reminders and support from relatives was identified as enablers.

Despite the risk of worsening DR during pregnancy, less than half of the participants adhered to recommended screening guidelines, suggesting that eye health is not a priority. Proactive measures to integrate care are needed to prevent visual loss in this growing population.

To enhance nursing students’ critical thinking abilities, numerous educators have explored alternative teaching methods. While meta-analyses have confirmed that various approaches are effective in developing critical thinking, consensus regarding their comparative effectiveness remains elusive. Furthermore, few investigations have directly contrasted the outcomes across these methods, highlighting the necessity to undertake a comprehensive evaluation of their impact on nursing students’ critical thinking skills. Accordingly, this study aims to assess the effects of six teaching methods on nursing students’ critical thinking abilities.

A comprehensive literature search will be carried out up to May 2025 across various databases, such as PubMed, Embase, The Cochrane Library, Web of Science, OVID, CNKI, Wanfang Database and the China Biological Literature Database (CBM). The search strategy will specifically target randomised controlled trials meeting predefined inclusion criteria. Two independent reviewers will screen the selected studies and extract pertinent data. The methodological quality of the included studies will be assessed using the Cochrane risk of bias tool. A network meta-analysis will then be performed using Stata software, incorporating the following analytical components: heterogeneity, network evidence diagrams, publication bias plots, league tables, forest plots, subgroup analyses or meta-regression and sensitivity analyses. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system will be leveraged to appraise the overall quality of evidence related to critical thinking abilities across all compared interventions.

No formal research ethics approval is required. The results will be submitted to a peer-reviewed journal for publication.

CRD42024618735.