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Objectives This study aimed to identify the factors that influence access to diabetic retinopathy screening (DRS).Design This is a qualitative case study.Setting Township health units in Shaoguan City, Guangdong Province, China.Participants This study included two representative patient groups (n=15) and five health-staff groups (n=42).Primary and secondary outcome measures Focus group discussions were guided by a female ophthalmologist and other ophthalmology staff to determine the contextual factors influencing DRS uptake in people with diabetes mellitus in Qujiang District, Shaoguan City, southern China. Directly observed treatment and short-course (DOTS) components for the assessment of tuberculosis services were referred to for health structure when themes were extracted using deductive thematic analysis.Results By referring to DOTS components related to the government, case detection, treatment, drug supply and recording system, we identified 31 factors associated with DRS uptake. Among these, six were from the perspective of service users whereas the remaining 25 were related to providers. From these factors, 10 modifiable themes pertained to policy, financing, interdepartmental coordination, hospital preparedness, primary healthcare staff training and public awareness through health education and quality enhancement of public health services. Two unmodifiable factors were also extracted: discomfort from pupil dilation during the examination and long travel distance to the facility.Conclusions This analysis identified contextual factors influencing DRS uptake, including policy, financing and public awareness, which, if addressed, could significantly enhance future screening uptake and disease management.