Effectiveness of interventions in improving compliance to spectacle wear and referral in school vision screening

Success of a school vision screening program depends on compliance with the advice that is offered to the children. This study evaluates the effect of an intervention package on compliance to spectacle wear and referral in a school vision screening program.

Among 8,442 children aged 13-17 years in 11 government schools in and around Chennai, India, 114 (2.2 per cent) children who required spectacles were allocated to the control arm (5,116 children) and 124 (3.7 per cent) children to the intervention arm (3,326 children). There were 44 (0.9 per cent) children in the control arm and 49 (1.5 per cent) children in the intervention arm who required referral for further management. Control schools received a conventional school screening protocol and intervention schools received 23-step interventions. Spectacle wear was noted in an unannounced direct observation after one, four and 12 months. Compliance to referral was noted based on the response of children with confirmation from medical records.

Spectacle compliance was significantly higher for the intervention arm compared to the control arm based on direct observation in the first month (17.6 per cent versus 49 per cent, adjusted odds ratio [OR] = 4.4, 95 per cent confidence interval [CI] 2.3-8.5, p < 0.05); in the fourth month (23 per cent versus 56 per cent, OR = 4.2, 95 per cent CI 2.3-7.8, p < 0.05); and in the 12th month (13.3 per cent versus 38.8 per cent, OR = 4.1, 95 per cent CI 1.8-9.4, p < 0.05). Referral compliance was significantly higher in the intervention arm in the first month (17.5 per cent versus 70.5 per cent, OR = 10.9, 95 per cent CI 3.8-30.9, p < 0.001) and in the fourth month (31.7 per cent versus 75.6 per cent, OR = 6.2, 95 per cent CI 2.3-16.0, p < 0.001).

A 23-step package of interventions was effective in improving compliance to spectacle wear and referral among adolescents in a school vision screening program.