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Published on: March 17, 2023
Effect of a complex intervention to improve post-vision screening referral compliance among pre-school children in
Yangfa Zeng1, Xiaotong Han1, Decai Wang1
1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Insights
Specific appointments for quality-assured eye care significantly improved referral compliance in children
Area of Science:
- Ophthalmology
- Public Health
- Pediatrics
Background:
- Referral uptake for children's vision screening is often low in China.
- Investigated the impact of specific appointments for quality-assured care on referral uptake.
Purpose of the Study:
- To determine if providing specific appointments for quality-assured care increases referral compliance in children's vision screening.
Main Methods:
- Randomized controlled trial involving 9936 children aged 4-7 years in Yudu, Jiangxi, China.
- Intervention group received specific appointments for quality-assured eye care; Control group received usual practice recommendations.
- Primary outcome: referral compliance at six months post-screening, assessed via parent interviews.
Main Results:
- Intervention group showed significantly higher compliance (60.0%) compared to the Control group (37.4%) (P < 0.001).
- Factors associated with compliance included intervention group membership, shorter travel time, baseline glasses wear, strabismus, and worse uncorrected vision.
- 11.2% of screened children failed, with 104 (20.3%) and 135 (22.5%) lost to follow-up in the Intervention and Control groups, respectively.
Conclusions:
- Providing specific appointments for quality-assured eye care is an effective strategy to improve referral compliance in pediatric vision screening.
- This intervention addresses a critical gap in ensuring children receive necessary follow-up eye care.
Background:
We investigated whether specific appointments for quality-assured care could increase referral uptake, often low in China, in children's vision screening.
Methods:
We randomized children aged 4-7 years in Yudu, Jiangxi, China, by school to Control (free school-based eye screening, parents of children failing screening recommended for further examination [usual practice]) or Intervention (identical examinations, with parents additionally provided with specific appointments for further examinations by quality-assured doctors at a designated local hospital). Both groups could select any hospital for referral exams, which were not free. Six months after screening, parents were interviewed on referral compliance at any hospital (primary outcome) and potential determinants. This trial is registered at the ClinicalTrials.gov, number NCT03251456.
Findings:
Among 9936 children at 63 schools randomized to Intervention (32 schools, 5053 [50·9%] children) or Control (31 schools, 4883 [49·1%] children), 1114 children (11·2%) failed screening. Among 513 referred Intervention children (46·1%, 32 schools, mean age 5·36 years, 53·0% boys) and 601 referred Control children (53·9%, 31 schools, mean age 5·30 years, 57·7% boys), 104 (20·3%) and 135 (22·5%) were lost to follow-up respectively. Under Intention to Treat analysis, assuming children lost to follow-up were non-compliant, Intervention children had significantly higher compliance than Controls (308/513 = 60·0% vs. 225/601 = 37·4%, P < 0·001). In regression models, Intervention group membership (Relative risk [RR] 1·53, 95% confidence interval, 1·36-1·72), travel time to hospital (RR: 0·97, 0·95-0·999), baseline glasses wear (RR: 1·37, 1·17-1·60), strabismus (RR: 1·17, 1·01-1·36) and worse uncorrected vision (RR: 1·41, 1·03-1·92) were associated with compliance.
Interpretation:
Providing specific appointments for quality-assured eye care improved referral compliance in this setting.
