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Adherence to referrals from preschool vision screening and identification of barriers for non-adherence in Israel
Ariela Gordon-Shaag1, Hadas Ben-Eli1, Orit Sztrigler Cohen1
1Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel.
Insights
Only half of parents followed through with recommended eye exams for their preschoolers. Parental education is key to improving adherence to vision screening referrals, especially for younger children.
Area of Science:
- Ophthalmology
- Public Health
- Pediatrics
Background:
- Preschool vision screening is crucial for early detection of visual impairments.
- Understanding parental adherence to referrals and associated barriers is vital for effective intervention.
Purpose of the Study:
- To assess parental adherence to referrals for comprehensive eye examinations after preschool vision screening.
- To identify factors and barriers influencing adherence.
Main Methods:
- A prospective cohort study involved 1283 children aged 3-6 years undergoing vision screening.
- Parents of children with abnormal findings were interviewed 3-6 months post-referral to assess adherence and barriers.
- Barriers were categorized into parental predisposing and health system factors.
Main Results:
- Overall adherence to referrals was 54.3%.
- Parents of older children (5-6 years) showed significantly higher adherence.
- Adherence did not vary by sex, ethnicity, or socio-economic status, unlike other health center services.
Conclusions:
- Low adherence to vision screening referrals necessitates targeted interventions.
- Predisposing parental factors were the primary barriers to adherence.
- Parental education is recommended to improve adherence rates for preschool vision screening.
Clinical Relevance:
Preschool vision screening is essential for the early detection and treatment of eye and vision problems.
Background:
The rate of parental adherence to referrals for comprehensive examination was assessed and factors and potential barriers associated with adherence were identified.
Methods:
In a prospective cohort study design, parents were offered to bring their 3-6 year old aged children to free-of-charge vision screening tests at community-based Mother Child Health Centers. Children with abnormal findings were referred to an ophthalmologist examination. Parents were interviewed three to six months after the referral to evaluate adherence and barriers. Barriers were organised into a conceptual framework of parental predisposing and health system factors. Adherence and barriers were assessed by sex, age, ethnic group and socio-economic-status.
Results:
Altogether 1283 children (mean age 4.5 ± 0.6 years, 47.8% girls) were screened in the Jerusalem district, Israel. The ethnic groups, Jewish (ultra-Orthodox 51.4%, secular/religious 33.2%) and Arab (15.4%), were similar by age and sex, but not by socio-economic status. The overall referral rate was 23.0% (N = 295). Referral rate was not associated with demographic factors. Overall, 54.3% (N = 160) of parents adhered to the referral to bring the child for a full eye examination. Adherence did not differ with sex, ethnicity or socio-economic-status. Parents of 5-6-year-old children were significantly more likely to adhere than parents of younger children. Of parents who did not adhere, 79.3% were attributed to predisposing factors, 16.3% to system factors and 4.4% to other reasons.
Conclusions:
Only half the parents proceeded with the recommended full eye examination. Parents of older children were more likely to adhere to referral. In contrast with vaccinations provided by Mother Child Health Centers, adherence to vision screening did not vary based on ethnicity or socio-economic factors. Since most barriers were associated with predisposing factors of parents, interventions to improve adherence should include parental education.
