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Evaluating the Effectiveness of Interventions to Improve the Follow-up Rate for Children With Visual Disabilities in
Manisha Shrestha1, Gopal Bhandari1, Sureshkumar Kamalakannan2
1Bharatpur Eye Hospital, Bharatpur Metropolitan City, Chitwan, Nepal.
Insights
Interventions like counseling and SMS reminders did not significantly improve pediatric ocular follow-up rates. Further research is needed to understand intervention effectiveness for children with visual impairments.
Area of Science:
- Ophthalmology
- Public Health
- Health Services Research
Background:
- Monitoring ocular morbidity in children necessitates consistent follow-up visits.
- Poor follow-up rates were observed among pediatric patients in the study setting.
- This highlights a critical gap in ensuring continuous care for children with visual impairments.
Purpose of the Study:
- To evaluate the effectiveness of counseling and SMS/phone call interventions in improving pediatric patient follow-up rates.
- To compare these interventions against routine standard care for pediatric ocular conditions.
- To assess strategies for enhancing adherence to follow-up schedules in pediatric eye care.
Main Methods:
- A nonrandomized, quasiexperimental design involving 264 pediatric patients (0-16 years) with ocular conditions.
- Three groups were compared: counseling, SMS/phone calls, and routine standard care.
- Compliance was defined as attending 3 follow-up visits within 2 days of the scheduled date.
Main Results:
- Overall compliance with 3 follow-up visits was very low (3%).
- No statistically significant difference in follow-up rates was found between the intervention groups.
- The SMS/phone call group showed a higher proportion of initial and overall follow-ups compared to counseling and standard care.
Conclusions:
- The tested interventions (counseling, SMS/phone calls) did not demonstrate effectiveness in improving pediatric ocular follow-up rates.
- The COVID-19 pandemic context and intervention intensity may have influenced outcomes.
- Rigorous studies without pandemic restrictions are needed to confirm intervention efficacy for pediatric visual impairment care.
Background:
Monitoring ocular morbidity among pediatric patients requires regular follow-up visits. We found that the follow-up rate was poor among children in our setting. Therefore, we intended to assess the effectiveness of 2 interventions-(1) counseling and (2) SMS text messaging and phone calls-to improve the follow-up rates.
Objective:
This study aimed to evaluate the effectiveness of 2 interventions, counseling and SMS and phone calls group, as well as a routine standard care for improving the follow-up rate of pediatric patients.
Methods:
A Nonrandomized, quasiexperimental design was used. Children (aged 0-16 years) with ocular conditions requiring at least 3 follow-up visits during the study period were included. A total of 264 participants were equally allocated to the 3 intervention groups of (1) counseling, (2) SMS and phone calls, and (3) routine standard care group. A 20-minute counseling session by a trained counselor with the provision of disease-specific leaflets were given to those in the counseling group. For the second intervention group, parents of children received an SMS text 3 days before and a phone call 1 day before their scheduled follow-up visits. Participants allocated for the routine standard care group were provided with the existing services with no additional counseling and reminders. Participants attending 3 follow-ups within 2 days of the scheduled visit date were considered compliant. The difference in and among the proportion of participants completing all 3 follow-up visits in each group was assessed.
Results:
The demographic characteristics of the participants were similar across the study groups. Only 3% (8/264) of participants completed all 3 follow-up visits, but overall compliance with the follow-up, as defined by the investigators, was found to be only 0.76% (2/264). There was no statistically significant difference in the proportion of follow-up between the intervention groups. However, the proportion of participants attending the first and second follow-ups, as well as the overall total number of follow-ups, was more in the SMS and phone-call group followed by the counseling group.
Conclusions:
We did not find any evidence on the effectiveness of our interventions to improve the follow-up rate. The primary reason could be that this study was conducted during the COVID-19 pandemic. It could also be possible that the intensity of the interventions may have influenced the outcomes. A rigorously designed study during the absence of any lockdown restrictions is warranted to evaluate intervention effectiveness. The study also provides useful insights and highlights the importance of designing and systematically developing interventions for improving the follow-up rate and ensuring a continuum of care to children with visual disabilities in Nepal and similar contexts.
Trial Registration:
ClinicalTrials.gov NCT04837534; https://clinicaltrials.gov/ct2/show/NCT04837534.
International Registered Report Identifier (Irrid):
RR2-10.2196/31578.
