Community-Based Eye Screening With Structured Referral Tracking for Preventing Avoidable Blindness in Adults in Rawalpindi, Pakistan

Официальное название

Community-Based Eye Screening With a Structured Referral Tracking Intervention for the Prevention of Avoidable Blindness Among Adults in Rawalpindi District, Pakistan

Обзор

This cluster randomized controlled trial aims to evaluate the effectiveness of a Structured Referral Tracking (SRT) intervention in improving referral completion among adults identified with avoidable blindness during community-based eye screening camps in Rawalpindi District, Pakistan. Ten community clusters will be randomized into intervention and control groups. Participants in the intervention group will receive structured referral counseling, weekly reminder calls or messages, and customized referral guidance for eight weeks, while the control group will receive standard referral procedures. The primary outcome is referral completion at a tertiary eye hospital within eight weeks after screening. Secondary outcomes include knowledge regarding avoidable blindness, treatment satisfaction, feasibility, acceptability, and barriers influencing referral completion.

Подробное описание

Avoidable blindness remains a major public health challenge in low- and middle-income countries, including Pakistan. Community-based eye screening camps are commonly used to identify individuals with visual impairment and eye diseases requiring treatment; however, referral completion to tertiary eye care facilities remains poor. Many patients fail to attend referral hospitals because of limited awareness, lack of follow-up, transportation barriers, and uncertainty regarding treatment procedures.

This study aims to evaluate the effectiveness and implementation of a Structured Referral Tracking (SRT) intervention in improving referral completion among adults identified with avoidable blindness during community-based eye screening camps in Rawalpindi District, Pakistan.

The study will use a cluster randomized controlled trial design. Ten community clusters (union councils) from five tehsils of Rawalpindi District will be selected using multistage random sampling. Clusters will be randomized into intervention and control arms. Participants attending eye screening camps who are diagnosed with eye conditions requiring referral to a tertiary eye hospital will be enrolled after informed consent.

Participants in the intervention arm will receive a multi-component Structured Referral Tracking intervention consisting of referral counseling, weekly reminder calls or mobile messages, visual educational material, and customized referral guidance regarding hospital location, estimated costs, and required documents. Participants in the control arm will receive standard referral procedures consisting of routine counseling and referral slips without structured follow-up.

The primary outcome will be referral completion at the tertiary eye hospital within eight weeks after screening, verified through hospital attendance records. Secondary outcomes will include knowledge regarding avoidable blindness, treatment satisfaction, feasibility and acceptability of the intervention, and barriers influencing referral completion.

The findings of this study are expected to provide evidence regarding the effectiveness and feasibility of structured referral tracking systems for improving eye care service utilization and reducing avoidable blindness in Pakistan.

Вмешательства

• Поведенческое Structured Referral Tracking (SRT)
  A multi-component referral tracking intervention including referral counseling, weekly reminder calls or mobile messages, visual educational material, and customized referral guidance to improve referral completion after community eye screening.

Первичные конечные точки

• Referral Completion Rate Verified Through Hospital Records [Срок оценки: Within 8 weeks after community eye screening]

Вторичные конечные точки (3)

• Knowledge Score on Avoidable Blindness Questionnaire [Срок оценки: Baseline and 8 weeks after screening]
• Participant Acceptability of Structured Referral Tracking Assessed Using Structured Feedback Questionnaire [Срок оценки: Within 8 weeks after screening]
• Barriers Influencing Referral Completion Assessed Using Structured Barrier Assessment Questionnaire [Срок оценки: Within 8 weeks after screening]

Критерии участия

Критерии включения

• Adults aged 18 years or above
• Individuals diagnosed with visual impairment or eye conditions requiring referral to a tertiary eye care facility
• Permanent residents of Rawalpindi District, Pakistan
• Willing and able to provide informed consent

Критерии исключения

• Individuals already undergoing treatment for the identified eye condition
• Individuals requiring emergency ophthalmic care
• Severe systemic or physical illness limiting follow-up
• Individuals unable to provide informed consent

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Простое слепое

Основная цель

Профилактика

Центры проведения

Пакистан · 1 центр

• ACCO Department, Al-Shifa Trust Eye Hospital, Rawalpindi — Rawalpindi

Публикации

• Harwood M, Cunningham W. Lessons from 2020 for equity in global eye health. Lancet Glob Health. 2021 Apr;9(4):e387-e388. doi: 10.1016/S2214-109X(21)00036-X. Epub 2021 Feb 16. No abstract available. PMID 33607017
• World Health Organization. Blindness and visual impairment. Geneva: World Health Organization; 2023
• Khan AA, Talpur KI, Awan Z, Arteaga SL, Bolster NM, Katibeh M, Watts E, Bastawrous A. Improving equity, efficiency and adherence to referral in Pakistan's eye health programmes: Pre- and post-pandemic onset. Front Public Health. 2022 Jul 22;10:873192. doi: 10.3389/fpubh.2022.873192. eCollection 2022. PMID 35937227

Идентификаторы

NCT: NCT07611682 · hsa2026135

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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