Increasing Access to Eye Care using Mobile Phone-based Interventions. The development, validation and implementation of Peek to optimise human resources and lower barriers to access for those most in need

HK Rono
A combination of limited access to eye services and low numbers of eye care providers in low and middle income (LMIC) populations results in high prevalence of avoidable visual impairment. Aim: To develop and evaluate a demonstration model of community volunteers and teachers using a novel mobile phone-based technology (Peek) in communities and schools, respectively, to identify and refer those with referable eye conditions and increase adherence to services so as to reduce avoidable visual
more » ... irment. Methods: This thesis comprises: (1) a three-year retrospective review of utilisation of hospital eye care services; (2) a cluster randomized trial (C-RCT) to determine the effectiveness of using of the mobile phone based, Peek School Eye Health System (Peek SEH) to increase identification and referral adherence to hospital of school pupils with visual impairment; (3) the development and validation of a smartphone based community screening decisionsupport algorithm (Peek Community Screening App) that enables Community Volunteers (CVs) to make referral decisions about patients with eye problems in the community; and (4) a second single masked C-RCT where the Peek Community Screening App was integrated into an mHealth system, Peek Community Eye Health system (Peek CEH) for integrating eye health screening in communities with primary and secondary health care facilities in Kenya to increase access and to optimise health system utilisation. Results For the first study, the retrospective analysis of records showed an average annual attendance rate increase from 60.9 to 79.2 per 10,000 population, incidence rate ratio (IRR) 1.30 (95% confidence interval (CI) 1.26–1.35) between 2013 and 2015. Also 61.0% of consultations in the three-year period were for primary eye conditions (allergic or other conjunctivitis or normal eyes) which could potentially be managed by primary eye care (PEC) and only 8.3% were for the three leading causes of vision loss in this population (cataract, glaucoma and refractive errors). In [...]
doi:10.17037/pubs.04657717 fatcat:3o4lbxaddjekhjobpfiasgqtji