Effect of door-to-door screening and awareness generation activities in the catchment areas of vision centres on service utilization: A study protocol (Preprint)

BACKGROUND Vision Centre (VC) is a significant eyecare service model to strengthen primary eye care services. VCs have been set-up at block level covering a population of 150,000-250,000 in rural areas in North India. Inadequate utilization by rural communities is a major challenge to sustainability of these VCs. This not only reduces the community’s vision improvement potential but also impacts self-sustainability and limits expansion of services in rural areas. Current literature reports lack of awareness regarding eye diseases and the need for care, social stigmas, low priority being given to eye problems, prevailing gender discrimination, cost, and dependence on caregivers as factors preventing utilization of primary eyecare. OBJECTIVE To address this, our organization is planning an awareness cum engagement intervention – door-to-door basic eye check-up and visual acuity screening in VC’s coverage areas, to connect with the community and improve rational utilization of the VCs. METHODS The study is a randomized parallel group experimental study, in which we will select 2 VCs each for intervention arm and control arm, among poor low performing VCs i.e., walk-in of ≤10 patients/day, from our two operational regions (Vrindavan, Mathura District and Mohammadi, Kheri District) of Uttar Pradesh. Intervention will include door to door screening and awareness generation in 8-12 villages surrounding VC, and control VC will follow existing practices of awareness generation through community activities and health talks. Data collected from each VCs for four months of intervention, primary outcome being utilization of VCs would include, number of walk-in patients, spectacle advised and uptake, referral and uptake for cataract and specialty surgery and operational expenses. Secondary outcomes would be uptake of refraction correction and referrals for cataract and other eye conditions. Differences in the number of walk-in patients, referrals, uptake of services and cost involved would be analyzed. RESULTS Participant recruitment in progress. CONCLUSIONS Through this study, we would analyze if of our door-to-door intervention is effective in increasing the number of visits at VC and the thus, the overall sustainability. We would also study the cost-effectiveness of this intervention to recommend it’s scalability. CLINICALTRIAL This protocol has been retrospectively registered as a clinical trial (NCT04800718) on 15th March 2021 at the ClinicalTrials.gov registry. Participant recruitment is still in progress. https://www.clinicaltrials.gov/ct2/show/NCT04800718?term=NCT04800718&recrs=ab&draw=2&rank=1