Identifying barriers and potential solutions to improve equitable access to community eye services in central Kenya: a rapid exploratory sequential mixed methods study

Background: Recent research has found that less than half of people identified with an eye problem in Meru countys screening programme were able to access care, with younger adults being the least likely to receive the care they needed. We aimed to interview and survey members of this "left-behind" group to explore barriers and identify potential solutions using a rapid mixed-methods approach. Methods: First, we conducted interviews to explore perceptions of barriers and potential solutions. Next, we asked a representative sample to rank the suggested solutions by likely impact. Finally, we held a multistakeholder meeting to identify which of the top-ranked interventions offered the best balance of impact, feasibility, cost, and potential risks. We used a deductive matrix and thematic analysis to rapidly analyse the interview data. Results: We conducted 67 interviews. Barriers to access included long queues, conflicting work engagements, and lack of clear information. Proposed solutions focused on reducing queue lengths, providing better counselling and clinic information, holding mop-up clinics, and maintaining adequate stocks & supplies. We conducted ranking surveys with 401 additional people from the left-behind group. All proposed solutions were ranked at moderately-to-highly likely to improve equitable access. Fifteen people attended the multistakeholder meeting, including community representatives. Workshop participants unanimously selected enhanced counselling and SMS reminders as the interventions that offered the best balance of impact, risk, cost, and feasibility. The other proposed solutions were deemed impractical or unaffordable. Conclusion: Rapid mixed-methods and multistakeholder collaboration were used to identify a range of potential service modifications that will be implemented within the ongoing programme. Our approach was centred on the experiences and perceptions of those who face the highest barriers to care. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by the National Institute for Health Research (NIHR) (using the UKs Official Development Assistance (ODA) Funding) and Wellcome [215633/Z/19/Z] under the NIHR-Wellcome Partnership for Global Health Research. The views expressed are those of the authors and not necessarily those of Wellcome, the NIHR or the Department of Health and Social Care. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was granted ethical approval by the Kenya Medical Research Institute (KEMRI) scientific and ethics review unit, and the London School of Hygiene & Tropical Medicine research ethics committee. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript.