Technology and task reallocation to improve access to quality refractive error services: Exploring the feasibility, acceptability, and cost implications

Abstract

Abstract:

Aim: The aim of this study is to explore the accuracy, feasibility, acceptability and cost implications of refractive error screening and diagnosis by personnel in basic health service centers and rural eye centers using a commercially available, handheld and portable technology.

Method: This cross sectional study was implemented in the rural municipality of Dhading and Lalitpur district of Bagmati province across 5 basic health service centers and 5 rural eye health centers. The 5 basic health service centers were Ruby Valley Basic Hospital, Semjong Health Post, Mahadevbeshi Health Post, Thangsingtar Hospital, Sankhu Health Post and 5 rural eye health centers were Jwalamukhi Rural Eye Center, Gangajamuna Rural Eye Center, Khaniyabas Rural Eye Center, Gajuri Urban Eye Clinic, Mahankal Rural Eye Center. 100 participants were selected from each site. Quantitative data was collected to assess the accuracy, cost implications, acceptability and feasibility of autorefractometer. Results: Out of 1000 enrolled participants, 624 (62.4%) were female and 376 (37.6%) were male. The mean age ± SD of the participants was 53.2 ± 15.9 years, ranged from 19 to 95 years. More than half of the participants (53.6%) were literate, with 41.6% having attained secondary education. Regarding employment, 304 participants (30.4%) were employed, and farming was the primary occupation for 507 individuals (50. 7%). Approximately half of the participants 499 (49.9%) were Hindu while 418 (41.8%) were Buddhist.

The overall agreement on BCVA (within the 6/6 or 6/9 range) between the optometrist (as a gold standard) and auto-refractometer readings was 71.6% (95% CI: 69.6% to 73.6%). This agreement operated by eye health worker was higher compared to allied health personnel at 78.7% (95% CI: 75.8–81.6), compared to 64.5% (95% CI: 60.8–68.2), which was statistically significant. P<0.001. Overall, around, 532 (92.8%) participants found that the autorefractometer acceptable and satisfied to use. Additionally among 84 responses, 78 (96.9%) indicated agreement that the autorefractometer is feasible to use, while 6 (7.1%) responses were neutral. Among 420 participants who had previously been prescribed spectacles, 51 (12.1%) did not make them. Similarly, out of the 369 who made spectacles, 247 (66.9%) did not use them.

Conclusion: Autorefractometer showed highly accurate measurement within ±1D Spherical Equivalent. Additionally, acceptance and the practicality of autorefractometer technology were also found very high. Also, more than 1 out of 10 people do not make spectacles even when prescribed. Additionally, more than two-thirds of those who make spectacle do not use them.