Eye health promotion in Western Pacific island countries

Does an integrated school eye health delivery model perform better than a vertical model in a real-world setting? A non-randomised interventional comparative implementation study in Zanzibar

BACKGROUND

Few studies on school eye health programmes have shown they were cost-effective. We compared the performance (Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM)) between an integrated model (IM) and a vertical model (VM) of school eye health delivery in Zanzibar.

METHODS

The set of RE-AIM performance indicators of the IM (n=9) and VM (n=10) cohorts was compared. The VM implemented only the eye health interventions, while the IM had the eye health interventions conducted within the school feeding programme. Semistructured interviews were conducted with 36 stakeholders to understand the challenges and outcomes experienced when implementing both models.

RESULTS

The IM achieved higher screening coverage, voluntary follow-up rate, screening validity and spectacle compliance than VM. This was due to effective coordination between implementers, motivated teachers to prevent vision problems and related negative impacts in children, and activities implemented timeously post-training. Both models recorded low wearing compliance. All schools in the IM cohort completed screening activities, but two schools in the VM cohort did not. Both models ceased activities after the funding stopped. Local stakeholders emphasised that evidence from this study can be used to advocate for more resources for children's eye health.

CONCLUSIONS

The IM cohort achieved better reach, effectiveness, adoption rate and implementation performance than the VM cohort. The poor maintenance performance indicators in both arms postfunding call for improvement to the implementation strategy to ensure the sustainability of school eye health. In the optics of scaling up, an integrated approach is recommended.

Eye Care Behaviors among Adults in Poland: A Nationwide Cross-Sectional Survey

Implementation of eye care behaviors may reduce the risk of eye symptoms and diseases. This study aimed to assess eye care behaviors and identify factors associated with eye care practices among adults in Poland. This cross-sectional survey was carried out between 9 and 12 December 2022 on a nationwide random quota sample of adults in Poland. The study questionnaire included a set of questions on 10 different eye care behaviors. The study population included 1076 participants with a mean age of 45.7 ± 16.2 years, and 54.2% of participants were females. The most common (30.2%) eye care behavior was the use of good lighting indoors, and 27.3% used sunglasses with a UV filter. More than one-fifth of participants declared taking regular screen breaks and limiting screen time. Less than one-tenth of participants used dietary supplements with lutein, beta-carotene, or zinc. Out of 12 factors assessed in this study, self-reported knowledge of eye diseases was the most important factor associated (p < 0.05) with eye care behaviors. There were no economic or educational gaps (p > 0.05) in the implementation of most of the eye care behaviors among adults in Poland. This study revealed a low level of implementation of eye care behaviors among adults in Poland.

Co-creating an arts-based eye health education strategy in Zanzibar: process, outcomes and lessons learnt

Introduction

Published examples of health programme co-creation are scarce and we found none in the field of eye care. We described the outcomes and lessons learnt from the ZANZIbar Arts for Children’s Eyesight (ZANZI-ACE) eye health programme co-creation process.

Methods

We used a 2.5-day stakeholder workshop (number of participants=34) to develop the ZANZI-ACE intervention, which aimed to use music performances in eye health education to improve child eye health service uptake in Zanzibar. A Zanzibar-wide music competition was then launched to encourage local participation, followed by a judging session to select three pieces as the ZANZI-ACE eye health programme intervention materials.

Results

The barriers to the improved uptake of child eye health services raised by the participants were mainly cultural and social. Sensitising parents, teachers, children and community members with proper eye health knowledge was the key to addressing these barriers. The goal of sensitisation is to improve children’s vision so that they can achieve their fullest potential. Music and song ranked highest among the proposed art forms, so three music pieces were chosen as the ZANZI-ACE eye health programme intervention materials. A detailed ZANZI-ACE implementation strategy, a theory of change and key performance outcomes indicators were developed.

Conclusion

The co-creation process and outcomes of the ZANZI-ACE eye health programme show that engaging a diverse group of stakeholders is critical to developing locally relevant health programmes. The lessons learnt from the process will prove useful to researchers who aspire to design innovative health programmes.