A mixed-methods study into the effect of a psycho-educational programme for children with cerebral visual impairment (CVI)

Cerebral visual impairment (CVI) is one of the most common causes of visual impairment in children. CVI is a complex visual disorder to understand and explain to others. Understanding one’s diagnosis and being able to explain it to others may facilitate adaptive functioning. To educate children and young people on their CVI and accompanying needs, the computerized psycho-educational programme ‘My CVI’ has been developed.

A mixed-methods study was conducted to evaluate the effect of this programme. The aims of the programme are to increase participants’ knowledge of CVI, as well as self-esteem (SDQ), adaptive coping (SCQ), and well-being (Cantril, PERIK, HRQoL). Thirty-nine children (aged 7–16 years; 51% boys) participated in a pre-test, post-test, and follow-up assessment. Qualitative interviews were conducted for a subjective evaluation of the programme.

Participation in the psycho-educational programme resulted in increased knowledge of CVI, as well as a better teacher-reported social and academic self-concept and less self-reported feelings of social exclusion. No effects of participation were found on self-reported self-esteem, coping or other measures for well-being. An increase in knowledge of CVI was not associated with changes in psychosocial functioning. Qualitative data revealed that children enjoyed participating in the programme; they learned there are others with CVI, and gained more knowledge and practical tools on how to deal with their CVI.

The results provide preliminary evidence that participation in the psycho-educational programme ‘My CVI’ increases children’s knowledge of their visual impairment as well as improves social outcomes and feelings of inclusion. The highest gains may be achieved through a personalized approach, depending on a child’s (developmental) age and parental involvement.

Factors related to the use of magnifying low vision aids: a scoping review

Background: The decision process around the (non-)use of assistive technologies is multifactorial. Its determinants have previously been classified into personal, device-related, environmental and interventional categories. Whether these categories specifically apply to the use of magnifying low vision aids was explored here, using this classification.Methods: A scoping review (Embase, MedLine, Cochrane, ERIC ProQuest, CINAHL, NICE Evidence, Trip Database) was conducted to summarize the extent, range, and nature of research regarding the categories that are associated with low vision aid (non-)usage. A combination of key words and MeSH terms was used based upon the identified core concepts of the research question: low vision, assistive technology and adherence. Inter-rater reliability for the selection process was considered acceptable (kappa = 0.87). A combination of numerical and qualitative description of 21 studies was performed.Results: Studies report high variability rates of people possessing devices but not using them (range: 2.3-50%, M = 25%, SD = 14%). We were able to replicate the conceptual structure of the four categories that had previsouly been identified with other devices. Age, diagnosis and visual acuity demonstrated contradictory influence on optical low vision aid usage. Change in vision, appropriate environment, consistent training, patient's motivation and awareness of low vision services, emerged as contributor factors of use.Conclusion: This review provides evidence that clinicians should not rely on traditionally available clinical factors to predict device use behavior. Worsening vision and low motivation appear as predictors of device nonuse and should be considered from the clinician's point of view. Education about potential facilitating factors and promotion of innovative care are strongly encouraged.Implications for rehabilitationInvestigation of the factors predicting (non-)use of magnifying low vision aids is important. These findings can help clinicians to identify patients with a higher risk of non-use of low vision aids as well as provide evidence for interventions designed to improve use.Knowledge of low vision services and types of magnifying low vision aids available to patients appears as fundamental in the process of device use and needs to be supported by more educational programs.Psychological factors predicting (non-)use of low vision aids need to be considered in the choice of rehabilitation and follow-up strategies by a multidisciplinary team, focusing more on mechanisms of adaptation and patient's motivation.Training intensity should play a central role in the development of innovative intervention programs to reduce device abandonment.