JMIR Publications

ABSTRACT

Background:

Fundus photography is the most important examination in the eye disease screening. A facilitated self-service eye screening pattern based on the full-automatic fundus camera has been developed in 2022 in Shanghai, China. It may help solve the problem of insufficient human resources in primary healthcare institutions. However, the service quality and residents' preference for this new pattern are unclear.

Objective:

To compare the service quality and residents' preference between the facilitated self-service eye screening and traditional manual screening, and to explore the relationships between the screening service quality and residents' preference.

Methods:

We conducted a cross-sectional study in Shanghai, China. Residents who underwent facilitated self-service fundus disease screening at one of the screening sites were assigned to the exposure group; Those who were screened with a traditional fundus camera operated by an optometrist at an adjacent site were set up as a control group. The primary outcome was the screening service quality, including effectiveness (image quality and screening efficiency), physiological dis-comfortableness, safety, convenience, and trustworthiness. The secondary outcome was the participants' preference. The differences of the service quality and the participants' preferences between the two groups were compared using Chi-square tests separately. Subgroup analyses for exploring the relationships between the screening service quality and residents' preference were conducted using generalised logit models.

Results:

A total of 358 residents enrolled. Among them, 176 residents (49.16%) participated in the exposure group, and the rest 182 residents (50.84%) participated in the control group. Residents' basic characteristics were balanced between the two groups. There was no significant difference of the service quality between the two groups (Image quality pass rate: p=0.79; the average screening time: p=0.57; No physiological discomfort rate: p=0.92; Safety rate: p=0.78; Convenience rate: p=0.95; Trustworthiness rate: p=0.20). However, the proportion of participants who were willing to use the same technology for their next screening in the exposure group was much lower than in the control group (p<0.001). Subgroup analyses suggested that distrust of the facilitated self-service eye screening might increase the probability of 'Refusal of screening' (p=0.02).

Conclusions:

This study confirmed the facilitated self-service fundus disease screening pattern could achieve good service quality. However, it was difficult to reverse residents' preference for manual screening in a short period of time, especially when the original manual service was already excellent. Therefore, the digital transformation of healthcare must be cautious. We suggest attention should be paid to the residents’ individual needs. More efficient man-machine collaboration and personalized health management solutions based on large language models are both needed.