Previously submitted to: JMIR Public Health and Surveillance (no longer under consideration since Sep 09, 2024)
Date Submitted: Jun 19, 2023
Open Peer Review Period: Jun 19, 2023 - Jul 3, 2023
(closed for review but you can still tweet)
NOTE: This is an unreviewed Preprint
Warning: This is a unreviewed preprint (What is a preprint?). Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn (a note "no longer under consideration" will appear above).
Peer review me: Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period (in this case, a "Peer Review Me" button to sign up as reviewer is displayed above). All preprints currently open for review are listed here. Outside of the formal open peer-review period we encourage you to tweet about the preprint.
Citation: Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author).
Final version: If our system detects a final peer-reviewed "version of record" (VoR) published in any journal, a link to that VoR will appear below. Readers are then encourage to cite the VoR instead of this preprint.
Settings: If you are the author, you can login and change the preprint display settings, but the preprint URL/DOI is supposed to be stable and citable, so it should not be removed once posted.
Submit: To post your own preprint, simply submit to any JMIR journal, and choose the appropriate settings to expose your submitted version as preprint.
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Effect of Door-to-Door Screening and Awareness Generation Activities in the Catchment Areas of Vision Centres on Service Use: A Pilot Randomized Control Trial from North India
ABSTRACT
Background:
Vision centres (VC) have developed as an effective primary eyecare delivery model in India. Their financial sustainability is dependent on the number of walk-in patients, spectacle sales, and surgery uptake. Door-to-door vision screening (DTDS) and awareness generation activities were conducted in VC catchments.
Objective:
This study analysed the effect of intervention- DTDS, in the catchment population on VC service utilisation. Costs have also been studied.
Methods:
Randomized, parallel-group experimental study, with a previously published protocol, conducted across our two operational regions having surgical centres and attached VCs. Two rural VCs chosen randomly from each region were further randomized in intervention (DTDS) and control group. The study was designed as a difference-in-difference analysis to examine the proportion of change (from baseline) across the two arms, in average VC walk-in numbers. Patients needing further care after DTDS (intervention arm) or routine community activities (control arm), were referred to the nearby VC. The main outcome variable was the change in average VC attendance per day (November’ 21 to February ’22) as compared to same months in previous year (November’ 20 to February ’21) in both arms. January was excluded to control for high Covid-19 cases. Difference between the two arms was compared. Spectacle and surgical uptake were also assessed. Costs were calculated and compared for- per person screened/referred, per village covered, unit increases in VC walk-in, per patient reporting at VC and per cataract surgery performed among patients referred from VC.
Results:
Less number of villages could be screened in the intervention arm as compared to those visited in the control arm. Average walk-in in the intervention and control arms, increased from 10.4 to 12.3, and 11.5 to 12.2 per day, respectively- a significant increase for both, though the difference between the baseline and study period was significantly more in the intervention. In the intervention arm, significantly more women (46.9% versus 39.9%; p<0.05) and more people with ocular morbidity (95.9% versus 86.1%; p<0.05) visited the VCs as compared to the control arm. Paediatric population had an increase in intervention arm and decrease in control arm. Decrease in proportion of females from baseline was more in control arm than the intervention arm. Compliance to VC referrals was higher in intervention arm. In the intervention arm, the cost per unit increase in VC walk-in was more while the cost per patient reported to VC after referral, was less.
Conclusions:
DTDS activities increased footfalls at the VC, but at higher cost in the study period. As some of the benefits of DTDS intervention like improvement of gender equity and health seeking behaviour, may not have an impact in short-term, a longer duration study incorporating societal perspective and measuring cost-effectiveness is recommended. Clinical Trial: This study was registered and approved as a clinical trial (NCT04800718) during the initial period of data collection, in accordance with ICMJE recommendations.
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.