Parents' reasons for nonadherence to referral to follow-up eye care for schoolchildren who failed school-based vision screening in Cross River State, Nigeria-A descriptive qualitative study.

Lynne Lohfeld,Ving Fai Chan,Christine Graham,Anne Effiom Ebri,Nathan Congdon,Ahmed Awadein

doi:10.1371/journal.pone.0259309

Abstract

BackgroundUncorrected refractive error (URE) is a major cause of vision impairment in children worldwide. Cases are often detected through a school-based vision screening program and then treated in a follow-up appointment. This requires parents or guardians (‘parents’) to adhere to referrals for the eye exam and care plan. We aim to understand the reasons for parents’ referral non-adherence in Cross River State, Nigeria, using qualitative methods.MethodsTen focus groups were held with parents who had not adhered to the referral for a follow-up eye examination. Participants were recruited with help from staff in schools hosting the vision screening programme. Interviews were conducted using a semi-structured interview guide, audio taped and transcribed verbatim. After identifying relevant quotes, the researchers labelled each one with a descriptive code/subcode label. Then they clustered the data into categories and overarching themes.ResultsForty-four parents participated in 10 focus group discussions with 28 women and 16 men. Three themes and participated in the focus group discussions with 28 women (63%). Twelve themes were generated. The three megathemes were Modifiable Factors (with 4 themes), Contextual Factors (with 6 themes), and Recommendations (with 2 themes).ConclusionParticipants identified modifiable barriers that make it difficult for parents to adhere to a referral for a follow-up eye exam. These include not believing their child has a vision problem or the screening test, and issues with the referral letter. They also described important contextual factors such as poverty, logistical problems, parental attitudes towards their children and beliefs about appropriate care. Many of these issues could be addressed by following their recommendation to educate the public on the importance of child eye care and correct parents’ misconceptions. These themes will be used by the Nigerian government to enhance and scale up its child eye health programme.

Highlights

Ten focus groups were held with parents who had not adhered to the referral for a follow-up eye examination
Participants identified modifiable barriers that make it difficult for parents to adhere to a referral for a follow-up eye exam
They described important contextual factors such as poverty, logistical problems, parental attitudes towards their children and beliefs about appropriate care. Many of these issues could be addressed by following their recommendation to educate the public on the importance of child eye care and correct parents’ misconceptions. These themes will be used by the Nigerian government to enhance and scale up its child eye health programme

Summary

Introduction

17.5 million children suffer from vision impairment and 1.4 million are blind globally, with most of them living in low- and middle-income countries (LMICs) [1,2,3]. Uncorrected refractive errors are known to have a major economic impact on households and nations [11], causing an estimated annual global loss of US $269 billion as of 2009 [12]. For these reasons, childhood blindness has been identified as a high-priority issue by the “World Health Organization’s VISION 2020: Right to Sight” program [13]. Cases are often detected through a school-based vision screening program and treated in a follow-up appointment This requires parents or guardians (‘parents’) to adhere to referrals for the eye exam and care plan. We aim to understand the reasons for parents’ referral non-adherence in Cross River State, Nigeria, using qualitative methods

Objectives

Methods

Results

Discussion

Conclusion