Evaluating the Effectiveness of Interventions to Improve the Follow-up Rate for Children With Visual Disabilities in an Eye Hospital in Nepal: Nonrandomized Study

Shrestha, Manisha, Bhandari, Gopal, Kamalakannan, Sureshkumar, Murthy, Gudlavalleti Venkata Satyanarayana, Rathi, Suresh Kumar, Gudlavalleti, Anirudh Gaurang, Agiwal, Varun, Pant, Hira, Pandey, Binod, Ghimire, Ramesh, Ale, Daman, Kayastha, Sajani, Karki, Rakshya, Chaudhary, Daya Shankar, Byanju, Raghunandan and Operational Research Capacity Building Study Group, (2023) Evaluating the Effectiveness of Interventions to Improve the Follow-up Rate for Children With Visual Disabilities in an Eye Hospital in Nepal: Nonrandomized Study. JMIR Pediatrics and Parenting, 6. e43814. ISSN 2561-6722

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Monitoring ocular morbidity among pediatric patients requires regular follow-up visits. We found that the follow-up rate was poor among children in our setting. Therefore, we intended to assess the effectiveness of 2 interventions—(1) counseling and (2) SMS text messaging and phone calls—to improve the follow-up rates.

This study aimed to evaluate the effectiveness of 2 interventions, counseling and SMS and phone calls group, as well as a routine standard care for improving the follow-up rate of pediatric patients.

A Nonrandomized, quasiexperimental design was used. Children (aged 0-16 years) with ocular conditions requiring at least 3 follow-up visits during the study period were included. A total of 264 participants were equally allocated to the 3 intervention groups of (1) counseling, (2) SMS and phone calls, and (3) routine standard care group. A 20-minute counseling session by a trained counselor with the provision of disease-specific leaflets were given to those in the counseling group. For the second intervention group, parents of children received an SMS text 3 days before and a phone call 1 day before their scheduled follow-up visits. Participants allocated for the routine standard care group were provided with the existing services with no additional counseling and reminders. Participants attending 3 follow-ups within 2 days of the scheduled visit date were considered compliant. The difference in and among the proportion of participants completing all 3 follow-up visits in each group was assessed.

The demographic characteristics of the participants were similar across the study groups. Only 3% (8/264) of participants completed all 3 follow-up visits, but overall compliance with the follow-up, as defined by the investigators, was found to be only 0.76% (2/264). There was no statistically significant difference in the proportion of follow-up between the intervention groups. However, the proportion of participants attending the first and second follow-ups, as well as the overall total number of follow-ups, was more in the SMS and phone-call group followed by the counseling group.

We did not find any evidence on the effectiveness of our interventions to improve the follow-up rate. The primary reason could be that this study was conducted during the COVID-19 pandemic. It could also be possible that the intensity of the interventions may have influenced the outcomes. A rigorously designed study during the absence of any lockdown restrictions is warranted to evaluate intervention effectiveness. The study also provides useful insights and highlights the importance of designing and systematically developing interventions for improving the follow-up rate and ensuring a continuum of care to children with visual disabilities in Nepal and similar contexts.

Trial Registration:
ClinicalTrials.gov NCT04837534; https://clinicaltrials.gov/ct2/show/NCT04837534

International Registered Report Identifier (IRRID):

Item Type: Article
Additional Information: Funding information: We gratefully acknowledge the Seva Foundation and the Indian Institute of Public Health–Hyderabad for their valuable guidance and support of this work, as well as the management and staff of Bharatpur Eye Hospital (BEH) for their contributions to various aspects of this study.
Uncontrolled Keywords: counseling; follow-up; intervention study; Nepal; ophthalmology; pediatrics; public health
Subjects: B500 Ophthalmics
Department: Faculties > Health and Life Sciences > Social Work, Education and Community Wellbeing
Depositing User: Elena Carlaw
Date Deposited: 24 Feb 2023 11:25
Last Modified: 24 Feb 2023 11:30
URI: https://nrl.northumbria.ac.uk/id/eprint/51488

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