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 (Preprint)
Authors: Sabherwal Shalinder , Sood Ishaana , Chinnakaran Anand , Garg Gaurav Kumar , Singh Birendra Pratap , Majumdar Atanu , Shukla Rajan , Reddy Priya A , Gilbert Suzanne , Bassett Ken , Murthy Gudlavalleti VS ,   Operations Research Capacity Building Group
Published: June 2023

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.

CLINICALTRIAL

This study was registered and approved as a clinical trial (NCT04800718) during the initial period of data collection, in accordance with ICMJE recommendations.

INTERNATIONAL REGISTERED REPORT

RR2-10.2196/35824