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Does an integrated school eye health delivery model perform better than a vertical model in a real-world setting? A non-randomised interventional comparative implementation study in Zanzibar
British Journal of Ophthalmology ( IF 4.1 ) Pub Date : 2024-01-01 , DOI: 10.1136/bjo-2022-321752
Ving Fai Chan 1, 2 , Elodie Yard 3 , Eden Mashayo 2 , Damaris Mulewa 3 , Lesley Drake 3 , Carlos Price-Sanchez 4 , Fatma Omar 5
Affiliation  

Background Few studies on school eye health programmes have shown they were cost-effective. We compared the performance (Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM)) between an integrated model (IM) and a vertical model (VM) of school eye health delivery in Zanzibar. Methods The set of RE-AIM performance indicators of the IM (n=9) and VM (n=10) cohorts was compared. The VM implemented only the eye health interventions, while the IM had the eye health interventions conducted within the school feeding programme. Semistructured interviews were conducted with 36 stakeholders to understand the challenges and outcomes experienced when implementing both models. Results The IM achieved higher screening coverage, voluntary follow-up rate, screening validity and spectacle compliance than VM. This was due to effective coordination between implementers, motivated teachers to prevent vision problems and related negative impacts in children, and activities implemented timeously post-training. Both models recorded low wearing compliance. All schools in the IM cohort completed screening activities, but two schools in the VM cohort did not. Both models ceased activities after the funding stopped. Local stakeholders emphasised that evidence from this study can be used to advocate for more resources for children’s eye health. Conclusions The IM cohort achieved better reach, effectiveness, adoption rate and implementation performance than the VM cohort. The poor maintenance performance indicators in both arms postfunding call for improvement to the implementation strategy to ensure the sustainability of school eye health. In the optics of scaling up, an integrated approach is recommended. Data are available in a public, open access repository. Data are available in a public, open access repository. The datasets generated and/or analysed during the current study are available in the Queen’s University Belfast PURE repository, (DOI:10.17034/04cc7ddf-ce69-49ae-9876-e5dfdcedb545).

中文翻译:

在现实环境中,综合学校眼健康服务模式是否比垂直模式表现更好?桑给巴尔的非随机干预比较实施研究

背景 很少有关于学校眼健康计划的研究表明它们具有成本效益。我们比较了桑给巴尔学校眼保健服务的综合模型 (IM) 和垂直模型 (VM) 的绩效(覆盖范围、有效性、采用、实施和维护 (RE-AIM))。方法 比较 IM (n=9) 和 VM (n=10) 队列的 RE-AIM 性能指标集。 VM 仅实施了眼睛健康干预措施,而 IM 在学校供餐计划中进行了眼睛健康干预措施。对 36 位利益相关者进行了半结构化访谈,以了解实施这两种模型时遇到的挑战和结果。结果 IM 比 VM 具有更高的筛查覆盖率、自愿随访率、筛查有效性和眼镜依从性。这是由于实施者之间的有效协调、教师积极预防儿童视力问题和相关负面影响以及培训后及时开展的活动。两种型号的佩戴依从性均较低。 IM 队列中的所有学校都完成了筛选活动,但 VM 队列中的两所学校没有完成。资金停止后,这两种模式都停止了活动。当地利益相关者强调,这项研究的证据可用于倡导为儿童眼睛健康提供更多资源。结论 IM 队列比 VM 队列实现了更好的覆盖范围、有效性、采用率和实施性能。资助后两个部门的维护绩效指标较差,需要改进实施策略,以确保学校眼健康的可持续性。在扩大规模方面,建议采用集成方法。数据可在公共、开放访问存储库中获取。数据可在公共、开放访问存储库中获取。当前研究期间生成和/或分析的数据集可在贝尔法斯特女王大学 PURE 存储库中获取(DOI:10.17034/04cc7ddf-ce69-49ae-9876-e5dfdcedb545)。
更新日期:2023-12-18
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