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Effectiveness of an mHealth system on access to eye health services in Kenya: a cluster-randomised controlled trial

BACKGROUND: There is limited access to eye health services in many low-income and middle-income populations. We aimed to assess the effectiveness in increasing service utilisation of the Peek Community Eye Health (Peek CEH) system, a smartphone-based referral system comprising decision support algor...

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Autores principales: Rono, Hillary, Bastawrous, Andrew, Macleod, David, Mamboleo, Ronald, Bunywera, Cosmas, Wanjala, Emmanuel, Gichuhi, Stephen, Burton, Matthew J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier Ltd 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8239618/
https://www.ncbi.nlm.nih.gov/pubmed/34167763
http://dx.doi.org/10.1016/S2589-7500(21)00083-2
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author Rono, Hillary
Bastawrous, Andrew
Macleod, David
Mamboleo, Ronald
Bunywera, Cosmas
Wanjala, Emmanuel
Gichuhi, Stephen
Burton, Matthew J
author_facet Rono, Hillary
Bastawrous, Andrew
Macleod, David
Mamboleo, Ronald
Bunywera, Cosmas
Wanjala, Emmanuel
Gichuhi, Stephen
Burton, Matthew J
author_sort Rono, Hillary
collection PubMed
description BACKGROUND: There is limited access to eye health services in many low-income and middle-income populations. We aimed to assess the effectiveness in increasing service utilisation of the Peek Community Eye Health (Peek CEH) system, a smartphone-based referral system comprising decision support algorithms (Peek Community Screening app), SMS reminders, and real-time reporting. METHODS: In this cluster-randomised controlled trial of eye health in Kenya, community unit clusters were defined as one health centre and its catchment population. Clusters were randomly allocated (1:1) to receive Peek CEH and referral (intervention group) or standard care via periodic health centre-based outreach clinics and onward referral (control group). Individuals in the intervention group were assessed at home by screeners and those referred were asked to present for triage assessment in a central location. They received regular SMS reminders. In both groups, community sensitisation was done followed by a triage clinic at the cluster health centre 4 weeks after sensitisation. During triage, individuals in both groups were assessed and treated and, if necessary, referred to a specific hospital. Individuals in the intervention group received further SMS reminders. The primary outcome was the mean attendance rate (the number of people per 10 000 population) at triage of those with confirmed eye conditions, as assessed at 4 weeks after sensitisation in the intention-to-treat population. We estimated the intervention effect using a Student's t-test on cluster-level rates. This trial is registered with Pan African Clinical Trial Registry, number 201807329096632. FINDINGS: Between Nov 26, 2018, and June 7, 2019, of the 85 community units in Trans Nzoia County, Kenya, 49 were excluded. We randomly allocated 18 community units each to the intervention group (68 348 individuals) and the control group (60 243 individuals). 9387 individuals from the intervention group and 3070 from the control group attended triage assessment. The mean attendance rate at triage by individuals with eye problems was 1429 (92% CI 1228–1629) in the intervention group and 522 (418–625) in the control group (rate difference 906 per 10 000 [95% CI 689–1124; p<0·0001]). INTERPRETATION: The Peek CEH system increased primary care attendance by people with eye problems compared with standard approaches, indicating the potential of this mobile health package to increase service uptake and guide appropriate task sharing. FUNDING: The Queen Elizabeth Diamond Jubilee Trust and Wellcome Trust.
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spelling pubmed-82396182021-06-29 Effectiveness of an mHealth system on access to eye health services in Kenya: a cluster-randomised controlled trial Rono, Hillary Bastawrous, Andrew Macleod, David Mamboleo, Ronald Bunywera, Cosmas Wanjala, Emmanuel Gichuhi, Stephen Burton, Matthew J Lancet Digit Health Articles BACKGROUND: There is limited access to eye health services in many low-income and middle-income populations. We aimed to assess the effectiveness in increasing service utilisation of the Peek Community Eye Health (Peek CEH) system, a smartphone-based referral system comprising decision support algorithms (Peek Community Screening app), SMS reminders, and real-time reporting. METHODS: In this cluster-randomised controlled trial of eye health in Kenya, community unit clusters were defined as one health centre and its catchment population. Clusters were randomly allocated (1:1) to receive Peek CEH and referral (intervention group) or standard care via periodic health centre-based outreach clinics and onward referral (control group). Individuals in the intervention group were assessed at home by screeners and those referred were asked to present for triage assessment in a central location. They received regular SMS reminders. In both groups, community sensitisation was done followed by a triage clinic at the cluster health centre 4 weeks after sensitisation. During triage, individuals in both groups were assessed and treated and, if necessary, referred to a specific hospital. Individuals in the intervention group received further SMS reminders. The primary outcome was the mean attendance rate (the number of people per 10 000 population) at triage of those with confirmed eye conditions, as assessed at 4 weeks after sensitisation in the intention-to-treat population. We estimated the intervention effect using a Student's t-test on cluster-level rates. This trial is registered with Pan African Clinical Trial Registry, number 201807329096632. FINDINGS: Between Nov 26, 2018, and June 7, 2019, of the 85 community units in Trans Nzoia County, Kenya, 49 were excluded. We randomly allocated 18 community units each to the intervention group (68 348 individuals) and the control group (60 243 individuals). 9387 individuals from the intervention group and 3070 from the control group attended triage assessment. The mean attendance rate at triage by individuals with eye problems was 1429 (92% CI 1228–1629) in the intervention group and 522 (418–625) in the control group (rate difference 906 per 10 000 [95% CI 689–1124; p<0·0001]). INTERPRETATION: The Peek CEH system increased primary care attendance by people with eye problems compared with standard approaches, indicating the potential of this mobile health package to increase service uptake and guide appropriate task sharing. FUNDING: The Queen Elizabeth Diamond Jubilee Trust and Wellcome Trust. Elsevier Ltd 2021-06-21 /pmc/articles/PMC8239618/ /pubmed/34167763 http://dx.doi.org/10.1016/S2589-7500(21)00083-2 Text en © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Articles
Rono, Hillary
Bastawrous, Andrew
Macleod, David
Mamboleo, Ronald
Bunywera, Cosmas
Wanjala, Emmanuel
Gichuhi, Stephen
Burton, Matthew J
Effectiveness of an mHealth system on access to eye health services in Kenya: a cluster-randomised controlled trial
title Effectiveness of an mHealth system on access to eye health services in Kenya: a cluster-randomised controlled trial
title_full Effectiveness of an mHealth system on access to eye health services in Kenya: a cluster-randomised controlled trial
title_fullStr Effectiveness of an mHealth system on access to eye health services in Kenya: a cluster-randomised controlled trial
title_full_unstemmed Effectiveness of an mHealth system on access to eye health services in Kenya: a cluster-randomised controlled trial
title_short Effectiveness of an mHealth system on access to eye health services in Kenya: a cluster-randomised controlled trial
title_sort effectiveness of an mhealth system on access to eye health services in kenya: a cluster-randomised controlled trial
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8239618/
https://www.ncbi.nlm.nih.gov/pubmed/34167763
http://dx.doi.org/10.1016/S2589-7500(21)00083-2
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