The University of New South Wales, Sydney, New South Wales, Australia.
The George Institute for Global Health, New Delhi, India.
Ophthalmic Physiol Opt. 2021 May;41(3):565-581. doi: 10.1111/opo.12815. Epub 2021 Apr 16.
This study investigates how and in what circumstances a school-based eye health programme, the Refractive Errors Among CHildren (REACH) programme, achieved its desired outcomes: accessibility, standards of refractive care, fidelity and availability of comprehensive services, for over 2 million school children in six districts across India.
We conducted a realist evaluation to identify programme aspects and their causal relationships with outcomes. Deductive and inductive thematic analysis of qualitative data included three phases: 1. theory gleaning, 2. eliciting programme theory, 3. revisiting programme theory. The Initial Programme Theories (IPTs) were developed and revised through review of the literature, programme documents and field notes. We reviewed informal and formal discussions from the participatory advisory workshops and conducted semi-structured interviews with key stakeholders for the development and refinement of the IPTs. We based our analysis on the programme designers' perspective; used contexts, mechanisms and outcomes configuration for the analysis and presentation of the findings and reported the revised IPTs for the REACH programme.
We identified four major programme aspects of the REACH programme for evaluation: programme governing unit, human resource, innovation and technology and funding. Based on the intended outcomes of the programme, themes and contexts were sorted and IPTs were defined. We revised the IPTs based on the analysis of the interviews (n = 19). The contexts and mechanisms that were reported to have potential influence on the attainment of favourable programme outcomes were identified. The revisions to the IPTs included: co-designing a collaborative model and involving local government officials to reinforce trust, community partnerships; local well-trained staff to encourage participation; use of the web-based data capturing system with built-in quality control measures and continued technical support; pre-determined costs and targets for the outputs promoted transparency and adherence with costs.
This process provided a comprehensive understanding of the opportunities and possibilities for a large-scale school eye health programme in diverse local contexts in India. This illustrated the importance of embracing principles of system thinking and considering contextual factors for School Eye Health programmes in low and middle-income countries.
本研究旨在探讨基于学校的眼健康计划——儿童屈光不正研究（REACH）计划——如何以及在何种情况下实现其预期目标：在印度六个地区的 200 多万名学童中实现可及性、屈光护理标准、保真度和综合服务的可用性。
我们进行了一项实际评估，以确定计划的各个方面及其与结果的因果关系。对定性数据进行了演绎和归纳主题分析，包括三个阶段：1. 理论收集，2. 引出计划理论，3. 重新审视计划理论。初始计划理论（IPTs）是通过对文献、计划文件和实地笔记的审查而制定和修订的。我们审查了参与性咨询研讨会的非正式和正式讨论，并对主要利益攸关方进行了半结构化访谈，以制定和完善 IPTs。我们的分析基于计划设计者的观点；使用背景、机制和结果配置来分析和呈现研究结果，并报告了 REACH 计划的修订 IPTs。
我们确定了 REACH 计划的四个主要评估方面：计划管理单位、人力资源、创新和技术以及资金。根据计划的预期结果，对主题和背景进行了分类，并确定了 IPTs。我们根据访谈的分析（n=19）修订了 IPTs。确定了报告对实现有利计划结果有潜在影响的背景和机制。对 IPTs 的修订包括：共同设计合作模式并纳入地方政府官员以加强信任、社区伙伴关系；当地受过良好培训的工作人员以鼓励参与；使用具有内置质量控制措施的基于网络的数据采集系统，并持续提供技术支持；预先确定产出的成本和目标以提高透明度和遵守成本。
该过程提供了对印度不同地方背景下大规模学校眼健康计划的机会和可能性的全面了解。这说明了在低收入和中等收入国家中，考虑系统思维原则和考虑学校眼健康计划的背景因素的重要性。
