School of Optometry & Vision Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
Centre for Health Equity Training Research & Evaluation, University of New South Wales, Sydney, New South Wales, Australia.
BMJ Glob Health. 2021 Sep;6(9). doi: 10.1136/bmjgh-2021-006188.
People who are distinct from the dominant ethnic group within a country can experience a variety of barriers to accessing eyecare services. We conducted a scoping review to map published interventions aimed at improving access to eyecare for non-Indigenous, non-dominant ethnic groups residing in high-income countries.
We searched MEDLINE, Embase and Global Health for studies that described an intervention to promote access to eyecare for the target population. Two authors independently screened titles and abstracts followed by review of the full text of potentially relevant sources. For included studies, data extraction was carried out independently by two authors. Findings were summarised using a combination of descriptive statistics and thematic analysis.
We screened 5220 titles/abstracts, of which 82 reports describing 67 studies met the inclusion criteria. Most studies were conducted in the USA (90%), attempted to improve access for Black (48%) or Latinx (28%) communities at-risk for diabetic retinopathy (42%) and glaucoma (18%). Only 30% included the target population in the design of the intervention; those that did tended to be larger, collaborative initiatives, which addressed both patient and provider components of access. Forty-eight studies (72%) evaluated whether an intervention changed an outcome measure. Among these, attendance at a follow-up eye examination after screening was the most common (n=20/48, 42%), and directly supporting patients to overcome barriers to attendance was reported as the most effective approach. Building relationships between patients and providers, running coordinated, longitudinal initiatives and supporting reduction of root causes for inequity (education and economic) were key themes highlighted for success.
Although research evaluating interventions for non-dominant, non-Indigenous ethnic groups exist, key gaps remain. In particular, the paucity of relevant studies outside the USA needs to be addressed, and target communities need to be involved in the design and implementation of interventions more frequently.
与一个国家的主流民族不同的人可能会在获得眼科保健服务方面面临各种障碍。我们进行了一项范围性综述，以绘制发表的旨在改善居住在高收入国家的非土著、非主要族裔群体获得眼科保健服务的干预措施图。
我们在 MEDLINE、Embase 和全球卫生数据库中搜索了描述针对目标人群促进获得眼科保健服务的干预措施的研究。两名作者独立筛选标题和摘要，然后对可能相关来源的全文进行审查。对于纳入的研究，两名作者分别进行数据提取。使用描述性统计和主题分析相结合的方法总结研究结果。
我们筛选了 5220 篇标题/摘要，其中 82 篇报告描述了 67 项符合纳入标准的研究。大多数研究在美国进行（90%），旨在改善处于糖尿病视网膜病变（42%）和青光眼（18%）风险的黑人（48%）或拉丁裔（28%）社区的获得途径。只有 30%的研究将目标人群纳入干预设计；这些研究往往是规模更大、协作性更强的倡议，同时解决了获得途径的患者和提供者两个方面。48 项研究（72%）评估了干预措施是否改变了一个结果衡量标准。在这些研究中，最常见的是在筛查后参加后续眼科检查（n=20/48，42%），而报告最有效的方法是直接支持患者克服参加的障碍。建立患者和提供者之间的关系、开展协调的、纵向的倡议以及支持减少不平等的根本原因（教育和经济）是取得成功的关键主题。
尽管有针对非主要、非土著族裔群体的干预措施研究，但仍存在关键差距。特别是，需要解决美国以外缺乏相关研究的问题，并且目标社区需要更频繁地参与设计和实施干预措施。
