Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, Shanghai, China.
Shanghai Eye Disease Prevention and Treatment Center, Shanghai, Shanghai, China.
BMJ Paediatr Open. 2024 Apr 17;8(1):e002459. doi: 10.1136/bmjpo-2023-002459.
To identify determinants of the utilisation of ophthalmic clinical health services among students who failed school vision screening.
This study employed a sequential explanatory mixed methods design, underpinned by Andersen's Behavioural Model of Health Service Utilisation. Data were initially gathered through interviews with 27 stakeholders-comprising 5 ophthalmologists, 7 community doctors, 7 public health professionals and 8 teachers. The qualitative insights informed the construction of a questionnaire, which subsequently garnered responses from 6215 participants. Qualitative data underwent thematic analysis with NVivo V.12, while quantitative data were analysed using multivariable multinomial logistic regression in SAS V.9.4. Data integration was performed using the Pillar Integration Process for a deductive, evidence-based synthesis of findings.
The research revealed that students attending vision demonstration schools and receiving encouragement from schools or communities to access clinical ophthalmic services demonstrated higher adherence to referral (OR=1.66, 95% CI 1.30 to 2.12; OR=1.54, 95% CI 1.33 to 1.80). Conversely, older students and those from higher-income families exhibited lower adherence rates (OR=0.31, 95% CI 0.23 to 0.44; OR=0.34, 95% CI 0.25 to 0.46). Moreover, students with less urgent medical needs were more likely to adhere to referrals compared with those needing immediate referrals (OR=1.24, 95% CI 1.06 to 1.45).Four pillars emerged: (a) adherence decreased with age, (b) financial constraints did not pose an obstacle, (c) public health services played a critical role, (d) referral urgency did not linearly correlate with adherence.
The utilisation of ophthalmic clinical health services following vision screening failure in students is significantly influenced by public health services provided by schools or communities, such as prompting those with abnormal screening results to access ophthalmic clinical health services.
确定在学校视力筛查失败的学生中，眼科临床卫生服务利用的决定因素。
本研究采用顺序解释性混合方法设计，以安德森卫生服务利用行为模型为基础。数据最初通过对 27 名利益相关者（包括 5 名眼科医生、7 名社区医生、7 名公共卫生专业人员和 8 名教师）进行访谈收集。定性见解为构建问卷提供了信息，随后该问卷从 6215 名参与者那里获得了回应。使用 NVivo V.12 对定性数据进行主题分析，同时使用 SAS V.9.4 对定量数据进行多变量多项逻辑回归分析。使用 Pillar 综合过程对数据进行整合，以对研究结果进行演绎、基于证据的综合。
研究表明，参加视力示范学校的学生和从学校或社区获得鼓励以获得临床眼科服务的学生，对转诊的依从性更高（OR=1.66，95%CI 1.30 至 2.12；OR=1.54，95%CI 1.33 至 1.80）。相反，年龄较大的学生和来自高收入家庭的学生的依从率较低（OR=0.31，95%CI 0.23 至 0.44；OR=0.34，95%CI 0.25 至 0.46）。此外，与需要立即转诊的学生相比，医疗需求不那么紧急的学生更有可能遵守转诊（OR=1.24，95%CI 1.06 至 1.45）。出现了四个支柱：（a）随着年龄的增长，依从性降低，（b）财务限制不是障碍，（c）公共卫生服务发挥了关键作用，（d）转诊的紧迫性与依从性没有线性关系。
在学生视力筛查失败后，眼科临床卫生服务的利用受到学校或社区提供的公共卫生服务的显著影响，例如促使那些筛查结果异常的学生获得眼科临床卫生服务。
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