[et_pb_section fb_built=”1″ admin_label=”section” _builder_version=”4.16″ custom_padding=”||43px|||” global_colors_info=”{}”][et_pb_row _builder_version=”4.16″ custom_padding=”12px||0px|||” locked=”off” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ global_colors_info=”{}”][et_pb_text _builder_version=”4.27.4″ text_font=”||||||||” header_font=”Roboto||||||||” header_text_color=”#323232″ header_font_size=”40px” header_line_height=”1.2em” max_width=”85%” module_alignment=”center” custom_margin=”||19px|||” global_colors_info=”{}”]<\/p>\n
[\/et_pb_text][et_pb_divider color=”#003389″ divider_weight=”3px” _builder_version=”4.16″ width=”100%” max_width=”21%” module_alignment=”left” custom_margin=”|||0px|false|false” custom_padding=”|||80px|false|false” global_colors_info=”{}”][\/et_pb_divider][et_pb_video src=”https:\/\/youtu.be\/Gj9M7w0S4PM?si=xkhSs2x0MbVBRcWY” _builder_version=”4.27.4″ _module_preset=”default” width=”100%” max_width=”85%” module_alignment=”center” global_colors_info=”{}”][\/et_pb_video][et_pb_text quote_border_color=”#29398e” _builder_version=”4.27.4″ text_font=”|600|||||||” text_text_color=”#323232″ link_text_color=”#3344dd” quote_font_size=”15px” header_font=”Roboto||||||||” header_text_color=”#323232″ header_2_font_size=”18px” header_3_font_size=”16px” max_width=”85%” module_alignment=”center” min_height=”88px” custom_margin=”-13px||40px||false|false” custom_padding=”0px||0px|||” global_colors_info=”{}”]<\/p>\n
Despite the tireless efforts of eye health workers, more than a billion people worldwide live with avoidable vision loss, and numbers are growing. Radical new approaches are needed.<\/p>\n
Most cases of vision loss can be treated or prevented, but the challenge is getting treatment to the people who need it most.<\/p>\n
Services need evidence-based, localised solutions to ensure that people receive treatment for eye conditions. Under-resourced programmes in low and middle-income countries (LMICs) often don\u2019t have the capacity to carry out studies that would help improve their services.<\/p>\n
<\/strong><\/p>\n The project aims to address this challenge by developing ways for eye health services to rapidly improve their efficiency by reaching the people least likely to attend services.<\/p>\n The main activity has been to develop and validate an agile service improvement methodology.<\/p>\n Essentially, this allows eye health service managers in LMICs to conduct high-quality implementation studies within existing eye care programmes.<\/p>\n The project is in collaboration with ICEH\u2019s close partner Peek Vision<\/a>, a social enterprise which provides a software system and data intelligence platform that tracks eye health patients from screening to diagnosis and treatment.<\/p>\n The project uses Peek to carry out rapid testing of new interventions to improve access, without the immense resources, timescales and specialist skills typically required to conduct such studies.<\/p>\n Example<\/em><\/strong><\/p>\n <\/em><\/p>\n In an eye care programme in country X, the data from Peek shows that older women are the least likely to come to follow-up appointments and receive treatment (e.g. glasses or cataract surgery).<\/em><\/em><\/p>\n <\/em><\/p>\n <\/em><\/p>\n <\/em><\/p>\n <\/em><\/p>\n <\/em><\/p>\n A group of older women from the local area are brought together for focused interviews, and provide feedback on why they didn\u2019t attend services. Some of the reasons could be a lack of time, transport or information on where the follow-up services are. These interventions are then ranked by a wider pool of older women via phone interviews.<\/em><\/em><\/p>\n Lack of transport is identified as a key issue for the group, and subsidised transport to the local hospital proposed as a solution. Within the existing eye care programme, participants are split into a control and intervention arm, with people in the intervention arm offered subsidised transport.The Peek software platform tracks how many people are screened, receive the intervention, and reach treatment.\u00a0<\/em><\/em><\/p>\n After two weeks, a statistical limit built into the programme is met, with the group receiving transport shown to be attending treatment more often. The intervention is then rolled out across the programme immediately, increasing the number of people who successfully receive eye treatment. The rapid nature of the trial means that programmes with few resources can implement successful changes quickly.\u00a0<\/em><\/p>\n <\/em><\/p>\n<\/blockquote>\n The interventions are local and contextual, proposed by the individuals facing the greatest barriers to care themselves, so can improve uptake of services in that specific area. They are also found at much lower cost and with fewer resources than a typical trial.<\/p>\n <\/p>\n An initial trial of the project was carried out in Meru County, Kenya.<\/p>\n In this area, only 46% of people identified with an eye problem during screening go on to access local clinics, with younger adults (those aged 18-44) being the least likely to receive care. In previous work, our team conducted interviews with non-attenders from this \u2018left-behind\u2019 group to explore how access to essential eye services could be equitably improved. They told us that better counselling and SMS reminders would improve access.<\/p>\n We developed enhanced counselling and SMS reminders, and tested them among two groups in Meru\u2019s ongoing screening programme using Peek technology. Every seven days, an algorithm assessed whether more people in one arm were attending clinics according to statistical rules.<\/p>\n The algorithm stopped the trial after 30 days based on analysis of outcome data from 879 people. The attendance rate in 18-44 year olds was 32.1% in the control arm vs 39.0% in the intervention arm (it made no difference among other age groups).<\/p>\n This initial trial showed that an intervention suggested by an underserved population increased access to care. The embedded, adaptive, equity-focused approach has broad applications, and could potentially improve access to treatment across health care.<\/p>\n <\/strong><\/p>\n Future research will involve validating and refining the process so that it can be implemented across Peek-powered programmes, and scaling the model to address other health conditions, while also going beyond improving access to improving the quality of care received.<\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row disabled_on=”on|off|off” _builder_version=”4.27.4″ custom_padding=”12px|||||” locked=”off” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ global_colors_info=”{}”][et_pb_text quote_border_color=”#29398e” _builder_version=”4.27.4″ text_font=”|600|||||||” text_text_color=”#323232″ link_text_color=”#3344dd” quote_font_size=”15px” header_font=”Roboto||||||||” header_text_color=”#323232″ header_2_font_size=”18px” header_3_font_size=”16px” max_width=”85%” module_alignment=”center” min_height=”88px” custom_margin=”0px||50px||false|false” custom_padding=”0px||0px|||” global_colors_info=”{}”]<\/p>\n Below are links to further videos that outline different elements of the project.<\/p>\n 1. Highlighting the equity driver behind the project:<\/p>\n [\/et_pb_text][et_pb_button button_url=”https:\/\/www.loom.com\/share\/4051a4bb089c4853802999c93b7c75a6″ button_text=”Watch video” button_alignment=”left” _builder_version=”4.27.4″ _module_preset=”default” custom_button=”on” button_text_size=”18px” button_text_color=”#ffffff” button_bg_color=”#003389″ button_border_width=”2px” custom_margin=”-35px||40px|80px|false|false” custom_padding=”5px||||false|false” global_colors_info=”{}”][\/et_pb_button][et_pb_text quote_border_color=”#29398e” _builder_version=”4.27.4″ text_font=”|600|||||||” text_text_color=”#323232″ link_text_color=”#3344dd” quote_font_size=”15px” header_font=”Roboto||||||||” header_text_color=”#323232″ header_2_font_size=”18px” header_3_font_size=”16px” max_width=”85%” module_alignment=”center” min_height=”88px” custom_margin=”-13px||0px||false|false” custom_padding=”0px||0px|||” global_colors_info=”{}”]<\/p>\n 2. The kick-off meeting for the project:<\/p>\n [\/et_pb_text][et_pb_button button_url=”https:\/\/www.loom.com\/share\/fa65512da4ce4155832300b9d6954103″ button_text=”Watch video” button_alignment=”left” _builder_version=”4.27.4″ _module_preset=”default” custom_button=”on” button_text_size=”18px” button_text_color=”#ffffff” button_bg_color=”#003389″ button_border_width=”2px” custom_margin=”-50px||40px|80px|false|false” custom_padding=”5px||||false|false” global_colors_info=”{}”][\/et_pb_button][et_pb_text quote_border_color=”#29398e” _builder_version=”4.27.4″ text_font=”|600|||||||” text_text_color=”#323232″ link_text_color=”#3344dd” quote_font_size=”15px” header_font=”Roboto||||||||” header_text_color=”#323232″ header_2_font_size=”18px” header_3_font_size=”16px” max_width=”85%” module_alignment=”center” min_height=”88px” custom_margin=”-13px||0px||false|false” custom_padding=”0px||0px|||” global_colors_info=”{}”]<\/p>\n 3. Project mid-term review (the project was referred to as IM SEEN at this time):<\/p>\n [\/et_pb_text][et_pb_button button_url=”https:\/\/www.loom.com\/share\/46cc98577dc3426babb68cdee2df63e4″ button_text=”Watch video” button_alignment=”left” _builder_version=”4.27.4″ _module_preset=”default” custom_button=”on” button_text_size=”18px” button_text_color=”#ffffff” button_bg_color=”#003389″ button_border_width=”2px” custom_margin=”-50px||40px|80px|false|false” custom_padding=”5px||||false|false” global_colors_info=”{}”][\/et_pb_button][et_pb_text quote_border_color=”#29398e” _builder_version=”4.27.4″ text_font=”|600|||||||” text_text_color=”#323232″ link_text_color=”#3344dd” quote_font_size=”15px” header_font=”Roboto||||||||” header_text_color=”#323232″ header_2_font_size=”18px” header_3_font_size=”16px” max_width=”85%” module_alignment=”center” min_height=”88px” custom_margin=”-13px||0px||false|false” custom_padding=”0px||0px|||” global_colors_info=”{}”]<\/p>\n 4. The final methodology (the project having led to a ‘Fair Access’ model):<\/p>\n [\/et_pb_text][et_pb_button button_url=”https:\/\/www.loom.com\/share\/333a12006f9b4d55a92fd8d993090d33″ button_text=”Watch video” button_alignment=”left” _builder_version=”4.27.4″ _module_preset=”default” custom_button=”on” button_text_size=”18px” button_text_color=”#ffffff” button_bg_color=”#003389″ button_border_width=”2px” custom_margin=”-50px||40px|80px|false|false” custom_padding=”5px||||false|false” global_colors_info=”{}”][\/et_pb_button][\/et_pb_column][\/et_pb_row][et_pb_row disabled_on=”off|on|on” _builder_version=”4.27.4″ custom_padding=”12px|||||” locked=”off” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ global_colors_info=”{}”][et_pb_text quote_border_color=”#29398e” _builder_version=”4.27.4″ text_font=”|600|||||||” text_text_color=”#323232″ link_text_color=”#3344dd” quote_font_size=”15px” header_font=”Roboto||||||||” header_text_color=”#323232″ header_2_font_size=”18px” header_3_font_size=”16px” max_width=”85%” module_alignment=”center” min_height=”88px” custom_margin=”0px||50px||false|false” custom_padding=”0px||0px|||” global_colors_info=”{}”]<\/p>\n Below are links to videos that outline different elements of the project.<\/p>\n 1. Highlighting the equity driver behind the project:<\/p>\n [\/et_pb_text][et_pb_button button_url=”https:\/\/www.loom.com\/share\/4051a4bb089c4853802999c93b7c75a6″ button_text=”Watch video” button_alignment=”left” _builder_version=”4.27.4″ _module_preset=”default” custom_button=”on” button_text_size=”18px” button_text_color=”#ffffff” button_bg_color=”#003389″ button_border_width=”2px” custom_margin=”-35px||40px|80px|false|false” custom_padding=”5px||||false|false” global_colors_info=”{}”][\/et_pb_button][et_pb_text quote_border_color=”#29398e” _builder_version=”4.27.4″ text_font=”|600|||||||” text_text_color=”#323232″ link_text_color=”#3344dd” quote_font_size=”15px” header_font=”Roboto||||||||” header_text_color=”#323232″ header_2_font_size=”18px” header_3_font_size=”16px” max_width=”85%” module_alignment=”center” min_height=”88px” custom_margin=”-13px||0px||false|false” custom_padding=”0px||0px|||” global_colors_info=”{}”]<\/p>\n 2. The kick-off meeting for the project:<\/p>\n [\/et_pb_text][et_pb_button button_url=”https:\/\/www.loom.com\/share\/fa65512da4ce4155832300b9d6954103″ button_text=”Watch video” button_alignment=”left” _builder_version=”4.27.4″ _module_preset=”default” custom_button=”on” button_text_size=”18px” button_text_color=”#ffffff” button_bg_color=”#003389″ button_border_width=”2px” custom_margin=”-40px||40px|80px|false|false” custom_padding=”5px||||false|false” global_colors_info=”{}”][\/et_pb_button][et_pb_text quote_border_color=”#29398e” _builder_version=”4.27.4″ text_font=”|600|||||||” text_text_color=”#323232″ link_text_color=”#3344dd” quote_font_size=”15px” header_font=”Roboto||||||||” header_text_color=”#323232″ header_2_font_size=”18px” header_3_font_size=”16px” max_width=”85%” module_alignment=”center” min_height=”88px” custom_margin=”-13px||0px||false|false” custom_padding=”0px||0px|||” global_colors_info=”{}”]<\/p>\n 3. Project mid-term review (the project was referred to as IM SEEN at this time):<\/p>\n [\/et_pb_text][et_pb_button button_url=”https:\/\/www.loom.com\/share\/46cc98577dc3426babb68cdee2df63e4″ button_text=”Watch video” button_alignment=”left” _builder_version=”4.27.4″ _module_preset=”default” custom_button=”on” button_text_size=”18px” button_text_color=”#ffffff” button_bg_color=”#003389″ button_border_width=”2px” custom_margin=”-20px||40px|80px|false|false” custom_padding=”5px||||false|false” global_colors_info=”{}”][\/et_pb_button][et_pb_text quote_border_color=”#29398e” _builder_version=”4.27.4″ text_font=”|600|||||||” text_text_color=”#323232″ link_text_color=”#3344dd” quote_font_size=”15px” header_font=”Roboto||||||||” header_text_color=”#323232″ header_2_font_size=”18px” header_3_font_size=”16px” max_width=”85%” module_alignment=”center” min_height=”88px” custom_margin=”-13px||0px||false|false” custom_padding=”0px||0px|||” global_colors_info=”{}”]<\/p>\n 4. The final methodology (the project having led to a ‘Fair Access’ model):<\/p>\n [\/et_pb_text][et_pb_button button_url=”https:\/\/www.loom.com\/share\/333a12006f9b4d55a92fd8d993090d33″ button_text=”Watch video” button_alignment=”left” _builder_version=”4.27.4″ _module_preset=”default” custom_button=”on” button_text_size=”18px” button_text_color=”#ffffff” button_bg_color=”#003389″ button_border_width=”2px” custom_margin=”-20px||40px|80px|false|false” custom_padding=”5px||||false|false” global_colors_info=”{}”][\/et_pb_button][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.16″ custom_padding=”12px|||||” locked=”off” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ global_colors_info=”{}”][et_pb_text quote_border_color=”#29398e” _builder_version=”4.27.4″ text_font=”|600|||||||” text_text_color=”#323232″ link_text_color=”#3344dd” quote_font_size=”15px” header_font=”Roboto||||||||” header_text_color=”#323232″ header_2_font_size=”18px” header_3_font_size=”16px” max_width=”85%” module_alignment=”center” min_height=”74px” custom_margin=”0px||15px||false|false” custom_padding=”0px||0px|||” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n Allen LN, Kim MJ, Gichangi M, et al. Enhanced patient counselling and SMS reminder messages to improve access to community-based eye care services in Meru, Kenya: an embedded, pragmatic, individual-level, randomised, controlled, adaptive platform trial. The Lancet Global Health<\/em>. Jan 2026. https:\/\/doi.org\/10.1016\/S2214-109X(25)00401-2<\/a><\/p>\n Allen L, Karanja S, Gichangi M, et al. Identifying barriers and potential solutions to improve equitable access to community eye services in central Kenya: a rapid exploratory sequential mixed methods study. BMJ Open. 2024. https:\/\/doi.org\/10.1136\/bmjopen-2023-082975<\/a><\/p>\n Allen L, Kim M, Tlhajoane M, et al. Protocol for an adaptive platform trial of intended service user-derived interventions to equitably reduce non-attendance in eye screening programmes in Botswana, India, Kenya & Nepal. BMJ Open. 2024.\u00a0 https:\/\/doi.org\/10.1136\/bmjopen-2024-085353<\/a><\/p>\n Allen L N, Karanja S, Gichangi M, Bunywera C, Rono H, Macleod D, Kim MJ, Tlhajoane M, Burton MJ, Ramke J, Bolster NM, Bastawrous A. Access to community-based eye services in Meru, Kenya: a cross-sectional equity analysis. Int J Equity Health 23, 170 (2024). https:\/\/doi.org\/10.1186\/s12939-024-02244-x<\/a><\/p>\n Allen LN, Azab H, Jonga R. Rapid methods for identifying barriers and solutions to improve access to community health services: a scoping review protocol.\u00a0BMJ Open.\u00a0<\/em>March 2023.\u00a0https:\/\/doi.org\/10.1136\/bmjopen-2022-066804<\/a><\/p>\n Allen, LN, Nkomazana O, Mishra SK et al. Improvement studies for equitable and evidence-based innovation: an overview of the \u2018IM-SEEN\u2019 model. Int J Equity Health.<\/em> June 2023. https:\/\/doi.org\/10.1186\/s12939-023-01915-5<\/a><\/p>\n Allen LN, Nkomazana O, Kumar Mishra S et al. Sociodemographic characteristics of community eye screening participants: protocol for cross-sectional equity analyses in Botswana, India, Kenya, and Nepal. Wellcome Open Research. <\/em>November 2023. https:\/\/doi.org\/10.12688\/wellcomeopenres.17768.2<\/a><\/p>\n McCormick I, Kim MJ, Hydara A et al. Socioeconomic position and eye health outcomes: identifying inequality in rapid population-based surveys.\u00a0BMJ Open. <\/em>March 2023.\u00a0\u00a0<\/em>https:\/\/doi.org\/10.1136\/bmjopen-2022-069325<\/a><\/p>\n Allen LN, Azab H, Jonga R, et al. Rapid methods for identifying barriers and solutions to improve access to community health services: a scoping review. BJGP Open<\/em>. December 2023. https:\/\/doi.org\/10.3399\/BJGPO.2023.0047<\/a><\/p>\n Allen LN, Mackinnon S, Gordon I et al. Performance and Resource Requirements of In-Person, Voice Call, and Automated Telephone-Based Socioeconomic Data Collection Modalities for Community-Based Health Programs: A Systematic Review. JAMA Network Open<\/em>. November 2022.\u00a0 https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.43883<\/a><\/p>\n Allen LN, Ratshaa B, Macleod D. Protocol for an automated, pragmatic, embedded, adaptive randomised controlled trial: behavioural economics-informed mobile phone-based reminder messages to improve clinic attendance in a Botswanan school-based vision screening programme.\u00a0Trials.\u00a0<\/em>August 2022. https:\/\/doi.org\/10.1186\/s13063-022-06519-y<\/a><\/p>\n Allen LN, Mackinnon S, Gordon I. Performance and Resource Requirements of In-Person, Voice Call, and Automated Telephone-Based Socioeconomic Data Collection Modalities for Community-Based Health Programs: A Systematic Review Protocol.\u00a0BMJ Open.\u00a0<\/em>April 2022. https:\/\/doi.org\/10.1136\/bmjopen-2021-057410<\/a><\/p>\n <\/p>\n <\/p>\n The Fair Access framework is funded by a Wellcome Trust Collaborative Award in Science and funding from the National Institute for Health Research (NIHR) using Official Development Assistance (ODA) funding.<\/p>\n https:\/\/wellcome.org\/grant-funding\/people-and-projects\/grants-awarded\/peek-practice-based-evidence-framework<\/p>\n The work is being led by the International Centre for Eye Health (ICEH) at London School of Hygiene & Tropical Medicine, in partnership with Peek Vision, the University of Botswana and the Ministry of Health, Kenya.<\/p>\n Additional work is taking place in Nepal with Nepal Netra Jyoti Sangh (NNJS), and in India with Dr Shroff\u2019s Charity Eye Hospital.<\/p>\nThe Project<\/strong><\/strong><\/h2>\n
\n
Activities<\/strong><\/h2>\n
Future work<\/strong><\/h2>\n
Videos<\/strong><\/h2>\n
Videos<\/strong><\/h2>\n
Publications<\/strong><\/h2>\n
Acknowledgements<\/strong><\/h3>\n