Research briefing
Title: A review of evidence to evaluate
effectiveness of intervention strategies to
address inequalities in eye health care
Introduction
In 2010, RNIB commissioned Mary Seacole Research Centre (MSRC) at De
Montfort University to undertake a review of the evidence relating to the
causes of inequalities in eye health, and interventions to reduce inequalities,
with particular reference to ethnicity, age, and socio-economic deprivation.
The focus was on preventive activity in relation to specified eye conditions
(glaucoma, diabetic retinopathy, age-related macula degeneration (AMD)
and cataract) and interventions designed to improve eye health outcomes.
This report presents the findings of the review and provides avenues of
interest for the development of intervention strategies to address inequalities
in eye health care
Method
The authors adopted the conventional rules of Systematic Reviews to
ensure comprehensive coverage of databases of published reports and
journals. The review also included current research in practice, grey
literature, good practice activities, and Third Sector initiatives. All searches
and fieldwork were conducted between September 2010 and January 2011.
In line with the rules of Systematic Reviews, all evidence collected during
the review was graded according to the strength of evidence. A summary of
the evidence collected and graded during the review is contained in an
annex to the report.
Inclusion criteria were deliberately set broadly, to ensure that all work that
might be applicable to the UK practice setting, and to minority groups
present in significant numbers in the UK, was included. Exclusion criteria
included intervention studies prior to 1990 and studies involving children.
Studies that did not provide adequate description or explanation of the
composition of ‘at risk’ groups were also excluded. Descriptive studies
without an intervention were considered, and included if they contributed to
the overall findings.
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The focus of the review was on preventive activity, rather than treatment of
established sight loss and eye disease. As such, studies detailing
advancements in clinical or surgical treatments without reference to a clear
preventative intervention were excluded.
Key messages from the research
The review found that the majority of studies into inequality in eye health
have concentrated on the needs of those found to have sight loss and the
maintenance of their quality of life, or on treatments, rather than on the
potential to prevent sight loss through earlier detection.
Previous research consistently points towards targeted interventions and
specific approaches. However, they often have differing levels of evaluation.
Despite this, certain interventions recur as recommendations from research,
or as the focus of short-term projects expected to bring about change.
Based on the review the following recommendations were made:
1.
Awareness raising and information provision in targeted media
campaigns
The evidence indicates that it is necessary to identify and use media specific
to the at-risk group of interest. General press or media releases are unlikely
to meet this need and campaigns should be explicitly targeted at risk groups.
2.
The use of Eye Health Champions
This approach seems to be the most likely to offer potential to succeed.
Properly designed research should include formal evaluation, which follows
the intervention to a point where measurable outcomes have been reported.
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Motivational Interviewers or other forms of Personal Support
Several reports focused on strategies leading to the training or
‘empowerment’ of service users. While promising, few were able to show
clear clinical outcomes although they all state that the processes involved
were popular among both practitioners and patients.
3.
Professional Development and Training of Service delivery staff
There remain shortcomings in the ability of service delivery staff to recognise
need or to support members of at-risk groups properly to access and adhere
to programmes of preventive eye health. Staff training is necessary.
4.
Structural Changes in service delivery
There is a weakness in systems of service delivery, including data recording
and monitoring, and tracking of patients along care pathways. There is
evidently scope for improvement, although no published papers report
interventions that demonstrate effects on inequality.
In summary
The report sought to review the evidence relating to the causes of
inequalities in eye health, and interventions to reduce inequalities, with
particular reference to ethnicity, age, and socio-economic deprivation. The
review included published reports and articles, current research in practice,
grey literature, good practice activities, and Third Sector initiatives.
The review identified that the majority of studies into inequality in eye health
have concentrated on the needs of those found to have sight loss, and the
maintenance of their quality of life, or on treatments, rather than on the
potential to prevent sight loss through earlier detection. Reports consistently
argue for targeted interventions and specific approaches. However, the
research often has differing levels of evaluation and very little research has
reported longer-term clinical outcomes.
To download the full research report visit:
© RNIB, 2011
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