Globally, at least 2.2 billion people have a vision impairment, of whom 1 billion have an impairment that could have been prevented or treated yet remains unaddressed. Universal access to eye care is essential to universal health coverage and extensive evidence shows that improving eye health contributes to achieving many sustainable development goals, including reducing poverty and improving work productivity, general and mental health, and education and equity. However, there are several barriers to accessing eye care services, including cost, lack of health insurance, trust in the service, communication, transportation, and distance to eye care facilities.

This study seeks to understand the barriers to accessing eye services, as perceived by patients (or their proxies) who have been referred to receive eye care but did not attend in the context of school and community-based screening programmes. We also seek to elicit potential interventions or service modifications that would have enabled non-attenders to receive the care they need.
This is a multi-phased mixed methods study design. First, we will conduct 80 interviews with non-attenders purposively selected from the sociodemographic subgroups within each screening programme that have the lowest overall attendance rate. We will explore their perceptions of barriers and potential service modifications that could boost attendance at eye clinics. We have used the Levesque and Obrist frameworks to develop a bespoke a priori deductive coding tool for analysis of qualitative data. Space will be made for the inductive identification of themes that are not necessarily captured in the framework.

Second, the list of barriers and mooted service modifications will be sent to a representative sample of 384 non-attenders in each setting using an online survey. We will ask this wider group to rank the options by likely impact.

Finally, this prioritised list of potential service modifications will be discussed with a purposively selected groups of service managers, programme implementers, and national and regional eye care policymakers at a workshop to assess each according to likely impact, feasibility, cost, and potential risks. The highest-ranked service modification(s) will be implemented and evaluated in a follow-on randomised controlled trial, the methods for which will be reported elsewhere.

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