BMJ public health · 2026
Identifying barriers and potential solutions to improve equitable access to community eye services in central Kenya: a rapid exploratory sequential mixed methods study.
СтатьяНазвание и аннотация: Перевод в очереди
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Allen Luke N, Karanja Sarah, Gichangi Michael, Bunywera Cosmas, Muturi Emmaculate, Gachobi Dickson, Kathure Purity, Muasa Elizabeth Mutile, Mutwiri Lorna, Kajuju Lorna, Kagwiria Faith, Ntabathia Benjamin, Rono Hillary, Macleod David, Kim Min, Tlhajoane Malebogo, Burton Matthew J, Ramke Jacqueline, Bolster Nigel M, Bastawrous Andrew
Аннотация
BACKGROUND: Recent research has found that less than half of people identified with an eye problem in Meru county's screening programme were able to access care, with younger adults being the least likely to receive the care they needed. We aimed to interview and survey members of this 'left-behind' group to explore barriers and identify potential solutions using a rapid mixed-methods approach.
METHODS: First, we conducted interviews to explore perceptions of barriers and potential solutions. Next, we asked a representative sample to rank the suggested solutions by likely impact. Finally, we held a multistakeholder workshop to identify which of the top-ranked interventions offered the best balance of impact, feasibility, cost and potential risks. We used a deductive matrix and thematic analysis to rapidly analyse the interview data.
RESULTS: We conducted 67 interviews. Barriers to access included long queues, conflicting work engagements and lack of clear information. Proposed solutions focused on reducing queue lengths, providing better counselling and clinic information, holding mop-up clinics and maintaining adequate stocks and supplies. We conducted ranking surveys with 401 additional people from the left-behind group. All proposed solutions were ranked at moderately-to-highly likely to improve equitable access. Fifteen people attended the multistakeholder meeting, including community representatives. Workshop participants unanimously selected enhanced counselling and SMS reminders as the interventions that offered the best balance of impact, risk, cost and feasibility. The other proposed solutions were deemed impractical or unaffordable.
CONCLUSIONS: Rapid mixed-methods and multistakeholder collaboration were used to identify a range of potential service modifications that will be implemented within the ongoing programme. Our approach was centred on the experiences and perceptions of those who face the highest barriers to care.
METHODS: First, we conducted interviews to explore perceptions of barriers and potential solutions. Next, we asked a representative sample to rank the suggested solutions by likely impact. Finally, we held a multistakeholder workshop to identify which of the top-ranked interventions offered the best balance of impact, feasibility, cost and potential risks. We used a deductive matrix and thematic analysis to rapidly analyse the interview data.
RESULTS: We conducted 67 interviews. Barriers to access included long queues, conflicting work engagements and lack of clear information. Proposed solutions focused on reducing queue lengths, providing better counselling and clinic information, holding mop-up clinics and maintaining adequate stocks and supplies. We conducted ranking surveys with 401 additional people from the left-behind group. All proposed solutions were ranked at moderately-to-highly likely to improve equitable access. Fifteen people attended the multistakeholder meeting, including community representatives. Workshop participants unanimously selected enhanced counselling and SMS reminders as the interventions that offered the best balance of impact, risk, cost and feasibility. The other proposed solutions were deemed impractical or unaffordable.
CONCLUSIONS: Rapid mixed-methods and multistakeholder collaboration were used to identify a range of potential service modifications that will be implemented within the ongoing programme. Our approach was centred on the experiences and perceptions of those who face the highest barriers to care.