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Aihua Dan, Ling Jin, Mingguang He, Nathan G Congdon, Zhongshan Ophthalmic Center,ORBIS,WDF,Huidong county hospital,Jieyangcounty hospital,Yangjiang Guangming eye hospital ,Chenghai county hospital,Wuchuan county hospital,Luoding county hostital,Sihui county hospital; The Impact of Multimedia Education on Uptake of Comprehensive Eye Examination in Rural Southern China: A Randomized, Controlled Trial. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4270.
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Initially asymptomatic diseases such as glaucoma and diabetic retinopathy are becoming rapidly more prevalent in China, and focus group studies suggest that patients may not understand the need for or accept the comprehensive eye examination(CEE) needed to detect these conditions. We sought to identify rate of acceptance of exams in the CREST rural Chinese hospital network, and to evaluate an educational intervention promoting these exams using a randomized controlled design.
Patients aged >= 40 years who had never had a CEE were recruited from 54 routine clinic sessions (27 intervention, 27 control) conducted by seven rural county-level hospitals in Guangdong, China. Prior to the exam, all subjects answered 20-items questionnaires, and were informed the cost of the examination. At intervention sessions, subjects were also shown a video demonstrating the value of CEE via patient stories, and completed the knowledge questionnaire again after watching the video. Patients refusing the CEE were asked why. Trial outcomes were acceptance of CEE (Primary outcome) and knowledge scores.
Subjects in the intervention group were more likely than controls to wear glasses (P=0.01), but the groups did not otherwise differ in 20 baseline characteristics. Among 241 intervention patients and 218 controls, CEE was accepted by 73% of intervention patients and 72% of controls (P>0.50). Predictors of acceptance included having been diagnosed with a systemic illness (P = 0.009), the offer of a free exam (P = 0.005) and rural residence (P = 0.01) though acceptance did not differ significantly between study groups (P > 0.60) when adjusting for these. Power to have detected 20% difference in acceptance between study groups was 96%, adjusting for clustering within clinic sessions. At baseline 74.7% (n=180) of patients could not answer a single question on the knowledge test correctly. After viewing the video, knowledge scores increased significantly ( P < 0.001), but scores were not associated (P = 0.40) with acceptance of CEE.
Though our intervention did not increase acceptance of examinations, acceptance of low-cost CEE was high in this setting despite very low levels of knowledge about eye disease. Offering low cost exams may be sufficient to reach the majority of patients without need for educational interventions.
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