Non-Compliance With Referral After a Positive Screening Test: Parents Who Denied Being Referred

Abstract

Purpose:: Screening for visual disorders is performed in the Netherlands at 9, 14, 24, 36, 45, 54 and 60 months. Children should be referred after a positive screening test, but many do not reach the orthoptist or ophthalmologist. We previously reported on parents truly non-compliant with referral (Tjiam AM, et al. 2006; ARVO E-Abstract 704) and now examined parents who denied being referred.

Methods:: The Rotterdam Amblyopia Screening Effectiveness Study, a 7 year-prospective-birth cohort study, comprised 4624 children. In 195 out of 750 children with a positive screening test, the referral was unclear. These parents were reached by phone calls or house visits to verify, whether they remembered the referral. Parents who did not remembered the referral were divided into the following categories:Parents, who actually were not referred; parents, who did not understand the referral recommendation and parents, who denied being referred, may have not spoken the truth. Fluency in Dutch was rated by the researchers on a five-point scale, from one "not speaking the national language at all", three "moderate fluency" and five "excellent fluency".

Results:: Out of 195 cases, 77 had actually been compliant, 14 truly non-compliant and 81 parents, subjects of this study, denied being referred.Of the 81 parents 61 parents had not understood the referral recommendation or denied being referred, 20 actually had not been referred._{^{The group that denied having been referred had a fluency in Dutch that ranged between "not speaking the national language all" and "moderate fluency" for 50 % of the parents. Approximately 70 % of these live in the western and southern parts of Rotterdam, low SES suburban areas. Contrary to the parents of the true non-compliant group, 75% of them have an excellent fluency in the Dutch language and had no geographical predilection.}}Discussion:This study shows that lack of good communication hampers adequate referral after a positive screening test.

Keywords: amblyopia • screening for ambylopia and strabismus