Theory- and evidence-based strategies to promote regular eye examinations for elderly centre members in Hong Kong

Abstract

Background and aim Regular preventive eye examination allows monitoring of visual wellbeing, facilitate early detection of age-related eye diseases and timely treatment if needed. However, suboptimal uptake of preventive eye examination by the older adults has been an on-going issue that is yet to be addressed by effective intervention strategies. To maximise the likelihood of implementing effective strategies, the current project proposes evidence-based, theory-driven, and preference-informed intervention strategies to encourage the uptake of such services. Methods and Results This was a mixed-method study consisting of three stages. All the older adults who participated were recruited from the elderly centre population. In Stage 1, semi-structured interviews were conducted with twenty-five older adults to explore their preventive eye examination utilisation decision-making process. Results were analysed using a grounded theory approach. This study found that older adults encountered barriers in prioritizing preventive eye health among the on-going healthcare needs. These were due to perceived low needs for a preventive eye examination, perceived low self-efficacy to use such service and the unmet expectation for service delivery. In Stage 2, an intervention was developed based on the quality evidence and guided by the Capability-Motivation-Opportunity Behaviour Model and the Behaviour Change Wheel framework. The theory-driven development followed a holistic approach to consider how behavioural drivers could be addressed by the proposed strategy. Opinions from the advisory group were incorporated to ensure prospective feasibility of the proposed strategy. The intervention strategy proposed will require collective effort from elderly centre and the service provider to empower the older adults to undergo regular eye examination. In Stage 3, a discrete choice experiment survey was conducted to determine whether the older adults have a preference for the proposed intervention design which was described in five attributes: service location, specified fee range, appointment booking, appointment reminder, and a supportive environment to facilitate informed decision-making. The results collected from 93 subjects were analysed using the conditional logit model and the potential uptake for the preferred strategy was estimated. The findings revealed that older adults have a preferred level for all five attributes. They preferred to receive a mobile service eye examination at the elderly centre to the optometric clinics, preferred having a specified service fee range to no specified fee range, preferred appointment booked by the service provider to booking by the users themselves and preferred an appointment reminder to no appointment reminder. They also preferred having a supportive environment to empower them with necessary information to facilitate decision-making to having no supportive environment. A strategy with the preferred levels has an estimated potential uptake of 90.6% supporting its potential usefulness in improving preventive eye examination by the older adults. Conclusion This thesis provided an explanation for the suboptimal uptake of preventive eye examination. Collective efforts are required from the community and service provider to motivate the older adults to engage in such services. The proposed intervention strategy demonstrated potential in improving service uptake, and therefore could be considered to implement to the older adults from the elderly centre population.