Development of an intervention to improve access to eye care for Hispanic children

1. Development of an intervention to improve access to eye care for Hispanic children Marcela Frazier OD, MPH, FAAO

2. Why this group? Immigrant parents Health disparities access barriers Children Dependence on parents Importance of early detection Hispanic children Higher prevalence of vision problems

3. Eye Problems in Hispanic Children Strabismus (Eye turn) 2.4%1 (AA 2.5%) Amblyopia (Lazy eye) 2.6%1 (AA 1.5%) Refractive errors2 Myopia 13.2 % (A 18.5 %, AA 6.6%, W 4.4%) Hyperopia 12.7% (W 19.3%, AA 6.4%, A 6.3%) Astigmatism 36.9% (A33.6%, W26.4%, AA 20%)

4. Can a parent tell when a young child has an eye problem? Not unless it’s very obvious

5. Refractive amblyopia Refractive errors may not be apparent Best detected during a full eye exam Timely correction is very important

6. Why do we need to find them early? Timely correction of refractive errors, eye turns and media opacities can greatly increase the probability of good vision Amblyopia treatment has a ‘critical period’ Psychosocial consequences

7. Amblyopia treatment May require: Glasses Patch Drops

8. What’s in place in Alabama? Pediatrician’s vision screening Observation of red reflex Visual acuity Some pre-school vision screenings K and 2nd grade vision screenings in PS Cahaba Valley Health Care vision screenings

9. What’s in place in Alabama? Insurance coverage Medicaid All Kids BCBS Caring Program for children Sight Savers of Alabama Transportation possibilities Several Spanish-speaking providers

10. Screening Results Parents typically receive a picture with a letter summarizing the report The current method may miss some conditions Sight Savers offers to coordinate follow-up care

11. What’s the problem? Sight Savers of Alabama coordinates follow-up eye care for school-aged children (after children have failed the vision screening and all efforts have been made to get them to follow-up care): 85.5% for the total population 57.9% for Hispanic children. 

12. General population findings3 Qualitative assessment of the general population Lack of awareness about the frequency and potential effect of refractive errors in children High cost of corrective lenses Scheduling difficulties

13. Purpose of this study To evaluate the perceptions related to seeking eye care for their children among Hispanic immigrant parents in order to develop a plan for culturally relevant interventions to encourage parents to seek appropriate eye care for their children.

14. Methods Five focus group discussions (number determined by saturation) Topic guide used to encourage dialogue Parents encouraged to discuss the possible reasons for not seeking follow up care for their children after failing a vision screening. Discussion was tape-recorded and transcribed. Qualitative analysis of perceived barriers and motivators

15. 40 Participants Country of birth 55% Mexico 45% Other (Peru, Guatemala…) Number of children per family mean 2.4 (SD:1.2) Ages of children mean 11.2 (SD: 6.4) Parental report of children having had an eye exam 55%Yes 45% No

16. What do you think about eye health for children? Overall, participants recognized that vision is very important. Some perceptions that emerged: watching too much television can damage the eyes Glasses may not be well accepted culturally

17. Cultural acceptance of glasses

18. When should parents try to get eye care for their children? Most parents gave a vague response Some said at preschool age Some believed you had to wait until the child knew the alphabet Assessment methods are available even for young children (Without a need to know the alphabet)

19. What are some reasons some parents may take their children for eye exams? Prevention was not mentioned much Parents believed it was mainly when they OBSERVED a problem! Amblyopia due to refractive error is NOT ‘visible’!!!

20. What are some reasons some parents may take their children for eye exams? ‘Children's eyes are ne, like a car, they do not have any problems yet until they are old’

21. What could some barriers to seeking eye care for children be? Financial Lack of symptoms or family history Lack of interest/desidia Cultural Lack of information Language difficulties Transportation Home remedies first Work Fear Lack of insurance coverage

22. What are some reasons some parents may not take their children for eye exams even after they have been told the child failed the screening and they have been given information about resources? Lack of interest/ desidia Financial Work Lack of information Lack of symptoms or family history Language difficulties

23. What programs have you noticed the school has to test children’s eyes?

24. Where do you think children could be taken for eye exams? Parents mentioned clinics, churches, but also mentioned the child’s school Parents seemed confused about the difference between a vision screening and an eye exam

25. What changes do you think could be done to make access to eye care for children easier? Information Extended schedules Policies/programs Language

26. How to inform? Churches/schools Radio Newspaper Brochures Television

27. What programs? Parents suggested that they would comply if the exam were mandatory for school entry (like the ‘blue card’) They also expressed that they would do seek eye care for their children if their pediatrician recommended it

28. References The Multi-ethnic Pediatric Eye Disease Study. Prevalence of Amblyopia and Strabismus in African American and Hispanic Children Ages 6 to 72 Months. Ophthalmol 2007; In Press. Kleinstein RN, Jones AL, Hullet S, and the CLEERE group. Refractive error and ethnicity in children. Arch Ophthalmol. 2003 Aug;121(8):1141-7. Yawn BP, Kurland M, Butterfield L, Johnson B. Barriers to seeking care following school vision screening in Rochester, Minnesota. J Sch Health. 1998 Oct;68(8):319-24.