“You’re too young to have an eye problem”: Reasons for nonadherence to referrals for follow-up eye care for schoolchildren in Nigeria -- a descriptive qualitative study

Abstract

Study objectives: to identify reasons for non-adherence to referrals for follow-up eye care after children fail a school vision screening test. Methods: Ten focus groups were held with parents or guardians (parents) of children who had not adhered to the referral for further care in Cross River State, Nigeria, in 2019. Data from verbatim transcripts were analysed deductively using topics from the interview guide plus OTHER to capture unanticipated results. Analysts followed procedures for Qualitative Content Analysis plus a modified Framework Method to identify overarching themes and barriers that are both highly salient (most frequently mentioned) and relevant (discussed in at least half of all groups). Results: Three themes identified in the data are 1) modifiable barriers (key among them being parental beliefs and problems with the referral letter), 2) contextual factors (parental situation, attitudes towards children and beliefs about care) and 3) participant recommendations to improve the child eye care program (educate the general public and correct parental misconceptions). Many of the findings echoed those from previous studies conducted in both low-and-middle income countries (LMICs) and high-income countries (HICs). Conclusion: This study went beyond identifying modifiable barriers to also identify contextual factors and what parents recommend be done to improve vision care for children in Cross River State, Nigeria. If acted on, these findings may increase acceptance and uptake of eye care services that can promote sustainability and spread of the program to other parts of Nigeria and/or Africa.