Interventions to promote access to eyecare for non-dominant ethnic groups in high-income countries: a scoping review

Abstract

Purpose: People who are distinct from the dominant ethnic group within a country can experience a variety of barriers to accessing eyecare services. We conducted a scoping review to map published interventions aimed at improving access to eyecare for non-Indigenous, non-dominant ethnic groups residing in high-income countries.

Methods: We searched MEDLINE, Embase and Global Health for studies that described an intervention to promote access to eyecare for the target population. Two authors independently screened titles and abstracts followed by review of the full text of potentially relevant sources. For included studies, data extraction was carried out independently by two authors. Findings were summarised using a combination of descriptive statistics and thematic analysis.

Results: We screened 5220 titles/abstracts, of which 82 reports describing 67 studies met the inclusion criteria. Most studies were conducted in the USA (90%), attempted to improve access for Black (48%) or Latinx (28%) communities at-risk for diabetic retinopathy (42%) and glaucoma (18%). Only 30% included the target population in the design of the intervention; those that did tended to be larger, collaborative initiatives, which addressed both patient and provider components of access. Forty-eight studies (72%) evaluated whether an intervention changed an outcome measure. Among these, attendance at a follow-up eye examination after screening was the most common (n=20/48, 42%), and directly supporting patients to overcome barriers to attendance was reported as the most effective approach. Building relationships between patients and providers, running coordinated, longitudinal initiatives and supporting reduction of root causes for inequity (education and economic) were key themes highlighted for success.

Conclusion: Although research evaluating interventions for non-dominant, non-Indigenous ethnic groups exist, key gaps remain. In particular, the paucity of relevant studies outside the USA needs to be addressed, and target communities need to be involved in the design and implementation of interventions more frequently.

Keywords: eye diseases; health services research; public Health; review.

Figure 1

PRISMA flow diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Figure 2

Characteristics of publications (studies) and target groups.

Figure 3

Characteristics of interventions, in terms of dimensions of access addressed and involvement of target community in study design. For the Levesque framework, a single study typically addressed more than one dimension of access (the denominator for each is the total number of studies). When studies were categorised as mainly addressing patient, provider or both sides of access, those which targeted both were most likely to have engaged with the target community.

Figure 4

Summary of included publications by relationship between authors and conditions. Each node represents an author, and each cluster of nodes represents a paper, or groups of papers by similar authors. Papers which included the target population in the design are highlighted in green. Note the clustering of green dots within collaborative networks (although with notable exceptions).