Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Dec 17;10(12):e33116.
doi: 10.2196/33116.

Augmenting the Referral Pathway for Retinal Services Among Patients With Diabetes Mellitus at Reiyukai Eiko Masunaga Eye Hospital, Nepal: Protocol for a Nonrandomized, Pre-Post Intervention Study

Ruchi Shrestha #  1 , Prerana Singh #  1 , Parami Dhakhwa #  2 , Shailaja Tetali #  3 , Tripura Batchu #  3 , Pragati Shrestha Thapa #  1
Affiliations

Augmenting the Referral Pathway for Retinal Services Among Patients With Diabetes Mellitus at Reiyukai Eiko Masunaga Eye Hospital, Nepal: Protocol for a Nonrandomized, Pre-Post Intervention Study

Ruchi Shrestha et al. JMIR Res Protoc. .

Abstract

Background: Diabetic retinopathy (DR) is an important public health issue in Nepal with a huge social and economic impact. Despite the availability of retinal services, people may not access them because of the lack of knowledge about DR and poor referral systems. Published studies on referral pathways in Nepal are scarce. Improving DR awareness among general physicians has the potential to address these challenges.

Objective: The aim of this study is to evaluate the effect of a health education intervention on health personnel, establish a referral pathway, and assess the impact of the intervention on the attendance of patients with diabetes mellitus for retinal screening at Reiyukai Eiko Masunaga Eye Hospital in Nepal.

Methods: This is a nonrandomized, pre- and postintervention study. Health education on DR will be provided to selected health personnel of the intervention hospital (Scheer Memorial) using information education and communication (IEC) materials in the form of PowerPoint presentations, posters, pamphlets, videos, and pre- and postevaluation questionnaires along with referral slip. Pre- and postevaluation will be undertaken during the study period. Data will be analyzed using MS Excel and Epi Info 7.

Results: The ethical approval for this study has been obtained from the Ethical Review Board of the Nepal Health Research Council (ERB Protocol Registration Number # 582/2020P). The study is expected to be completed in 18 months from the start of the project. The baseline data collection was from June to January 2020 for a period of 8 months. The postintervention data collection was from February to September 2021 for a period of 8 months. The last 2 months are planned for data analysis and report writing.

Conclusions: Health education intervention could be a low-cost solution to improve the awareness, access, and utilization of retinal health care services; this is an understudied topic in Nepal. Working closely with the stakeholders, this study will evaluate the role of health education interventions (which are already validated in other low-income settings) to strengthen referral and reduce the burden of DR in Nepal.

Trial registration: ClinicalTrials.gov NCT04829084; https://clinicaltrials.gov/ct2/show/NCT04829084.

International registered report identifier (irrid): DERR1-10.2196/33116.

Keywords: Nepal; diabetes mellitus; diabetic retinopathy; health education; study protocol.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

References

    1. Thapa R, Twyana SN, Paudyal G, Khanal S, van Nispen R, Tan HS, Thapa S, van Rens G. Prevalence and risk factors of diabetic retinopathy among an elderly population with diabetes in Nepal: the Bhaktapur Retina Study. OPTH. 2018 Mar;12:561–568. doi: 10.2147/opth.s157560. - DOI - PMC - PubMed
    1. World Health Organization . Prevention of blindness from diabetes mellitus: report of a WHO consultation in Geneva, Switzerland, 9-11 November 2005. Geneva, Switzerland: World Health Organization; ‎2006. pp. 9–11.
    1. Yau JWY, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, Chen S, Dekker JM, Fletcher A, Grauslund J, Haffner S, Hamman RF, Ikram MK, Kayama T, Klein BEK, Klein R, Krishnaiah S, Mayurasakorn K, O'Hare JP, Orchard TJ, Porta M, Rema M, Roy MS, Sharma T, Shaw J, Taylor H, Tielsch JM, Varma R, Wang JJ, Wang N, West S, Xu L, Yasuda M, Zhang X, Mitchell P, Wong TY, Meta-Analysis for Eye Disease (META-EYE) Study Group Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012 Mar;35(3):556–64. doi: 10.2337/dc11-1909. http://europepmc.org/abstract/MED/22301125 dc11-1909 - DOI - PMC - PubMed
    1. World Health Organization . Tool for the Assessment of Diabetic Retinopathy and Diabetes Management Systems. Geneva, Switzerland: World Health Organization; 2015. p. 4.
    1. Mishra SK, Pant BP, Subedi P. The Prevalence of Diabetic Retinopathy Among Known Diabetic Population in Nepal. Kathmandu Univ Med J (KUMJ) 2016;14(54):134–139. - PubMed

Associated data