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Abstract

Objective: To assess the effectiveness of mobile health (mHealth) based vision screening and automated multicomponent SMS reminders on referral uptake among school children in a low resource setting.
Methodology: This was a concurrent parallel group; single blinded, randomized control trial. The participants were first screened for visual impairment using mHealth visual acuity app. Then schools were randomly allocated (1:1) to an intervention and control group. Children 5-15 years old with parents having smart phone and diagnosed with visual impairment on screening were eligible. A multicomponent SMS reminder in addition to printed referral form was given to the intervention group. It contained a health promotion message, visual depiction of child’s vision along with customized action plan. SMS was delivered through visual acuity application with automated SMS software. Referred children were followed for eight weeks through telephonic follow up. Data was analyzed according to intention to treat principle with Cox regression model to analyze the effect of SMS reminder on referral uptake.
Results: A total of 320 children were enrolled in this study. Visual impairment was identified in 82 children (25.6%). At eight weeks post intervention the proportion of children who attended the hospital was significantly higher in the intervention group compared to the control group, 73.8% vs. 37.5%, [Hazard ratio (HR) 2.428; (95% CI 1.26-4.675); p=0.008]. About 9 (10.9%) enrolled participants were lost to follow up. There was no statistically significant association between hospital attendance among referred children and their sociodemographic characteristics.
Conclusion: mHealth referral reminder effectively improves the uptake of referral services following vision screening among school children as the percentage of children who attend the hospital was significantly increased in the intervention group.
Trial registration: ClinicalTrials.gov ID NCT06616051