Normalisation process theory and the implementation of a new glaucoma clinical pathway in hospital eye services: Perspectives of doctors, nurses and optometrists.

BACKGROUND: Normalisation process theory reports the importance of contextual integration in successfully embedding novel interventions, with recent propositions detailing the role that 'plasticity' of intervention components and 'elasticity' of an intended setting contribute. We report on the introduction of a clinical pathway assessing patient non-responsiveness to treatment for glaucoma and ocular hypertension. The aim of this study was to assess the feasibility of implementing the Cardiff Model of Glaucoma Care into hospital eye services, identifying any issues of acceptability for staff through the filter of normalisation process theory. METHODS: A prospective observational study was undertaken in four hospital eye services. This incorporated detailed qualitative semi-structured interviews with staff (n = 8) to gather their perceptions on the intervention's usefulness and practicality. In addition, observational field notes of patient and staff consultations (n = 88) were collected, as well as broader organisational observations from within the research sites (n = 52). Data collection and analysis was informed by the normalisation process theory framework. RESULTS: Staff reported the pathway led to beneficial knowledge on managing patient treatment, but the model was sometimes perceived as overly prescriptive. This perception varied significantly based on the composition of clinics in relation to staff experience, staff availability and pre-existing clinical structures. The most commonly recounted barrier came in contextually integrating into sites where wider administrative systems were inflexible to intervention components. CONCLUSIONS: Flexibility will be the key determinant of whether the clinical pathway can progress to wider implementation. Addressing the complexity and variation associated with practice between clinics required a remodelling of the pathway to maintain its central benefits but enhance its plasticity. Our study therefore helps to confirm propositions developed in relation to normalisation process theory, contextual integration, intervention plasticity, and setting elasticity. This enables the transferability of findings to healthcare settings other than ophthalmology, where any novel intervention is implemented.

Impact of COVID-19 on Indian optometrists: A student, educator, and practitioner's perspective.

PURPOSE: The optometry profession has experienced massive changes amid lockdown in COVID 19 pandemic. This study gauges the impact of COVID-19 on optometry education and practices in India. METHODS: The impact of COVID-19 among key stakeholders of Indian optometry that included educators, students, and practitioners was surveyed. The content validity of the survey tool was achieved through a focused group discussion with experts. RESULTS: Of the 1408 responses, 118 were educators, 845 were students and 445 were practitioners. Post COVID-19 lock-down, a high percentage of students (96%) and educators (94%) were now using online mode of education to learn and teach. The blended learning methods were reported to be used by 81% of educators. Practical skills were the most difficult to teach by educators and to learn by students. Almost a third of the students were concerned about their internships and job opportunities amid the pandemic. Practitioners felt confident in performing routine eye examinations with personal protective equipment (PPE). Telemedicine was found to be adopted by 55% of the private practitioners and 49% of the eye hospitals. CONCLUSION: The COVID-19 pandemic has provided an opportunity to reform Indian optometry education through blended learning methods. Optometry practices changed and adapted instantly to the new hygiene norms that have raised the standard of care provided to patients. Telemedicine emerged as a mode of providing care by optometrists. Overall, all key stakeholders of optometry in India were found to have adapted well to the sudden changes due to COVID 19 pandemic.

Factors influencing the prescribing behaviour of independent prescriber optometrists: a qualitative study using the Theoretical Domains Framework.

PURPOSE: Whilst the number of independent prescriber (IP) optometrists in the United Kingdom is increasing, there is limited evidence describing the experiences of these individuals. The Theoretical Domains Framework (TDF) provides an evidence-based approach to understand determinants of behaviour. This conceptual framework can enable mapping to the COM-B behaviour change model and the wider Behaviour Change Wheel to develop interventions to optimise behaviour-change and healthcare processes more systematically. The study aimed to use the TDF to identify the factors that influence independent prescribing behaviour, and to map these findings to the COM-B system to elucidate the relevant intervention functions, in order to identify the support required by optometrist prescribers. METHODS: Using a qualitative design, semi-structured interviews based on the TDF were undertaken with independent prescriber optometrists. Thematic analysis was used to identify themes inductively, which were then deductively mapped to the TDF and linked to the COM-B. RESULTS: Sixteen participants (9 male, 7 female; median age 45 years, range 28-65 years), based in community (n = 10) and hospital (n = 6) settings, were interviewed. Eleven of the TDF domains were found to influence prescribing behaviour. Findings highlighted the need for good communication with patients (TDF domain: Skills, COM-B: Capability); confidence (TDF domain: Beliefs about capabilities, COM-B: Motivation); good networks and relationships with other healthcare professionals, e.g., general practitioners (TDF domain: Social influences, COM-B: Opportunity; TDF domain: Social/professional role and identity, COM-B: Motivation); the need for appropriate structure for remuneration (TDF domain: Reinforcement, COM-B: Motivation; TDF domain: Social/professional role and identity, COM-B: Motivation) and the provision of professional guidelines (TDF domain: Knowledge, COM-B: Capability; TDF domain: Environmental context and resources, COM-B Opportunity). CONCLUSIONS: Having identified theory-derived influencers on prescribing decisions by optometrists, the findings can be used to develop a structured intervention, such as a support package to help optimise prescribing by optometrists, with the ultimate goal of eye care quality improvement.

Job satisfaction and its associated factors among optometrists in Ghana: a cross-sectional study.

BACKGROUND: Job satisfaction describes an employee's motivation and/or feeling of satisfaction towards his/her work. Globally, healthcare professionals' turnover and retention play a critical role in the delivery of essential health services. In Ghana, however, little has been done to ascertain job satisfaction levels among human resources for eye-health. The objective of this study therefore was to assess job satisfaction and its associated factors among optometrists in Ghana. METHODS: A cross-sectional survey was conducted among 304 registered and licensed optometrists of the Ghana Optometric Association between September 2018 and June 2019. A validated, well-structured questionnaire was used to elicit information on socio-demographic characteristics of participants and measures on job satisfaction. Scores from a five-point Likert scale was employed to examine job satisfaction and its associated factors. Linear regression analyses were used to evaluate the association between overall job satisfaction and its associated factors using Rasch logit scores. RESULTS: A total of 214 optometrists gave valid responses to the questionnaires used for the final analysis. The mean (± SD) score of the overall perception of job satisfaction among optometrists was 3.36 (± 1.00), with 74.3% of them being satisfied with their jobs. After statistical adjustment, Good work-life balance (Unstandardized co-efficient (ß) = 0.288, p = 0.001), Salary (ß = 0.222, p < 0.0005), Supervision (ß = 0.117, p = 0.044), and Continuing Education Opportunities (ß = 0.138, p = 0.017) were all significantly associated with higher levels of overall job satisfaction. CONCLUSIONS: Most optometrists were satisfied with their jobs. Effective strategic planning and management of human resources for eye-health in Ghana are essential in the development of quality eye-health systems and the provision of high-quality eyecare services.

Omega-3 Fatty Acids and Eye Health: Opinions and Self-Reported Practice Behaviors of Optometrists in Australia and New Zealand.

This study investigated optometrists' attitudes and self-reported practice behaviors towards omega-3 fatty acids for eye health, and knowledge and understanding of their potential risks and benefits. An anonymous online survey was distributed to optometrists in Australia and New Zealand. Questions included practitioner demographics and practice modality; self-reported practices and recommendations relating to diet, nutritional supplements, and omega-3 fatty acids for age-related macular degeneration (AMD) and dry eye disease (DED); and practitioner knowledge about omega-3 fatty acids. Of 206 included surveys, most respondents (79%) indicated recommending for their patients to consume omega-3 fatty acids to improve their eye health. Sixty-eight percent of respondents indicated recommending omega-3-rich foods for AMD management, while 62% indicated recommending omega-3 supplements. Most respondents (78%) indicated recommending omega-3-rich foods or supplements for DED. For DED, recommended omega-3 supplement dosages were (median [inter-quartile range, IQR]) 2000 mg [1000-2750 mg] per day. The main sources of information reported by respondents to guide their clinical decision making were continuing education articles and conferences. In conclusion, optometrists routinely make clinical recommendations about diet and omega-3 fatty acids. Future education could target improving optometrists' knowledge of differences in the evidence for whole-food versus supplement sources of omega-3 fatty acids in AMD. Further research is needed to address uncertainties in the evidence regarding optimal omega-3 dosage and formulation composition in DED.

An Eye Tracking Analysis on Diagnostic Performance of Digital Fundus Photography Images between Ophthalmologists and Optometrists.

To investigate the parameters of eye movement between ophthalmologists and optometrists while diagnosing digital fundus photographs, sixteen participants (eight ophthalmologists and eight optometrists) were recruited in this study. Every participant's eye movement during diagnosis of a randomized set of fundus photographs displayed on an eye tracker were recorded. Fixation metrics (duration, count and rate) and scan path patterns were extracted from the eye tracker. These parameters of eye movement and correct diagnosis score were compared between both groups. Correlation analyses between fixation metrics and correct diagnosis score were also performed. Although fixation metrics between ophthalmologists and optometrists were not statistically different (p > 0.05), these parameters were statistically different when compared between different area of interests. Both participant groups had a similar correct diagnosis score. No correlation was found between fixation metrics and correct diagnosis score between both groups, except for total fixation duration and ophthalmologists' diagnosis score of diabetic retinopathy photographs. The ophthalmologists' scan paths were simpler, with larger saccades, and were distributed at the middle region of the photographs. Conversely, optometrists' scan paths were extensive, with shorter saccades covering wider fundus areas, and were accumulated in some unrelated fundus areas. These findings indicated comparable efficiency and systematic visual search patterns between both the groups. Understanding visual search strategy could expedite the creation of a novel training routine for interpretation of ophthalmic diagnostic imaging.

Seeing New Opportunities to Help Smokers Quit: A UK National Survey of Optometrist-Delivered Smoking Cessation Behavioral Support Interventions.

BACKGROUND: Smoking is a risk factor for various eye conditions. Brief smoking cessation interventions have demonstrated effectiveness when delivered by a range of health care professionals. Optometrists are well placed in the community to advise otherwise healthy smokers to quit, yet remain relatively neglected in smoking cessation research and policy. In a national survey, this study investigated self-reported practices of UK optometrists for delivering brief tobacco smoking cessation interventions to patients. METHODS: A randomly selected sample of 1200 optometrists out of the 9000 optometrists registered on the UK College of Optometrists database were invited to complete a 40-item, web-based survey assessing: training related to smoking cessation, current practice (ie, the proportion of patients to which components of very brief advice [Ask, Advise, Assist] and other evidence-based smoking cessation behavior change techniques were delivered), and barriers/enablers to intervention delivery. RESULTS: In total, 408 (34%) responses were received. Most (83%) optometrists received no training in practical skills for delivering smoking cessation support. A third (34%) routinely assessed smoking status. Fewer self-reported advising smokers to quit (22%), offering assistance (via referral to dedicated services) (3%), or advice on smoking cessation medications (2%). Perceived barriers included insufficient knowledge/training (81%) and time (65%). Optometrists were more likely to assess and advise on smoking cessation if they practiced in Scotland, χ2(2) = 32.95, p < .001; an independent optometry practice, χ2(1) = 4.27, p = .39; or had received smoking cessation training, χ2(1) = 13.1, p < .001. CONCLUSIONS: Substantial gaps exist in UK optometrists' current smoking cessation training and practice. Evidence-based training resources are needed to support the implementation of smoking cessation interventions into routine optometry practice. IMPLICATIONS: Optometrists are well placed in the community to deliver brief advice interventions to a large population of smokers. This survey provides a comprehensive description of current UK optometry practice related to the provision of evidence-based brief tobacco smoking cessation interventions to patients. Although optometrists perceive advising on smoking cessation as part of their role, numerous substantial gaps in current practice and training remain, which need to be addressed through targeted interventions to increase implementation.

Patients' and prescribers' perception of contact lenses as a potential ocular drug delivery system.

Contact lenses (CLs) designed to deliver medication gradually to the eye are being developed and investigated for the use in ocular drug delivery. The aim of the current research is to determine patients' acceptance of the use of lenses for ocular drug delivery. In addition, the study aimed to seek the views and perceptions of healthcare professionals (HCPs) on CLs as a method of ocular drug delivery and whether it will be prescribed to treat ocular conditions. This was a cross-sectional survey targeted at patients and HCPs. Two separate questionnaires were created with open-closed ended and multiple response questions, gauging the perceptions and acceptance of CLs as drug delivery tool. The patients' survey was distributed in John Radcliffe (JR), Oxford and Moorfields eye hospital (MEH), London, UK. The HCPs' questionnaire was manually distributed and was also devised on Survey Monkey and sent by email to ophthalmologists, optometrists, opticians, GPs and hospital and community pharmacists. The data were analysed using SPSS statistical software and Excel. Over 60% (92/151) of patients would accept the use of CLs for their ocular treatment with the highest acceptance being reported by patients in the age group of 30-49 years old. The most frequently used conventional treatment formulation was eye drops as indicated by 87% (131/151) of the responses. More than half of eye drop users (57%, 75/131) indicated that they would accept using CLs expecting them to reduce the frequency of application of the medicine and be less time consuming. Interestingly, half of HCPs were not aware of CLs as an ocular drug delivery method; nevertheless, a total of 65 HCPs out of the 112 surveyed stated that they would prescribe/dispense CLs to treat ocular disease.