School-based eye health interventions for improving eye care and spectacles compliance in children in low- and middle-income countries: A scoping review

Background: School vision screening is a cost-effective approach to identifying eye conditions like uncorrected refractive errors among children in low- and middle-income countries (LMICs), but challenges with spectacle compliance, procurement, and follow-up persist. This review examines school-based eye health interventions in LMICs to assess their impact on spectacle compliance, knowledge, attitudes, practices, and referral adherence, highlighting limitations and gaps in current literature. 

Methods: A literature search was performed in three databases, focusing on studies published from 1999 onward. Following the PRISMA-ScR guidelines, the review included studies involving school children in LMICs that assessed school-based interventions aimed at improving spectacle compliance, knowledge, attitudes, practices and referral adherence. Studies conducted in universities or studies that did not perform primary data collection were excluded. Titles, abstract, full-text screening and data extraction was performed independently by two researchers. 

Results: Of the 108 articles identified, seven studies from five countries met inclusion criteria. Study designs included four randomised controlled trials, one cross-sectional study, one quasi-experimental study, and one qualitative prospective study. Interventions varied: five studies (71 %) included eye health education, three (43 %) focused on promotional activities, two (29 %) provided free spectacles, and one (14 %) used media campaigns and incentives. Eye health education and free spectacles were most effective in increasing spectacle compliance, while education and promotional interventions improved knowledge, attitudes, and practices. Only one study measured referral adherence. 

Conclusion: Eye health education, promotion, media reminders, and free spectacles improves spectacle compliance, knowledge, attitudes, practices, and referral adherence. Further research should investigate the cost-effectiveness of these interventions in LMICs.