PDF(Pubmed)
Abstract：
OBJECTIVE: To identify determinants of the utilisation of ophthalmic clinical health services among students who failed school vision screening.
METHODS: This study employed a sequential explanatory mixed methods design, underpinned by Andersen\'s Behavioural Model of Health Service Utilisation. Data were initially gathered through interviews with 27 stakeholders-comprising 5 ophthalmologists, 7 community doctors, 7 public health professionals and 8 teachers. The qualitative insights informed the construction of a questionnaire, which subsequently garnered responses from 6215 participants. Qualitative data underwent thematic analysis with NVivo V.12, while quantitative data were analysed using multivariable multinomial logistic regression in SAS V.9.4. Data integration was performed using the Pillar Integration Process for a deductive, evidence-based synthesis of findings.
RESULTS: The research revealed that students attending vision demonstration schools and receiving encouragement from schools or communities to access clinical ophthalmic services demonstrated higher adherence to referral (OR=1.66, 95% CI 1.30 to 2.12; OR=1.54, 95% CI 1.33 to 1.80). Conversely, older students and those from higher-income families exhibited lower adherence rates (OR=0.31, 95% CI 0.23 to 0.44; OR=0.34, 95% CI 0.25 to 0.46). Moreover, students with less urgent medical needs were more likely to adhere to referrals compared with those needing immediate referrals (OR=1.24, 95% CI 1.06 to 1.45).Four pillars emerged: (a) adherence decreased with age, (b) financial constraints did not pose an obstacle, (c) public health services played a critical role, (d) referral urgency did not linearly correlate with adherence.
CONCLUSIONS: The utilisation of ophthalmic clinical health services following vision screening failure in students is significantly influenced by public health services provided by schools or communities, such as prompting those with abnormal screening results to access ophthalmic clinical health services.
METHODS: This study employed a sequential explanatory mixed methods design, underpinned by Andersen\'s Behavioural Model of Health Service Utilisation. Data were initially gathered through interviews with 27 stakeholders-comprising 5 ophthalmologists, 7 community doctors, 7 public health professionals and 8 teachers. The qualitative insights informed the construction of a questionnaire, which subsequently garnered responses from 6215 participants. Qualitative data underwent thematic analysis with NVivo V.12, while quantitative data were analysed using multivariable multinomial logistic regression in SAS V.9.4. Data integration was performed using the Pillar Integration Process for a deductive, evidence-based synthesis of findings.
RESULTS: The research revealed that students attending vision demonstration schools and receiving encouragement from schools or communities to access clinical ophthalmic services demonstrated higher adherence to referral (OR=1.66, 95% CI 1.30 to 2.12; OR=1.54, 95% CI 1.33 to 1.80). Conversely, older students and those from higher-income families exhibited lower adherence rates (OR=0.31, 95% CI 0.23 to 0.44; OR=0.34, 95% CI 0.25 to 0.46). Moreover, students with less urgent medical needs were more likely to adhere to referrals compared with those needing immediate referrals (OR=1.24, 95% CI 1.06 to 1.45).Four pillars emerged: (a) adherence decreased with age, (b) financial constraints did not pose an obstacle, (c) public health services played a critical role, (d) referral urgency did not linearly correlate with adherence.
CONCLUSIONS: The utilisation of ophthalmic clinical health services following vision screening failure in students is significantly influenced by public health services provided by schools or communities, such as prompting those with abnormal screening results to access ophthalmic clinical health services.
摘要：
目的：确定在学校视力筛查失败的学生中使用眼科临床卫生服务的决定因素。
方法：本研究采用序贯解释性混合方法设计，以安德森的卫生服务利用行为模型为基础。数据最初是通过对27位利益相关者的访谈收集的，其中包括5位眼科医生，7名社区医生，7名公共卫生专业人员和8名教师。定性的见解为问卷的构建提供了信息，随后获得了6215名参与者的回应。定性数据使用NVivoV.12进行主题分析，而定量数据使用SASV.9.4中的多变量多项逻辑回归进行分析。数据集成使用支柱集成过程进行演绎，基于证据的研究结果综合。
结果：研究表明，参加视力示范学校并接受学校或社区鼓励获得临床眼科服务的学生对转诊的依从性更高（OR=1.66，95％CI1.30至2.12；OR=1.54，95％CI1.33至1.80）。相反，年龄较大的学生和来自高收入家庭的学生的依从率较低(OR=0.31,95%CI0.23~0.44;OR=0.34,95%CI0.25~0.46).此外，与需要立即转诊的学生相比,医疗需求较低的学生更有可能坚持转诊(OR=1.24,95%CI1.06~1.45).出现了四个支柱：（a）依从性随着年龄的增长而下降，(b)财政困难并不构成障碍，(c)公共卫生服务发挥了关键作用，（d）转诊紧迫性与依从性没有线性关系。
结论：学生视力筛查失败后眼科临床卫生服务的利用受到学校或社区提供的公共卫生服务的显著影响，例如促使筛查结果异常的人获得眼科临床健康服务。
方法：本研究采用序贯解释性混合方法设计，以安德森的卫生服务利用行为模型为基础。数据最初是通过对27位利益相关者的访谈收集的，其中包括5位眼科医生，7名社区医生，7名公共卫生专业人员和8名教师。定性的见解为问卷的构建提供了信息，随后获得了6215名参与者的回应。定性数据使用NVivoV.12进行主题分析，而定量数据使用SASV.9.4中的多变量多项逻辑回归进行分析。数据集成使用支柱集成过程进行演绎，基于证据的研究结果综合。
结果：研究表明，参加视力示范学校并接受学校或社区鼓励获得临床眼科服务的学生对转诊的依从性更高（OR=1.66，95％CI1.30至2.12；OR=1.54，95％CI1.33至1.80）。相反，年龄较大的学生和来自高收入家庭的学生的依从率较低(OR=0.31,95%CI0.23~0.44;OR=0.34,95%CI0.25~0.46).此外，与需要立即转诊的学生相比,医疗需求较低的学生更有可能坚持转诊(OR=1.24,95%CI1.06~1.45).出现了四个支柱：（a）依从性随着年龄的增长而下降，(b)财政困难并不构成障碍，(c)公共卫生服务发挥了关键作用，（d）转诊紧迫性与依从性没有线性关系。
结论：学生视力筛查失败后眼科临床卫生服务的利用受到学校或社区提供的公共卫生服务的显著影响，例如促使筛查结果异常的人获得眼科临床健康服务。
