Validity and feasibility of a self-administered home vision examination in Yueqing, China: a cross-sectional study

Zhengyan Ge; Linshan Li; Lynne Lohfeld; Chunjie Lu; Nathan Congdon; Sigeng Lin; Yuxuan Deng; Yuan Lan; Shaodan Zhang; Laurence Hou; Weihe Zhou; Lele Cui; Jia Qu; Yuanbo Liang

doi:10.1136/bmjopen-2019-030956

Validity and feasibility of a self-administered home vision examination in Yueqing, China: a cross-sectional study

BMJ Open. 2020 Apr 16;10(4):e030956. doi: 10.1136/bmjopen-2019-030956.

Authors

Zhengyan Ge¹, Linshan Li¹, Lynne Lohfeld^{1

2}, Chunjie Lu¹, Nathan Congdon^{2

3}, Sigeng Lin¹, Yuxuan Deng¹, Yuan Lan¹, Shaodan Zhang¹, Laurence Hou⁴, Weihe Zhou¹, Lele Cui¹, Jia Qu⁵, Yuanbo Liang¹

Affiliations

¹ The Affiliated Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China.
² Centre for Public Health, Queen's University Belfast, Belfast, Belfast, UK.
³ State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
⁴ Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁵ The Affiliated Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China qujia@eye.ac.cn.

Abstract

Objective: To investigate the validity and feasibility of a self-administered home vision examination programme in China.

Design: Cross-sectional study.

Setting: Yueqing, China.

Participants: A two-stage convenience sampling procedure was used to randomly select 600 households from 30 communities participating in the Yueqing Eye Study (YES). The aim of YES is to encourage home-based vision screening, reporting of visual acuity (VA) annually through social media and encouraging people to attend follow-up clinic appointments as a way to improve eye care access for adults with VA ≤+0.5 log of the minimum angle of resolution (logMAR).

Interventions: Household screeners (one per household) who tested other family members' VA completed a questionnaire on family structure, demographic information and knowledge about screening procedures. Other family members then underwent confirmatory VA testing by researchers.

Outcome measures: The completion rate of home-based VA screening, its sensitivity and specificity were used to evaluate validity. Factors that determined whether families participated in the self-VA screening were used to evaluate feasibility.

Results: 345 (66%) of the 523 (87.2%) households with valid data form their home-based vision examinations also were retested by researchers. There was no statistically significant difference in scores on the family-administerd or researcher-administerd VA test (VA≤+0.5 logMAR, p=0.607; VA >+0.5 logMAR, p=0.612). The sensitivity and specificity of home-based vision screening were 80.5% (95% CI 70.2% to 86.9%) and 95.1% (95% CI 92.6% to 96.8%), respectively. 14.7% (77/523) of tested respondents had VA ≤+0.5 logMAR. Predictors of performing home screening for VA remaining in regression models included higher economic status ('fair and above' vs 'poor': OR 1.74; 95% CI 1.08 to 2.76; p=0.022), age (<45 years vs ≥45 years: OR 0.46; 95% CI 0.25 to 0.85; p=0.014) and living in a nuclear (OR 5.17; 95% CI 2.86 to 9.36; p<0.001) or extended family (OR 8.37; 95% CI 4.93 to 14.20; p<0.001).

Conclusion: Self-administered home vision screening is reliable and highly accepted by Chinese adults.

Keywords: epidemiology; public health; quality in health care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
China
Cross-Sectional Studies
Family Characteristics*
Feasibility Studies
Female
Health Knowledge, Attitudes, Practice
Humans
Male
Middle Aged
Odds Ratio
Program Evaluation
Reproducibility of Results
Self-Testing*
Sensitivity and Specificity
Social Media / statistics & numerical data
Socioeconomic Factors
Time Factors
Vision Screening / methods*
Vision Screening / organization & administration
Visual Acuity*