Protocol for a platform trial of interventions to equitably improve access to community eye services in Botswana, India, Kenya and Nepal

INTERVENTION: This is a platform architecture for RCTs, embedded within local screening programmes so further eligibility criteria will be set locally. Interventions will be suggested by intended service users from groups that face the highest barriers to accessing care (as identified in previous sister studies in each setting). The intention is to continuously improve attendance rates with the most significant gains focused on left‐behind groups. All interventions will be low‐risk public health/service modifications. This platform trial forms the testing element of a broader continuous improvement model called ‘IM‐SEEN’ (IMprovement Studies for Equitable and Evidence‐based iNnovation). The model has already been integrated into Peek programmes. The Peek app is the mature and validated app‐based screening system developed by Peek Vision – an LSHTM not‐for‐profit spin‐out. In this continuous improvement approach, data collectors gather contact details and sociodemographic data from those found to have an eye problem prior to referring them. This means that programme managers using Peek have a complete record of who has not attended the clinic on the appointed day, and they are able to identify the population group with the lowest attendance. Next, the programme leadership team can engage with representatives of left‐behind groups to elicit barriers and identify potential service improvements that would reduce non‐attendance – such as changing the clinic location or amending the wording of the SMS reminder messaging. The final step is to use embedded RCTs to test these proposed improvements with new referrals. Effective interventions will be adopted across the programme. Further information on the broader IM‐SEEN approach has been published elsewhere. CONDITION: Undifferentiated eye problems identified by community‐based screeners using the Peek Vision screening app. ; Eye Diseases PRIMARY OUTCOME: The proportion of people from the population group attending the triage clinic with the lowest attendance, measured using attendance data collected by staff in the Peek app when people check in at baseline SECONDARY OUTCOME: The proportion of people attending the triage clinic on their appointed date across the entire population, measured using attendance data collected by staff in the Peek app when people check in at baseline INCLUSION CRITERIA: 1. Community members screened using the Peek Vision app and referred to the local eye service for further assessment/treatment 2. Aged 5 years old and over