Enhanced patient counselling and enhanced SMS reminder messages to improve access to community-based eye care services in Meru, Kenya

INTERVENTION: This trial is part of an adaptive platform that 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 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 (ISRCTN53970958). The researchers will use computer‐generated random numbers to generate the allocation sequence and assign all consented, referred participants to intervention arms, with equal numbers of participants in each arm. The allocation sequence will be generated within the Peek system in real‐time, as participants are referred. As human trial managers are not involved in allocation there is no need for concealment. The intervention for this RCT is a script and reminder SMS message that have been developed in line with suggestions from intended service beneficiaries from the groups least likely to attend. More specifically, this includes the provision of information about clinic opening times, services, costs, and the importance of attend CONDITION: Undifferentiated eye problems identified by community‐based screeners using the Peek Vision screening app ; Eye Diseases PRIMARY OUTCOME: The proportion of people attending the triage clinic on their appointed date among adults aged 18‐44 years old, measured using attendance data collected by staff when people check in for the duration of the study 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 when people check in for the duration of the study INCLUSION CRITERIA: Adults (>18 years) screened by the Vision Impact Project in Meru, Kenya and referred to a local treatment outreach clinic to receive further eye care