Frequency of Visual Impairment Among School Children and Effectiveness of mHealth Referral Reminder on Uptake of Referral Services

NCT06616051 | Completed

• 1 other identifier: vision320rct
• Study Type: interventional
• Target: 320
• Locations: 1 country
• Sites: 1

Brief Summary

This study tested whether mobile health (mHealth) tools can affect referral uptake among schoolchildren with vision problems.Visual impairment in children often goes untreated in low- and middle-income countries, even when detected during school screenings, because parents do not follow up on referral advice. In this randomized controlled trial, children aged 5-15 years from two government schools in Rawalpindi, Pakistan, were screened for vision problems using a smartphone-based application. Those identified with possible impairment were randomly assigned to one of two groups. The control group received the usual printed referral form, while the intervention group received the printed referral plus automated, multicomponent SMS reminders in the local language. These reminders included health promotion messages, a visual depiction of the child's vision, and practical instructions about how to reach the hospital. The main outcome was the proportion of referred children who attended the hospital within eight weeks. Secondary analysis examined whether referral uptake was linked with child and family characteristics such as age, sex, and parental education. This was a minimal-risk, school-based trial with 80 participants. The study was ethically approved by the Army Medical College Ethics Review Committee (NUMS). Findings are expected to provide new evidence on the usefulness of mobile phone-based reminders for improving eye health care among children in resource-limited settings.

Conditions

Visual Impairment; Refractive Error

Keywords

visual impairment; mhealth; refractive error; referral reminder

Outcome Measures

Primary Outcomes (1)

• Proportion of referred children who will attend the hospital within 8 weeks of referral in both groups

  Primary outcome of interest is the proportion of referred children who attend the hospital within eight weeks of referral in both groups. It will be assessed by weekly telephonic follow up of referred children.

  Follow up for 8 weeks on weekly basis after identification of visual impairment

Secondary Outcomes (1)

• Secondary outcome of interest is the association of hospital attendance with sociodemographic characteristics of referred participants

  1 - 56 day

Study Arms (2)

Intervention arm

EXPERIMENTAL

Parents or guardians in the intervention group will receive a multicomponent SMS reminder in addition to printed referral forms. These reminders will be delivered every Sunday, Tuesday and Thursday for a duration of eight weeks, or until the child attends the hospital. Research team has already developed an automated text message reminder system for this study, taking into account the local context. The content of the messages was designed with input from a panel of public health consultants and research supervisors, drawing on resources from the WHO Health Promotion and Disease Prevention Messages Library \[21\]. Messages will be sent in Urdu, the native language, and will not require a reply. Each message will include four elements: Health promotion message, visual depiction of a child's vision, a customized action plan detailing how to get to the hospital including the location, how much money is needed and what to carry with them.

Other: Multicomponent SMS reminder

Control arm

NO INTERVENTION

Among control arm, the participants screened positive for visual impairment in the control group will receive a referral form. There will be no mHealth referral reminder sent to the identified visual impaired children.

Interventions

Multicomponent SMS reminder OTHER

SMS reminder will be delivered every Sunday, Tuesday and Thursday for a duration of eight weeks, or until the child attends the hospital. Research team has already developed an automated text message reminder system for this study, taking into account the local context. The messages was designed with input from a panel of public health consultants and research supervisors, drawing on resources from the WHO Health Promotion and Disease Prevention Messages Library \[21\]. It will comprise two main components: a) web-based application for children registration and automated reminder scheduling, and b) an SMS application for text messaging that is sent automatically. Messages will be sent in Urdu, the native language, and will not require a reply. Each message will include four elements: Health promotion message, visual depiction of a child's vision, a customized action plan detailing how to get to the hospital including the location, how much money is needed and what to carry with them.

Intervention arm

Eligibility Criteria

• Age: 5 Years - 15 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17)

Participants will only be enrolled if they meet all eligibility criteria: * Age 5 to 15 years * Detected with visual impairment on screening, * Parent in possession of or have access to smartphone * Parents have ability to receive, read and understand an SMS Children may not enter the study if any of the following apply: * Children with known refractive error (myopia) * Children with spectacles * Children with apparent eye diseases (e.g. conjunctivitis, red eye, ocular trauma, trachoma, etc.) * Plan to travel outside the city in the next two months following enrollment

Contact the study team to discuss eligibility requirements. They can help determine if this study is right for you.

Sponsors & Collaborators

• Syed Fawad Mashhadi: lead

Study Sites (1)

Federal government schools

Rawalpindi, Punjab Province, 46000, Pakistan

Location

Related Publications (2)

• Javed A, Mohsin S. Effectiveness of mHealth-based vision screening on uptake of referral services among children of government schools in Rawalpindi, Pakistan: study protocol for a randomised controlled trial. BMJ Open. 2025 Oct 29;15(10):e096970. doi: 10.1136/bmjopen-2024-096970.

  PMID: 41161831 DERIVED

• Javed A, Mohsin S, Habib R, Malik UA. Effectiveness of mobile health based vision screening on uptake of referral services in school children: A randomized control trial. Pak J Med Sci. 2025 Aug;41(8):2328-2337. doi: 10.12669/pjms.41.8.11742.

  PMID: 40980391 DERIVED

Related Links

• The Global Burden of Disease (GBD) study provides a comprehensive picture of mortality and disability across countries, time, age, and sex.
• Telecom Indicators, WHO fact sheet on blindness and visual impairment providing key facts, definitions, causes.
• The IAPB Vision Atlas presents the very latest eye health data and evidence.

MeSH Terms

Conditions

Vision Disorders; Refractive Errors

Condition Hierarchy (Ancestors)

Sensation Disorders; Neurologic Manifestations; Nervous System Diseases; Eye Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Shamaila Mohsin, PhD

  National University of Medical Sciences

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: The individual responsible for follow-up contacts will remain blinded to group allocation by working from a coded participant list that does not identify arm membership and will record outcomes using participant IDs only. The data analyst will receive a de-identified dataset with intervention arm masked to permit unbiased analysis.
• Purpose: SCREENING
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Professor and Head of the department, community medicine and public health, Army medical college

Model Details: This study is a Concurrent parallel group, single blinded Randomized Control Trial with 1:1 allocation ratio.

Study Record Dates

• First Submitted: September 22, 2024
• First Posted: September 27, 2024
• Study Start: October 21, 2024
• Primary Completion: December 30, 2024
• Study Completion: December 30, 2024
• Last Updated: October 7, 2025

Record last verified: 2025-10

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)