A Qualitative Description of Stakeholder Perceptions of Factors Influencing Implementation of School-Based Vision Screening in Ontario

Abstract

In Canada, nearly 25% of school-aged children have vision problems. Common childhood vision disorders include amblyopia, refractive errors, and strabismus. Early identification and treatment of these disorders can prevent long-term vision loss and improve academic achievement. In 2018, the Ontario Ministry of Health and Long-Term Care legislated universal childhood vision screening of all senior kindergarten students. Although studies have explored the effectiveness of these interventions, few have explored the barriers and facilitators to program implementation. This study used a qualitative descriptive approach to examine the perceptions of key informants regarding the factors influencing the implementation of school-based vision screening in Ontario, and the role of nurses in supporting implementation. Semi-structured interviews were conducted with parents (n = 3), optometrists (n = 3), clinical research personnel (n = 2), public health staff (n = 5), school staff (n =2), and community vision program personnel (n = 2) from across Ontario. The Consolidated Framework for Implementation Research (CFIR) was used to frame the analysis. The following factors were found to influence vision screening implementation: (1) student and parent needs; (2) presence of external partnerships; (3) dedication of tangible resources; (4) presence of internal networks and communications; and (5) the cost, complexity, and perceived quality of the vision screening program. Participants reported that public health nurses’ knowledge and skills, and their position within schools, communities, and the health system, facilitated vision screening implementation. This study suggests that a comprehensive and coordinated approach is necessary when implementing school-based vision screening programs. Future research examining vision screening implementation should consider the use of the CFIR to guide all phases of the implementation process, and explore the experience and perspectives of vision screening implementation of students, non-English speaking families, and those who had experienced failed vision screening.