title: Identifying barriers to follow-up eye care for children after failed vision screening in a primary care setting.
abstract: OBJECTIVE
  To identify barriers to follow-up eye care in children who failed a visual acuity screening conducted by their primary care provider.
  
  
  METHODS
  Children aged 3-14 years who failed a visual acuity screening were identified. A phone survey with the parent of every child was conducted 4 months after the screening. Family demographics, parental awareness of childhood eye diseases and eye care for children, and barriers to follow-up eye care were assessed.
  
  
  RESULTS
  Of 971 children sampled, 199 (20.5%) failed a visual acuity screening. The survey was completed by the parents of 58 children (29.1%), of whom 27 (46.6%) presented for follow-up examination. The most common reason for failure to follow-up was parental unawareness of screening results (29.3%). Follow-up rates were higher in children with previous eye examinations than in those without (81% versus 17%; P = 0.005) and in children who waited <2 months for a follow-up appointment than in those who had to wait longer (100% versus 63%; P = 0.024). Child's sex, ethnicity, and health insurance status, parent's marital, education and employment status, household income, and transportation access were not associated with statistically significant different follow-up rates.
  
  
  CONCLUSIONS
  Parental unawareness of a failed visual acuity screening is an important barrier to obtaining follow-up. Strategies to improve follow-up rates after a failed visual acuity screening may include communicating the results clearly and consistently, providing education about the importance of timely follow-up, and offering logistic support for accessing eye appointments to families.
authors.affiliation: Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Su
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Marvin
authors.forename: Bing Q
authors.initials: BQ
authors.lastname: Wang
authors.forename: Tavé
authors.initials: T
authors.lastname: van Zyl
authors.forename: Maxwell D
authors.initials: MD
authors.lastname: Elia
authors.forename: Esteban N
authors.initials: EN
authors.lastname: Garza
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Salchow
authors.forename: Susan H
authors.initials: SH
authors.lastname: Forster
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003237:Connecticut; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D008297:Male; D010290:Parents; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care / Q000458:organization & administration; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014786:Vision Disorders / Q000175:diagnosis*; D015351:Vision Screening / Q000458:organization & administration*