title: The Impact of Multimedia Education on Uptake of Comprehensive Eye Examinations in Rural China: A Randomized, Controlled Trial.
abstract: OBJECTIVE
  To study the effect of multimedia education on acceptance of comprehensive eye examinations (CEEs), critical for detecting glaucoma and diabetic eye disease, among rural Chinese patients using a randomized, controlled design.
  
  
  METHODS
  Patients aged ≥40 years were recruited from 52 routine clinic sessions (26 intervention, 26 control) conducted at seven rural hospitals in Guangdong, China. Subjects answered demographic questionnaires, were tested on knowledge about CEEs and chronic eye disease, and were told the cost of examination (range US$0-8). At intervention sessions, subjects were cluster-randomized to view a 10-minute video on the value of CEEs and retested. Control subjects were not retested. Trial outcomes were acceptance of CEEs (primary outcome) and final knowledge scores (secondary outcome).
  
  
  RESULTS
  At baseline, >70% (p = 0.70) of both intervention (n = 241, 61.2 ± 12.3 years) and control (n = 218, 58.4 ± 11.7 years) subjects answered no knowledge questions correctly, but mean scores on the test (maximum 5 points) increased by 1.39 (standard deviation 0.12) points (p < 0.001) after viewing the video. Intervention (73.0%) and control (72.9%) subjects did not differ in acceptance of CEEs (p > 0.50). In mixed-effect logistic regression models, acceptance of CEEs was associated with availability of free CEEs (odds ratio 18.3, 95% confidence interval 1.32-253.0), but not group assignment or knowledge score. Acceptance was 97.5% (79/81) when free exams were offered.
  
  
  CONCLUSIONS
  Education increased knowledge about but not acceptance of CEEs, which was generally high. Making CEEs free could further increase acceptance.
authors.affiliation: Translational Research for Equitable Eyecare (TREE), Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , China.
authors.forename: Aihua
authors.initials: A
authors.lastname: Dan
authors.forename: Graham
authors.initials: G
authors.lastname: Raubvogel
authors.forename: Tingting
authors.initials: T
authors.lastname: Chen
authors.forename: Tiantian
authors.initials: T
authors.lastname: Ye
authors.forename: Ling
authors.initials: L
authors.lastname: Jin
authors.forename: Baixiang
authors.initials: B
authors.lastname: Xiao
authors.forename: Ana
authors.initials: A
authors.lastname: Sanchez
authors.forename: Nathan
authors.initials: N
authors.lastname: Congdon
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People / Q000208:ethnology; D002681:China / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005901:Glaucoma / Q000175:diagnosis / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019212:Multimedia; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000379:methods*; D010808:Physical Examination / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014787:Vision Tests
keywords: Adherence; China; comprehensive eye examination; diabetic retinopathy; education; glaucoma; randomized trial; rural