title: Visual health screening by schoolteachers in remote communities of Peru: implementation research.
abstract: OBJECTIVE
  To describe the adaptation and scaling-up of an intervention to improve the visual health of children in the Apurimac region, Peru.
  
  
  METHODS
  In a pilot screening programme in 2009-2010, 26 schoolteachers were trained to detect and refer visual acuity problems in schoolchildren in one district in Apurimac. To scale-up the intervention, lessons learnt from the pilot were used to design strategies for: (i) strengthening multisector partnerships; (ii) promoting the engagement and participation of teachers and (iii) increasing children's attendance at referral eye clinics. Implementation began in February 2015 in two out of eight provinces of Apurimac, including hard-to-reach communities. We made an observational study of the processes and outcomes of adapting and scaling-up the intervention. Qualitative and quantitative analyses were made of data collected from March 2015 to January 2016 from programme documents, routine reports and structured evaluation questionnaires completed by teachers.
  
  
  RESULTS
  Partnerships were expanded after sharing the results of the pilot phase. Training was completed by 355 teachers and directors in both provinces, belonging to 315 schools distributed in 24 districts. Teachers' appraisal of the training achieved high positive scores. Outreach eye clinics and subsidies for glasses were provided for poorer families. Data from six districts showed that attendance at the eye clinic increased from 66% (45/68 children referred) in the pilot phase to 92% (237/259) in the implementation phase.
  
  
  CONCLUSIONS
  Adaptation to the local context allowed the scaling-up of an intervention to improve visual health in children and enhanced the equity of the programme.
authors.affiliation: Public Health Research Group, University of Alicante, Campus San Vicente del Raspeig, Ap. 99 CP 03080, San Vicente del Raspeig, Alicante, Spain .
authors.forename: Sergio
authors.initials: S
authors.lastname: Latorre-Arteaga
authors.affiliation: Public Health Research Group, University of Alicante, Campus San Vicente del Raspeig, Ap. 99 CP 03080, San Vicente del Raspeig, Alicante, Spain .
authors.forename: Diana
authors.initials: D
authors.lastname: Gil-González
authors.affiliation: International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, England .
authors.forename: Covadonga
authors.initials: C
authors.lastname: Bascarán
authors.affiliation: Regional Educational Direction of Apurimac, Abancay, Peru .
authors.forename: Richard Hurtado
authors.initials: RH
authors.lastname: Núñez
authors.affiliation: ONCE Foundation for Solidarity with Blind People in Latin America, Madrid, Spain .
authors.forename: María Del Carmen Peral
authors.initials: MD
authors.lastname: Morales
authors.affiliation: Universidad Peruana Los Andes, Lima, Peru .
authors.forename: Guillermo Carrillo
authors.initials: GC
authors.lastname: Orihuela
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003159:Community-Institutional Relations; D005139:Eyeglasses / Q000191:economics; D005178:Faculty; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D010568:Peru / Q000453:epidemiology; D010865:Pilot Projects; D012017:Referral and Consultation; D012030:Refractive Errors / Q000453:epidemiology / Q000628:therapy; D012424:Rural Population; D012574:Schools; D015351:Vision Screening / Q000379:methods*