A new, evidence-based tool to support community engagement in eye health

Community engagement is critical to the success of our programmes at The Fred Hollows Foundation. People are at the centre of all we do. We seek to respond to the needs of local people and empower communities to access eye health services and demand better care. By raising awareness about eye-health and working to ensure services provide people-centred eye care, we confront some of the barriers to treatment. These barriers can be particularly pronounced for marginalised groups – including women, indigenous and tribal peoples, people with a disability, and people in rural and remote areas. Ensuring these groups of eye care users are effectively engaged and have a voice in the design and implementation of eye health care is critical to the success of efforts to achieve universal health coverage.

At The Fred Hollows Foundation, we have come to realise that effective community engagement begins with a sound understanding of a community’s needs, circumstances and preferences. In our efforts to strengthen our practice, we developed the  Community Engagement in Eye Health Assessment Tool (CEEHAT)  to assess community opportunity, capacity and motivation to engage with eye health and care, and identify areas for eye health service quality improvement.

The tool is free for programme designers, researchers, health care planners and any others interested in understanding the needs of communities prior to the development of programmes, or in testing the effectiveness of their community engagement approaches.

Why did we develop it?

CEEHAT was developed to address the lack of a valid and reliable tool to assess community ‘Knowledge, Attitudes and Practices’ (KAP). KAP studies are often undertaken to understand barriers and enablers of access to community attitudes towards social and economic services in a given area. There are however a number of known issues with the way KAP studies are typically undertaken. Often the methodology used lacks rigor, and the tools used are not valid or reliable. Poor quality design may result in poor quality data.

 How reliable and valid is it?

The CEEHAT is evidence and theory driven. We worked with Deakin University in Australia to develop a conceptual framework that seeks to articulate what community engagement in eye health requires from a behaviour change and a behavioural determinant point of view. We based this on a rigorous review of published literature on community engagement, behaviour change and health promotion.

We have tested the tool in a few settings now, and have used the data from a pilot in Myanmar to assess the psychometrics of the tool. We then worked with experts from the Centre for Eye Research Australia at the University of Melbourne to understand item discrimination and difficulty, fitness, validity, targeting, precision, dimensionality… and have made some adjustments in response to these results.

How does it work? 

The CEEHAT has several modules and is a multi-dimensional tool. The core module assesses community engagement using 18 questions across 4 domains:

  • Understanding of eye healthcare
  • Motivation to engage with eye healthcare
  • Trust in eye healthcare
  • Opportunity to engage with eye healthcare

The tool allows scores to be generated for each of these domains. Average scores across groups of participants can be used to identify areas of strength and challenges that can then inform programme design. For example, if the results reveal that women generally have a very low ‘opportunity’ score then a programme may need to particularly address these sorts of challenges. If motivation is the key issue for older men, then mobilisation efforts can be particularly directed to the sorts of messages that might engage older men.

Supplementing the core CEEHAT module are six additional/optional modules (1. Willingness to pay; 2. Trachoma; 3. River Blindness; 4. Diabetes; 5. Experience with eye healthcare; 6. Patient journey). Standard sets of demographic questions are also provided.

Target group:
The CEEHAT is intended to be administered to adults aged over 16 years.

Potential uses:
The CEEHAT may assist health services and other stakeholders to:

  1. Understand (and identify responses to) local barriers to eye health service access and uptake;
  2. Evaluate the effectiveness of programs intending to address determinants of eye health service access and uptake.

Please contact fhfresearchunit@hollows.org with any questions regarding the CEEHAT and its uses. We’d love to hear about your interest and experience in community engagement and implementing the CEEHAT!