Impact of interprofessional eye health education using the Arclight training package and the International Classification of Function Disability and Health (ICF) framework among health sciences students in Rwanda : a mixed methods study

Abstract

The World vision report states that 1.1 billion people live with vision loss with 90% being preventable or treatable. Interprofessional education (IPE) promotes interprofessional collaboration (IPC) improving outcomes from stretched and under-resourced health care systems. Strategies such as IPE can strengthen primary eye care in resource poor settings. This study was conducted to evaluate the impact of interprofessional eye health education (IPEHE) in Rwanda.

A mixed methods approach was used to address the study objectives. 261 final year students from nursing, ophthalmic clinical officers, general medicine, midwifery, and pharmacy professions at the University of Rwanda were randomised to either attend the IPEHE intervention (n=161) or online guided uni-professional learning for the control group (n=100). Knowledge and skills were assessed at different time points. Participants were followed up in-service to investigate changes in referral patterns to ophthalmology services. Data were analysed using t-tests multivariate analysis and Kruskal-Wallis’s test in SPSS. All qualitative data were thematically analysed using NVivo software.

The intervention training was administered to 155 participants as IPEHE champions and 90 control participants who were not exposed to the intervention were recruited. The in-service follow-up phase included 6 intervention and 5 control hospitals. The findings showed statistically significant collaborative eye health knowledge and skills acquisition among intervention participants through the IPE approach. In the intervention hospitals, the ratio of false positive referrals, as a ratio of internal referrals to external referrals decreased by 40% (p-value 0.046) with the ratio of true positive referrals increasing by 45.7% (p-value 0.046). No change was observed in control hospitals. Moreover, collaboration through internal referrals resulted in improved efficiency and patient eye care outcomes in the intervention hospitals.

This study has contributed to the limited evidence on IPE impact on health services and patient eye care outcomes. The findings will contribute to the development of human resource for eye health and IPECP in Rwanda starting with higher education institutions.