Identifying barriers and potential solutions to improve equitable access to community eye services in central Kenya: a rapid exploratory sequential mixed methods study

Background: Recent research has found that less than half of people identified with an eye problem in Meru countys screening programme were able to access care, with younger adults being the least likely to receive the care they needed. We aimed to interview and survey members of this "left-behind" group to explore barriers and identify potential solutions using a rapid mixed-methods approach. Methods: First, we conducted interviews to explore perceptions of barriers and potential solutions. Next, we asked a representative sample to rank the suggested solutions by likely impact. Finally, we held a multistakeholder meeting to identify which of the top-ranked interventions offered the best balance of impact, feasibility, cost, and potential risks. We used a deductive matrix and thematic analysis to rapidly analyse the interview data. Results: We conducted 67 interviews. Barriers to access included long queues, conflicting work engagements, and lack of clear information. Proposed solutions focused on reducing queue lengths, providing better counselling and clinic information, holding mop-up clinics, and maintaining adequate stocks & supplies. We conducted ranking surveys with 401 additional people from the left-behind group. All proposed solutions were ranked at moderately-to-highly likely to improve equitable access. Fifteen people attended the multistakeholder meeting, including community representatives. Workshop participants unanimously selected enhanced counselling and SMS reminders as the interventions that offered the best balance of impact, risk, cost, and feasibility. The other proposed solutions were deemed impractical or unaffordable. Conclusion: Rapid mixed-methods and multistakeholder collaboration were used to identify a range of potential service modifications that will be implemented within the ongoing programme. Our approach was centred on the experiences and perceptions of those who face the highest barriers to care.