{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T15:02:07Z","timestamp":1790002927716,"version":"4.0.1"},"reference-count":48,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"unspecified","delay-in-days":82,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["215633\/Z\/19\/Z"],"award-info":[{"award-number":["215633\/Z\/19\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,7,15]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Recent research has found that less than half of people identified with an eye problem in Meru county\u2019s 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 \u2018left-behind\u2019 group to explore barriers and identify potential solutions using a rapid mixed-methods approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 workshop 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 and 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-002856","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T14:12:34Z","timestamp":1789999954000},"page":"e002856","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Identifying barriers and potential solutions to improve equitable access to community eye services in central Kenya: a rapid exploratory sequential mixed methods study"],"prefix":"10.1136","volume":"4","author":[{"given":"Luke N","family":"Allen","sequence":"first","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"},{"name":"Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Karanja","sequence":"additional","affiliation":[{"name":"Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Gichangi","sequence":"additional","affiliation":[{"name":"Ophthalmic Services Unit, Kenya Ministry of Health, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cosmas","family":"Bunywera","sequence":"additional","affiliation":[{"name":"Peek Vision Ltd, Kitale, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmaculate","family":"Muturi","sequence":"additional","affiliation":[{"name":"College of Ophthalmology of Eastern Central and Southern Africa, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dickson","family":"Gachobi","sequence":"additional","affiliation":[{"name":"Lifecare Hospital, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Purity","family":"Kathure","sequence":"additional","affiliation":[{"name":"College of Ophthalmology of Eastern Central and Southern Africa, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth Mutile","family":"Muasa","sequence":"additional","affiliation":[{"name":"College of Ophthalmology of Eastern Central and Southern Africa, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorna","family":"Mutwiri","sequence":"additional","affiliation":[{"name":"Meru County Health Department, Meru, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorna","family":"Kajuju","sequence":"additional","affiliation":[{"name":"Meru County Health Department, Meru, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faith","family":"Kagwiria","sequence":"additional","affiliation":[{"name":"Chuka University, Chuka, Eastern, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Ntabathia","sequence":"additional","affiliation":[{"name":"College of Ophthalmology of Eastern Central and Southern Africa, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hillary","family":"Rono","sequence":"additional","affiliation":[{"name":"Kitale County District Hospital, Kitale, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Macleod","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, 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