Health care professional perspectives on vision screening in older adults who attend hospital following a fall: a focus group study

Background: The assessment and management of impaired vision is included in falls prevention guidance, however implementation is inconsistent. We conducted focus groups to explore the perspectives of Health Care Professionals (HCP) on vision screening in older adults attending acute hospitals following a fall.

Methods: A focus group study was undertaken with HCPs from a single acute hospital trust. Semi-structured topic guides were informed by the Consolidated Framework for Implementation Research (CFIR). Transcripts were first inductively then deductively coded using CFIR constructs. Demographic data was collected and summarised.

Results: Five focus groups were conducted with 19 HCPs overall. Six interconnecting themes were identified, mapped to 14 CFIR constructs, relating to barriers and facilitators to vision screening. Barriers encompassed: lack of training, referral networks to manage impaired vision and prioritisation of task-focussed, rather than person-centred, care in the acute setting. Facilitators included: perceived mission alignment, adequate training, tools, guidance on roles, responsibilities and management pathways, integration of eye care professionals in multidisciplinary falls care and time in job plans.

Conclusions: HCPs were motivated to vision screen and felt it aligned with person-centred falls care, however there were individual, structural and organisation-level barriers related to staff capability and opportunity to implement vision screening in the acute setting. Multi-component and multi-level interventions and implementation strategies are needed to integrate eye care professionals into the falls Multidisciplinary Team, engage supportive leaders, develop an effective vision screening assessment, define roles, responsibilities and management pathways, organise individual training and time allocation for staff to perform screening.