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Table 2 preliminary assessment of the implementation outcomes after one year.

From: Implementation of paediatric vision screening in urban and rural areas in Cluj County, Romania

Acceptability
 On-site interviews with nurses, family doctors and kindergarten staff Urban & rural Vision screening was considered as important by the majority of nurses, family doctors and kindergarten staff.
 Questionnaires for screeners Urban & rural The majority of nurses expressed a positive attitude towards screening and indicated they believe screening is important and should be provided to all children.
 Questionnaires for family doctors Rural All rural family doctors considered vision screening important.
Feasibility
 On-site interviews with nurses Urban The kindergartens were a practical setting, because the nurses see a lot of children every day and know the children and their parents well.
Rural The family doctors’ offices were not a practical setting, because parents did not bring their children. Some nurses did not have the time to screen. Screening in rural kindergartens was hampered by low attendance and travel distances.
 On-site interviews with family doctors Rural Most family doctors indicated their nurses lacked time to screen and do the paperwork involved.
 On-site interviews with kindergarten staff Urban Kindergarten nurses could screen large numbers of children.
Rural Kindergartens were considered less practical because of a lack of nurses and the low numbers of children attending.
 Questionnaires for family doctors Rural Lack of funds, too many patients, personnel costs, travel time to patients in remote areas would make screening difficult.
 On-site observation of screening Urban Nurses were able to carry out screening according to protocol in the kindergartens.
Rural Nurses were able to carry out screening according to protocol in family doctors’ offices and kindergartens. On few occasions, available spaces were too small to measure visual acuity.
Appropriateness
 On-site interviews with nurses Urban Most parents reacted well to the idea of vision screening.
Rural Some parents reacted well, but others were not interested in vision screening at all.
 On-site interviews with family doctors Rural Most family doctors felt they had too much other preventive healthcare priorities and that parents lack awareness of the benefits of preventive healthcare.
 On-site interviews with kindergarten staff Urban Screening by nurses in kindergartens was considered suitable for the setting. Most parents reacted well to the idea of vision screening.
Rural Opinions among kindergarten staff were divided. Some said parents were positive about vision screening while others said parents were negative.
 Questionnaires for rural family doctors Rural Some family doctors said parents would be positive about vision screening, others said they would not.
Adoption
 On-site interviews with nurses Urban Introducing vision screening was considered a good idea and were enthusiastic to participate.
Rural Some nurses were enthusiastic to participate in screening, but others said they lacked the time to do so.
 On-site interviews with family doctors Rural Most family doctors indicated their nurses did not have to time to take up screening and do the paperwork involved.
 On-site interviews with kindergarten staff Urban & rural Vision screening was considered a good idea and staff were inclined to cooperate.
 Questionnaires for screeners Urban & rural The majority of nurses considered vision screening a natural part of their work.
 Data analysis of screening results Urban More than two-thirds of the nurses who followed the course participated in vision screening.
Rural Only 22% of all nurses participated in vision screening.
Fidelity
 On-site interviews with nurses Urban & rural Nurses said they were able to perform screening adequately, though some mentioned it was a bit difficult in the beginning.
 Questionnaires for screeners Urban & rural Nurses felt confident they were able to screen.
 On-site observation of screening Urban & rural Most nurses performed screening according to protocol.
 Data analysis of screening results Urban & rural There were many outliers among nurses when it came to referral rates – both very low and very high referral rates – and also other indications that the protocol was not always followed correctly.
Coverage
 On-site interviews with nurses Urban Most parents consented to having their child screened.
Rural Most parents did not bring their children to the doctor’s office for screening. Most family doctors’ nurses who went on to screen in kindergartens said that they only found small numbers of children there.
 Data analysis of screening results Urban 81% (Cluj-Napoca) and 82% (small cities) of eligible children were screened.
Rural 25% of eligible children were screened. Screening took place in 24 out of 75 rural communes.