Effectiveness of mHealth-based vision screening on uptake of referral services among children of government schools in Rawalpindi, Pakistan: study protocol for a randomised controlled trial.

introductionVision screening in educational settings holds significant importance for early detection of visual impairment. A key challenge is the low uptake of referral services which significantly limits the effectiveness of screening. Mobile health (mHealth) is one intervention that is rapidly being adopted in Pakistan with more than 100 million smartphones users. However, evidence of its effectiveness on referral uptake outcomes is still limited. METHODS AND ANALYSIS: A concurrent, parallel-group, single-blinded randomised controlled trial will be conducted in government schools of Rawalpindi district, Pakistan. Participants will first be screened for visual impairment using the mHealth visual acuity application. After screening, schools will be randomly allocated (1:1) to intervention and control groups. Eligible participants will include children aged 5-15 years whose parents own a smartphone and who are diagnosed with visual impairment during screening. The intervention group will receive a multicomponent SMS reminder in addition to a printed referral form. The SMS will include a health promotion message, visual depiction of the vision of the child and a customised action plan. Reminders will be delivered automatically through the visual acuity application. All referred children will be followed for 8 weeks by telephone. Data will be analysed according to the intention-to-treat principle. A Cox regression model will be used to assess the effect of SMS reminders on referral uptake. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Ethical Review Committee of Army Medical College, Rawalpindi, Pakistan (ERC/ID/415, dated 5 September 2024). Permission to conduct screening was granted by the Federal Government Education Institutions Directorate, Rawalpindi (0409/F-28/2024 FGEI, CPD-Trg), dated 20 October 2024. All children participating in the trial will be required to provide written informed consent from parents or guardians, along with assent from the child. Findings will be disseminated through methodology papers, conference presentations and peer-reviewed publications. Results will be reported according to the Consolidated Standards of Reporting Trials guidelines. Participation in national and international academic conferences will provide further opportunities for dissemination. TRIAL REGISTRATION NUMBER: NCT06616051 (dated 26 September 2024).