What are the implementation lessons from a high-volume cataract screening and surgical programme? A mixed-methods implementation evaluation in Sierra Leone
Year: 2026
Type: article
Abstract: Objective(s) To evaluate the first implementation cycle of the cataract screening and surgical programme in Sierra Leone using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework and the Plan-Do-Study-Act approach. Design Mixed-methods implementation evaluation of routine programme data with interviews and focus group discussions. Setting Sierra Leone. Participants Cataract-positive patients identified through community screening. Primary and secondary outcomes Primary outcome includes programme reach and implementation, vision-related quality of life measured. Secondary outcomes included qualitative assessment of implementation barriers and programme adaptations. Results Among 9117 individuals screened, 7738 complete records were analysed, and 1433 cataract surgeries were performed. The programme predominantly reached economically vulnerable populations and mean composite National Eye Institute Visual Function Questionnaire score improved by 17 points following surgery (p<0.001). High patient demand, transportation and road infrastructure barriers, limited workforce and equipment affected implementation and postoperative follow-up. Adaptation included changes to staffing and workflows and plans for decentralised follow-up services. Conclusions High-volume cataract outreach in Sierra Leone substantially improved vision-related quality of life while highlighting the importance of adaptive implementation strategies in resource-constrained settings.
Source: BMJ Open
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,839
Funder: Wellcome Trust
Award: G585067916
OpenAlex ID: W7221148152