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Dear Readers,
Welcome to the November issue of SiteNews! We hope you have found the resources on the site to be helpful. For those of you who are first-timers this issue includes a quick overview of the new products uploaded and the feedback about the site.
This month we have decided to feature the Diabetic Retinopathy resources which would be of great significance and also useful to our readers. Hence we highlight a particularly effective available product on Diabetic Retinopathy Diabetic Retinopathy Knowledge, Attitude and Practice Study as the featured product of this month, a protocol that deals with how to create awareness in the community for a particular activity to get their support. Also you can go through all the resources of Diabetic Retinopathy which is available on our site as a quick overview for your easy reference.
This month we feature Vision 2020 - India in the Collaborating Partner section.
As per Vision 2020 - The Right to Sight programme, the five major diseases for the South East Asian region is Cataract, Diabetic Retinopathy, Refractive Errors, Paediatric diseases, and Low Vision disorders. Moreover in India, the number of Diabetic Retinopathy patients is increasing in a drastic way. Hence there is an urge to control this hike by initiating various awareness programmes within the community and also to the Ophthalmologists to know about the seriousness of the problem. Hence as a part of extending the Eye hospital services from General Ophthalmology to Diabetic Retinopathy, Estimation of Diabetic Retinopathy Service for the Service Area Population (automated Excel sheet) tool is prepared to help them calculate potential for Diabetic Retinopathy services, Gross revenue and net revenue obtained etc.
In addition to all our regular columns this issue provides you with an article "Diabetic Retinopathy Awareness Strategies" that spotlights the integral part of creating awareness in the community and also the methods that can be followed to prepare such awareness materials.
Hope this issue will impart the resources which are worth to be read. Looking forward to come up with more resources in future.
Wish you a productive reading!

Happy reading!
Regards,
Vision 2020 e-resource team
The Issue Features...
Diabetic Retinopathy Knowledge, Attitude and Practice Study
Vol. 1 No.11 November 2004
•   Vision2020 e-resource
•   The Way it Works
•   Featured Product
•   Collaborating partner
•   Management Article

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As part of developing new products we have come up with the Patient Education materials on Squint with a poster and brochure which could be used to educate the patients on the eye diseases.

As we want to feature all the Diabetic Retinopathy resources this month, this part will take you to the quick overview of all the products available on this topic.

To access all the products on Diabetic Retinopathy, go to the homepage of the site (www.v2020eresource.org) and enter your user name and password on the boxes provided at the end of the page. This will take you to the Resource bank page where you will find the key areas and management processes. Or please click on the following link to go directly to the Resource Bank page: www.v2020eresource.org.

Click on the Plus mark of the Disease Strategies and checkmark "Diabetic Retinopathy" box and


Click Submit button at the bottom of the page. The resources under this category of check will be listed down in 6 pages, with 27 products. You can find an Abstract, Guideline, Refer to friends, See Product, Write a Review and Place your vote for each product. Some of the most excellent products under this category are listed below:
  1. Diabetic Retinopathy Knowledge, Attitude and Practice Study Protocol
  2. Estimation of Diabetic Retinopathy services in a service area population
  3. Managing Diabetic Retinopathy for Medical Practitioners - A booklet
  4. DR Counselling Guidelines with Frequently Asked Questions
  5. Diabetic Retinopathy Series - A booklet
  6. Are you Diabetic - a Poster

All these materials are useful as a tool for building up the quality in your work. We are expecting your usage of the materials and the feedback.

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Introducing the Estimation of Diabetic Retinopathy Services for a service area population - A new tool that makes it possible to know the potential for an eye hospital in terms of estimating the magnitude of Diabetic Retinopathy services in a given service area population.

Since Diabetes becomes one of the major causes of blindness today, Eye hospital and Organizations in Eye care service delivery are turning up towards Diabetic Retinopathy services which make up the large part of their service delivery. The tool Estimation of Diabetic Retinopathy Services for a service area population will be a boon to all those particularly planning to start the Diabetic Retinopathy services for a particular service area.

Since there is no proven statistical data and its related complication in a given population, this tool has been developed. This tool will help the users to know the estimated number of prevalence and annual estimated workload at tertiary care centre. There is a User Manual which provides a layman a perspective on how to effectively use this tool or one has the option of the PowerPoint Broadcast to provide a Tutorial for complete understanding of the tool.

How to start the search:
You can access the tool on Estimation of Diabetic Retinopathy Services for a service area population through these series of steps:
  1. Go to the homepage of the site by pasting the website address: www.v2020eresource.org
  2. Click on the Resource Bank link provided at the Menu bar of the homepage.
  3. After the Resource Bank Page has loaded, please click on the Disease Strategies box.
  4. Check mark the Diabetic Retinopathy Services box
  5. Check mark the Planning box on the Management Processes section and then click Submit at the bottom.
  6. You will be taken to a page which shows you the materials listed for this selection process
  7. In that page you can find the Estimation of Diabetic Retinopathy Services for a service area population as the second product.
  8. You will find an Abstract and Guideline for the product and also the See Product link to see the full product.
  9. Also you will find the User Manual and Tutorial for the product.
  10. You can refer this product to your friend, Write a review to us and also vote the product about its usage.

Find the Product:
Have a look at the Excel Sheet by clicking here: Estimation of Diabetic Retinopathy Services for a service area population. It gives you details on the Estimated Diabetic Retinopathy patients & uptake, Annual workload estimation, Laser treatment etc. to make things more clear. More over you can provide your comments and suggestions by clicking on the Comments & Suggestions in homepage of the Excel document.

You can download the User Manual and also have a look at the Tutorial we have prepared for this.

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This section features products which our voters have ranked highly. This month we are featuring Diabetic Retinopathy Knowledge, Attitude and Practice Study Protocol. Currently our site contains other standardized protocols like,
  1. Medical Records Protocol
  2. Sterilization Protocol
  3. Cataract Surgical techniques protocol
  4. Community Outreach Protocol
Diabetic Retinopathy Knowledge, Attitude and Practice Study Protocol:

Abstract:
KAP Study tells us what people know about certain things, how they feel and also how they behave. The three topics that a KAP study measures are Knowledge, Attitude and Practice. Understanding the levels of Knowledge, Attitude and Practice will allow for a more efficient process of awareness creation as it will allow the program to be tailored more appropriately to the needs of the community.

Guideline: To be used by Organizations and Eye Care service providers for better understanding of the strategies to be followed to reach the broader community.

Have a look at the product:
Diabetic Retinopathy Knowledge, Attitude and Practice Study Protocol


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Vision 2020 - India:

We are delighted to collaborate with other resource centres and eye care websites. In this issue we wish to feature one of our collaborating partners: Vision 2020 - India. The Vision 2020: the Right to Sight - India a National Confederation of INGOs and NGOs established in 2004 as a coordinating, umbrella organization to lead national effort in mobilizing resources for blindness prevention activities. It is a National confederate Body to strengthen the implementation of the Vision 2020 activities in alignment to national objectives and targets and thus contribute to the elimination of avoidable blindness. It is poised to develop as a National Entity for Transformation, Human Resource Development, Research, and Advocacy- NETHRA (meaning eye) for action in eye care in India.

Aravind and Vision 2020 - India:
Aravind is one of the partners of Vision 2020 India and the National Secretariat is located at Lions Aravind Institute of Community Ophthalmology. Aravind is one of the Advisory Board members for Vision 2020 India Programme and our Executive Director Mr. R.D. Thulasiraj is the President of the SEAR region for Vision 2020 - The Right to Sight Programme. Moreover this website in particular aims to reach the goals of Vision 2020 offering the resources which the developing countries would need to implement their service delivery on a sustainable basis. Hence we are looking forward to extend the support more widely and we place our deep appreciation in strengthening the relationship.

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Diabetic Retinopathy Awareness Strategies


Introduction
A successful program to combat any disease in the community relies on the awareness of the community on that disease. The community must be aware of the problem and the efforts being taken to help solve it so that they can actively engage in health seeking behavior, such as coming in for treatment. In addition, general knowledge on the specifics of the disease and on what can be done to combat it will help enormously in the effectiveness of the program.

Rationale
Awareness creation is a vitally important step in the creation of a successful program to battle against any disease in the community. This is especially true of the growing problem of Diabetic Retinopathy. Studies previously completed have revealed that Diabetic Retinopathy, despite its status as one of the greatest causes of blindness in both developed and developing countries, is virtually unknown to a large majority of the population. This lack of knowledge is not restricted to the general public, but pervades the medical and paramedical communities as well. Without awareness of the disease it is impossible for any individual to aid the cause of preventing blindness from Diabetic Retinopathy, either in him or herself or in the community as a whole. Awareness creation is therefore necessary as one of the first steps in any program aimed at reducing Diabetic Retinopathy.

Objectives of the Awareness Creation Module
  1. To explain the undertaking of a successful Knowledge, Attitude and Practice (KAP) study
  2. To gauge the necessary awareness creation level in a community.
  3. To help in the selection of target areas for awareness creation.
  4. To define effective strategies in creating awareness in the community.
  5. To help in the overall administration and management of an effective awareness creation project.
The Diabetic Retinopathy Program launched by the Aravind Eye Hospital and the Lions Institute will serve as a model from which this module will draw its experiences.

Communication Approaches
People vary so widely in their socio-economic conditions, traditions, attitudes, beliefs and level of knowledge that uniform communication approach may not be viable. A mixture of different approaches must be developed depending upon the local circumstances. The approaches are classified as individual approach, group approach and mass approach. Each has its own place and value depending on the circumstances and inspite of some overlap, each has its own unique features. There are three main approaches to awareness creation activities, each intended to reach a different audience and each with a different goal in mind. As their names suggest, the basic difference between these approaches is the number of people they are intended to reach. This intent affects the mediums that are used in each approach. An effective awareness creation program will employ each of these strategies, to varying degrees, to educate the population targeted.


Mass Approach
The Mass Approach is intended to reach a large number of people. Its primary goal is to create awareness of the problem in those whom it reaches and to begin to increase their level of Knowledge. Activities that fall under this category are not intended to result in great understanding in those they reach, but an increased awareness of the problem and basic knowledge about its specifics. A poor result in the Knowledge section of the KAP survey amongst the population studied is a good indication that a high level of effort should be focused on the Mass approach to awareness creation. The mediums that are most appropriate for this type of awareness creation vary largely.


  1. Mass Media, such as television, newspapers, and the radio can be effectively used to increase the level of knowledge in the community about diabetes and diabetic retinopathy. These forms of communication have the potential benefit that they almost invariably reach a large audience, and therefore can spread information very effectively to a large population. Television and radio announcements are potentially more useful in creating awareness of the problem, as they can be heard by those with visual impairment, and heard or seen by those who cannot read. Television and radio announcements, however, are likely to be too expensive to convey more than very basic details. Illiteracy is a common obstacle to awareness creation in rural areas, and, in any project whose intended audience is assumed to suffer from vision problems, audio messages are very useful.
  2. Poster display in hospitals or public meeting places have the same advantage of being widely seen, but also carry a disadvantage. Since most of the targeted population may be illiterate or visually impaired and poster message may not be clearly transmitted. They have the additional benefit of the possibility to more specifically target your intended audience, as they can be displayed in eye hospitals or diabetes treatment centers, and therefore are likely to be seen by those who most need to see them.
  3. Pamphlets and Booklets may be distributed in the community to spread more specific knowledge about the disease. Newspapers and television or radio programs are not likely to provide in depth information concerning diabetic retinopathy due to the costs involved. Pamphlets and booklets can provide very specific details about the disease, and can be re-read many times by those who pick them up - another advantage over mass media communications like TV and radio. They can also be tailored to specific groups of people, and contain information meant specifically for them.

  4. Exhibition and local Fairs or Festivals provide opportunity to reach a large audience through the use of a booth distributing IEC materials. This is a particularly valuable venue for awareness creation because of the possibility for interaction between knowledgeable project staff and the public during the distribution of these materials, which can help to provide elucidation of the information provided in these materials or additional information to those who desire to learn more. Exhibition and fairs are also valuable because of the large potential audience they provide.


Group Approach
The Group approach is designed to help change the opinions and attitudes of the targeted people. It is characterized by efforts to reach a smaller target audience for a more sustained period of time. This approach is more effective in educating its audience than methods conducted under the Mass approach. Activities characterized under the Group approach should occur after those under the Mass approach. This is because the activities that this approach includes assume that the audience already possesses some level of awareness and some form of basic knowledge of the problem. The need for sustained efforts using the Group approach is demonstrated by poor results in any section of the KAP study, as Group awareness creation activities can effectively increase knowledge, change attitudes and correct wrong practices. The following activities are included in the Group approach:
  1. Group discussion: Group discussions are highly effective tools in efforts to provide education and change the attitude of those who attend them. They are effective because they facilitate a free flow of ideas in an informal setting, and allow for one-on-one interaction with a knowledgeable person who can answer questions pertaining to the disease. Group discussions can be conducted during orientation training, teachers' meetings, religious gatherings, self-help groups, and other settings like these.
  2. Guest Lectures: Guest lectures offer the opportunity to spread knowledge to small groups in a manner that cannot be achieved through mass media. They are given by doctors and project staff, and are designed to educate specific groups on the problems identified by the KAP. Guest lectures should be arranged at professional gatherings, medical conferences, diabetic associations, rotary meetings, NGO conferences and similar settings. These groups are selected for a variety of reasons, including being at a high risk for developing diabetes or diabetic retinopathy, or being in a position to effect a positive change in the community.
  3. Health Education Training Sessions: Health education training sessions are presentations given to small groups made of up of very specific members. Typical groups that can benefit greatly from these sessions are known diabetics, who represent a high-risk group for diabetes (and therefore diabetic retinopathy) because of the sedentary nature of their employment. These sessions involve a short presentation on diabetes and diabetic retinopathy, followed by a question and answer session between the audience and the presenter.

Individual Approach
The activities undertaken that are classified as part of the Individual approach are aimed at a goal similar to that of the activities carried out for the Group approach. They are designed to change the attitudes and practices of those with mistaken perceptions concerning diabetes and diabetic retinopathy. Although this approach has the greatest possibility of success, due to the great interaction between the educators and those they are educating, this approach is most costly and would consume lot of time than the Mass or Group approaches do. For this reason, activities that are classified under the Individual approach should be conducted only after Mass and Group awareness creation campaigns.

  1. Door-to-door home visits: Conducted either by project staff or sufferers of diabetes and diabetic retinopathy who have undergone treatment, home visits are a very effective way to disseminate information.
  2. Counselling: Counselling sessions during screening camps and eye examination provide a perfect opportunity for awareness creation. Because of the one-on-one interaction between a doctor and the patient this is a good time to provide specific, detailed information designed to increase knowledge, change attitudes, or alter incorrect practices.

The activities undertaken that are classified as part of the Individual approach are aimed at a goal similar to that of the activities carried out for the Group approach. They are designed to change the attitudes of those with mistaken perceptions concerning diabetes and diabetic retinopathy.

Mass approach and interpersonal approach have individual and complimentary roles. Information transmitted by media carries a certain amount of weightage. Interpersonal communication helps to reach deeper into the attitudinal and motivational core of the individual. It also helps in decision-making process and to solve psychological problem.

Feedback is possible in interpersonal communication. Mass communications cannot replace interpersonal approaches. Each has its definite and well-defined objectives. Mass media programmes are best followed up with the effective system of interpersonal communication, so that awareness can be concerted into action without any lapse of time. By these methods many satisfied customer could be created in the community on diabetic retinopathy. They act as change agents and motivators for diabetic retinopathy project. This strategy is followed based on the principle of "Satisfied customer is selling the product in an effective manner".

References
1. Education for better health of mother and child in primary health care proceedings of first Southeast Asia regional conference, Madras. 5-8 November 1986
2. Ramachandran etal "A Text Book of Health Education" - Vikas Publishing House (Private) Limited, New Delhi.
3. Report of the IPP-II, I.E.C. activities in Andhra Pradesh 1984-85.
4. David K. Berlo "The Process of Communication".