Effect of school health nurse-supported child-to-family strategy for Diabetic Retinopathy prevention in Bhimeshwor Municipality of Bagmati Province, Nepal: A quasi-experimental study.

Abstract

Diabetic retinopathy (DR) is a leading cause of vision loss among individuals with diabetes, with prevention depending heavily on awareness and timely action. This study assesses the effectiveness of a school health nurse-supported child-to-family strategy for diabetic retinopathy prevention in Bhimeshwor Municipality, Nepal, focusing on students' knowledge, family members' knowledge and practices, and students' retention in promoting health. A quasi-experimental pre-test-post-test control group design was conducted in purposively selected government schools with grades 7 and 8 that had school health nurse. One school was assigned as an intervention site and two schools as controls. A total of 140 students (70 intervention, 70 control) were selected using proportionate random sampling, each paired with a co-residing family member aged ≥30 years. The intervention included a six-week school nurse-led education program followed by student-led sessions at home. Quantitative data were collected using self-administered semi-structured questionnaires for students and face-to-face interviews for family members and analyzed using descriptive and non-parametric tests. Qualitative data was gathered through focus group discussions (one with students and one with family members) and a key informant interview with the school health nurse. Post-intervention, students in the intervention group showed a significant increase in DR knowledge (median score: 0-16, p < 0.001), with large effect sizes (0.853) for knowledge and skills. Among family members, the intervention group demonstrated significant improvements in knowledge (median: 0-10, p < 0.001), attitude, perceived behavioral control, subjective norms, perceived severity, and self-efficacy (all p < 0.001), However, no significant change was observed in DR preventive practices, including regular eye check-ups, health tests (blood sugar and blood pressure), balanced diet and physical activity (p = 0.875). Qualitative findings supported the quantitative results, highlighting improved awareness, behavioral intentions, and family-level engagement. The intervention showed medium-to-high improvements in the experiential processes of diabetic-retinopathy prevention (knowledge, attitudes, subjective norms, perceived severity, perceived behavioral control and self-efficacy). However, behavioral change in actual preventive practices was not evident, likely due to the short intervention period. Approximately half of the students maintained high retention in sharing health information with their families. Strengthening experiential processes appears feasible, but further research with longer follow-up is needed to promote sustained behavioral change in diabetic-retinopathy preventive practices. The study trial was registered in the Australian New Zealand Clinical Trials Registry (ANZCTR). The trial registration number is ACTRN12625000560493 on 02/06/2025.