How Dutch Orthoptists Deal with Noncompliance with Occlusion Therapy for Amblyopia

Abstract

Background: We previously found that compliance with occlusion therapy for amblyopia is poor, especially among children of non-native parents who spoke Dutch poorly and who were low educated. We investigated conception, awareness, attitude, and actions to deal with noncompliance among Dutch orthoptists.

Methods: Orthoptists working in non-native, low socioeconomic status (SES) areas and a selection of orthoptists working elsewhere in the Netherlands were studied. They were observed in their practice, received a structured questionnaire, and underwent a semi-structured interview. Finally, a short survey was sent to all working orthoptists in the Netherlands.

Results: Nine orthoptists working in non-native, low-SES areas and 23 working elsewhere in the Netherlands participated. One hundred and fifty-one orthoptists returned the short survey. Major discrepancies existed in conception, awareness, and attitude. Opinions differed on what should be defined as noncompliance and on what causes noncompliance. Some orthoptists found noncompliance annoying, unpleasant, and hard to imagine, others were more understanding. Many pitied the noncompliant child. Almost all thought that the success of occlusion therapy lies both with the parents and the orthoptist, but one third thought that noncompliance was not solely their responsibility. Patients’ compliance was estimated at 69.3% in non-native, low-SES areas (electronically, 52% had been measured), at 74.1% by the other 23 orthoptists, and at 73.8% in the short survey. Actions to improve compliance were diverse; some increased occlusion hours whereas others decreased them. In non-native, low-SES areas, 22% spoke Dutch moderately to none; the allotted time for a patient’s first visit was 21′; the time spent on explaining to the parents was 2’30” and to the child 10”. In practices of the other 23 orthoptists, 6% spoke Dutch moderately to none (P<0.0001), the time for a patient’s first visit was 27’24” (P=0.47), and the periods spent explaining were 2’51” (P=0.59) and 26” (P=0.17), respectively.

Conclusion: Conception, awareness, attitude, and actions to deal with noncompliance varied among orthoptists. In non-native, low-SES areas, time spent on explanation was shorter, despite a lower fluency in Dutch among the parents.

KEYWORDS::

• amblyopia
• orthoptist
• patients’ compliance
• amblyopia treatment
• dealing with noncompliance

DECLARATION OF INTEREST AND ACKNOWLEDGMENTS

This study was financially supported by ZonMW—the Netherlands Organization for Health Research and Development (grant number: #6320.0008). The study is registered in the Dutch trial register (ISRCTN22835481  / NTR713).

The Occlusion Dose Monitor was developed at the department for Medical Technical Development at the Academical Medical Center Amsterdam, the Netherlands in 1996-1997 as a public domain project.

The authors thank the 32 participating orthoptists for their contribution to the study (names are listed per group, in alphabetical order of the clinic, and in alphabetical order of the names):

Group A: Medical Center Haaglanden, The Hague (E. van Minderhout, B. Simonsz - Tóth, M. Vermeulen- Jongen), Mesos Medical Center, Utrecht (A. van de Bovenkamp - Scheper, A. Versteeg), Ruwaard van Putten Hospital, Spijkenisse (M. Kruiswijk), Sint Lucas Andreas Hospital, Amsterdam (A. Burger - Meywaard), Vlietland Hospital, Vlaardingen (S. Rousse, D. Valster).

Group B: Amphia Hospital, Breda & Oosterhout (K. Corft, C. Klerks - Kuijpers, P. Neomagus, C. Stoop), Catharina Hospital, Eindhoven (E. van Rooijen - Troost), Flevo Hospital, Almere (L. Bakker, N. Bos - De Bruin), Isala Clinics, Zwolle (A. Wellner - Fokker), Kennemer Hospice, Haarlem (W. Jutte, A. Hupsch - Van den Heuvel, A. Spaan), Lievensberg Hospital, Bergen op Zoom (M. de Rooij, A. van Voorden - Van der Knaap), Máxima Medical Center, Eindhoven & Veldhoven (E. Cockx - Huitema), Medical Clinic, Alkmaar (W. Hoogeveen, I. Huisman), Rivierenland Hospital, Tiel (T. Kooij - ‘t Spijker), Tergooi Hospitals, Hilversum (D. Hamers), Twenteborg Hospital, Almelo (I. ‘t Hart- Leemhuis, M. Hazenkamp - Boekhold, F. Jansen, D. van der Nagel - Pronk), Swedish Red Cross Hospital, Zierikzee; Van Weel-Bethesda Hospital, Dirksland; & Medical Center, Middelburg (J. Kieviet - De Geus).

The authors also wish to thank all 57 Dutch orthoptists for completing the questionnaire, G. Borsboom of the Department of Public Health, Erasmus MC University Medical Center Rotterdam, for assistance with statistics, and Prof. J. Passchier of the Department of Psychology and Education, Free University Amsterdam, for his advice.

APPENDIX

APPENDIX 1  The figure represents the geographical map of the Netherlands (country) and the locations of the participating clinics. Each dot represents a clinic. Black dots are clinics in low-SES areas; gray-black dots are clinics elsewhere in the Netherlands. The table depicts the average [range] population, proportion non-natives, mean income per resident, and social security welfare payment (Statistics/Netherlands, February 26, 2010) of the Netherlands and the areas where clinics of the orthoptists of both groups were located.

APPENDIX 2  The extended structured questionnaire for orthoptists in both groups. Group A represents the orthoptists in non-native, low-SES areas, Group B represents those working elsewhere in the Netherlands. It contained 125 questions in two parts: part I, “Orthoptists’ individual personality features,” and part II, “Attitude towards non compliance.”

APPENDIX 3  The short structured questionnaire, which was sent to all Dutch orthoptists. It contained 37 questions and was subdivided into the following sections: “general information of the orthoptist,” “concept of (non-) compliance,” “attitude towards non compliance,” “attitude towards non-native patients,” “relationship between patient & orthoptist,” and “managing non compliance.” In total, all orthoptists of both groups, and 119 orthoptists from the NOAN, completed the questionnaire.

How Dutch Orthoptists Deal with Noncompliance with Occlusion Therapy for Amblyopia

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