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
- 1School of Health and Allied Sciences, Pokhara University, Pokhara, Nepal
- 2Tilganga Institute of Ophthalmology, Kathmandu, Nepal
Abstract
Introduction: 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. Methods: 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. Results: 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. Conclusion: 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. Trial registration: The study trial was registered in the Australian New Zealand Clinical Trials Registry (ANZCTR). The trial registration number is ACTRN12625000560493 on 02/06/2025.
Related
- The Views of Clients and Healthcare Professionals on the Perceived Effectiveness of HIV Prevention Programmes in Selected O. R. Tambo District Municipality Clinics
- Artificial intelligence-supported diabetic retinopathy screening in Tanzania: a randomised controlled trial
- A Family-Inclusive, Visually Supported Sexual Abuse Prevention Intervention for Children with Moderate Intellectual Disabilities
- Digital, Mobile and Artificial Intelligence‐Supported Interventions for Pressure Injury Prevention and Management: A Systematic Review of Clinical, Workflow and Implementation Outcomes
- Effect of animation-based edutainment compared with pamphlet-based education on hand hygiene and HAI prevention among surgical patients: a quasi-experimental study
BibTeX
@article{shrestha2026effect,
title = {{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}},
author = {Ramesh Shrestha and Chiranjivi Adhikari and Mohan Krishna Shrestha and Damaru Prasad Paneru and Amar Dawadi and Uma D.C},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0357023},
url = {https://doi.org/10.1371/journal.pone.0357023},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - 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
AU - Ramesh Shrestha
AU - Chiranjivi Adhikari
AU - Mohan Krishna Shrestha
AU - Damaru Prasad Paneru
AU - Amar Dawadi
AU - Uma D.C
PY - 2026
DA - 2026/09/02
JO - PLOS One
DO - 10.1371/journal.pone.0357023
UR - https://doi.org/10.1371/journal.pone.0357023
AB - Introduction: 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. Methods: 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. Results: 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. Conclusion: 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. Trial registration: The study trial was registered in the Australian New Zealand Clinical Trials Registry (ANZCTR). The trial registration number is ACTRN12625000560493 on 02/06/2025.
SN - 1932-6203
ER -