Increasing compliance with protective eyewear to reduce ocular injuries in stone-quarry workers in Tamil Nadu, India: a pragmatic, cluster randomised trial of a single education session versus an enhanced education package delivered over six months

Abstract

Objective: To evaluate the efficacy of standard education versus enhanced education in increasing compliance with protective eyewear to prevent ocular injuries in stone-quarry workers.

Design: Pragmatic, allocation concealed, participant and outcome assessor blinded, cluster randomised trial.

Setting: Six stone-quarries around Vellore, Tamil Nadu, South India.

Participants: 204 consenting adult stone quarry workers.

Interventions: Protective eyewear plus enhanced education (one education session, plus 11 sessions of group education, individual discussions, and educational plays over six months) versus protective eyewear plus standard education (one education session and 5 follow up visits).

Outcomes: The primary outcomes were observer-rated compliance with protective eyewear and reduction in incidence of ocular injuries (slit-lamp examination by an observer blinded to allocation status) at three and six months. Analysis was by intention to treat.

Results: Quarries and participants were similar at enrolment. All quarries; 92/103 (90%) of workers in three quarries given enhanced intervention, and 91/101 workers (89%) in three quarries given standard education, completed six months follow up. Compared to standard education, enhanced education significantly increased compliance with protective eyewear by 16% (95% CI 3-28%) at three months (OR 2.1; 95% CI 1.2-3.8); and by 25% (95% CI 11-35%) at six months (OR 2.7; 95% CI 1.5-4.8). Protective eyewear and enhanced education reduced the incidence of eye injuries at three months by 16% (95% CI 7-24%); and standard education by 13% (95% CI 4-22%), compared to the three months before interventions. The cumulative reduction over baseline in eye injuries at the six months was greater with enhanced education (12% decrease; 95% CI 3-21%) than with standard education (7% decrease; 95% CI 17% decrease to 3% increase). However, this incidence did not differ significantly between intervention arms at three months (OR 0.7% 95% CI 0.3-2.1); and at six months (OR 0.8; 95% CI 0.4-1.5).

Conclusion: Provision of appropriate protective eyewear reduces the incidence of eye injuries in stone-quarry workers. Periodic educational and motivational sessions with individuals and groups facilitates sustained use of protective eyewear.