"Eye diseases pose an enormous threat to our citizens. Many who are at increased risk of blindness from these diseases do not know that there are precautionary measures they should take to help save their sight."

—1988 U.S. Senate Appropriations Committee Report

With these justifying words, the U.S. Congress, in 1988, provided the National Eye Institute (NEI) new funds for public education on eye health and blindness prevention. As a result, the National Eye Health Education Program (NEHEP) was established.

The program's initial emphasis has been to educate the public about the importance of early detection and treatment of glaucoma and diabetic eye disease. These two prevalent diseases were chosen because scientific evidence revealed that blindness caused by them can in many cases be prevented. For the past five years, the NEHEP has spread this message and other eye health information, especially to high-risk groups.

NEI director Carl Kupfer, M.D., chose Judith Stein, M.A., to develop and direct the new health education program, which was then unnamed. The program's early development also was led by Julian Morris, then associate director of NEI's Office of Science Policy and Legislation. Said Ms. Stein, "We knew that we needed the help and support of all the groups with an interest in eye health to get this new program off the ground. Only by working together could we really make things happen." In late 1989, Rosemary Janiszewski, M.S., CHES, joined the NEI staff as health education coordinator for the NEHEP. She became director in 1994, when Ms. Stein became director of the Office of Health Education and Communication, which oversees the NEHEP.

At a planning conference in 1989, more than 65 professionals from around the country representing 35 organizations advised NEI about target audiences, potential channels of communication, and resources needed. Since that time, the NEHEP has developed strategies to improve public health by efficiently targeting high-risk groups such as African Americans over age 40 and everyone over age 60 (at risk for glaucoma) and people with diabetes, including a special program for Hispanics (at risk for diabetic eye disease).

Roger Vilsack, of Vilsack Productions, presents the NEHEP's first promotional concepts to the Partnership at the Second National Conference in Hilton Head, South Carolina.

The chart above shows how the program operates to use community, media, and interpersonal channels to disseminate eye health messages. In its first five years, the NEHEP has supported many activities, such as developing educational kits and public service campaigns about glaucoma and diabetic eye disease and conducting a national survey of knowledge, attitudes, and practices of people at risk for eye diseases. These and other activities have been successful in large part because of the NEHEP's Partnership of organizations, which links the NEHEP to ongoing efforts in eye health throughout the country and extends the reach and effectiveness of the program.

Steering the Course: The NEHEP Planning Committee

The original NEHEP planning conference created a two-tiered advisory structure comprising the Partnership of organizations and a Planning Committee, which oversees activities and provides expertise and guidance.

Dr. Carl Kupfer, director of NEI, presented Dr. Bradley Straatsma with a cake in appreciation for serving as first chairman of the NEHEP Planning Committee.

In 1989, Dr. Kupfer asked Bradley Straatsma, M.D., now Professor of Ophthalmology at the University of California at Los Angeles, to be the first chairman of the newly formed NEHEP Planning Committee, joining other eye health experts (see the box on page 6). Under Dr. Straatsma's early leadership, the Planning Committee charted a course for the NEHEP that focused on including as many interested groups and people as possible and increasing awareness of glaucoma and diabetic eye disease.

In 1992, Alfred Sommer, M.D., now Dean of the School of Hygiene and Public Health at The Johns Hopkins University, became the Chairman of the Planning Committee. One of only two original committee members still serving today, he noted, "The Planning Committee always has had the expertise relevant to the key issues and activities of the program: glaucoma, diabetic eye disease, health communication, and program evaluation."

Former Planning Committee members (l-r) Melvin Shipp, O.D., Aaron Kassof, M.D., Alfred Sommer, M.D., Ronald Klein, M.D., and Vicki Freimuth, Ph.D.

About the NEHEP as a whole, Dr. Sommer said, "That research gets translated into effective programs to help citizens is as important as the research itself." Ronald Klein, M.D., another original Planning Committee member, added, "The NEHEP offers an excellent opportunity to translate findings into public policy. And it has been successful in gathering support from diverse groups that don't always work well together."

The Committee recently expanded with the addition of members who brought new expertise and influence. For example, Norma Bowyer, O.D., brings to the Committee her experience working with Native Americans, who suffer from high rates of diabetes. She recognizes the urgent need to reach Americans with information about diabetic eye disease. Delighted to serve on the Planning Committee, Dr. Bowyer said, "If people have access to information, they can make informed choices."

The NEHEP Planning Committee serves as "a proactive resource to facilitate creating and strengthening of the Partnership," added Dr. Sommer. "It is a resource for scientific information and educational materials." The Planning Committee also creates and participates in working groups and task forces. Early on, focus groups provided the committee with information leading to strategies for spokespersons, messages, and materials. Task forces studied and reported on separate issues concerning glaucoma and diabetic eye disease. The Committee has steadily supported the idea of reaching goals through the activities of organizations working at the grassroots level, that is, through the members of the NEHEP Partnership.

Going Beyond a Sum of Parts: The NEHEP Partnership

The representatives from professional, voluntary, civic, government, and private organizations who attended the 1989 planning session formed the original members of the NEHEP Partnership, the body that works to reach select target audiences with information about early detection and treatment of eye diseases. By the time the NEHEP began full operation in 1991, the Partnership had grown to 41 members. Today the number is 51.

The NEHEP Partnership includes eye health organizations (such as the American Academy of Ophthalmology and the American Optometric Association); groups that target specific audiences (such as the American Association of Retired Persons and the National Black Nurses Association); and civic and voluntary groups (such as Prevent Blindness America and Lions Clubs International) with members who possess special skills and influence that can advance the program (See the box on page 7 for a complete list). Partnership members bring to the NEHEP vast knowledge of populations at risk, networks spanning the country, and experience in countless health education efforts. The members perform crucial NEHEP outreach activities and bolster their own organizations' programs and activities with NEHEP materials. Said Ms. Janiszewski, "The strength of the NEHEP comes from the Partnership. The Partnership is the program. By working together and sharing resources, we have and will accomplish so much."

Members of the Partnership engage in the NEHEP's activities enthusiastically. Egon Werthamer, O.D., representative from the American Academy of Optometry, appreciates the NEHEP's effort "to make eye care understandable to the consumer and the community." His organization includes scientists and researchers in eye health and does not conduct its own educational programs. Yet, through the Partnership, the Academy can advise the NEHEP in the development of new strategies and materials.

Mary Clark, of The Links, Inc.,
spoke at the third NEHEP
conference, in Hershey.

The 6,000 African American nurses and nursing students of the Chi Eta Phi Sorority, Inc., provide educational activities at conferences, health fairs, and workshops. They focus on urban African American populations, including older Americans. Mildred Norman, Chi Eta Phi's former representative to the NEHEP, praised its educational materials, emphasizing their ability "to get the information out and explain it." In particular, she noted, "The kits are great, as are the Hispanic materials." The sorority distributes NEHEP materials through its national chapters and displays them at its annual conference.

The American Pharmaceutical Association (APhA), which represents pharmacists, has publicized the NEHEP's resources in its professional journal, distributed to 45,000 members, and in its newspaper, distributed to 95,000 pharmacists nationwide. Elizabeth Keyes, director of education for the APhA and NEHEP representative for the past three years, stated, "For the APhA, NEHEP is helpful for building relationships with other health care provider organizations."

A good example of Partnership collaboration is the successful dissemination of information about diabetic eye disease during National Diabetes Month. At the NEHEP's 1993 Partnership conference, held in Hershey, Pennsylvania, participants raised the idea of working together to bring an eye health focus to National Diabetes Month, held each November.

The American Diabetes Association, a member of the NEHEP Partnership, committed to the idea, thereby giving the NEHEP a new avenue for increasing awareness about diabetic eye disease. During the past three Novembers, NEHEP Partnership members, such as the Delta Gamma Foundation and The Links, have brought an eye health focus to National Diabetes Week. The 1996 collaborative effort reached more than 80 million people, encouraging those with diabetes to have dilated eye examinations.

Present and Future

As the NEHEP evolves, its activities will shift to incorporate new educational strategies and new areas of focus (see Planning for the Future: Low Vision Education on page 10). What will stay the same is the commitment to pursuing the NEHEP's goal of preventing blindness through public education programs and encouraging dilated eye examinations. "The NEHEP is poised to realize even greater results in eye health education throughout the country," noted Edward McManus, deputy director of NEI. And the NEHEP will continue, in the words of Dr. Straatsma, "to make a bridge between scientific discovery and the perception and value of scientific discovery by and to the public."