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National Eye Health Education Program (NEHEP) |
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Overview of the Low Vision Education Program
The National Eye Health Education Program (NEHEP) of the National Eye Institute (NEI), one of the National Institutes of Health (NIH), coordinates education programs on diabetic eye disease, glaucoma, and low vision. Low vision is a is a visual impairment, not correctable by standard glasses, contact lenses, medicine, or surgery that interferes with a person's ability to perform everyday activities. Low vision can result from a variety of diseases, disorders, and injuries that affect the eye. Many people with low vision have age-related macular degeneration, cataract, glaucoma, or diabetic retinopathy.
The goal of the low vision program is to improve the quality of life for people age 65 and older that have decreased visual function that interferes with their activities of daily living. The program has developed strategies to reach this goal. They include consumer media campaigns, educational materials, an outreach program for professionals and a traveling exhibit that will be displayed in shopping malls nationwide.
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Overview of the Spanish-Language Low Vision Booklet
The Spanish-language version of the low vision booklet was adapted from the English version to educate various Hispanic/Latino populations about low vision. The low vision booklet explains and illustrates the various eye diseases and conditions that cause low vision. The booklet also describes the types of rehabilitation services and devices that are available and provides a listing of organizations that provide Spanish-language materials.
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Purpose of Focus Groups
The Spanish-language focus groups were conducted to test the usage of various key terms, photographs, and colors, and also to gather general information on knowledge of eye health and low vision issues. The booklet was also tested to ensure that it was culturally and linguistically appropriate to relay vision-related concepts and practices. The focus groups also examined the best possible methods to distribute health-related information to the Hispanic/Latino populations.
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Recruitment and Composition of Groups
Eight focus groups were conducted nationally during the latter part of November and early December 2000. Four major metropolitan areas were selected due to their large Hispanic/Latino populations and to provide a cross-section of different Hispanic/Latino populations (i.e., Central American, Cuban American, Mexican American, Puerto Rican). Research analysts at ORC Macro collected data generated by the U.S. Census Bureau. The data was then submitted to the National Eye Institute for a final decision. The four selected sites were Los Angeles, CA (39.9%); New York, NY (24.3%); Miami, FL (62.4%); and Washington, D.C. (5.4%). In order to be age inclusive, one elderly population (ages 65 and over) focus group and one general population (ages 64 and under) focus group were conducted in each city.
The four focus group facilities selected were chosen because they were assessed to have extensive experience in recruiting Hispanic/Latino persons. A Spanish-language screener was provided to the research analysts at the facilities in assist to recruiting persons who were native speakers of Spanish. Participants were also required to have low vision or know someone who had low vision. Persons with graduate degrees were restricted from participating in the focus groups. The purpose of this restriction was to prevent a select few from dominating the conversations, thereby potentially decreasing the quality of data collected.
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The moderator's guide was designed to address the cultural appropriateness of the low vision booklet. The moderator's guide began by examining the general eye health and preventive maintenance habits of participants. The guide continued to ask questions related to participants' and their family members' experiences with specific eye conditions and diseases such as cataracts, diabetic retinopathy, glaucoma, and macular degeneration. This section of the moderator's guide was included to ascertain the participants' knowledge of these eye disease and conditions.
After addressing general health-related issues and topics, the guide then included questions created specifically for the low vision booklet. Questions in this section asked about the use of pictures inside and on the cover of the booklet. The use of Spanish terminology (e.g., ophthalmologist, optometrist, low vision, magnifying glass, and the like) was also tested. The moderator's guide also probed participants to find out whether they preferred information of this type in English or Spanish. Participants were then asked to explain what additional information they would consider vital to their overall eye care and how they would like to receive this type of information. In order to facilitate a monolingual environment, the moderator's guide was adapted to Spanish.
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General Health
Overall, the majority of the participants in each of the eight focus groups said they considered themselves to be in good health. Only a few participants at the different sites said they did not consider themselves to be in good health. Those participants who said they were not in good health cited an eye-related illness to be the primary problem. Participants in all of the eight focus groups said that the lack of health insurance and financial resources were the primary obstacles that people faced when trying to obtain regular, preventive health care. As a result, people choose to risk their health. As one participant in the Washington, D.C. elderly population said,
"Imagine if you become ill and you don't have so much money to pay so many doctors. (It) is better to keep suffering."
A few participants in several of the focus groups mentioned that time constraints are contributing factors as well. One participant in the Los Angeles general population said,
"I have to work to support my family. Sometimes I just don't have time. I have my responsibilities..."
A participant in the Washington, D.C. elderly population group said,
"(People) have no time. Even on vacation. Work, work and they don't take care of their persons."
Although participants attributed a lack of insurance, money, and/or time to obtaining preventative health care, they all agreed that it was important to maintain good health. When asked why it was important to obtain preventive health care, the responses from the general population focus group participants included the following:
"Prevention is very important. Because if you anticipate the disease, there are more possibilities that if there is something wrong, they can take care of it."
"To control your vision."
"Because you can stop it in time. Because there's an illness that you might find out early, because if it's too late, there is no remedy."
"That way illnesses are caught before they worsen."
The responses from the elderly population focus group participants regarding the importance of preventive health care included the following:
"(Doctors) find what you have before it (worsens), because the body is giving out signals that there is a deficiency somewhere, so they can treat you."
"You can detect illnesses that might be discovered."
"Visit the doctor before getting too sick. That is what is best."
Many of the participants in all of the eight focus groups said they usually obtain health-related information from television, radio, pamphlets, and magazines. When asked where they obtain health-related pamphlets and magazines, participants said they obtained them from doctors' offices or public clinics. Some of the participants in the eight focus groups mentioned watching Univision, a popular Spanish-language channel, where they obtain a fraction of their health-related information. A couple of participants in the Miami and New York general populations said that they watch call-in television programs where a doctor answers questions asked by the general viewing audience. Very few of the participants mentioned that they obtain health-related information from the Internet.
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Most of the participants in the focus groups said that they have their eyes examined once a year. The remaining few participants said that they usually have their eyes checked once every 2 years. Only those participants who had a chronic eye condition (e.g., cataracts, diabetic retinopathy, glaucoma, or macular degeneration) said that they visited the doctor every 3-6 months as directed by their eye care professional. Regardless of how often participants said that they visited their eye care professional, participants said that they have their eyes dilated every time.
The majority of participants said they see an ophthalmologist, while only some of the participants said they see an optometrist. Participants in the Los Angeles and D.C. groups expressed some confusion about the difference between an optometrist and an ophthalmologist. However, participants in the Miami and New York groups expressed a clear distinction between the two. The Spanish term "oculista" was the general term used at all of the locations when referring to an optometrist or ophthalmologist. However, participants in the Miami, D.C., and New York groups used the Spanish terms "oftalmólogo" and "optometrista" to distinguish between the two professionals. Participants in the Miami and New York focus groups said that they see an ophthalmologist for their diagnostic needs and an optometrist for their subsequent eyeglass and contact needs.
Some participants said that they have seen brochures and other information in their doctors' offices, but very few said that they have been given information by their actual eye care professional even though they rely on them for their eye care needs. A few of the participants went on to say that that they do not engage in detailed discussions with their eye care professional concerning their respective eye conditions and diseases. One woman from the New York general population focus group said,
"I go (to the eye doctor) every six months, and since I do not speak English, and (the doctor) doesn't speak Spanish, we don't talk that much. I don't even know what my illness is called. He never explained anything to me. "
A few of the participants in the Los Angeles, Miami, and New York focus groups said that their doctors have told them that there was nothing that could be done for their eye conditions. One woman from the New York focus group responded that she was diagnosed with macular degeneration and was told that she would inevitably become blind. The woman went on to say that she was quite saddened and disappointed by what the doctor told her.
A couple of focus group participants at other sites said that they had encountered the same situation. When asked if they sought a second opinion, a respondent in the Los Angeles general population said that he experienced frustration when he sought a second opinion.
"I remember he said there was no cure for that. (He said the illness) goes away. But I don't know. I don't know if in reality, he was telling me the truth or not. So, I went to see someone else. He said to me that I needed laser surgery. I don't know who lied between the two. "
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Participants commented on the use of the terms limited vision and low vision. Participants said that the term "baja visión" was okay, but they said the term "visión limitada" was better. When asked what they thought the term "baja visión" meant, one participant responded,
"Well (it means) low, when you get more and more blind." Another participant from the same group agreed by saying, "low vision is like a blind person."
Therefore, participants thought that the term "visión limitada" was better since it did not imply complete blindness. Participants in the New York elderly population focus group, however, expressed some confusion concerning the difference between the terms limited vision and low vision. One participant said,
"About low vision and limited vision, I understood that there is a certain difference between limited vision and low vision. When you suffer from low vision, you don't lose your eyesight totally... A person who has limited vision, you are in a shape that you can improve. As opposed to low vision where you inevitably go blind?"
Several participants suggested the terms "pérdida de vista" and "pérdida de vision" as additional alternatives. However, other participants commented that these terms imply a total loss of vision.
Although several of the participants in the eight focus groups acknowledged having some form of diagnosed eye disease or condition, they did not perceive themselves as having low vision. Even during the course of the focus groups, participants experienced difficulty reading, but did not classify themselves as having low vision. Their conversation implied that only those whom they perceived to be close to blindness had low vision. At the conclusion of the focus groups, only participants in the New York elderly population focus group and one participant in the Miami elderly population focus group thought that they might have low vision. The one participant from the Miami focus group said that her vision loss has had a significant impact on her life.
"Well, I'm a fan of sculptures, especially miniatures, and the low vision has made me incapable of having a concept -- seeing the concept of dimensions on one side or the other. So therefore, the work that I used to do is no longer perfect, and I cannot do them, among other things. My other hobby was reading, and then after reading for a little bit and forcing my sight to be able to get the whole line, my eyes get tired and I cannot continue. "
Although participants from the other groups said they did not believe they had low vision, a few of the participants in the New York general population group said that problems with their vision have impeded their day-to-day activities.
"Sometimes I want to buy low calorie products, and I cannot see the label. I cannot read small or large print."
"You know, I like to do things, like read books and stuff, and I cannot do it. That's a problem. Sometimes I walk, and I bump into things."
"Walking down the stairs with my daughter, I sometimes fall down."
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As a general rule, the more educated the focus group participants, the less they were impressed with the booklet. Participants who had attended college expressed boredom with the booklet, while participants who had not attended college were quite pleased with the information provided in the booklet. This appreciation was especially true for the elderly population focus groups in Los Angeles, Washington, D.C., and New York, and may be attributed to the fact that many of the participants in the elderly population groups did not complete high school.
Other participants in the Los Angeles and Washington, D.C. focus groups had not attended college or finished high school and were also very impressed with the booklet. Participants in the Los Angeles and Washington, D.C. focus groups said that the booklet was very informative and seemed quite happy to have the information. Washington, D.C. participants were happy to discover that there was help for people living with low vision. The booklet was also well received by the New York focus groups. The following are general focus group participants' first impressions of the booklet and what they remembered most after reading it.
"This was well written and well elaborated. It's important that someone has access to this. It's going to be very helpful."
"I like this booklet because 15 years ago, if I had read it, I could have asked all the things that are happening (to me) right now. I can't see."
"This booklet is very comprehensive. It has a lot of information about the vision, diseases. Anybody can understand it."
"This booklet has helped me with a lot of information. Information that I didn't know."
"It's good. This is very good information for people. They give you the options. Okay, this is what I have because this is how I see."
"To me, what I read is very important, to know where you put your things. The doctor will teach you where you put your things. The doctor will teach you how to survive with your age and your problem with vision. To me that is very important. The clocks, you know, that say the time (are also important)."
"All of the doctors' offices should carry this booklet."
"The alternatives offered. They will teach you to be independent, telling you how to manage your daily life, your home; how to cook safely; use the oven, the microwave."
"It tells you how to go to the rehab center."
The following are elderly focus group participants' first impressions of the booklet and what they remembered most after reading it.
"This is really good - very well written."
"It's very informative. Big letters. It's easy for you to read."
"Well explained and I like it."
Unlike the Los Angeles, New York, and Washington, D.C. focus groups, participants in the Miami focus groups were not as impressed with the booklet. Participants in this group said the information provided was a good start, but it did not provide the causes of the diseases mentioned in the booklet. Participants continued to say that they would also like to have information regarding prevention to avoid developing low vision altogether and stop the advancement of it. There was also some confusion in the general population regarding the concept of low vision. Several of the participants in this group said that they did not understand whether low vision was a disease in and of itself or whether it was the result of an individual eye disease.
The information contained in the booklet was easy to read and understand by all. One woman from Washington, D.C. group said, "it could not be better explained, everything is very good." Other participants from the Los Angeles, Miami, and New York focus groups also agreed that the booklet was not too technical or complex.
When asked in what language they prefer to have this type of information, participants in several of the focus groups said that they would like to have it in English and Spanish. The participants in the elderly population focus groups said that they are more comfortable reading in Spanish, while their children and grandchildren prefer to read in English. Many of the participants said that it would be very advantageous for them if the booklet included text in Spanish and English. They said this would be helpful because many of them rely on their younger relatives to assist them in their day-to-day activities.
Responses from the general population focus group participants included the following:
"Spanish with English. Because there are a lot of children who read English only."
"There are people that don't know how to read, but their children do read or understand English, and they can go, 'Look Grandma, this is what it means...'"
"My daughter was born here but she speaks English and Spanish without an accent. But literally, in English, it's easier for her."
"I prefer Spanish. It is my language, but my children speak English."
Responses from the elderly population focus group participants included the following:
"Sometimes children do not want to read in Spanish. They only want to read in English. The ones who were born here don't like to read in Spanish, because they're here in their country."
"My grandchildren do not read Spanish, but they do understand it. They read English. So, if I had a booklet in both languages, then it would be better."
Other participants in the New York general population said that it would be helpful to have the booklet written in both languages because it would help when communicating with their doctors who are not bilingual. One participant said, "Many times you go to the doctor, and he uses a word, and you don't relate it to the way that it is said in Spanish."
Several participants in the various groups said that the booklet would help others understand what people with low vision experience on a daily basis. They said that the book effectively communicates how people with low vision function.
Participants in every group agreed that the booklet was intended for adults as well as younger people. However, one participant from the Miami general population disagreed by saying,
"A young person would not look at (it). They're not even going to read it. They're not even going to open it up -- only if they maybe add colors or a boy or a girl in one of these four pictures. "
Participants in other groups also said that the booklet should include younger people on the cover in order to attract them to the information inside the booklet. One participant in the New York general population focus group said, "The cover should include children so that you can see that the information is also for children, not only old people." Another participant from the Los Angeles general population said, "I believe that (the National Eye Institute) needs to put children, younger people on the cover. So the entire family will pay attention to it." Apparently, the inclusion of all age ranges was especially an issue for many of the participants since eye diseases such as diabetic retinopathy and cataracts are not uncommon among the younger Hispanic/Latino populations.
The photographs that depicted people with obvious visual impairments were preferred among the respondents. The pictures inside the booklet that were best received were those with high contrast between the black and white tones. The pictures that demonstrated the visual effects of the four diseases (e.g., cataracts, diabetic retinopathy, glaucoma, and macular degeneration) were also favorites.
There were not many participants that had a least favorite thing concerning the booklet. Some of the participants noted that only one of the organizations listed in the back of the booklet mentioned having information available in Spanish. Participants continued to say that people of Hispanic/Latino origin would be more likely to call if they knew that there were bilingual people available to provide them with bilingual products, materials, and services. This was especially true since participants noted that not all of the organizations had toll-free numbers listed. Participants agreed that people would be more willing to call if a toll-free phone number was provided.
In several of the focus groups, participants said that the African American man on the front cover appeared to have no immediate recognizable visual impairment. Consequently, participants said that he did not look as if he belonged on the front cover of the booklet.
The red cover was by far the more favored of the two covers presented to focus group participants. Many of the respondents said that the red was much more aggressive and eye catching. A Miami participant explained, "When they put up a traffic light, they put it on red, (so) you stop and you look." A few of the participants in the Los Angeles elderly population said that the color green made them feel sad when looking at it. Blue was suggested by a couple of the participants in the Miami focus groups because of its perceived calming effect, and the colors orange and yellow were also suggested by respondents in the New York and Washington, D.C. groups because of their attention-getting effect. A few of the participants in various focus groups remarked that the color of the booklet was of little importance. A participant from the Los Angles elderly population explained,
"The color doesn't matter. It's what it has inside. The vocabulary. The color? It doesn't make any difference. Any color would do. The important thing is the instructions and the information that it has inside. Those are the most important things."
When asked what people with low vision would do differently after reading this booklet, participants said they would be better prepared to ask their doctors more specific questions related to their respective eye diseases. A woman from the Washington, D.C. elderly population said,
"I like it. It would help me to ask my doctor if there is anything that can correct low vision. In the first page, it says that a person's vision cannot be corrected. Then this taught me that in the next visit to my doctor I should ask him whether in addition to the cataract (if) I have low vision. That way I could follow the advice given in the booklet because there is much advice about what to do, right? That is what I have learned from this booklet. I am delighted to have this booklet. Every little thing that it says is interesting and one knows what to expect thanks to the advice given here. "
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Many of the participants said that they used magnifying glasses to read. Participants used the Spanish term "lupa" when referring to magnifying glasses. Therefore, "lupa" was agreed to as the correct term for magnifying glass as it is written in the booklet. When asked whether they had been instructed on the proper use of magnifying glasses, Miami participants responded "those are things that you learn as time goes by." Other participants said that they learned to use assistive devices by watching their elder relatives. A participant said,
"I use the magnifier because my grandfather used to use it."
Other devices used by participants included clocks and watches with large numbers on the dials and telephones with large numbers. Participants that mentioned owning these devices said that they learned about them by happenstance while shopping at various local supermarkets and drug stores. When asked how they could learn about additional devices available to people with low vision, participants said that the eye doctor or local hospital could tell them.
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Very few of the participants said they were aware of what types of rehabilitation services and training were available to them. When asked how they could find out what services were available to people with low vision, participants in several of the focus groups again answered, "the doctor." For instance, a man from the Washington, D.C. focus group said,
"He knows about (the) clinics he could refer you to where they have the rehabilitation equipment, or when you need to change your life to know how to adapt to your new form of life."
Another participant from the New York elderly population made a similar statement. The participant said,
"The doctors. They help you if you need something like (that)."
Other participants said that they were not reliant on their ophthalmologist or optometrist. As one participant from the New York general population explained, "Well, sometimes the doctor doesn't do such a good job, because he's not dedicated to inform(ing) the patient what are the choices, this is where you can get help if you need products like devices, clocks." Another participant in the same group reinforced the sentiment by saying, "doctors should give information."
Some participants said that they could obtain information regarding available services through their local community centers and organizations. A couple of participants in the New York elderly population focus group mentioned obtaining information from state offices and local community agencies. One participant from the same focus group said that she has frequently obtained information from a local center that employs bilingual workers who speak Spanish and English. The participant also mentioned obtaining information from her church, as well.
Participants said that they would be eager to obtain additional information related to eye health. A participant from the Los Angeles general population said,
"The information about vision is very poor. So, you have to go out to look for it. So, you really need to look for people. You need to know, because sometimes you get frustrated because you don't get that information."
Similarly, participants in most of the eight focus groups said that they would like to use the services if they knew about them. However, most of the participants were under the impression that if the services were available, then they must be costly. When asked whether they would be willing to use the services if they were made available to them, one participant in the New York general population said,
"Sure. I suppose that if they are going to have them, they must be for some money, because they are not going to do it for free."
Another participant in the Los Angeles general population focus group said that they were aware of the services available, but would not be willing to use them because of the cost. The participant explained,
"I never got to know what the rehabilitation place is. They're very, very expensive. But due to lack of money, that's the reason why people don't go there."
Along the same vein, a participant in the Los Angeles elderly population focus group said,
"A woman I know went completely blind; they taught her how to cook and other things for years. I remember she had to learn by feeling the heat in the kitchen. But those things are expensive. Only people with money have access."
The participants in the Miami elderly population focus group said that they were aware of services available to people with low vision. However, most of the participants in the group said that they would not go there because they believed the services were only for low-income persons who were completely blind.
Only a few participants in the eight focus groups said that low vision had affected one of their family members or friends. One participant in particular said that he believed cataracts were the cause of his mother's death. The participant said,
"Cataracts. My mother died from that." Another participant continued to say, "My mother died like that. She couldn't do anything. My cousin used to do everything for my mother. They operated on her and after the operation, she went blind."
A few of the participants in the eight focus groups said that they knew someone who had received rehabilitation training. A couple of the New York respondents spoke very highly of the training. One participant in the New York elderly population said,
"a neighbor friend of mine, she had low vision and they sent her to the Lighthouse. They taught her how to cook. She's totally blind, but she cooks. They taught her how to pick out her clothes, the laundry..."
Another participant in the New York general population said,
"I know a lady. She (went) completely blind. She was taught how to cook (and) how to sew."
Although a few of the participants said that they knew people who had received rehabilitation training in the past, none of them replied that they knew of anyone who had attended a support group for persons with low vision. None of the actual participants said that they had attended a support group for low vision themselves.
All of the participants in the eight focus groups said that the term "servicios de rehabiliatación" was correct. None of the participants said that is was used incorrectly, nor did they suggest an alternative term.
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When asked what they would want to know if they were told they were losing their vision, several of the participants from the general population groups said they would want to know how to prevent the disease from advancing.
"I mean, if they're going to say that I'm going to lose it, then I'm going to try to do the most possible to retain the vision that I already have."
"I would like to know how to prevent it from advancing."
"To find a way to stop the advancing of it."
"I would ask what could you do to try to detain or cure; you know, what are the alternatives, the options."
A participant from an elderly population focus group stated that,
"(If) they tell me that I am losing my eyesight, (I would find out if) there is anything I could do, like a treatment, so that I do not lose it totally."
A few of the other participants said that they would like to know the cause of their vision loss and how could they receive training to lead an independent life.
Participants in all of the focus groups said that doctors' offices, mail, video, television, radio, and churches were vehicles for distributing information of this type. Of the six mediums, doctors' offices and mail were the most popular. A participant in the Miami elderly population group said,
"There are some people that are inside their homes and don't get anything in the mail. So, it would be good to have it sent in the mail as well as have it in (the) doctor's office. Because like I told you, there are people at home, and maybe they feel something bothering them in their eyes and they don't pay attention to it. But when they get this, it will open up their minds, and they will think about it."
In the same focus group, another participant explained that eye care professionals could assist in the development of a mass mailing list.
"Now that we have computers, they can take the names of the people that have visited the ophthalmologist, and from there make a mailing list. And that doesn't cost much, because it has a special postage price."
Other participants in various focus groups suggested a video that could be played on a loop in doctors' offices. A participant in the New York general population suggested,
"Watching it on video is better than reading it, because people don't have patience to read. For those who like to read, it's better to read, but for others it's better (on) the video. Video is easier for me because I cannot read small print."
Another participant in the same group agreed and explained,
"They can show you the eye, the progress, the process, and you can see if you (should) do this or that, for example, diabetic people have this due to diabetes. (It should tell you) what that person can eat so that their vision loss doesn't advance."
Ultimately, some participants still said that they would prefer obtaining information from their doctor. They would prefer talking to the doctor so that the doctor could provide them with a step-by-step guideline to follow so that their disease would not advance. In addition to preventive care, participants again said they would like information pertaining to rehabilitative services so they could adapt to their new way of life.
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In conclusion, all of the participants, with the exception of the Miami focus groups, were pleased with the information provided in the booklet. Participants in the Miami group were bored by the booklet's contents. However, they said that the provision of information pertaining to preventive care would be helpful and important.
The red cover was the most popular cover among participants. Participants in all of the eight focus groups said that the color red was more of an attention grabber and implied joy and happiness, and would therefore attract more people to the contents of the booklet. The green cover denoted sadness to some participants.
Participants in several of the focus groups said that since the booklet was intended for all age groups, the booklet's cover should include photographs of younger people. It should also be written in English and Spanish for younger Hispanic/Latino populations who prefer to read English. Older participants also said that younger Hispanics/Latinos could assist their elder relatives in trying to obtain health care information.
The majority of focus group participants said they use magnifying glasses to read small print. Very few participants mentioned using any other assistive devices. Other devices that were mentioned included clocks with big numbers, watches with big numbers, and clocks that talk.
Available rehabilitation services were not well known among focus group participants. In several of the groups, participants said they assumed that if rehabilitation services were available, then they must be costly. However, participants in most of the groups said that if rehabilitation services were available, and they were told they were losing their sight, then they would be willing to use the services. Those participants who were familiar with available rehabilitation services were quite impressed with the training services provided to people with low vision.
Participants in various groups said that if they were told they were losing their eyesight, they would want information on how to stop the disease from advancing and how to cope with their impending vision loss. In order to receive this information, participants in various groups said that postal mail and videos would be the best ways. Other means of distribution that were mentioned included churches, television, and radio. Participants stressed that they would not like to receive information of this type in supermarkets and drug stores. They said that many times people rush through these types of establishments, and therefore would not take the time to read it.
Lastly, the following are a list of changes as suggested by participants:
- Add more pictures of people with immediately recognizable vision defects.
- Use the red cover instead of the green.
- Distribute health-related information through doctors' offices, television, mail, radio, video, and churches.
- Include information pertaining to preventive care in the booklet.
- Provide a step-by-step guideline explaining what to do if diagnosed with low vision.
- Include toll-free numbers for all of the organizations listed in the back of the booklet.
- State explicitly which organizations have bilingual employees and Spanish-language materials, products, and services.
- Explain whether low vision is a disease in and of itself or the result of another eye disease and/or condition.
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Health