Accredited Social Health Activists are Effective in Promoting Optometric Public Health

Girl eye exam
Trained ASHAs can be a crucial resource with respect to facilitating patients to seek eye care, according to a report.

Accredited Social Health Activists (ASHAs) can improve eye care knowledge and vision screening skills immediately after completing 1 day of training and sustain it for a period of 1 year, according to research published in the Indian Journal of Ophthalmology.

Researchers designed a 1-day training regimen consisting of conceptual instruction and hands-on vision screening. The training covered ocular structure and functioning, common ocular pathologies, initiating the referral process for disease management, and the role of the ASHA in each condition. Investigators trained ASHAs in estimating visual acuity using the 6/18 Snellen’s Optotype “E chart.” Overall, researchers included 102 ASHAs in the assessment. 

Baseline knowledge assessments reveal that a majority of ASHAs could identify causes of blindness such as glaucoma, knew that cataracts should be operated on as soon as possible, and could identify 3 symptoms of conjunctivitis (67.7%, 68.6%, and 59.8%, respectively). However, ASHAs lacked knowledge with other concepts such as understanding the role of the crystalline lens in cataracts, the impact of diabetes on the retina, and removing near vision glasses for visual acuity analysis (9.8%, 15.7%, and 1%, respectively). 

Researchers noted an overall improvement in the knowledge competency of the cohort immediately following training, evidenced by an increase in knowledge score (14.96±4.34 to 25.38±3.48, P <.001). They also recorded satisfactory vision screening skills in 86.3% of ASHAs. Overall knowledge score and satisfactory screening proficiency declined at 1 year follow-up, but remained higher than baseline assessment among participants (21.75±4.16 and 77.5%, respectively). ASHAs scored lower at 1 year follow up compared with baseline in only 3 categories: understanding refractive surgery as a means of correcting refractive error, understanding contact lenses as a means of correcting refractive error, and believing a myth that gazing at individuals can transmit conjunctivitis (13.7 to 5.9%, 10.8 to 8.8%, and 25.5 to 22.6%, baseline to 1 year follow-up, respectively).   

“A trained ASHA could be an important resource in facilitating patients to seek eye care, and hence, increase the service utilization of eye care services available at the primary or secondary levels,” according to the researchers. “The study also provides evidence that 1 day of conceptual training with a few hours of hands‑on training on vision screening skills is enough to capacitate ASHAs to take up community‑based primary eye care activities.”

Limitations include 1 mode of assessment and exclusion of ASHAs working less than 6 months.


Shukla P, Vashist P, Senjam SS, Gupta V, Gupta N. A study to assess the knowledge and skills of accredited social health activists and its retention after training in community-based primary eye care. Indian J Ophthalmol. 2022;70(1):36-42. doi:10.4103/ijo.IJO_1020_21