Scientia PhD Candidate
Research Title: iCareTrack: Improving the Appropriateness of Australian Glaucoma Eyecare Delivery (ImAAGED)
Supervisors: Associate Professor Isabelle Jalbert, Scientia Professor Fiona Stapleton, Professor Lisa Keay
Background: It is estimated that 50% of Australians with glaucoma are currently undiagnosed yet half of them have visited an eyecare practitioner in the prior 12 months. Australian optometrists deliver glaucoma care appropriately in 63% of patient encounters indicating an evidence-to-practice gap and that 14 clinical indicators (measurable components of guideline recommendations) were delivered below 60% appropriateness. This research aims to develop a theory-based intervention tailored to the determinants (barriers and enablers) of practice to improve the appropriateness of glaucoma care delivery by Australian optometrists.
Method: Co-design with optometrists and/or stakeholders was used at each stage of intervention development. A three-step process (behaviour diagnosis, determinant identification, intervention design) was used. The behaviour diagnosis stage identified glaucoma care clinical indicators that required improvement via stakeholder discussion and a prioritisation exercise. Determinants of glaucoma practice were identified via focus groups and interviews involving optometrists. Determinants were mapped to the COM-B (capability, opportunity, motivation, behaviour) model and Behaviour Change Wheel to identify behaviour change techniques (BCTs) that were assessed for feasibility via APEASE (affordable, practical, effective/cost-effective, acceptable, safe, equitable) criteria. Feasible BCTs were modified and refined using co-design workshops.
Results: Fifty participants have engaged in the co-design process. Behaviour diagnosis identified nine glaucoma care clinical indicators requiring improvement. Key determinants were mapped to capability (knowledge; memory, attention, and decision processes), opportunity (environmental context and resources; social influences), and motivation (beliefs about consequences; reinforcement). Twelve out of 44 BCTs identified were deemed most feasible and were presented to workshop participants for further development. The resulting co-designed multifaceted intervention comprised of education (lectures), resources (checklists, algorithms), audit and feedback, and peer support (face-to-face and online discussions) to be delivered via a web portal, videoconferencing and/or in-person workshops.
Conclusion: A multifaceted quality improvement program to improve glaucoma care delivery by Australian optometrists was co-designed. The next stage of the research will be an effectiveness-implementation hybrid study to investigate the clinical effectiveness of the intervention via cluster randomised control trial and to assess the feasibility and feasibility of the quality improvement program implementation.
Melinda is an optometrist researcher with a wide range of clinical, academic, management and research experience in a variety of health care settings. Melinda is a UNSW Scientia PhD Scholar whose current research focuses on understanding and improving the delivery of appropriate glaucoma care in Australia. Melinda has special interest in ocular diseases, ocular therapeutics, evidence-based practice and public health optometry. Melinda has also gained the following qualifications: MBA, Master of Optometry, and Graduate Certificate in Ocular Therapeutics. Melinda has both participated in and lead teams providing eyecare to Indigenous communities in Australia and an international mission to Panama.
1993, Bachelor Applied Science (Optometry), Queensland University of Technology, Brisbane
2011, Master of Business Administration, Southern Cross University, Lismore
2016, Master of Optometry, University of New South Wales, Sydney
2017, Graduate Certificate Ocular Therapeutics, University of New South Wales, Sydney
2020, Certificate in Public Health and Leadership in Eye Care, Australian College of Optometry, Melbourne
- Gyawali R, Toomey M, Stapleton F, et al. “Multiple things going on at the same time”: Determinants of appropriate primary diabetic eyecare delivery. Ophthalmic Physiol Opt 2021; Accepted 5 October 2021.
- Gyawali R, Toomey M, Stapleton F, et al. Systematic review of diabetic eye disease practice guidelines: more applicability, transparency and development rigor are needed. J Clin Epidemiol 2021;140:56-68. DOI: 10.1016/j.jclinepi.2021.08.031
- Toomey M, Gyawali R, Stapleton F, et al. Facilitators and barriers to the delivery of eye care by optometrists: a systematic review using the theoretical domains framework. Ophthalmic Physiol Opt 2021;41(4):782-98.
- Toomey M, Jalbert I. Knowledge translation for the everyday optometrist. Clin Exp Optom 2021;104(7):744-55.
- Gyawali R, Toomey M, Stapleton F, Jalbert I. Clinical record keeping in glaucoma. MiVision March 2019 Available: https://www.mieducation.com/clinical-record-keeping-in-glaucoma/
2021 The Association of Research in Vision and Ophthalmology, Travel Grant
2021 UNSW Women in Maths and Science Champion
2020 UNSW School of Optometry and Vision Science Teaching Fellowship
2019 Public Health @ UNSW Symposium, Runner Up Best Short Oral Presentation
2019 UNSW Science Postgraduate Research Showcase – Best 1-minutes thesis in School
2018 The Postgraduate Ocular Therapeutics Prize UNSW
2016 UNSW School of Optometry and Vision Science Teaching Fellowship
2012, Leader of the New Dawn, Luxottica
2021, Poster presentation, American Academy of Optometry, Boston USA
2021, Virtual presentation, World Glaucoma Congress (Virtual)
2021, Poster presentation, The Association of Research in Vision and Ophthalmology (Virtual)
2020, Poster presentation, American Academy of Optometry (Virtual)
2019, Poster presentation, National Health and Medical Research Council Research Translation Symposium, Melbourne
2019, Oral presentation, Public Health @ UNSW Symposium, Sydney
2019, Poster presentation, American Academy of Optometry, Florida USA
Affiliations and Memberships
Immediate Past President and Director, Optometry Queensland Northern Territory
Fellow, American Academy of Optometry
Member, Australian College of Optometry
Student member, The Association of Research in Vision and Ophthalmology