Scientia PhD Candidate
Research Title: iCareTrack Diabetes: Improving the appropriateness of diabetic eyecare in Australia
Linked in: https://www.linkedin.com/in/rajendragyawali
Research Gateway: https://research.unsw.edu.au/people/mr-rajendra-gyawali
Introduction: The iCareTrack I study recently showed that the primary eyecare provided to patients with diabetes and diabetic eye disease in Australia is appropriate about 2/3rd of the time. To improve the quality of diabetic eyecare, it is important to understand the determinants (barriers and facilitators) of the appropriate care process. This will inform the design and implementation of a future intervention strategy to improve the eyecare for people with diabetes.
Objectives: The main aim of the iCareTrack II (Diabetes) is to understand the determinants of appropriate eyecare delivery and develop effective interventions to improve the quality of diabetic eyecare provided by optometrist in Australia. The objectives are to examine the quality of commonly used diabetic eyecare guidelines; to investigate the barriers and facilitators to appropriate diabetic eyecare delivery; and to examine the efficacy of a theory-based intervention to improve the appropriateness of diabetic eyecare delivered by Australian optometrists.
Methodology: A mixed method approach will be used throughout the thesis. A systematic review and quality appraisal of evidence-based diabetic eyecare guidelines is being conducted. Guidelines are searched through online databases, citations and grey literature search and the identified guidelines are evaluated using the AGREE II tool. In the second phase, a qualitative approach is utilised through a series of focus group discussions (FGD). The data collection and analysis will be guided by the validated Theoretical Domain Framework and Behaviour Change Wheel model. Study 3 methodology is in the development phase and will include a theory-based intervention designed based on the results of study 2. A randomised controlled trial with a pre- and post-intervention record audit will be chosen to assess the impact of the intervention.
Result/Progress: The protocol for the systematic review has been registered in PROSPERO and the database search is being conducted. The first series of the FGDs were conducted in Melbourne, Brisbane, Sydney and Townsville 2019 with a total of 15 participants. Data collection will continue until saturation is reached. Based on the preliminary analysis the FGDs, the most frequently reported barriers are environmental resources (e.g. limited chair-time); beliefs about consequences (e.g. lack of perceived importance); and knowledge/skills (e.g. poor understanding). These barriers influenced all aspects of the COM-B model.
Rajendra is an optometrist trained in Nepal and South Africa. He is a Fellow of the American Academy of Optometry and Ezell Fellow (2019). His professional experience includes clinical practice, program coordination, academics and research in Nepal, Maldives, Malawi, Eritrea, Vietnam and Australia. His PhD research aims to improve the appropriateness of eyecare delivery (i.e. the care provided in line with current best evidence) for people with diabetes in Australia. He has research interests in evidence-based practice, refractive error and visual impairment, glaucoma, eye care in marginalized communities and patient centred eye care.
Master’s in Optometry (2017), University of KwaZulu Natal, Durban, South Africa
Bachelor of Optometry (2010), Institute of Medicine, Tribhuvan University
- Gyawali R, Toomey M, Stapleton F, Jalbert I. Clinical recordkeeping in glaucoma. MiVision 2019 (March); 143: 51-56.
- Gyawali R, Moodley VR. Need for optical intervention in children attending the school for the blind in Eritrea. Clin Exp Optom. 2018;101(4):565-570
- Gyawali R, Moodley VR. Causes of childhood vision impairment in the school for blind in Eritrea. Optom Vis Sci. 2017;94(12):1138-1144.
- Gyawali R, Bhayal B et al. Retrospective data on causes of childhood vision impairment in Eritrea. BMC Ophthalmol. 2017;17(1):209.
- Kafle D, Gyawali R et al. Vision impairment and ocular morbidity in a refugee population in Malawi. Optom Vis Sci 2016;93:188-93
- Gyawali R, Sarkar N. Glaucoma awareness and knowledge in hospital presenting population in eastern Nepal. J Glaucoma 2014;23:594–8
- Gyawali R, et al. Compliance and hygiene behavior of soft contact lens users in Maldives. Clin Exp Optom. 2014; 97: 43–7
- Gyawali R, et al. Quality of life in Nepalese patients with low vision and the impact of low vision services. J Optom. 2012;05:188-95
Reports and Book Chapters
Gyawali R, Toomey M, Ho KC, Alkhawajah SM, Zangerl B, Liew G, Keay L, Stapleton F, Jalbert I. Systematic review and quality appraisal of the evidence-based clinical practice guidelines for management of diabetic retinopathy. PROSPERO 2019 CRD42019129584 Available: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42019129584
William C. Ezell Fellowship (AAOF) (2019)
American Academy of Optometry (AAO) Travel Award. 2015
World Council of Optometry Travel Award 2015
Eritrean Research Fund award (2014 and 2015)
India Vision Institute Grant 2013
NHMRC Research Translation Symposium, Sydney (2018)
Third National Blindness Prevention Program Workshop, Eritrea (2016)
Presentations (Optometry technicians in Eritrea, and Paediatric Refractive Error in Maldives). 1st World Optometry Congress, Colombia (2015)
Presentation: Blind School Survey in Eritrea. AAO New Orleans, USA (2015)
9th General Assembly of International Agency for Prevention of Blindness. India (2012)
National workshop on refractive error and optical dispensing in Nepal (2009)
AFFILIATIONS AND MEMBERSHIPS
Fellow, American Academy of Optometry (2015 to present)
President: Better Vision Foundation Nepal, (2017- present)
Member: Nepalese Association of Optometrist (2010 to present)