Social risk factors associated with non-adherence to pediatric eye care referrals after abnormal vision screening findings: a scoping review

Despite the importance and benefits of vision screening and comprehensive eye examinations, up to 60% of children with abnormal vision screenings do not attend recommended appointments with eye care professionals. The purpose of this study is to identify social risk factors associated with referral non-adherence to eye care referrals following abnormal vision screening findings. A scoping review was conducted following the Joanna Briggs Institute methodology. This review is part of a broader study exploring adherence to pediatric eye care referrals. A companion review reporting strategies to improve adherence to eye care referrals following abnormal vision screening findings is under review. Bibliographic databases and grey literature were searched from their inception to July 2023, with an updated search in November 2024. The review protocol was registered with Open Science Framework. Four reviewers screened and extracted relevant data from the included studies. Identified social risk factors were synthesized using a three-stage process consisting of inductive coding, theme generation, and theme mapping using the Penchansky and Thomas’s model of access, extended by Saurman. Seventeen studies reported social risk factors associated with referral nonadherence. The most frequently cited social risk factor in included studies was limited affordability ( n = 14) and low awareness ( n = 14), while limited accessibility was the least cited ( n = 5). None ( n = 0) of the studies indicated the use of a conceptual framework to inform the organization of their extracted data. Most of the included studies targeted populations in high-income (as compared to low, lower-middle, upper-middle income) countries. This study identifies limited affordability and low health awareness as the primary social risk factors for referral non-adherence, as well as a critical data void in low- and middle-income countries. Mapping these to the Penchansky and Thomas framework provides an evidence-based foundation for policy reforms and interventions to close the care gap.