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Improving community optometry practice in scotland


With the implementation of the NHS (General Ophthalmic Services) (Scotland) Regulations 2006, Optometry in Scotland has undergone significant changes. Some eye care has shifted from hospitals into the community and Optometrists now have increased responsibility for the diagnosis and treatment of eye conditions. To support this transition NHS Education for Scotland’s TRiaDS in Optometry initiative is exploring the generalisability of the TRiaDS research framework to address the challenges of translating knowledge into practice in priority areas for practice improvement in community optometry.

A stepped approach was taken which included:

  1. A stakeholder consultation to identify and prioritise area(s) for practice improvement and to identify the initial area of practice to be addressed using the TRiaDS framework;
  2. A review of the literature and guidance in the prioritised area to identify best practice;
  3. Stakeholder interviews, underpinned by the COM-B [1] system and the Theoretical Domains Framework (TDF) [2,3] to identify key professional behaviours and the barriers and facilitators to change;
  4. A national survey to all community optometrists in Scotland to measure current practice and to explore the barriers and facilitators to change.

The stakeholder consultation identified the initial area of practice to be addressed as ‘The management of patients complaining of flashes and floaters’. The review of literature and guidance in this area identified one document (The NICE Clinical Knowledge Summary on Retinal Detachment) as being of sufficient quality for use but highlighted that modifications would be required for use in community optometry.

A national online survey was developed and distributed to all community optometrists in Scotland. The content of this survey was informed by semi-structured telephone interviews. Interview data identified the target behaviour to focus on in the survey as ‘the decision-making process around whether or not to refer a patient to secondary care’. Analysis of this survey data identified six TDF domains, salient to the decision about whether or not to refer patients with flashes and floaters to secondary care – ‘social influences’, ‘emotion’, ‘beliefs about capabilities’, ‘beliefs about consequences’, ‘behavioural regulation’ and ‘reinforcement’.

For more information about the TRiaDS in Optometry initiative contact: Tel: 01382 740913 or email at


  1. Michie, S., Atkins, L. & West, R. The Behaviour Change Wheel – A Guide to Designing Interventions. (Silverback Publishing, 2014).
  2. Michie, S. et al. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual. Saf. Health Care 14, 26–33 (2005).
  3. Cane, J., O’Connor, D. & Michie, S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement. Sci. 7, 37 (2012).

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