Document Type

Theses, Ph.D


Available under a Creative Commons Attribution Non-Commercial Share Alike 4.0 International Licence



Publication Details

Successfully submitted for the award of Doctor of Philosophy (Ph.D) to the Technological University Dublin, 2015.


Purpose The development of competency- based education for optometrists and mid-level eye-care personnel has been identified as an important component in the elimination of avoidable blindness and vision impairment. The Mozambique Eye care Project (MEP) is a multi-institutional collaboration, which seeks to facilitate greater access to training in eye health professions, which will ultimately contribute to providing affordable and accessible eye care within the public health system in Mozambique. An important tenet of the MEP is to develop and enhance the refraction training of all existing (ophthalmic technicians) and new eye care personnel (four-year training of optometrists and eighteen-month training of ophthalmic technicians) and evaluate the outcome of the training. The overall aim of my research was to develop competency frameworks for ophthalmic technicians (OTs) and optometrists and provide recommendations for developing a comprehensive training plan for eye care service provision in the country. Methods A comprehensive evaluation of refraction competencies of OTs was conducted by the use of demographic and confidence levels questionnaire and theoretical and practical competency assessments. A competency assessment process was developed for the assessment of optometry students at UniLúrio, which consisted of direct observation of refractions on two clinic patients, a two-part theory exam consisting of short answer questions and an oral structured viva. Qualitative observations of the competency assessment process were also made. Factors affecting student performance were identified using semi-structured individual interviews with the course lecturers and a course evaluation questionnaire with the students. A modified Delphi approach was used to develop competency frameworks for the two cadres, OTs and optometrists in Mozambique. Results, Initial evaluations of the OTs demonstrated that their refraction confidence and competence levels varied depending on their training (location and duration), and their location of work (clinical load, availability of equipment and other eye care personnel). The only skill the OTs and trainees demonstrated competence in was correcting presbyopia. Only four optometry students out of fifteen were graded as competent in all the elements of the clinical competency exam. Analysis of data from lecturer interviews and student questionnaire yielded four dominant themes that were viewed as important determinants of student performance: student learning context; teaching context; clinic conditions and assessment; and the existing operating healthcare context. Two socially responsive competency frameworks for both cadres were developed using the modified Delphi approach. Conclusion These evaluations identified factors affecting the refraction competencies of the OTs and optometrists at UniLúrio while taking country-specific factors into context. The socially responsive frameworks developed will inform the evolution of standardised curricula for both OTs and optometrists.