Peer-reviewed article

Changes in the knowledge, attitudes, and practices of school teachers following an educational intervention in Skardu: a quasi-experimental study.

Abid K, Ali F, Tayyab H, Damji KF · 25 Sept 2026

Abstract

Objective To evaluate within-participant changes in knowledge, attitude, and practice (KAP) among school teachers following a structured educational intervention on children's eye health in Skardu District, Gilgit-Baltistan (GB), Pakistan. Methods This single-group pre-post quasi-experimental study was conducted across 132 government schools in Skardu District, GB, Pakistan. A total of 264 full-time school teachers were purposively selected in consultation with district education authorities. A structured two-day paediatric eye health and vision screening training programme combined theory-based instruction with supervised hands-on practice and was delivered by ophthalmologists and optometrists. The primary outcomes were within-participant changes in knowledge (0-10), attitude (5-25) and self-reported practice (5-25) scores. Knowledge was reassessed immediately after training, while attitude and practice were reassessed 2-3 weeks later, after school-based screening activities had begun. Results Knowledge showed the largest within-participant change, increasing from a median of 6 to 9, with an estimated paired location shift of 2.5 points (95% CI 2.0-3.0; p < 0.001; standardised Wilcoxon effect size r = 0.66, large). Self-reported practice increased from a median of 22 to 23, with an estimated paired location shift of 2.0 points (95% CI 1.5-2.5; p < 0.001; r = 0.39, moderate), although the absolute change in the median was modest. Attitude scores were high at baseline and showed a statistically significant but small-magnitude change; the median remained 23 (IQR 21-24 to 22-25), with an estimated paired location shift of 1.0 point (95% CI 0.5-1.5; p < 0.001; r = 0.27, small). Item-level knowledge gains were greatest for childhood cataract and glaucoma (+ 50.4% points) and recommended eye examination (+ 33.3% points). No evidence of differential change was detected across the examined teacher subgroups (all p > 0.05). Conclusion Following the structured two-day teacher-training programme, teachers demonstrated substantial within-participant gains in knowledge, a moderate improvement in self-reported practice, and a small change in attitude from an already high baseline. Because the study had no control group, used short-term follow-up, and relied on self-reported attitude and practice measures, the findings should not be interpreted as proof of causal effectiveness or sustained behavioural change. The results support further controlled and longer-term evaluation of teacher training as one component of school eye-health programmes in remote settings.