. 2021 Sep 7;21:325. doi: 10.1186/s12886-021-02085-0

Table 2.

Interview excerpts supporting key factors related to the ‘Knowledge’ category

Sub category	Sub-subcategory	Example of Interview Excerpts
1.Basic information for the CLWs	1.1 Familiarity with eye structure and its function ^* 1.2 Necessary eye examinations for CL prescription ^ 1.3 Indispensable preparations before going to the CL clinic ^ 1.4 Accredited centers for prescribing and selling CL ^* 1.5 Common CL brands ^* 1.6 Information Resources ^*	1. “Provide more specialized information to CLWs. Explain about the eye structure and how different lenses are placed on its surface. How the eyes and eyelids interact with the CL and provide better vision.”(P15) 2.“CL fitting is performed with trial lenses and age, lens history, visual acuity, eyelids, eye tears, and eye measurement such as corneal curvature are also examined. Each trial lens is placed in the eye for half an hour and examinations are done to determine whether it is appropriate or not. CLWs should be aware of the examinations before prescribing the lens and know that this process is time-consuming and requires patience.”(P30) 3. “Normally, CL is not given to patients during pregnancy and breastfeeding. If the CLW has had a hard CL, he should stop wearing lenses for two weeks before coming to the clinic; three-four days is enough in case of using soft lenses.”(P27) 4. “People should search for authorized centers and qualified individuals, who prescribe lens, and support and save CLWs quickly. The pharmacy or beauty salon is not qualified to prescribe and sell CL.”(P30) 5. “My friends ask me about the brand of my lenses. Some of my friends used invalid brands and had red eyes. I always recommend them buying a good brand.”(P14) 6. “The practitioner gave me just a brochure explaining about lenses and hygiene after prescribing the lens. There was no source to read and ask about the lens. I wanted much more information.”(P2)
2. Acquaintance with the CL	2.1 CL introduction and types of them ^* 2.2 CL applications ^* 2.3 CL advantages and disadvantages ^* 2.4 Reasons to wear CL ^* 2.5 CL lifespan ^*	1. “I want to know about the structure of CL and their types, the difference between soft, hard and oxygen-permeable CL” (P8) 2. “Explain the applications of CL to CLWs. One person has poor eyesight and needs a soft lens to improve vision and another person wants to use it for beauty. Athletes must wear CL for better vision. People with corneal disease use hard lenses such as scleral and RGP.”(P26) 3. “I have keratoconus and used a hard lens (RGP) for short time. It was unbearable. I want to get a scleral lens because I heard it is comfortable. I have to use the lens for a long time during the day and want to know which lens has more advantages and is better for me.” (P8) 4. “It’s very good to give the user some information while prescribing the lens. Explain the individual visibility and extent of the illness and why he/she should use a CL” (P10) 5. “CLWs should know that the lifespan of lenses varies depending on the type, and some people use a three-month lens for up to six months. The appearance of the lens may not have changed, but the lens does not have any water and oxygen.”(P33)
3. Caring for CL	3.1 Lens protection ^** 3.2 Gradual use of hard CL^* 3.3 Follow up examination schedule ^* 3.4 CL and climatic conditions ^* 3.5 CL at work environment ^* 3.6 Emergency and non-emergency CL referrals ^*** 3.7 Lens care in special groups ^* 3.8 When to use and not to use CL ^***	1. “We explain to CLWs that they need sunglasses for protection CL from wind, dust and sunshine. They must not use sprays or powder shadows and expose to hot places or hair dryers and smoking.” (P33) 2. “During the first days, I was unaware and wore CL from morning to evening that caused me to get headaches. I later found out that I had to use the lens gradually, for example, one hour on the first day, two hours on the second day.”(P4) 3. “I have keratoconus and refer to my doctor according to the time appointed by her to change my lens if necessary. The examination is necessary and the time a doctor visits the patient is different from one case to another. Sometimes the lens can still be used if the lens is intact.” (P13) 4. “CLWs should know what to do during dust scattering, I had to quickly find a place to go and take my lenses out.” (P14) 5. “I had no problems with my lens in the office, but as soon as I entered the building site, the dust went inside the lens and it was no longer possible to use the lens, so I had to take my lens out.” (P15) 6. “I want to know when to see a doctor and what symptoms are dangerous so that I have to remove the lens and what the important and emergency symptoms are” (P14) 7. “When I inserted lenses for my baby, the lens fell out of his eye and there was a possibility of breaking the lens. Later I realized that my baby should be in a lying position about five minutes after the lens insertion to prevent it from falling out of his eyes. The necessary tips about CL in children should be explained for mothers.” (P17) 8. “CLWs should be aware of the dangers. I had a patient who had not taken his/her lens out of his eye for 1 months, and he will certainly tell other people that there is no need to remove the lens daily. It is very helpful to recognize what happens if the lenses are not taken out for several days.”(P31)
4. Hygiene and vigilance of CL	4.1 Disinfection of CL and CL cases ^* 4.2 CL solutions ^* 4.3 CL maintenance ^* 4.4 Makeup materials and CL ^*	1. “CLWs do not know how to disinfect CL and CL cases and come back to the clinic with eye redness and infections. They must disinfect the CL and container with a special solution. They should place the CL container in boiling water for five minutes to sterilize and replace it every three months.”(P30) 2. “I need to know where to put my solution and normal saline. Doctors should explain us about the solutions we need, how to use and maintain it, and whether it should be kept in the refrigerator or not” (P5) 3. “I bought another lens to use when my lens expired, I did not know how to maintain it. Also I didn’t know where to keep the lens after opening it, and whether I should keep it in the refrigerator” (P5) 4. “I have been wearing CL for a long time. In my opinion, CLWs should be taught how to wear lenses with makeup and what cosmetic products are the best for the eyes. Women have more problems with wearing CL than men because of the use of makeup.”(P15)
5. Challenges of using CL	5.1 CLWs concerns ^* 5.2 CL displacement ^* 5.3 CL complications ^*** 5.4 CL incidents ^* 5.5 Intolerance of the lens at the beginning of the use ^*** 5.6 CL and diseases ^*	1. “At first, my vision was not good half an hour after putting the lens in my eye. I was worried and thought that my keratoconus was progressing. I stopped wearing CL for two weeks. I went to the CL clinic and expressed my concerns. I was not calm. The doctors explained that my vision would gradually improve. It is better that physicians explain CLWs’ concerns when prescribing CL.” (P8) 2. “My lens was displacing during an eye movement and wind blowing. I was horrified and did not know what to do. I came back home quickly and removed it.” (P23) 3. “The patient’s eye becomes red when using CL. The patient comes to the CL clinic after a long time, who has not used the lens for several months due to redness. He would not take the lens out if he knew about redness. Patients must acquire more information about complications and how to react to them.” (P29) 4. “I need to know what to do if an accident happened. For example, CL torn and broke in my sister’s eye; we did not know how to get the broken lens out of her eye because we did not know where the broken lens had gone.”(P2) 5. “When the patient receives the lens, he should know that the RGP lens takes two weeks to become ordinary and tolerable. After a short time of lens insertion, the patient usually comeback and needs help. We must provide information beforehand.”(P30) 6. “I have migraines and when I use CL, my headache gets worse. At first, I did not know, but later I realized that my lens affected migraines.” (P1)

Sub
category

Sub-subcategory

Example of Interview Excerpts

1.Basic information for the CLWs

1.1 Familiarity with eye structure and its function ^*

1.2 Necessary eye examinations for CL prescription ^**

1.3 Indispensable preparations before going to the CL clinic ^**

1.4 Accredited centers for prescribing and selling CL ^***

1.5 Common CL brands ^***

1.6 Information Resources ^*

1. “Provide more specialized information to CLWs. Explain about the eye structure and how different lenses are placed on its surface. How the eyes and eyelids interact with the CL and provide better vision.”(P15)

2.“CL fitting is performed with trial lenses and age, lens history, visual acuity, eyelids, eye tears, and eye measurement such as corneal curvature are also examined. Each trial lens is placed in the eye for half an hour and examinations are done to determine whether it is appropriate or not. CLWs should be aware of the examinations before prescribing the lens and know that this process is time-consuming and requires patience.”(P30)

3. “Normally, CL is not given to patients during pregnancy and breastfeeding. If the CLW has had a hard CL, he should stop wearing lenses for two weeks before coming to the clinic; three-four days is enough in case of using soft lenses.”(P27)

4. “People should search for authorized centers and qualified individuals, who prescribe lens, and support and save CLWs quickly. The pharmacy or beauty salon is not qualified to prescribe and sell CL.”(P30)

5. “My friends ask me about the brand of my lenses. Some of my friends used invalid brands and had red eyes. I always recommend them buying a good brand.”(P14)

6. “The practitioner gave me just a brochure explaining about lenses and hygiene after prescribing the lens. There was no source to read and ask about the lens. I wanted much more information.”(P2)

2. Acquaintance with the CL

2.1 CL introduction and types of them ^***

2.2 CL applications ^***

2.3 CL advantages and disadvantages ^*

2.4 Reasons to wear CL ^***

2.5 CL lifespan ^***

1. “I want to know about the structure of CL and their types, the difference between soft, hard and oxygen-permeable CL” (P8)

2. “Explain the applications of CL to CLWs. One person has poor eyesight and needs a soft lens to improve vision and another person wants to use it for beauty. Athletes must wear CL for better vision. People with corneal disease use hard lenses such as scleral and RGP.”(P26)

3. “I have keratoconus and used a hard lens (RGP) for short time. It was unbearable. I want to get a scleral lens because I heard it is comfortable. I have to use the lens for a long time during the day and want to know which lens has more advantages and is better for me.” (P8)

4. “It’s very good to give the user some information while prescribing the lens. Explain the individual visibility and extent of the illness and why he/she should use a CL” (P10)

5. “CLWs should know that the lifespan of lenses varies depending on the type, and some people use a three-month lens for up to six months. The appearance of the lens may not have changed, but the lens does not have any water and oxygen.”(P33)

3. Caring for CL

3.1 Lens protection ^**

3.2 Gradual use of hard CL^*

3.3 Follow up examination schedule ^***

3.4 CL and climatic conditions ^***

3.5 CL at work environment ^*

3.6 Emergency and non-emergency CL referrals ^***

3.7 Lens care in special groups ^*

3.8 When to use and not to use CL ^***

1. “We explain to CLWs that they need sunglasses for protection CL from wind, dust and sunshine. They must not use sprays or powder shadows and expose to hot places or hair dryers and smoking.” (P33)

2. “During the first days, I was unaware and wore CL from morning to evening that caused me to get headaches. I later found out that I had to use the lens gradually, for example, one hour on the first day, two hours on the second day.”(P4)

3. “I have keratoconus and refer to my doctor according to the time appointed by her to change my lens if necessary. The examination is necessary and the time a doctor visits the patient is different from one case to another. Sometimes the lens can still be used if the lens is intact.” (P13)

4. “CLWs should know what to do during dust scattering, I had to quickly find a place to go and take my lenses out.” (P14)

5. “I had no problems with my lens in the office, but as soon as I entered the building site, the dust went inside the lens and it was no longer possible to use the lens, so I had to take my lens out.” (P15)

6. “I want to know when to see a doctor and what symptoms are dangerous so that I have to remove the lens and what the important and emergency symptoms are” (P14)

7. “When I inserted lenses for my baby, the lens fell out of his eye and there was a possibility of breaking the lens. Later I realized that my baby should be in a lying position about five minutes after the lens insertion to prevent it from falling out of his eyes. The necessary tips about CL in children should be explained for mothers.” (P17)

8. “CLWs should be aware of the dangers. I had a patient who had not taken his/her lens out of his eye for 1 months, and he will certainly tell other people that there is no need to remove the lens daily. It is very helpful to recognize what happens if the lenses are not taken out for several days.”(P31)

4. Hygiene and vigilance of CL

4.1 Disinfection of CL and CL cases ^***

4.2 CL solutions ^***

4.3 CL maintenance ^***

4.4 Makeup materials and CL ^***

1. “CLWs do not know how to disinfect CL and CL cases and come back to the clinic with eye redness and infections. They must disinfect the CL and container with a special solution. They should place the CL container in boiling water for five minutes to sterilize and replace it every three months.”(P30)

2. “I need to know where to put my solution and normal saline. Doctors should explain us about the solutions we need, how to use and maintain it, and whether it should be kept in the refrigerator or not” (P5)

3. “I bought another lens to use when my lens expired, I did not know how to maintain it. Also I didn’t know where to keep the lens after opening it, and whether I should keep it in the refrigerator” (P5)

4. “I have been wearing CL for a long time. In my opinion, CLWs should be taught how to wear lenses with makeup and what cosmetic products are the best for the eyes. Women have more problems with wearing CL than men because of the use of makeup.”(P15)

5. Challenges of using CL

5.1 CLWs concerns ^*

5.2 CL displacement ^*

5.3 CL complications ^***

5.4 CL incidents ^*

5.5 Intolerance of the lens at the beginning of the use ^***

5.6 CL and diseases ^*

1. “At first, my vision was not good half an hour after putting the lens in my eye. I was worried and thought that my keratoconus was progressing. I stopped wearing CL for two weeks. I went to the CL clinic and expressed my concerns. I was not calm. The doctors explained that my vision would gradually improve. It is better that physicians explain CLWs’ concerns when prescribing CL.” (P8)

2. “My lens was displacing during an eye movement and wind blowing. I was horrified and did not know what to do. I came back home quickly and removed it.” (P23)

3. “The patient’s eye becomes red when using CL. The patient comes to the CL clinic after a long time, who has not used the lens for several months due to redness. He would not take the lens out if he knew about redness. Patients must acquire more information about complications and how to react to them.” (P29)

4. “I need to know what to do if an accident happened. For example, CL torn and broke in my sister’s eye; we did not know how to get the broken lens out of her eye because we did not know where the broken lens had gone.”(P2)

5. “When the patient receives the lens, he should know that the RGP lens takes two weeks to become ordinary and tolerable. After a short time of lens insertion, the patient usually comeback and needs help. We must provide information beforehand.”(P30)

6. “I have migraines and when I use CL, my headache gets worse. At first, I did not know, but later I realized that my lens affected migraines.” (P1)

^* Needs described only by CLWs ^** Needs described only by Practitioners ^*** Needs described jointly by CLWs & Practitioners