This is the fifth of a series evaluating the American Optician, and the role they may play in the future of the eyecare delivery system. In today's environment, the Optician has done little to evaluate strategically what education and training may be needed in the future, and often leave their hands in the fate of the marketplace. The last article made comparisons between US Opticians and our international counterparts. It is obvious that Opticians in other countries have a greater scope of practice and require more formal preparation than those in the US. Many, including this writer, see a need for change in Opticianry if it is to grow as a profession. But change is difficult. How do we in the US change a long-standing profession that seems to be complacent or at least uncertain what direction to take?

Planning for Change

It is important to begin an evaluation of the profession and where we stand in the eyecare delivery system. If change is to occur, the realizing how to effectively manage it is important. Change typically occurs in stages. The five stages of the process of change are as follows:

Precontemplation - In this stage people do not have the intention to change or take action. They are characterized as being uninformed as to the consequences of their present condition.

Contemplation - People in this stage intend to change as they become more aware of the Pros and Cons of changing. They may still be ambivalent to the situation.

Preparation - People in this stage intend to take action in the near future. They have an action strategy but it has yet to be implemented.

Action - In this stage people have implemented their action strategy.

Maintenance - In this stage people are "working to prevent relapse but they do not apply change processes as frequently as do people in action."

The profession is at a place in time where there is recognition of the need to change and discuss the direction it needs to take in the future, according to the Opticians Association of America in a resolution in 2002. Opticians are currently mired in the contemplation and preparation stages, and have been for many years. It is time for action now. Strategic Planning must occur at the national level to provide direction for the profession across all boundaries.

The Research Methodology

To establish a "game plan" to assist the leadership in planning for the future, a study was conducted. The primary research methods used for the study was a cross-sectional survey of Opticians utilizing a questionnaire to collect the data needed to determine the demographics of practicing Opticians in the United States, and to develop pertinent information and data about their practice. The questionnaire was also designed to gather information about the use of advanced technologies by Opticians which is closely related to the theory supporting this research. The Delphi Method was the second research method used in this study. It was used as a process to query experts in the field of eye care to examine the role that Opticians will perform in the future.

Cross-Sectional Study

A cross sectional study was conducted of Opticians utilizing a questionnaire. The survey/questionnaire was designed, in part, based on information gathered from an extensive review of pertinent literature. The study population for this study was Opticians belonging to the 5000+ member National Academy of Opticianry (NAO). The NAO is a nationally recognized professional association and is the largest professional Opticianry organization in the country. The NAO is open to all Opticians in the United States. It is unknown just how representative the NAO membership is of the profession at all levels of practice, but was the best available source for the collection of data.

The questionnaire provides data on the education, experience, and professional licensure/certification requirements for those participating in the study. It also collected data on the current level of technology practiced by Opticians. It serves as the foundation upon which this study is based. The questionnaire was limited to demographic information and specific information regarding current practice. The questionnaire used closed-ended and scaled questions which were reviewed by experts in the field before the questionnaire was released for the study. Based on the review of the questionnaire by subject matter experts it is considered to have face validity.

A randomized sample of 800 persons was selected from the NAO membership and the study questionnaire was mailed to each person. Cooperation was requested and received from the NAO in mailing the questionnaire. The questionnaire was mailed to only practicing Opticians.

The actual number of questionnaires completed and received was 200. In fact, a courtesy reminder was sent to all randomly selected Opticians to complete and submit the study questionnaire. No incentives were offered to the sample population for participating in the study. Acceptance of questionnaires for this study was discontinued when at least 200 questionnaires were received. Of the 800 Opticians that received questionnaires, 200 were returned for a response rate of 25%.

The Delphi Method

The second research method used in this study was the Delphi Method. The Delphi method was utilized to respond to the question of "What role Opticians will play in the eye care delivery system in the future." A Delphi Method brings together a panel of experts to present their views and the rationale or information supporting their view. Anonymity of panel members is maintained to protect panel members to be unduly influenced by a more highly regarded "expert". Panel members are provided feedback in the form of the rationale and information supporting each panel member's position or opinion. Upon the review of the other panel members responses each panel member is then able to change their position; hopefully, regressing to the consensus response of the panel. This process continues for two or three iterations until consensus of the panel is achieved on the particular subject or it cannot be reached. Regardless, the Delphi Method should provide some answers to the pertinent research questions and a greater understanding of the future of Opticians can be presented.

The panel for Delphi study consisted of experts from the fields of Optometry, Ophthalmology and Opticianry. Additionally, the Delphi Study results were used to validate/support the findings of the cross-sectional study. The Delphi Technique has been extensively used in research, including a great deal of work in the medical arena, government planning and business and industry. It is defined as a group decision process in which reliable and creative exploration of information for decision-making. According to Wenzenried (2000), "the Delphi technique is designed to collect opinions from a group of experts in a given discipline. By collecting these opinions, resubmitting them a number of times to the panel members for reconsideration and by providing continuous feedback with each new round of consideration, a satisfactory consensus may be reached. This consensus may be considered as a relevant and valid measure of future in that it is the summation of the collected opinions of experts." This method allows for group decision-making without having to actually bring individuals together, and can be generally considered an accurate predictor for the future.

Next month, we look at the study results and see the direction clearly established in the questionnaire and Delphi Method. You will find the experts and members of the profession agree on the future direction of Opticianry. I think you will find the results interesting, and clearly point to a need for change in the way Opticians are educated and trained. Stay tuned!