1

KIU
Faculty of Health Sciences Department of Nursing BSc (Hones) Nursing course Code:
NUR 4108

RESEARCH PROPOSAL

Assessment of visual impairment and quality of life among older adults

attending to a selected eye clinic at National Eye Hospital, Colombo,

Sri Lanka

Name of the Investigators : Mrs. W. S. T. Wedage (KIU/N/ 7314)

Mrs. M. P. Deepani (KIU/N/ 7341)

Mrs. W. P. N. M. Thennakoon (KIU/N/ 7276)

Ms. C. P. Wickramage (KIU/N/ 7207)

Mrs. K.N. Sithumini (KIU/N/ 7251)

Name Of the Supervisor: Mrs. Nishadhi Dharmarathna

Name of the Co – Supervisor: MS. Akindra Kariyawasam

Group Number: Group 4 – 11 D

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Table of content

Abbreviation List ......................................................................................................................3

Introduction .............................................................................................................................. 4
Significance of the study ..........................................................................................................6
Purpose of the study .................................................................................................................7
Research question .................................................................................................................7
General objective ..................................................................................................................7
Specific objectives ................................................................................................................7
Literature Review .....................................................................................................................8
Methodology........................................................................................................................... 15
Study Design ......................................................................................................................15
Study Settings .....................................................................................................................15
Study Population ................................................................................................................15
Inclusion Criteria ................................................................................................................15
Exclusion Criteria ...............................................................................................................15
Sample Method...................................................................................................................15
Sample Size ........................................................................................................................ 16
Data Collection Method .....................................................................................................16
Data collection Tool ...........................................................................................................17
Data Analysis ......................................................................................................................17
Ethical Consideration .........................................................................................................18
Gantt chart………………………………………………………………………………..19
References .............................................................................................................................. 20
Annexures ............................................................................................................................... 23
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Abbreviation List

QOL - Quality of life

VF - Visual function

VI - Vision impairment

VFQ -Visual Function Questionnaire

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Introduction

The aging population is rapidly increasing all over the world. Both the total

number and the percentage of elderly people are increasing in every country in the world

(WHO, 2022). It is estimated that one in six people in the world will be 60 years or over in

2030. In Sri Lanka, the elderly population indicates 12.3% of the total population and a

majority of the elderly population 31.7% lives in the Western province of the country

(Solano, 2021). The healthcare sector of the country has to face many health-related

problems due to this aging population.

Visual impairment is a common and main health problem among older adult

people. It is a condition that affects a significant amount of the elderly population, while it

largely impacts to the quality of life (Yibekal et al., 2019). It is estimated that nearly 2.2

billion people worldwide have a near or distances vision impairment (WHO, 2023). It is a

pressing global health issue in the developed and developing countries (Yibekal et al., 2019).

Visual impairment is defined as decreased of vision, the decreased ability to see in normal

level or deformity of visual foundations (Wang, Chan & Chi, 2014, Adigun et al., 2014). It

can range from low vision to blindness, where “low vision is defined as visual acuity of less

than 6/18, but equal to or better than 3/, 60 in the better eye with best correction. Blindness

is defined as visual acuity of less than 3/60 in the better eye with best correction.” (Abeysena

& Kapugoda, 2018). WHO has reported that about 38 million people were blind and 285

million of the world's population suffer from vision impairment including 154 million people

aged 50 years and older. (El-banna, Ismail, & Sharaa, 2019).

The vital causes of visual impairment are different and multiple. Within the

aging, Cataract, age-related macular degeneration, glaucoma, and we are main causes for

visual impairment. (Li et al., 2010, Wang, Chan, &Chi, 2014, Dev et al., 2014). These
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conditions can result in various stage of vision loss. The most important sensory function is

the visual function of the human body, thus visual impairment generally affects badly to

people’s daily life activities and the quality of life. (Li et al., 2010, Dev et al., 2014, Court et

al., 2014). Visual activity is important for the best orientation in social life and social

activity. It also has a significant effect on a person’s physical and emotional well-being.

Man is especially motivated for sight in order to survive and sight is considered

to account for around 80% of the functions of all five senses combined. (Adigun et al.,

2014). Therefore, visual impairment leads to limitation in all domains of life and especially

in the quality of life. Whether, partial or complete, vision loss may impact many aspects of

daily living including reading, driving, writing, mobility, self- care and basic activities such

as shopping, cooking meals (Wang, Chan, & Chi, 2014), and other types of activities that

must be performed to live independently and enjoy good quality of life. (Bonsaksen, Brunes,

& Heir, 2023, Court et al., 2014). The definition to the phrase “quality of life differs for each

person in the society. Yibekal et al. in a research article, in 2020 defined the vision-related

quality of life as a person’s satisfaction with their visual ability and how their vision impact

on their daily life. The restrictions posed by vision impairment on daily life activities, is one

possible factor that reduce quality of life. (Yibekal et al., 2020, Adigun et al., 2022). It

affects the older adult ability to perform basic tasks necessary for physical self-care.

Therefore, marking them require help from family members, friends of caregivers. (El-banna

, Ismail, & Sharaa, 2019, Jackson et al., 2019). Specifically, visual impartment may cause

accidents during daily activities which may lead to falls, fractures specially hip fractures

(Dev et al., 2014) and social loneliness and isolation, anxiety, depression (Jackson et al.,

2019), and suicide due to lower life satisfaction, increase the need for domestic care or

nursing, caregiver care increases the need for help from healthcare services. (El-banna,

Ismail, & Sharaa, 2019, Yibekal et al., 2020, Wang, Chan, & Chi, 2014).
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Significance of the study

Eyes are the most important and valuable organ of the human body. It is

sometimes referred to as “The window of the soul.” As a main sensory organ, they are

essential to carry out basic daily task. This study intends to assess visual impairment and

quality of life among older adults attending to an eye clinic at the National Eye Hospital,

Colombo, Sri Lanka. The survey which organized by vision 2020 Sri Lanka and the ministry

of Health in 2016, views the prevalence of blindness as 1.7% among those aged 40 or over,

of population in Sri Lanka. Also, the survey shows that 1.6% suffer from severe visual

improvement and 15.4% are visual impaired among the population subject to the study.

(IAPB, 2016).

Through the past 20 years, many researchers have studied the impact of visual

impairment on the quality of life among older adults. Even though, some analysis articles

concerning the relationship of visual improvement and quality of life can be found in

literature, there have mostly been presented by the specialists in the ophthalmology failed

like Scientists, Researchers, and Optometrists etc. but not by those in nursing field.

Also, the National Eye Hospital of Colombo in Sri Lanka stands as a significant

institution for diagnosing and treating visual improvements in this demographic making it a

perfect place for assessing in the visually impaired and the QOL among older adults. This

research will not only provide a beneficial perception into the prevalence and causes of

visual impairment in this population, but also offer a comprehensive understanding of the

complicated interplay between visual health and overall well-being. It is vital to recognize

that visual impairment is not only a medical issue but also a social and psychological one,

affecting an individual’s ability to perform daily task, engage in social interactions, and

maintain a sense of independence. Therefore, the aim of this research is to assess visual
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impairment and the quality of life among older adults attending to a selected eye clinic at the

National eye hospital in Colombo, Sri Lanka.

Purpose of the study

Research question

Assessment of visual impairment and quality of life among older adults attending to a

selected eye clinic at National Eye Hospital, Colombo, Sri Lanka.

General objective

To assess the visual impairment and quality of life among older adults attending to a

selected eye clinic at National Eye Hospital, Colombo, Sri Lanka.

Specific objectives

1. To assess the visual impairment among older adults attending to a selected eye clinic

at Colombo, Sri Lanka.

2. To assess the quality of life among older adults attending to a selected eye clinic at

Colombo, Sri Lanka.

3. To assess the association between visual impairment and quality of life among older

adults attending to a selected eye clinic at Colombo, Sri Lanka.

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Literature Review

Visual impairment is a significant health concern, particularly among the aging

population. With the global increase in life expectancy, the prevalence of visual impairments

has surged, necessitating a better understanding of its impact on the quality of life in older

adults. According to the World Health Organization (WHO, 2020), approximately 285

million people worldwide suffer from visual impairment, with the majority being older

individuals (WHO, 2020). Sri Lanka, including Colombo, has witnessed a parallel increase

in the aging population, underscoring the urgency to assess the relationship between visual

impairment and quality of life in this demographic. This research proposal aims to

investigate the nexus between visual impairment and quality of life among older adults

attending a selected eye clinic in Colombo, shedding light on the implications for healthcare

and public policy.

The study has done by faculty of infectious and tropical diseases about, Impact of

blindness, visual impairment, and cataract surgery on quality of life and visual functioning

among adults aged 40 years and above in Sri Lanka. Methods Multi-stage cluster random

sampling was used to identify a nationally representative sample of persons aged ≥ 40 years

in Sri Lanka.

Questionnaires were also administered to persons who had undergone cataract surgery in

one or both eyes and had a post-operative vision ≥ 6/60 (Murthy et al., 2018). The study

evaluated the relationships between quality of life (QOL) and visual function (VF) in adults

over 40 in Sri Lanka. The findings demonstrated that blind people had considerably lower

VF/QOL scores and more difficulty completing VF tasks and activities related to QOL. The

most difficulty with VF activities and QOL domains was experienced by those who were
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visually impaired due to cataracts. The study found that in Cataract surgery patients showed

better visual quality of life (VF/QOL) outcomes compared to those without cataract,

suggesting the use of self-reported questionnaires for monitoring functional benefits.

In 2016, another Qualitative study has been done by Holmes et al., (2016) about, Impact

of vision impairment and self-reported barriers to vision care: The views of elders in Nuwara

Eliya district, Sri Lanka. The study aimed to understand older people's views on VI (Vision

impairment) and barriers to eye care in Nuwara Eliya district, Sri Lanka, through focus

group discussions and thematic analysis. A study was conducted in Nuwara Eliya district, Sri

Lanka, between July and September 2013, focusing on the population of 711,644, with 40%

Sinhalese and 53% Tamil. A comprehensive guide on health and well-being, including VI

impact and barriers to eye care, was developed, and refined by a local team in Tamil and

Sinhala.VI significantly impacts older people's health and well-being, posing a challenge for

eye care services. Addressing the backlog and increasing needs is crucial. Integrating

primary healthcare with eyewear promotion, treatment, and distribution is essential.

Consultation with older individuals and families is crucial to minimize VI effects and

improve access to eye care services.

The association between visual impairment and quality of life is complex and

multifaceted. Chiang et al., (2018) conducted a cross-sectional study involving

comprehensive ophthalmic examinations among older adults in Colombo. The study

identified a significant association between visual impairment and a decreased quality of

life, particularly affecting emotional wellbeing and social relationships.

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Visual impairment has a substantial impact on the quality of life for older adults. It often

leads to limitations in daily activities, such as reading, mobility, and recognizing faces,

which can result in a reduced sense of independence and autonomy (Wang et al., 2016). This

is a mixed-methods study, combining quantitative measures of visual function with

qualitative interviews to provide a comprehensive understanding of how visual impairment

affects various dimensions of quality of life, found that improving visual function through

interventions such as cataract surgery led to a significant enhancement in the overall quality

of life among older adults. This evidence underscores the importance of early diagnosis and

intervention in improving the quality of life for older adults with visual impairments.

Additionally, assessments may consider the causes of visual impairment, such as

cataracts, glaucoma, and age-related macular degeneration (Klein et al., 2017). These

assessments serve as the foundation for understanding the scope of visual impairment among

older adults attending eye clinics in Colombo. This study is a longitudinal study, focusing on

age-related macular degeneration as a primary cause of visual impairment in older adults.

They tracked participants over several years to understand the progression and impact of this

condition on quality of life.

Furthermore, visual impairment has been linked to an increased risk of falls and injuries.

Loprinzi et al., (2017) investigated falls and injuries related to visual impairment among

older adults. They employed a case-control research design, comparing individuals with

visual impairment to a control group to assess the relationship between visual impairment

and fall risk.

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Bourne et al., (2016) employed a randomized controlled trial (RCT) design to evaluate

the effectiveness of psychosocial intervention for older adults with visual impairment. The

study focused on reducing depression and anxiety to enhance their quality of life. In Sri

Lanka, there is a need for targeted research to assess the specific challenges and factors

influencing the quality of life among older adults attending eye clinics in Colombo. Cultural,

socioeconomic, and healthcare system factors may play a unique role in this context, which

calls for tailored interventions and support systems. Additionally, addressing the

psychosocial aspects of visual impairment, such as depression and anxiety, should be a

priority in this setting (Bourne et al., 2016).

Studies have highlighted the significance of regular eye examinations and access to

appropriate eye care services for older adults. Early detection and timely treatment of visual

impairments can significantly improve quality of life and prevent further deterioration (Li et

al., 2019). Li et al., (2019) conducted a retrospective cohort study to examine the impact of

cataract surgery on the quality of life among older adults in an Asian population. This study

evaluated changes in quality of life before and after surgical intervention.

Zhao et al., (2018) explored the efficiency of different eye care service providers in

China's healthcare system. This cross-sectional study assessed the accessibility and

affordability of eye care services among older adults and its impact on their visual health.

Tajunisah et al., (2012) undertook a population-based cross-sectional survey in a

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Malaysian context to assess visual impairment and quality of life among older adults. They

utilized a vision related quality of life questionnaire and vision testing in their research

design.

The impact of visual impairment on the quality of life has been extensively studied. For

instance, a study by Owsley and McGwin (2004) found that visual impairment significantly

affects an older adult's ability to perform activities of daily living, leading to a reduced

quality of life. Moreover, Varma et al., (2016) highlighted that visual impairment is strongly

associated with an increased risk of depression, anxiety, and social isolation among the

elderly.

Assessment tools for visual impairment among older adults encompass various measures,

including visual acuity tests, contrast sensitivity assessments, and perimetry. The Visual

Function Questionnaire (VFQ-25) developed by Mangione et al., (2001) is a commonly used

tool to evaluate the impact of visual impairment on quality of life. This questionnaire

provides insights into the functional, social, and emotional aspects affected by visual

impairment.

Furthermore, the impact of visual impairment goes beyond physical limitations. A study

by Rees et al., (2017) revealed that beyond the functional limitations, individuals

experiencing visual impairment also encounter a diminished sense of independence and a

decrease in overall life satisfaction.

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Addressing visual impairment in older adults involves not only clinical interventions but

also social support and rehabilitation programs. Research by Lamoureux et al., (2009)

indicated that low vision rehabilitation significantly improved the quality of life for older

adults with visual impairment by enhancing their ability to perform daily tasks and boosting

their self-efficacy.

There is also an emerging focus on the psychological and social aspects of visual

impairment. The study by Chiang et al., (2015) emphasized the importance of psychosocial

interventions to mitigate the negative impact of visual impairment on mental health and

social well-being among older adults.

In addition to interventions, the role of assistive technology cannot be overlooked.

Devices such as magnifiers, screen readers, and wearable aids have shown promise in

enhancing the quality of life for visually impaired individuals (Subhi et al., 2019).

Moreover, policy and societal changes are crucial in supporting older adults with visual

impairment. Improving accessibility, ensuring inclusive environments, and promoting

awareness about the challenges faced by visually impaired individuals are essential steps in

enhancing their quality of life (Taylor et al., 2018).

In conclusion, the proposed research on the assessment of visual impairment and its

impact on the quality of life among older adults attending an eye clinic in Colombo is of

paramount importance. As the global population ages, understanding the relationship

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between visual impairment and quality of life becomes increasingly crucial (WHO, 2020).

By conducting this research, we aim to provide valuable insights that can inform healthcare

strategies and policies to improve the well-being of older adults facing visual impairments.

Moreover, the findings from this study could contribute to the development of targeted

interventions to enhance the lives of this vulnerable population and promote healthy aging.
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Methodology

The chapter will describe the study design, study setting, study population, sampling method,

sample size, data collection tools and method and data analysis.

Study Design

The study will be conducted as a descriptive cross-sectional study to assess visual

impairment and quality of life among older adults attending to a selected eye clinic at

Colombo.

Study Settings

This research study will be carried out in the eye clinic at National Eye Hospital, Colombo,

Sri Lanka.

Study Population

Target population will be adults who are under treatments for visual impairment in the eye

clinic at National Eye Hospital, Colombo, Sri Lanka.

Inclusion Criteria

Loss of visual acuity patients of older adults who are under treatments in eye clinic,

Colombo.

Exclusion Criteria

Patients with other non-communicable diseases such as diabetes, hypertension etc and their

quality of life will be excluded. Their medical history and the diagnosis will be taken from

the clinic file.

Sample Method

Consecutive sampling method will be used as the sampling method.

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Sample Size

Sample size was calculated using following Daniel formula (Pourhoseingholi et al,2013).

According to the annual statistic, The Western province in Sri Lanka, which consists of

Colombo, Kalutara, Gampaha: 31.7% of the population is aged 60 or older ( Balachandran

P.K, 2023).

n = sample size

d = 0.05 (margin error)

z = 1.96 (standard normal deviation)

p = expected proportion of the total population in Sri

Lanka

n = z2p(1-p)

d2

n = 1.96 × 1.96 × 0.317 (1 – 0.317)

0.05 × 0.05

n = 1.218 × 0.683

0.0025

n = 333

Data Collection Method

Data will be collected using questionnaire which was developed by the researchers.
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Information sheet, written consent form and volunteer consent form will be given prior to the

administering the questionnaire. The help of someone who knows Tamil language is obtained

to make the questionnaire. The entire procedure will take around 20 minutes.

Data collection Tool

The questionnaire is the main data collection tool of this study. This questionnaire consists of

three sections.

Section 01 – part 1 - Socio demographic data (Age, gender, marital status, ethnicity,

education level, occupation)

part 2 - Past and present medical history

Section 02 - Visual function data

Section 03 - Quality of life data

The WHO QOL field test instrument exists of 12 questions, covering quality of life aspects

related to physical health, psychological health, social relationships and environment (WHO,

1996).

Data Analysis

The collected data will be analyzed using Statistical Package for Social Sciences (SPSS)

software. The data will be presented by using grafts and charts. Frequencies, means and

standard deviations will be used to describe the characteristics of the sample. Pearson chi

square test values will be taken to interpret the results.

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Ethical Consideration

Ethical approval will be obtained from the committee of KIU and other permission will be

taken from the director of the National Eye Hospital. All the relevant information such as

information sheet. (Annexure 02) and the consent form (Annexure 03) will be explained to

all the subjects prior to the study. Only voluntary participants will be participated in the

study. Privacy and confidentiality will be explained to all participants. Participant

information will only be used for the purpose of the study. All documents and data will be

archived and stored in a secure manner. Only the authors will be able to access it when re-

evaluation is required.
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Gantt chart

Activity October November December January February March

2023 2023 2023 2024 2024 2024

1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

Decide topic

Assess for
feasibility

Literature
review

Preparation of
research
proposal

Developing a
data collection
instrument

Ethical
clearance

Data collection

Data entry

Data analysis

Writing the

final report
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References

Balachandran, P.K. (2023). Challenges posed by Sri Lanka's ageing population

Chiang, P. P. C., O’Connor, P. M., & Le Mesurier, R. T. (2018). Visual function and quality of

life: The impact of visual impairment and age. American Journal of Ophthalmology,

203, 89-93.

Chiang PPC, O’Connor PM, Leung., A validation study of the Hong Kong version of the

25item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) in

Chinese.

Optom Vis Sci. 2015;92(4):e110-e118.

Holmes, W., Shajehan, R., Kitnasamy, S., Abeywickrama, C., Arsath, Y., Gnanaraj, F., &

Luchters, S., (2018). Impact of vision impairment and self-reported barriers to vision

care: The views of elders in Nuwara Eliya district, Sri Lanka. Global public health,

13(5), 642655.

Klein, B. E. K., Howard, K. P., Lee, K. E., & Iyengar, S. K. (2017). The relationship of

cataract and cataract extraction to age-related macular degeneration: The Beaver

Dam Eye Study. Ophthalmology, 124(11), 1679-1685.

Loprinzi, P. D., Crush, E., & Joyner, C. (2017). A brief overview of falls among older adults.

Current Gerontology and Geriatrics Research, 2017, 1-5.

Lamoureux, E. L, Pallant J. F, Pesudovs K, Hassell J. B., Keeffe J.E. (2007) The Impact of

Vision Impairment Questionnaire: an evaluation of its measurement properties using

Rasch analysis. Invest Ophthalmol Vis Sci. 2007;48(11):4739-4741.

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Mangione C.M., Lee P.., Pitts J., Gutierrez., Berry S., Hays R.D. Psychometric properties of

the National Eye Institute Visual Function Questionnaire (NEI-VFQ). NEI-VFQ

Field Test Investigators. Arch Ophthalmol. 1998;116(11):1496-1504.

Murthy, G. V. S., Schmidt, E., Gilbert, C., Edussuriya, K., & Pant, H. B. (2018). Impact of

blindness, visual impairment and cataract surgery on quality of life and visual

functioning among adults aged 40 years and above in Sri Lanka. Ceylon Medical

Journal, 63(5), 2626.

Owsley C, McGwin G. Vision and aging. New York: Springer; 2002.

Rees G, Mellor D, Heutink J, et al. The psychosocial impact of high myopia in adults. Br J

Ophthalmol. 2017;101(4):1-6.

Pourhoseingholi, M. A., Vahedi, M., & Rahimzadeh, M. (2013). Sample size calculation in

medical studies. Gastroenterology and Hepatology from Bed to Bench, 6(1), 14–17.

Subhi H, Latham K, Myint J, Crossland M.D. (2018). Rehabilitation for patients with central

visual field loss: a systematic review. Int Ophthalmol. 2018;38(5):2271-2286.

Taylor DJ, Hobby AE, Binns AM, et al. How does age-related macular degeneration affect

realworld visual ability and quality of life? A systematic review. BMJ Open.

2016;6(12): e011504.

Varma R, Wu J, Chong K, Azen SP, Hays RD; Los Angeles Latino Eye Study Group. Impact

of severity and bilaterality of visual impairment on health-related quality of life.

Ophthalmology. 2006;113(10):1846-1853.
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Wang, J. J., Mitchell, P., & Smith, W. (2016). Vision and low self-rated quality of life: The

Blue Mountains Eye Study. Investigative Ophthalmology & Visual Science, 43(2),

603-607.

World Health Organization. (1996). Quality of life assessment. WHO.

Zhao, H., Zhang, H., & Wong, L. (2018). Comparing the efficiency of eye care services

between different providers in China’s “Healthy Eyes” program. International

Journal for Quality in Health Care, 30(2), 111-116.

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Annexures

Annexure 01 – Questionnaire

Assessment of visual impairment and quality of life among older adults attending to a

selected eye clinic at Colombo district, Sri Lanka.

Location of the eye clinic:

Code no of the participant:

Date:

Please answer following questions and put a tick ( ) for appropriate answer.

1. Section 1 – Demographics

1.1.Gender

1.1.1. Male ☐

1.1.2. Female ☐

1.2.Age

1.2.1. 50 – 59 ☐

1.2.2. 59 – 60 ☐

1.2.3. 70 < ☐

1.3. Marital status

1.3.1. Married ☐

1.3.2. Unmarried ☐

1.3.3. Divorced ☐

1.3.4. Widowed ☐

1.3.5. Separated ☐
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1.4. Religion

1.4.1. Buddhist ☐

1.4.2. Christian ☐

1.4.3. Islam ☐

1.4.4. Hindu ☐

1.5. Nationality

1.5.1. Sinhala ☐

1.5.2. Tamil ☐

1.5.3. Muslim ☐

1.5.4. Other ☐

1.6. Education Level

1.6.1. Never went to school ☐

1.6.2. Up to grade 5 ☐

1.6.3. Up to O/L ☐

1.6.4. Up to A/L ☐

1.6.5. Graduate ☐

1.7. Working status

1.7.1. Unemployed ☐

1.7.2. Self employed ☐

1.7.3. Private sector ☐

1.7.4. Government sector ☐

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1.7.5. Retired ☐

1.8. Monthly Income (Rupees)

1.8.1. <10000 ☐

1.8.2. 10000 – 30000 ☐

1.8.3. 30000 – 70000 ☐

1.8.4. >70000 ☐

2. Section 2 – General health

2.1. In general, how would you rate your overall health

2.1.1. Excellent ☐

2.1.2. Very good ☐

2.1.3. Good ☐

2.1.4. Fair ☐

2.1.5. Poor ☐

2.2. At the present time how would you describe your sleep quality and patterns

2.2.1. Very satisfied ☐

2.2.2. Satisfied ☐

2.2.3. Neutral ☐

2.2.4. Dissatisfied ☐

2.2.5. Very dissatisfied ☐

2.3. How would you rate your current diet and nutrition?

2.3.1. Excellent ☐

2.3.2. Very good ☐

2.3.3. Neutral ☐

2.3.4. Dissatisfied ☐
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2.3.5. Very dissatisfied ☐

3. Section 3 – Visual impairment

3.1. Do you use any type of visual aid?

3.1.1. Yes ☐

3.1.2. No ☐

3.2. Do you experience difficulty in reading or recognizing objects even with the use of

glasses?

3.2.1. Yes ☐

3.2.2. No ☐

3.3. Have you experienced a significant decrease in your visual acuity over the past year?

3.3.1. Yes ☐

3.3.2. No ☐

3.4. Do you have any diagnosed eye condition or disease?

3.4.1. Yes ☐

3.4.2. No ☐

3.5. Do you have difficulty seeing clearly in low-light conditions?

3.5.1. Yes ☐

3.5.2. No ☐

3.6. Do you have a family history of visual impairment or eye disease?

3.6.1. Yes ☐

3.6.2. No ☐

3.7. Have you ever undergone eye surgery or received any eye related treatments?
 27

3.7.1. Yes ☐

3.7.2. No ☐

3.8. Do you have trouble with colour vision?

3.8.1. Yes ☐

3.8.2. No ☐

3.9. Do you have any difficulty when see the large print headlines in the newspapers?

3.9.1. Yes ☐

3.9.2. No ☐

3.10. You have any difficulty when see the regular print in newspapers, magazines

or books?

3.10.1. Yes ☐

3.10.2. No ☐

3.11. Do you have any difficulty when see the labels on medicine bottles?

3.11.1. Yes ☐

3.11.2. No ☐

3.12. Do you have any difficulty when see prices while shopping?

3.12.1. Yes ☐

3.12.2. No ☐

4. Section 4 – Quality of life

4.1. How has your visual impairment affected your ability to perform everyday tasks such

as cooking, cleaning, or managing finance?

4.1.1. Not at all ☐

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4.1.2. Slightly ☐

4.1.3. Moderately ☐

4.1.4. Significantly ☐

4.1.5. Completely ☐

4.2. Have you experienced a decrease in your in your social and interactions due to your

visual impairment?

4.2.1. Never ☐

4.2.2. Rarely ☐

4.2.3. Sometimes ☐

4.2.4. Often ☐

4.2.5. Always ☐

4.3. How your visual impairment led to feeling of frustration or sadness?

4.3.1. Not at all ☐

4.3.2. Slightly ☐

4.3.3. Moderately ☐

4.3.4. Significantly ☐

4.3.5. Completely ☐

4.4. How well do you satisfied with the support and resources available to help you cope

with your impairment?

4.4.1. Very satisfied ☐

4.4.2. Satisfied ☐
 29

4.4.3. Neutral ☐

4.4.4. Dissatisfied ☐

4.4.5. Very dissatisfied ☐

4.5. How do you ever feel that problems with your vision make it difficult for you to do
the things that you would like to do?

4.5.1. Never ☐

4.5.2. Rarely ☐

4.5.3. Sometimes ☐

4.5.4. Often ☐

4.5.5. Always ☐

4.6. Are you experiencing any emotional impact due to your visual impairment such as
depression, anxiety, or social isolation?

4.6.1. Never ☐

4.6.2. Rarely ☐

4.6.3. Sometimes ☐

4.6.4. Often ☐

4.6.5. Always ☐

4.7. How do you require assistance with managing your medications due to vision issues?

4.7.1. Not at all ☐

4.7.2. Slightly ☐

4.7.3. Moderately ☐

4.7.4. Significantly ☐

4.7.5. Completely ☐

For each of the following statement, please put a tick ( ) in the box to indicate whether for

you the statement is definitely true, mostly true, mostly false, definitely false, or not sure.
 30

Definitely Mostly true Not sure Mostly false Definitely

true false

4.8 I am able
to navigate
public
transportation
independently

4.9 I feel
comfortable
discussing
my vision
problems
with others

4.10 I am
satisfied with
the ability to
maintain my
personal
hygiene

4.11 I feel
safe in my
daily life
 31

ඇමුණුම්

ඇමුණුම 01 - ප්‍රශ්නාවලිය

ශ්‍රී ලංකාවේ වකාළඹ දිස්ත්‍රික්කවේ ව ෝරාගත් අක්ි සායනයකට සහභාගී වන

වැඩිහිටියන්වේ දෘශ්‍යාබාධි භාවය සහ ජීවන ත්ත්වය ක්වස්ත්‍රරු කිරීම.

අක්ි සායනවේ ස්ත්‍රථානය:

සහභාගිවන්නාවේ වක් අංකය:

දිනය:

කරුණාකර පහ ප්‍රශ්නවලට පිළිතුරු දී සුදුසු පිළිතුර සඳහා ( ) ලකුණ

වයාදන්න.

1. ක ාටස - ජනවි ාස දත්ත

1.1 ලංගවේදය

1.1.1 පිරිමි ☐

1.1.2 ගැහැණු ☐

1.2 වයස

1.2.1 50 – 59 ☐

1.2.2 59 – 60 ☐

1.2.3 70 < ☐

1.3 විවාහක අවිවාහක බව

1.3.1 විවාහක ☐

1.3.2 අවිවාහක ☐

1.3.3 දික්කසාද ☐

1.3.4 වැන්දඹු ☐
 32

1.3.5 වවන් වූ ☐

1.4 ආගම

1.4.1 වබෞද්ධ ☐

1.4.2 කිතුනු ☐

1.4.3 ඉස්ත්‍රලාම් ☐

1.4.4 හින්දු ☐

1.5 ජාතිය

1.5.1 සංහල ☐

1.5.2 වදමළ ☐

1.5.3 මුස්ත්‍රලම් ☐

1.5.4 වවනත් ☐

1.6 අධ්යාපන මට්ටම

1.6.1 කවදාවත් ඉස්ත්‍රවකෝවේ ගිහින් නෑ ☐

1.6.2 5 වේණිය දක්වා ☐

1.6.3 O/L දක්වා ☐

1.6.4 උසස්ත්‍ර වපළ දක්වා ☐

1.6.5 උපාධිධාරී ☐

1.7 වැඩ ත්ත්වය

1.7.1 රැකියා විරහි ☐

1.7.2 ස්ත්‍රවයං රැකියා ☐

1.7.3 පුද්ගලක අංශ්‍ය ☐

1.7.4 රාජ්ය අංශ්‍ය ☐

 33

1.7.5 විශ්‍රාමිකයි ☐

1.8 මාසක ආදායම (රුපියේ)

1.8.1 <10000 ☐

1.8.2 10000 – 30000 ☐

1.8.3 30000 – 70000 ☐

1.8.4 >70000 ☐

2. ක ාටස - සාමාන්ය කසෞඛ්‍යය

2.1 වපාදුවේ, ඔබ ඔවේ සමස්ත්‍ර වසෞඛ්‍යය ක්වස්ත්‍රරු කරන්වන් වකවස්ත්‍රද?

2.1.1 විශිෂ්ටයි ☐

2.1.2 ඉ ා වහාඳයි ☐

2.1.3 වහාඳයි ☐

2.1.4 සාධාරණ ☐

2.1.5 දුර්වලයි ☐

2.2 වර් මානවේ ඔබ ඔවේ නින්වද් ගුණාත්මකභාවය සහ රටා විස්ත්‍ර ර කරන්වන්

වකවස්ත්‍රද?

2.2.1 ඉ ා ෘප්තතිමත් ☐

2.2.2 ෘප්තතිමත් ☐

2.2.3 මධයස්ත්‍රථව ☐

2.2.4 අ ෘප්තතිමත් ☐

2.2.5 ඉ ාඅ ෘප්තතිමත් ☐

2.3 ඔබවේ වර් මාන ආහාර සහ වපෝෂණය ඔබ ඇගයීමට ලක් කරන්වන්

වකවස්ත්‍රද?
 34

2.3.1 විශිෂ්ටයි ☐

2.3.2 ඉ ා වහාඳයි ☐

2.3.3 මධයස්ත්‍රථව ☐

2.3.4 අ ෘප්තතිමත් ☐

2.3.5 ඉ ාඅ ෘප්තතිමත් ☐

3. ක ාටස - දෘශ්‍යාබාධිතභාවය

3.1 ඔබ කිසයම් ආකාරයක දෘශ්‍ය ආධාරකයක් භාවි ා කරනවාද?

3.1.1 ඔේ ☐

3.1.2 නැ ☐

3.2 කණ්නාඩි භාවි වයන් පවා වස්ත්‍රතු කියවීමට වහෝ හඳුනා ගැනීමට ඔබට අපහසු

වේද?

3.2.1 ඔේ ☐

3.2.2 නැ ☐

3.3 පසුගිය වසර තුළ ඔවේ දෘශ්‍ය තීව්‍ර ාවවේ සැලකිය යුතු අඩුවීමක් ඔබ අත්විඳ

තිවේද?

3.3.1 ඔේ ☐

3.3.2 නැ ☐

3.4 ඔබට හඳුනාගත් අක්ි වරෝග වහෝ වරෝග තිවේද?

3.4.1 ඔේ ☐

3.4.2 නැ ☐

3.5 අඩු ආවලෝක ත්ත්වයන් තුළ ඔබට පැහැදිලව දැකීමට අපහසුද?

3.5.1 ඔේ ☐
 35

3.5.2 නැ ☐

3.6 ඔබට දෘශ්‍යාබාධි වහෝ අක්ි වරෝග පිළිබඳ පවුේ ඉතිහාසයක් තිවේද?

3.6.1 ඔේ ☐

3.6.2 නැ ☐

3.7 ඔබ කවදා වහෝ අක්ි ශ්‍ලයකර්මයකට භාජනය කර තිවේද වහෝ අක්ි ආශ්‍රි

ප්‍රතිකාර ලබාවගන තිවේද?

3.7.1 ඔේ ☐

3.7.2 නැ ☐

3.8 ඔබට වර්ණ දර්ශ්‍නය පිළිබඳ ගැටළු තිවේද?

3.8.1 ඔේ ☐

3.8.2 නැ ☐

3.9 පුවත්පත්වල විශ්‍ාල මුද්‍රණ සරස්ත්‍ර ල දකින විට ඔබට අපහසුවක් තිවේද?

3.9.1 ඔේ ☐

3.9.2 නැ ☐

3.9. පුවත්පත්වල, සඟරාවල වහෝ වපාත්වල නිතිප ා මුද්‍රණය දකින විට ඔබට

කිසයම් දුෂ්කර ාවයක් තිවේද?

3.9.1 ඔේ ☐

3.9.2 නැ ☐

3.10 ඖෂධ වබෝ ේවල වේබේ කියවීමට ඔබට අපහසුද?

3.10.1 ඔේ ☐

3.10.2 නැ ☐

3.11. සාප්තපු යාවම්දී මිල ගණන් බැලීවම්දී ඔබට කිසයම් දුෂ්කර ාවයක් තිවේද?
 36

3.11.1 ඔේ ☐

3.11.2 නැ ☐

4. ක ාටස - ජීවන තත්ත්වය

4.1 ඉවුම් පිහුම්, පිරිසදු කිරීම වහෝ මූලය කළමනාකරණය වැනි එදිවනදා කාර්යයන්

ඉටු කිරීමට ඔවේ දෘශ්‍යාබාධි භාවය බලපා ඇත්වත් වකවස්ත්‍රද?

4.1.1 වකාවහත්ම නැහැ ☐

4.1.2 රමක් ☐

4.1.3 මධයස්ත්‍රථව ☐

4.1.4 සැලකිය යුතු වලස ☐

4.1.5 සම්පුර්ණවයන්ම ☐

4.2 ඔවේ දෘශ්‍යාබාධි භාවය වේතුවවන් ඔවේ සමාජීය සහ අන් ර් ක්‍රියාවල

අඩුවීමක් ඔබ අත්විඳ තිවේද?

4.2.1 කවදාවත් නැ ☐

4.2.2 කලාතුරකින් ☐

4.2.3 සමහර විට ☐

4.2.4 වබාවහෝ විට ☐

4.2.5 සෑම විටම ☐

4.3 ඔවේ දෘශ්‍යාබාධි භාවය කලකිරීමක් වහෝ දුකක් දැනීමට වේතු වූවේ

වකවස්ත්‍රද?

4.3.1 වකාවහත්ම නැහැ ☐

4.3.2 රමක් ☐

4.3.3 මධයස්ත්‍රථව ☐
 37

4.3.4 සැලකිය යුතු වලස ☐

4.3.5 සම්පුර්ණවයන්ම ☐

4.4 ඔවේ දුර්වල ාවයට සාර්ථකව මුහුණ දීමට ඔබට උපකාර කිරීමට පවතින

සහවයෝගය සහ සම්පත් පිළිබඳව ඔබ වක රම් වහාඳින් සෑහීමකට පත්වේද?

4.4.1 ඉ ා ෘප්තතිමත් ☐

4.4.2 ෘප්තතිමත් ☐

4.4.3 මධයස්ත්‍රථව ☐

4.4.4 අ ෘප්තතිමත් ☐

4.4.5 ඉ ාඅ ෘප්තතිමත් ☐

4.5 ඔවේ වපනීවම් ගැටලු නිසා ඔබ කිරීමට කැමති වද් කිරීමට ඔබට අපහසු වන

බව ඔබට කවදා වහෝ හැවඟන්වන් වකවස්ත්‍රද?

4.5.1 කවදාවත් නැ ☐

4.5.2 කලාතුරකින් ☐

4.5.3 සමහර විට ☐

4.5.4 වබාවහෝ විට ☐

4.5.5 සෑම විටම ☐

4.6 මානසක අවපීඩනය, කාංසාව වහෝ සමාජ හුදකලාව වැනි ඔවේ

දෘශ්‍යාබාධි භාවය වේතුවවන් ඔබ කිසයම් චිත් වේගීය බලපෑමක්

අත්විඳිනවාද?

4.6.1 කවදාවත් නැ ☐

4.6.2 කලාතුරකින් ☐

4.6.3 සමහර විට ☐

 38

4.6.4 වබාවහෝ විට ☐

4.6.5 සෑම විටම ☐

4.7 වපනීවම් ගැටළු වේතුවවන් ඔවේ ඖෂධ කළමනාකරණය කිරීමට ඔබට

සහාය අවශ්‍ය වන්වන් වකවස්ත්‍රද?

4.7.1 වකාවහත්ම නැහැ ☐

4.7.2 රමක් ☐

4.7.3 මධයස්ත්‍රථව ☐

4.7.4 සැලකිය යුතු වලස ☐

4.7.5 සම්පුර්ණවයන්ම ☐

පහ සඳහන් සෑම ප්‍රකාශ්‍යක් සඳහාම, කරුණාකර ඔබ සඳහා ප්‍රකාශ්‍ය නිය

වශ්‍වයන්ම ස යද, වබාවහෝ දුරට ස යද, වබාවහෝ දුරට අස යද, නිය

වශ්‍වයන්ම අස යද, නැ වහාත් විශ්වාසද නැද්ද යන්න දැක්වීමට වකාටුවවහි

( ) ලකුණ වයාදන්න.
 39

නිය වබාවහෝ විශ්වාස වබාවහෝ නිය

වශ්‍වයන්ම දුරට නැ දුරට වශ්‍වයන්ම
ස යය ස යය අස ය අස යය

4.8 මට
ස්ත්‍රවාධීනව
වපාදු ප්‍රවාහන
වස්ත්‍රවවේ යා
හැකිය

4.9 මවේ
වපනීවම්
ගැටළු අන් අය
සමඟ
සාකච්ඡා
කිරීමට මට
පහසුවක්
දැවන්

4.10 මවේ
පුද්ගලක
සනීපාරක්ෂාව
පවත්වා
ගැනීමට ඇති
හැකියාව ගැන
මම සෑහීමකට
පත්වවමි

4.11 මවේ
එදිවනදා
ජීවි වේදී මට
ආරක්ෂාවක්
දැවනනවා
 40

இணைப் புகள்

இணைப் பு 01 – ககள் வித்தாள்

இலங் கையின் கைொழும் பு மொவட்டத்தில் ததர்ந்கதடுை்ைப்பட்ட ைண்

மருத்துவ மகனயில் ைலந்துகைொள் ளும் முதித ொர்ைளின் பொர்கவை்

குகைபொடு மை் றும் வொழ் ை்கைத் தரத்கத மதிப்பீடு கெ ் தல் .

ைண் மருத்துவ மகனயின் இடம் :

பங் தைை் பொளரின் குறியீடு எண்:

தததி:

பின் வரும் தைள் விைளுை்குப் பதிலளித்து, கபொருத்தமொன பதிலுை்கு டிை்

( ) இடவும் .

1. பிரிவு 1 - மக்கள் த ொகக

1.1. பொலினம்

1.1.1. ஆண் ☐

1.1.2. கபண் ☐

1.2. வ து

1.2.1. 50 – 59 ☐

1.2.2. 59 – 60 ☐

1.2.3. 70 < ☐

1.3 திருமண நிகல

1.3.1. திருமணமொனவர் ☐

1.2.1. திருமணமொைொதவர் ☐
 41

1.2.2. விவொைரத்து ☐

1.2.3. விதகவ ☐

1.2.4. பிரிை்ைப்பட்டது ☐

1.4 மதம்

1.4.1. கபௌத்த ☐

1.4.2. கிறிஸ்தவர் ☐

1.4.3. இஸ்லொம் ☐

1.4.4. இந்து ☐

1.5 ததசி ம்

1.5.1. சிங் ைளம் ☐

1.5.2. தமிழ் ☐

1.5.3. முஸ்லிம் ☐

1.5.4. மை் ைகவ ☐

1.6 ைல் வி நிகல

1.6.1. பள் ளிை்கு கெல் ல தவண்டொம் ☐

1.6.2. தரம் 5 வகர ☐

1.6.3. O/l வகர ☐

1.6.4. A/l வகர ☐

1.6.5. பட்டதொரி ☐

1.7 பணி நிகல

1.7.1. தவகலயில் லொதவர் ☐

1.7.2. சு கதொழில் ☐
 42

1.7.3. தனி ொர் துகை ☐

1.7.4. அரசு துகை ☐

1.7.5 ஓ ் வு கபை் ைவர் ☐

1.8 மொத வருமொனம் (ரூபொ ் )

1.8.1. <10000 ☐

1.8.2. 10000 – 30000 ☐

1.8.3. 30000 – 70000 ☐

1.8.4. >70000 ☐
 43

2. பிரிவு 2 - த ொது ஆரரொக்கியம்

2.1.கபொதுவொை, உங் ைள் ஒட்டுகமொத்த ஆதரொை்கி ம் சிைந்ததொை

எப்படி மதிப்பிடுவீர்ைள் ?

2.1.1. மிைவும் நல் லது ☐

2.1.2. நல் லது ☐

2.1.3. சிைப்பு

2.1.4. ஏகழ ☐

2.2. தை் தபொது உங் ைள் தூை்ைத்தின் தரம் மை் றும் முகைைள் மிைவும்
திருப்திைரமொை இருப்பகத எப்படி விவரிப்பீர்ைள் ?

2.2.1. திருப்தி ொன ☐

2.2.2. நடுநிகல ☐

2.2.3. அதிருப்தி ☐

2.2.4. மிைவும் ☐

2.2.5. அதிருப்தி ☐

2.3. உங் ைள் தை் தபொகத உணவு மை் றும் ஊட்டெ்ெத்து சிைந்தகத
எப்படி மதிப்பிடுவீர்ைள் ?

2.3.1. மிைவும் நல் ல ☐

2.3.2. நடுநிகல ☐

2.3.3. அதிருப்தி ☐

2.3.4. மிைவும் ☐

2.3.5. அதிருப்தி ☐

3. பிரிவு 3 - பொர்கவை் குகைபொடு

3.1. நீ ங் ைள் எந்த வகை ொன ைொட்சி உதவிக யும்

ப ன் படுத்துகிறீர்ைளொ?

3.1.1. ஆம் ☐
 44

3.1.2. இல் கல ☐

3.2. ைண்ணொடிக ப் ப ன் படுத்தினொலும் , கபொருட்ைகளப்

படிப்பதில் அல் லது அங் கீைரிப்பதில் நீ ங் ைள் சிரமப்படுகிறீர்ைளொ ?

3.2.1. ஆம் ☐

3.2.2. இல் கல ☐

3.3. ைடந்த ஆண்டில் உங் ைள் பொர்கவை் கூர்கமயில் குறிப்பிடத்தை்ை

குகைகவ நீ ங் ைள் அனுபவித்திருை்கிறீர்ைளொ ?

3.3.1. ஆம் ☐

3.3.2. இல் கல ☐

3.4. உங் ைளுை்கு ஏததனும் ைண்டறி ப்பட்ட ைண் நிகல அல் லது

தநொ ் உள் ளதொ?

3.4.1. ஆம் ☐

3.4.2. இல் கல ☐

3.5. குகைந்த கவளிெ்ெத்தில் கதளிவொைப் பொர்ப்பதில் சிரமம்

உள் ளதொ?

3.5.1. ஆம் ☐

3.5.2. இல் கல ☐

3.6. குடும் பத்தில் பொர்கவை் குகைபொடு அல் லது ைண் தநொ ்

உள் ளதொ?

3.6.1. ஆம் ☐

3.6.2. இல் கல ☐

3.7. நீ ங் ைள் எப்தபொதொவது ைண் அறுகவ சிகிெ்கெ

கெ ் திருை்கிறீர்ைளொ அல் லது ஏததனும் ைண் கதொடர்பொன

சிகிெ்கெைகளப் கபை் றிருை்கிறீர்ைளொ?
 45

3.7.1. ஆம் ☐

3.7.2. இல் கல ☐

3.8. உங் ைளுை்கு வண்ண பொர்கவயில் பிரெ்ெகன உள் ளதொ?

3.8.1. ஆம் ☐

3.8.2. இல் கல ☐

3.9. கெ ் தித்தொள் ைளில் கபரி அெ்சுத் தகலப்புைகளப்

பொர்ை்கும் தபொது உங் ைளுை்கு ஏததனும் சிரமம் இருை்கிைதொ?

3.9.1. ஆம் ☐

3.9.2. இல் கல ☐

3.10. கெ ் தித்தொள் ைள் , பத்திரிை்கைைள் அல் லது புத்தைங் ைளில்

வழை்ைமொன அெ்சுைகளப் பொர்ை்கும் தபொது உங் ைளுை்கு ஏததனும்

சிரமம் உள் ளதொ?

3.10.1. ஆம் ☐

3.10.2. இல் கல ☐

3.11. மருந்து பொட்டில் ைளில் உள் ள தலபிள் ைகளப் பொர்ை்கும் தபொது

உங் ைளுை்கு ஏததனும் சிரமம் இருை்கிைதொ?

3.11.1. ஆம் ☐

3.11.2. இல் கல ☐

3.12. ஷொப்பிங் கெ ் யும் தபொது விகலைகளப் பொர்ை்கும் தபொது

உங் ைளுை்கு ஏததனும் சிரமம் உள் ளதொ ?

3.12.1. ஆம் ☐

3.12.2. இல் கல ☐
 46

4. பிரிவு 4 - வொழ் க்கக ் ரம்

4.1. உங் ைள் பொர்கவை் குகைபொடு ெகம ல் , சுத்தம் கெ ் தல்

தபொன் ை அன் ைொடப் பணிைகளெ் கெ ் யும் உங் ைள் திைகன எவ் வொறு
பொதித்தது அல் லது நிதி தமலொண்கம?

4.1.1. சிறிதும் ☐

4.1.2. மிதமொை ☐

4.1.3. இல் கல ☐

4.1.4. குறிப்பிடத்தை்ை வகையில் ☐

4.1.5. முழுகம ொை ☐

4.2. உங் ைள் பொர்கவை் குகைபொட்டின் ைொரணமொை உங் ைள் ெமூை

மை் றும் கதொடர்புைளில் உங் ைளின் குகைகவ நீ ங் ைள்

அனுபவித்திருை்கிறீர்ைளொ?

4.2.1. அரிதொை ☐

4.2.2. சில தநரங் ைளில் ☐

4.2.3. கபரும் பொலும் ☐

4.2.4. எப்தபொதும் ☐

4.3. உங் ைள் பொர்கவை் குகைபொடு எப்படி விரை்தி அல் லது தெொைத்கத

ஏை் படுத்தி து?

4.3.1. ெை் று ☐

4.3.2. மிதமொன ☐

4.3.3. ைணிெமொை ☐

4.3.4. முழுகம ொை ☐
 47

4.4. உங் ைள் குகைபொட்கடெ் ெமொளிை்ை உங் ைளுை்கு உதவும் ஆதரவு

மை் றும் ஆதொரங் ைளில் நீ ங் ைள் எவ் வளவு திருப்தி அகடகிறீர்ைள் ?

4.4.1. மிைவும் திருப்தி ொன ☐

4.4.2. திருப்தி ☐

4.4.3. நடுநிகல ☐

4.4.4. அதிருப்தி ☐

4.4.5. மிைவும் அதிருப்தி ☐

4.5. உங் ைள் பொர்கவயில் உள் ள சிை்ைல் ைள் நீ ங் ைள் கெ ் விரும் பும்
விஷ ங் ைகளெ் கெ ் வகத ைடினமொை்குகிைது என் று நீ ங் ைள் எப்படி

உணர்கிறீர்ைள் ?

4.5.1. அரிதொை ☐

4.5.2. சில தநரங் ைளில் ☐

4.5.3. அடிை்ைடி ☐

4.5.4. எப்தபொதும் ☐

4.6. மனெ்தெொர்வு, பதட்டம் அல் லது ெமூைத் தனிகம தபொன் ை உங் ைள்

பொர்கவை் குகைபொட்டின் ைொரணமொை நீ ங் ைள் ஏததனும் உணர்ெ்சித்

தொை்ைத்கத அனுபவிை்கிறீர்ைளொ?

4.6.1. அரிதொை ☐

4.6.2. சில தநரங் ைளில் ☐

4.6.3. அடிை்ைடி ☐

4.6.4. எப்தபொதும் ☐

4.7. பொர்கவை் குகைபொடுைள் இல் லொத ைொரணத்தொல் உங் ைள்

மருந்துைகள நிர்வகிை்ை உங் ைளுை்கு எப்படி உதவி ததகவ?

 48

4.7.1. சிறிது ☐

4.7.2. மிதமொன ☐

4.7.3. ைணிெமொை ☐

4.7.4. முழுகம ொை ☐

பின் வரும் ஒவ் கவொரு கூை் றுை்கும் , உங் ைளுை்ைொன கூை் று ைண்டிப்பொை

உண்கம ொ, கபரும் பொலும் உண்கம ொ, கபரும் பொலும் தவைொனதொ,

நிெ்ெ மொை தவைொனதொ, அல் லது உறுதி ொை கதரி வில் கல ொ

என் பகதை் குறிை்ை, கபட்டியில் ( ) டிை் இடவும் .

 49

ைண்டி கபரும் பொ உறுதி கபரும் பொ ைண்டிப்

ப்பொை லும் ொை லும் கபொ ் பொை
உண்கம கதரி கபொ ்
உண் வில் கல
கம
4.8 என் னொல்
கபொதுவில்
சுதந்திரமொை
தபொை்குவரத்து
கெல் ல
முடிகிைது

4.9 என் பொர்கவ

பிரெ்சிகனைள்
மை் ைவர்ைளுடன்
விவொதிை்ை
வெதி ொை
உணர்கிதைன்

4.10 எனது திைன்

தனிப்பட்ட
சுைொதொரத்கத
பரொமரிை்ைவும்
நொன் திருப்தி
அகடகிதைன்

4.11 நொன்
பொதுைொப்பொை
உணர்கிதைன்
என் அன் ைொட
வொழ் ை்கை
 50

Annexure 02 - information sheet

Topic

Assessment of visual impairment and quality of life among older adults attending to a

selected eye clinic at Colombo district, Sri Lanka.

Introduction

We are Mrs.W.S.T.Wedage (KIU/N/7314), Mrs. M.P.Deepani (KIU/N/7341),

Mrs.W.P.N.M.Thennakoon (KIU/N/7276), Mrs. K.N.Sithumini (KIU/N/7251),

Ms.C.P.Wickramage (KIU/N/7207) undergraduate of the Bachelor of Science Honors in

Nursing Degree Programme at the KAATSU International University. We are interest in

conducting research study on "Assessment of visual impairment and quality of life among

older adults attending to a selected eye clinic at Colombo district, Sri Lanka.

Address of the institution where study is to be carried out

Bachelor of Science Honours in Nursing Degree programme. Faculty of Health Science,

KAATSU International University, Koswatta, Baththaramulla.

Purpose of the study

This study is being conducted as a partial fulfilment of the degree of Bachelor of Science

Honors in Nursing. The purpose is to assess the association between visual impairment and

quality of life among older adults in a selected eye clinic in Colombo district.

Procedures of Research

You will ask to participate for this research after giving full information about the study.
 51

After you adequately aware about the research study, you will ask to sign consent form. Then

I will ask the questions included in the questionnaire. After answering the questionnaire,

visual acuity tests will be taken. You will also be asked about your current clinic records.

Participant selection and voluntary participation

Your participation in this research is entirely voluntary. It is your choice whether to

participate or not. You are free to ask questions about the study at any time. Duration You

have only spent 20 - 25 minutes for completion this questionnaire.

Potential benefits

Your participation is likely to help us find the answer to the research question. The

information you provide will help you to assess your visual impairment and to get necessary

help to enhance quality of life. This information will contribute to improve the quality of life

of others similarly affected and would help plan better healthcare for the country.

Risk/Hazards/Discomforts

There will be no harm to any participant.

Reimbursements

There will not be any payment or refreshments for the participation of the study.

Confidentiality

The anonymity and confidentiality of all records of yours is guaranteed and no information

by which you can be identified will be released.

Termination of study participation

Your consent to participation in this study can be withdrawn by you anytime, with no less of

benefits. There will be no loss of medical care or any other available treatment your illness or
 52

condition to which you are otherwise entitled. Please notify the investigator as soon as you

decide to withdraw your consent.

Whom to contact

Your participation for the study is highly appreciated. Privacy and confidentially of data

gathered is completely secure and will be used for the research purpose only. If you have any

questions or any unclear topic with regards to the study and need further information, you can

contact us through following contact details.

Investigators

Name: Mrs. W.S.T.Wedage

Official Address: KIU, Koswatta, Battramulla.

Contact Number: 0714969392

Name: Mrs. M.P.Deepani

Official Address: KIU, Koswatta, Battramulla.

Contact Number: 0711505304

Name: Mrs. W.P.N.M.Thennakoon

Official Address: KIU, Koswatta, Battramulla.

Contact Number: 0711615732

Name: Mrs. K.N.Sithumini

 53

Official Address: KIU, Koaita, Battramulla.

Contact Number: 0765907968

Name: Ms. C.P.Wickramage

Official Address: KIU, Koswatta, Battramulla.

Contact Number: 0714042058

Supervisor

Name: Ms. Nishadi Dharmarathna

Official Address: KIU, Koswatta, Battaramulla

Contact Number:

Co-supervisor:

Name: Ms. Akindra kariyawasam

Official Address: KIU, Koswatta, Battaramulla.

Contact Number:
 54

ඇමුණුම 02 - කතාරතුරු පත්‍රි ාව

මාතෘ ාව

ශ්‍රී ලංකාවේ වකාළඹ දිස්ත්‍රික්කවේ ව ෝරාගත් අක්ි සායනයකට සහභාගි වන

වැඩිහිටි වැඩිහිටියන්වේ දෘශ්‍යාබාධි භාවය සහ ජීවන ත්ත්වය ක්වස්ත්‍රරු

කිරීම.

හැදින්ීම

අපි W.S.T. වවදවේ මහත්මිය (KIU/N/7314), M.P. දීපානි මිය (KIU/N/7341), W.P.N.M.

ව න්නවකෝන් මහත්මිය (KIU/N/7276), K.N. සතුමිණි (KIU/N/7251), C.P. වික්‍රමවේ

වමනවිය (KIU/N/7207) KAATSU ජා යන් ර විශ්ව විදයාලවේ වහද උපාධි

පාඨමාලාවේ විදයාවේදී වගෞරව උපාධිය. ශ්‍රී ලංකාවේ වකාළඹ දිස්ත්‍රික්කවේ

ව ෝරාගත් අක්ි සායනයකට සහභාගී වන වැඩිහිටි වැඩිහිටියන්වේ

දෘශ්‍යාබාධි භාවය සහ ජීවන ත්ත්වය ක්වස්ත්‍රරු කිරීම පිළිබඳ පර්වේෂණ

අධයයනයක් පැවැත්වීමට අපි උනන්දු වවමු.

අධ්‍යයනය සිදුකිරීමට නියමිත ආයතනකේ ලිපිනය

වහද උපාධි වැඩසටහවන් විදයාවේදී උපාධිය. වසෞඛ්‍ය විදයා පීඨය, KAATSU

ජා යන් ර විශ්වවිදයාලය, වකාස්ත්‍රවත් , බත් රමුේල.

අධ්‍යයනකේ අරමුණ
 55

වමම අධයයනය සදු කරනු ලබන්වන් වහද විදයාව පිළිබඳ ශ්‍ාස්ත්‍රරවේදී වගෞරව

උපාධිවේ අර්ධ සම්ූර්ණ කිරීමක් වලස ය. වකාළඹ දිස්ත්‍රික්කවේ ව ෝරාගත්

අක්ි සායනයක වැඩිහිටි වැඩිහිටියන් අ ර දෘශ්‍යාබාධි භාවය සහ ජීවන

ත්ත්වය අ ර සම්බන්ධය ක්වස්ත්‍රරු කිරීම වමහි අරමුණයි.

පර්කේෂණ ක්‍රියා පටිපාටිය

අධයයනය පිළිබඳ සම්ූර්ණ ව ාරතුරු ලබා දීවමන් පසු වමම පර්වේෂණය

සඳහා සහභාගී වීමට ඔවබන් අසනු ඇ .

පර්වේෂණ අධයයනය පිළිබඳව ඔබ ප්‍රමාණවත් වලස දැනුවත් වූ පසු, ඔබ

කැමැත් වපෝරමය අත්සන් කිරීමට අසනු ඇ . එවිට මම ප්‍රශ්නාවලවයහි

ඇතුළත් ප්‍රශ්න අසමි. ප්තරශ්නාවලයට පිළිතුරු සැපයීවමන් පසුව, දෘශ්ය තීේර ා

පරීක්ෂණ සදු කරනු ලැවේ. ඔබවේ වත්මන් සායන වාර් ා ගැනද ඔවබන් අසනු

ඇ .

සහභාගිවන්නන් කතෝරා ගැනීම සහ ස්කේච්ඡා සහභාගීත්වය

වමම පර්වේෂණයට ඔවේ සහභාගීත්වය සම්ූර්ණවයන්ම ස්ත්‍රවේච්ඡාවවන් සදු

වේ. සහභාගී වීම වහෝ වනාකිරීම ඔවේ කැමැත් යි. ඔබට ඕනෑම අවස්ත්‍රථාවක

අධයයනය පිළිබඳ ප්‍රශ්න ඇසීමට නිදහස ඇ . කාලසීමාව වමම ප්‍රශ්නාවලය

සම්ූර්ණ කිරීම සඳහා ඔබ වැය කර ඇත්වත් විනාඩි 20 - 25ක් පමණි.

විභව ප්‍රතිලාභ
 56

පර්වේෂණ ප්‍රශ්නයට පිළිතුර වසායා ගැනීමට ඔබවේ සහභාගීත්වය අපට

උපකාර වනු ඇ . ඔබ සපයන ව ාරතුරු ඔවේ දෘශ්‍යාබාධි භාවය ක්වස්ත්‍රරු

කිරීමට සහ ජීවන ත්ත්වය ඉහළ නැංවීමට අවශ්‍ය උපකාර ලබා ගැනීමට

උපකාරී වේ. වමම ව ාරතුරු ඒ හා සමානව පීඩාවට පත් වූ අවනකුත් අයවේ

ජීවන ත්ත්වය ඉහළ නැංවීමට දායක වන අ ර රට සඳහා වඩා වහාඳ වසෞඛ්‍ය

වස්ත්‍රවාවක් සැලසුම් කිරීමට උපකාරී වනු ඇ .

අවදානම්/උපද්‍රව/අසහනයන්

සහභාගිවන්වනකුට කිසදු හානියක් සදු වනාවනු ඇ .

ප්‍රතිපූරණය

අධයයනයට සහභාගී වීම සඳහා කිසදු වගවීමක් වහෝ ප්‍රවබෝධයක් වනාමැ .

රහසයභාවය

ඔබවේ සයලුම වාර් ා වල නිර්නාමිකභාවය සහ රහසයභාවය සහතික කර

ඇති අ ර ඔබව හඳුනාග හැකි කිසදු ව ාරතුරක් නිකුත් වනාවකවර්.

අධ්යයන සහභාගීත්වය අවසන් කිරීම

වමම අධයයනයට සහභාගී වීමට ඇති ඔවේ කැමැත් අඩු ප්‍රතිලාභයක්

වනාමැතිව ඔබට ඕනෑම වේලාවක ඉේලා අස්ත්‍රකර ග හැක. වවදය ප්‍රතිකාර

වහෝ ඔබට වවනත් ආකාරයකින් හිමිවන ඔවේ අසනීප වහෝ ත්ත්වය සඳහා

පවතින වවනත් ප්‍රතිකාරයක් අහිමි වනාවේ. ඔබ ඔවේ කැමැත් ඉේලා අස්ත්‍රකර

ගැනීමට තීරණය කළ වහාම විමර්ශ්‍කයාට දන්වන්න.

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සම්බන්ධ්‍ විය යුත්කත් ාවද

අධයයනය සඳහා ඔබවේ සහභාගීත්වය ඉ ා අගය වකාට සලකනු ලැවේ. එකතු

කරන ලද දත් වල රහසයභාවය සහ රහසග ව සම්ූර්ණවයන්ම ආරක්ි

වන අ ර පර්වේෂණ කටයුතු සඳහා පමණක් භාවි වකවර්. ඔබට අධයයනය

සම්බන්ධවයන් කිසයම් ප්‍රශ්නයක් වහෝ කිසයම් අපැහැදිල මා ෘකාවක් ඇත්නම්

සහ වැඩිදුර ව ාරතුරු අවශ්‍ය නම්, ඔබට පහ සම්බන්ධ ා විස්ත්‍ර ර හරහා අප

හා සම්බන්ධ විය හැක.

පරීක්ෂ යන්

නම: W.S.T.වවදවේ මහත්මිය

නිල ලපිනය: KIU, වකාස්ත්‍රවත් , බත් රමුේල.

සම්බන්ධ ා අංකය: 0714969392

නම: එම්.පී.දීපානි මිය

නිල ලපිනය: KIU, වකාස්ත්‍රවත් , බත් රමුේල.

සම්බන්ධ ා අංකය: 0711505304

නම: ඩේලේ.පී.එන්.එම්.ව න්නවකෝන් මිය

නිල ලපිනය: KIU, වකාස්ත්‍රවත් , බත් රමුේල.

සම්බන්ධ ා අංකය: 0711615732

නම: K.N. සතුමිණි මිය

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නිල ලපිනය: KIU, වකාස්ත්‍රවත් , බත් රමුේල.

සම්බන්ධ ා අංකය: 0765907968

නම: සී.පී.වික්‍රමවේ වමනවිය

නිල ලපිනය: KIU, වකාස්ත්‍රවත් , බත් රමුේල

සම්බන්ධ ා අංකය: 0714042058

සුපරීක්ෂ

නම: නිෂාදි ධර්මරත්න වමනවිය

නිල ලපිනය: KIU, වකාස්ත්‍රවත් , බත් රමුේල

ඇමතුම් අංකය:

සම-අධීක්ෂ :

නම: අකින්ද්‍රා කාරියවසම් වමනවිය

නිල ලපිනය: KIU, වකාස්ත්‍රවත් , බත් රමුේල.

ඇමතුම් අංකය
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இகை ் பு 02 - கவல் ொள்

கல ் பு

இலங் கையின் கைொழும் பு மொவட்டத்தில் ததர்ந்கதடுை்ைப்பட்ட ைண்

மருத்துவ மகனயில் ைலந்துகைொள் ளும் முதித ொர்ைளின் பொர்கவை்

குகைபொடு மை் றும் வொழ் ை்கைத் தரத்கத மதிப்பீடு கெ ் தல் .

அறிமுகம்

நொங் ைள் திருமதி.டபிள் யூ.எஸ்.டி. கவடஜ் (KIU/N/7314), திருமதி

M.P.தீபொனி (KIU/N/7341), திருமதி.W.P.N.M.கதன் னதைொன் (KIU/N/7276),

திருமதி K.N.சித்துமினி (KIU/N/7251), M.C.P. விை்கிரதமஜ் (KIU/N/7207)

KAATSU இன் டர்தநஷனல் பல் ைகலை்ைழைத்தில் நர்சிங் பட்டப்படிப்பில்

இளங் ைகல அறிவி ல் பட்டம் கபை் ைவர்.

"இலங் கையின் கைொழும் பு மொவட்டத்தில் ததர்ந்கதடுை்ைப்பட்ட

ைண் மருத்துவ மகனயில் ைலந்துகைொள் ளும் முதித ொர்ைளின்

பொர்கவை் குகைபொடு மை் றும் வொழ் ை்கைத் தரத்கத மதிப்பீடு கெ ் தல்

பை் றி ஆரொ ் ெ்சி ஆ ் கவ நடத்துவதில் நொங் ைள் ஆர்வமொை

உள் தளொம் .

ஆய் வு ரமற் தகொள் ள ் டும் நிறுவன ்தின் முகவரி

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நர்சிங் பட்டப்படிப் பில் இளங் ைகல அறிவி ல் பட்டம் . சுைொதொர

விஞ் ஞொன பீடம் , KAATSU ெர்வததெ பல் ைகலை்ைழைம் , கைொஸ்வத்கத,

பத்தரமுல் ல.

டி ் பின் ரநொக்கம்

நர்சிங் கில் இளங் ைகல அறிவி ல் பட்டப்படிப்கப ஓரளவு பூர்த்தி

கெ ் யும் வகையில் இந்த ஆ ் வு நடத்தப்படுகிைது. கைொழும் பு

மொவட்டத்தில் ததர்ந்கதடுை்ைப்பட்ட ைண் மருத்துவ மகனயில்

வ தொனவர்ைளிகடத பொர்கவை் குகைபொடு மை் றும் வொழ் ை்கைத்

தரம் ஆகி வை் றுை்கு இகடத ொன கதொடர்கப மதிப்பிடுவதத இதன்

தநொை்ைமொகும் .

ஆரொய் ச்சி தசயல் முகறகள்

ஆ ் கவப் பை் றி முழுத் தைவகலயும் அளித்த பிைகு இந்த

ஆரொ ் ெ்சியில் பங் தைை் ைெ் கெொல் வீர்ைள் . ஆரொ ் ெ்சிப் படிப்கபப் பை் றி

நீ ங் ைள் தபொதுமொன அளவு அறிந்த பிைகு, ஒப்புதல் படிவத்தில்

கைக ொப்பமிடெ் கெொல் வீர்ைள் . பின் னர் தைள் வித்தொளில் உள் ள

தைள் விைகளை் தைட்தபன் . தைள் வித்தொளுை்கு பதிலளித்த பிைகு,

பொர்கவை் கூர்கம தெொதகனைள் எடுை்ைப்படும் . உங் ைள் தை் தபொகத

கிளினிை் பதிவுைள் பை் றியும் தைட்ைப்படும் .

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ங் ரகற் ொளர் ர ர்வு மற் றும் ன்னொர்வ ங் ரகற் பு

இந்த ஆரொ ் ெ்சியில் உங் ைள் பங் தைை் பு முை் றிலும்

தன் னொர்வமொனது. பங் தைை் பதொ இல் கல ொ என் பது உங் ைள் விருப்பம் .

நீ ங் ைள் எந்த தநரத்திலும் படிப்கபப் பை் றி தைள் விைகளை்

தைட்ைலொம் . இந்த தைள் வித்தொகள முடிை்ை நீ ங் ைள் 20 - 25 நிமிடங் ைள்

மட்டுதம கெலவிட்டீர்ைள் .

சொ ்தியமொன நன்கமகள்

ஆரொ ் ெ்சிை் தைள் விை்ைொன பதிகலை் ைண்டறி உங் ைள்

பங் தைை் பு எங் ைளுை்கு உதவும் . நீ ங் ைள் வழங் கும் தைவல் ைள் உங் ைள்

பொர்கவை் குகைபொட்கட மதிப்பிடவும் , வொழ் ை்கைத் தரத்கத

தமம் படுத்த ததகவ ொன உதவிக ப் கபைவும் உதவும் . இந்தத் தைவல் ,

இதததபொல் பொதிை்ைப்பட்ட மை் ைவர்ைளின் வொழ் ை்கைத் தரத்கத

தமம் படுத்த பங் ைளிை்கும் மை் றும் நொட்டிை் ைொன சிைந்த சுைொதொரத்

திட்டத்கதத் திட்டமிட உதவும் .

ஆ ்து/அ ொயங் கள் /அதசௌகரியங் கள்

பங் தைை் பொளருை்கு எந்தத் தீங் கும் ஏை் படொது.

திரு ் பிச் தசலு ்து ல்

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படிப்பில் பங் தைை் பதை் கு ைட்டணம் அல் லது சிை் றுண்டி எதுவும்

இருை்ைொது.

இரகசிய ் ன்கம

உங் ைளின் அகனத்து பதிவுைளின் கப ர் கதரி ொத தன் கம மை் றும்

ரைசி த்தன் கம உத்தரவொதம் மை் றும் நீ ங் ைள் அகட ொளம்

ைொணை்கூடி எந்த தைவலும் கவளியிடப்படொது.

டி ் பில் ங் ரகற் க நிறு ்து ல்

இந்த ஆ ் வில் பங் தைை் பதை் ைொன உங் ைள் ஒப்புதகல எந்த

தநரத்திலும் நீ ங் ைள் திரும் பப் கபைலொம் , எந்த நன் கமயும் இல் கல.

மருத்துவ ைவனிப்பு அல் லது தவறு எந்த சிகிெ்கெயும் உங் ைள் தநொ ்

அல் லது உங் ைளுை்கு உரிகம உள் ள நிகலயில் எந்த விதமொன

சிகிெ்கெயும் இழை்ைப்படொது. உங் ைள் ஒப்புதகல திரும் பப் கபை முடிவு

கெ ் தவுடன் , விெொரகண ொளருை்குத் கதரிவிை்ைவும் .

யொகர த ொடர்பு தகொள் வது

ஆ ் வில் உங் ைள் பங் தைை் பு மிைவும் பொரொட்டத்தை்ைது.

தெைரிை்ைப்பட்ட தரவுைளின் தனியுரிகம மை் றும் ரைசி மொனது

முை் றிலும் பொதுைொப்பொனது மை் றும் ஆரொ ் ெ்சி தநொை்ைத்திை் ைொை

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மட்டுதம ப ன் படுத்தப்படும் . ஆ ் வு கதொடர்பொை ஏததனும் தைள் விைள்

அல் லது ஏததனும் கதளிவை் ை தகலப்பு இருந்தொல் தமலும் தைவல்

ததகவப்பட்டொல் , பின் வரும் கதொடர்பு விவரங் ைள் மூலம் எங் ைகளத்

கதொடர்புகைொள் ளலொம் .

புலனொய் வொளர்கள்

கப ர்: திருமதி W.S.T..கவதடஜ்

உத்தித ொைபூர்வ முைவரி: KIU, கைொஸ்வத்த, பத்திரமுல் ல.

கதொடர்பு எண்: 0714969392

கப ர்: திருமதி M.P..தீபொனி

உத்தித ொைபூர்வ முைவரி: KIU, கைொஸ்வத்த, பத்திரமுல் ல.

கதொடர்பு எண்: 0711505304

கப ர்: திருமதி W.P.N.M.கதன் னதைொன்

உத்தித ொைபூர்வ முைவரி: KIU, கைொஸ்வத்த, பத்திரமுல் ல.

கதொடர்பு எண்: 0711615732

கப ர்: திருமதி K.N..சித்துமினி

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உத்தித ொைபூர்வ முைவரி: KIU, கைொஸ்வத்த, பத்திரமுல் ல.

கதொடர்பு எண்: 0765907968

கப ர்: கெல் வி C.P..விை்ரமதை

உத்தித ொைபூர்வ முைவரி: KIU, கைொஸ்வத்த, பத்திரமுல் ல.

கதொடர்பு எண்: 0714042058

ரமற் ொர்கவயொளர்

கப ர்: கெல் வி. நிஷொதி தர்மரத்னொ

உத்தித ொைபூர்வ முைவரி: KIU, கைொஸ்வத்த, பத்தரமுல் ல

கதொடர்பு எண்:

இகை ரமற் ொர்கவயொளர்:

கப ர்: கெல் வி அகிந்திரொ ைொரி வெம்

உத்தித ொைபூர்வ முைவரி: KIU, கைொஸ்வத்த, பத்தரமுல் ல.

கதொடர்பு எண்
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Annexure 03 - Volunteer Consent Form

KIU, 249/1,

Malabe Road,

Koswatta,

Battaramulla.

Date: ........ / ....... / ............

Dear participants,

We are Mrs. W. S. T. Wedage (KIU/N/7314), Mrs. M. P. Deepani (KIU/N/7341), Mrs. W. P.

N. M. Thennakoon (KIU/N/7276), Mrs. K. N. Sithumini (KIU/N/7251), and Ms. C. P.

Wickramage (KIU/ N/ 7207) undergraduates of the Bachelor of Science Honors in Nursing

Degree Programme at the KAATSU International University. We are interest in conducting

research study on assessment of visual empowerment and quality of life among older adults

attending to a selected eye clinic at Colombo, Sri Lanka. We would like to invite you for

voluntary participation in this study.

• If you are interested, please you may have to spend approximately 20 minutes with us in

answering questionnaire related to the topic. You may free to decide whether to take part in

this study or not.

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• The time and place of answering the questionnaire will be entirely up to you. This may be a

place agreeable to you.

• If may be necessary to take notes or write down answers to a questionnaire during the

meeting, so that important information we will not be forgotten.

• All information will be confidential and anonymous. You will be assigned a code number to

ensure the anonymity. The findings will be used for the educational purposes and the benefit

of the profession and society, but your name and names of any other people or place will not

be identified.

• You are not in any obligation to participate in this study and whenever you want, you are

free to withdrawal at any time without any risk. No need to provide reason for your

withdrawal. You will not receive any financial or material compensate for participation.

Purpose of the study

This study is being conducted as partial fulfilment of the degree of Bachelor of Science

Honours in nursing. The purpose is to assess the visual impairment and quality of life among

older adults’ attendant to a selected eye clinic at Colombo district.

Project Title: Assessment of visual impairment and quality of life among older adults

attending to a selected eye clinic at Colombo, Sri Lanka.

Supervisor:

Name: Ms. Nishadhi Dharmarathna

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Official Address: KIU, Koswatta, Battaramulla

Contact Number:

Co-supervisor:

Name: Ms. Akindra kariyawasam

Official Address: KIU, Koswatta, Battaramulla.

Contact Number:

Investigators:

1. Name: Mrs. W. S. T. Wedage

Official Address: KIU, Koswatta, Battaramulla

Contact Number: 0714969392

2. Name: M. P. Deepani

Official Address: KIU, Koswatta, Battaramulla

Contact Number: 07115053304

3. Mrs. W. P. N. M. Thennakoon

Official Address: KIU, Koswatta, Battaramulla

Contact Number: 0711615732

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4. Mrs. K. N. Sithumini

Official Address: KIU, Koswatta, Battaramulla

Contact Number: 0765907968

5. Ms. C. P. Wickramage

Official Address: KIU, Koswatta, Battaramulla

Contact Number: 071404205

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ඇමුණුම 03 - ස්කේච්ඡා ැමැත්ත කපෝරමය

KIU, 249/1,

මාලවේ පාර,

වකාස්ත්‍රවත් ,

බත් රමුේල.

දිනය: ........ / ....... / ............

හි වත් සහභාගිවන්නන්,

අපි W. S. T. වවදවේ මිය (KIU/N/7314), M. P. දීපානි මිය (KIU/N/7341), W. P.

N.M. ව න්නවකෝන් මිය (KIU/N/7276), K. N. සතුමිණි මිය (KIU/N/7251), සහ C. P.

වික්‍රමවේ වමනවිය. (KIU/ N/ 7207) වහද විදයාවේදී වගෞරව උපාධි අවප්තක්ෂකයින්

KAATSU ජා යන් ර විශ්ව විදයාලවේ උපාධි වැඩසටහන. පැවැත්වීමට අපි

උනන්දු වවමු.

වැඩිහිටි වැඩිහිටියන් අ ර දෘශ්‍ය සවිබල ගැන්වීම සහ ජීවන ත්ත්වය ක්වස්ත්‍රරු

කිරීම පිළිබඳ පර්වේෂණ අධයයනය ශ්‍රී ලංකාවේ වකාළඹ පිහිටි ව ෝරාගත් අක්ි

සායනයකට සහභාගී වීම. අපි ඔබට ආරාධනා කිරීමට කැමැත්ව මු.

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වමම අධ්යයනය සඳහා ස්ත්‍රවේච්ඡා සහභාගීත්වය ඔබ උනන්දුවක් දක්වන්වන් නම්,

කරුණාකර ඔබට අප සමඟ විනාඩි 20ක් පමණ ග කිරීමට සදු විය හැක.

මා ෘකාවට අදාළ ප්තරශ්නාවලයට පිළිතුරු සැපයීම. සහභාගී විය යුතුද යන්න

තීරණය කිරීමට ඔබට නිදහස තිබිය හැක.

වමම අධ්යයනය වහෝ නැ .

• ප්‍රශ්නාවලයට පිළිතුරු සපයන වේලාව සහ ස්ත්‍රථානය සම්ූර්ණවයන්ම ඔබට

භාරයි. වමය විය හැක ඔබට සුදුසු ස්ත්‍රථානය.

• කාලය තුළ ප්‍රශ්නාවලයකට සටහන් ගැනීමට වහෝ පිළිතුරු ලවීමට අවශ්‍ය විය

හැකි නම් රැස්ත්‍රවීම එවිට වැදගත් ව ාරතුරු අපට අම ක වනාවනු ඇ .

• සයලුම ව ාරතුරු රහසග සහ නිර්නාමික වනු ඇ . ඔබට වක් අංකයක්

පවරනු ලැවේ.

නිර්නාමිකභාවය සහතික කරන්න. වසායාගැනීම් අධයාපනික අරමුණු සහ

ප්‍රතිලාභ සඳහා භාවි ා කරනු ඇ .

වෘත්තිවේ සහ සමාජවේ, නමුත් ඔවේ නම සහ වවනත් පුද්ගලයින්වේ වහෝ

ස්ත්‍රථානයක නම් එවස්ත්‍ර වනාවේ හඳුනා ග යුතුය.

• වමම අධයයනයට සහභාගී වීමට ඔබ කිසදු බැඳීමක් වනාමැති අ ර ඔබට

අවශ්‍ය විවටක, ඔබ වේ කිසදු අවදානමකින් ව ාරව ඕනෑම අවස්ත්‍රථාවක මුදේ

ආපසු ගැනීමට වනාමිවේ. ඔබ සඳහා වේතු දැක්වීමට අවශ්ය නැ .

ආපසු ගැනීම. සහභාගීත්වය සඳහා ඔබට කිසදු මූලය වහෝ ද්‍රවයමය වන්දියක්

වනාලැවබනු ඇ .
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අධ්යයනවේ අරමුණ

වමම අධයයනය සදු කරනු ලබන්වන් වහද වස්ත්‍රවවේ වගෞරව විදයාවේදී උපාධිවේ

අර්ධ වශ්‍වයන් සම්ූර්ණ කිරීමක් වශ්‍වයනි.

වකාළඹ දිස්ත්‍රික්කවේ ව ෝරාගත් අක්ි සායනයකට වැඩිහිටියන් අ ර

දෘශ්‍යාබාධි භාවය සහ ජීවන ත්ත්වය ක්වස්ත්‍රරු කිරීම අරමුණයි.

වයාපෘති මා ෘකාව :

ශ්‍රී ලංකාවේ වකාළඹ පිහිටි ව ෝරාගත් අක්ි සායනයකට සහභාගී වීම.

වැඩිහිටියන් අ ර දෘශ්‍යාබාධි භාවය සහ ජීවන ත්ත්වය ක්වස්ත්‍රරු කිරීම.

අධීක්ෂක:

නම: නිෂාධි ධර්මරත්න වමනවිය

නිල ලපිනය: KIU, වකාස්ත්‍රවත් , බත් රමුේල

ඇමතුම් අංකය:

සම-අධීක්ෂක:

නම: අකින්ද්‍රා කාරියවසම් වමනවිය

නිල ලපිනය: KIU, වකාස්ත්‍රවත් , බත් රමුේල.

ඇමතුම් අංකය:
 72

විමර්ශ්‍කයින්:

1. නම: ඩේලේ.එස්ත්‍ර.ටී. වවදවේ මහත්මිය

නිල ලපිනය: KIU, වකාස්ත්‍රවත් , බත් රමුේල

ඇමතුම් අංකය: 0714969392

2. නම: එම්.පී දීපානි

නිල ලපිනය: KIU, වකාස්ත්‍රවත් , බත් රමුේල

ඇමතුම් අංකය: 07115053304

3. ඩේලේ.පී.එන්.එම්.ව න්නවකෝන් මහත්මිය

නිල ලපිනය: KIU, වකාස්ත්‍රවත් , බත් රමුේල

ඇමතුම් අංකය: 0711615732

4. වක්.එන්.සතුමිණී මිය

නිල ලපිනය: KIU, වකාස්ත්‍රවත් , බත් රමුේල

ඇමතුම් අංකය: 0765907968

5. සී.පී.වික්‍රමවේ වමනවිය

නිල ලපිනය: KIU, වකාස්ත්‍රවත් , බත් රමුේල

 73

ඇමතුම් අංකය: 0714042058

 74

இகை ் பு 03 - ன்னொர்வ ஒ ் பு ல் டிவம்

KIU, 249/1,

மொலதப வீதி,

கைொஸ்வத்த,

பத்தரமுல் ல.

தததி: ........ / ....... / ............

அன் புள் ள பங் தைை் பொளர்ைதள,

நொங் ைள் திருமதி W. S. T. கவதடஜ் (KIU/N/7314), திருமதி M. P. தீபொனி

(KIU/N/7341), திருமதி W. P.N. M. கதன் னதைொன் (KIU/N/7276), திருமதி K. N.

சித்துமினி (KIU/N/7251), மை் றும் Ms. C. P. விை்கிரதமஜ் (KIU/ N/ 7207)

இளங் ைகல இளங் ைகல பட்டதொரிைள் நர்சிங் பட்டம் கபை் ைவர்ைள்

KAATSU ெர்வததெ பல் ைகலை்ைழைத்தில் பட்டப்படிப்பு. நடத்துவதில்

ஆர்வமொை உள் தளொம் வ தொனவர்ைளிகடத ைொட்சி.

அதிைொரமளித்தல் மை் றும் வொழ் ை்கைத் தரத்கத மதிப்பிடுவதை் ைொன

ஆரொ ் ெ்சி ஆ ் வு இலங் கையின் கைொழும் பில் ததர்ந்கதடுை்ைப்பட்ட

 75

ைண் மருத்துவ மகனயில் ைலந்து கைொள் கிைொர். நொங் ைள் உங் ைகள

அகழை்ை விரும் புகிதைொம் இந்த ஆ ் வில் தன் னொர்வ பங் தைை் பு.

• நீ ங் ைள் ஆர்வமொை இருந்தொல் , நீ ங் ைள் எங் ைளுடன் சுமொர் 20

நிமிடங் ைள் கெலவிட தவண்டும்

தகலப்பு கதொடர்பொன தைள் வித்தொளுை்கு பதில் . பங் தைை் ை தவண்டுமொ

என் பகத நீ ங் ைள் சுதந்திரமொை முடிவு கெ ் லொம்

இந்த ஆ ் வு இல் கல ொ.

• தைள் வித்தொளுை்கு பதிலளிை்கும் தநரம் மை் றும் இடம் முை் றிலும்

உங் ைளுகட து. இது ஒரு இருை்ைலொம்

உங் ைளுை்கு ஏை் ை இடம் .

• தைள் வித்தொளின் தபொது குறிப்புைகள எடுை்ை அல் லது பதில் ைகள

எழுத தவண்டி அவசி ம் ஏை் பட்டொல்

ெந்திப்பு, அதனொல் முை்கி மொன தைவல் ைகள நொம் மைை்ை மொட்தடொம் .

• அகனத்து தைவல் ைளும் ரைசி மொனதொைவும் அநொமதத மொைவும்

இருை்கும் . உங் ைளுை்கு ஒரு குறியீட்டு எண் ஒதுை்ைப்படும்

அநொமதத த்கத உறுதிப்படுத்தவும் . ைண்டுபிடிப்புைள் ைல் வி

தநொை்ைங் ைளுை்ைொைவும் நன் கமை்ைொைவும் ப ன் படுத்தப்படும்

கதொழில் மை் றும் ெமூைம் , ஆனொல் உங் ைள் கப ர் மை் றும் தவறு எந்த

நபர் அல் லது இடத்தின் கப ர்ைளும் இருை்ைொது

 76

அகட ொளம் ைொணப்பட தவண்டும் .

• இந்த ஆ ் வில் பங் தைை் ை நீ ங் ைள் எந்தை் ைடகமயிலும் இல் கல,

நீ ங் ைள் விரும் பும் தபொகதல் லொம் , நீ ங் ைள்

எந்த ஆபத்தும் இல் லொமல் எந்த தநரத்திலும் திரும் பப் கபைலொம் .

உங் ைளுை்ைொன ைொரணத்கத கதரிவிை்ை ததகவயில் கல

திரும் பப் கபறுதல் . பங் தைை் பதை் ைொை நீ ங் ைள் நிதி அல் லது கபொருள்

இழப்பீடு எகதயும் கபைமொட்டீர்ைள் .

படிப்பின் தநொை்ைம்

அறிவி ல் இளங் ைகலப் பட்டப்படிப் கப ஓரளவு பூர்த்தி கெ ் வதொை

இந்த ஆ ் வு நடத்தப்படுகிைது

கெவிலி த்தில் கைௌரவம் . பொர்கவை் குகைபொடு மை் றும் வொழ் ை்கைத்

தரத்கத மதிப்பிடுவதத இதன் தநொை்ைம்

கைொழும் பு மொவட்டத்தில் ததர்ந்கதடுை்ைப்பட்ட ைண் மருத்துவ

மகனை்கு வ தொன கபரி வர்ைள் .

திட்டத்தின் தகலப்பு: வ தொனவர்ைளிகடத பொர்கவை் குகைபொடு

மை் றும் வொழ் ை்கைத் தரம் பை் றி மதிப்பீடு

இலங் கையின் கைொழும் பில் ததர்ந்கதடுை்ைப்பட்ட ைண் மருத்துவ

மகனயில் ைலந்து கைொள் கிைொர்.

 77

தமை் பொர்கவ ொளர்:

கப ர்: கெல் வி. நிஷொதி தர்மரத்னொ

உத்தித ொைபூர்வ முைவரி: KIU, கைொஸ்வத்த, பத்தரமுல் ல

கதொடர்பு எண்:

இகண தமை் பொர்கவ ொளர்:

கப ர்: கெல் வி அகிந்திரொ ைொரி வெம்

உத்தித ொைபூர்வ முைவரி: KIU, கைொஸ்வத்த, பத்தரமுல் ல.

கதொடர்பு எண்:

புலனொ ் வொளர்ைள் :

1. கப ர்: திருமதி W. S. T. Wedage

உத்தித ொைபூர்வ முைவரி: KIU, கைொஸ்வத்த, பத்தரமுல் ல

கதொடர்பு எண்: 0714969392

2. கப ர்: எம் .பி.தீபொனி

உத்தித ொைபூர்வ முைவரி: KIU, கைொஸ்வத்த, பத்தரமுல் ல

 78

கதொடர்பு எண்: 07115053304

3. திருமதி W. P. N. M. கதன் னதைொன்

உத்தித ொைபூர்வ முைவரி: KIU, கைொஸ்வத்த, பத்தரமுல் ல

கதொடர்பு எண்: 0711615732

4. திருமதி தை.என் .சிதுமினி

உத்தித ொைபூர்வ முைவரி: KIU, கைொஸ்வத்த, பத்தரமுல் ல

கதொடர்பு எண்: 0765907968

5. கெல் வி சி.பி.விை்கிரமதை

உத்தித ொைபூர்வ முைவரி: KIU, கைொஸ்வத்த, பத்தரமுல் ல

கதொடர்பு எண்: 0714042058

 79

Application for Ethical Review

 80

Part I
1. Title of the Project
Assessment of visual impairment and quality of life among older adults attending to a

selected eye clinic at Colombo, Sri Lanka.

2. Investigators

2.1. Principal investigator

Name Ms. Nishadhi Dharmarathna
Qualifications
Designation
Official Address
Telephone
E-mail address
Signature

2.2. Other investigators

Name Miss Akindra Kariyawasam
Qualifications BSc (Hons) in Nursing (USJ), RN, PgDCP (UOC) (Reading)
Designation Lecturer
Official Address Department of Nursing Education, Faculty of Nursing, KIU
Telephone 07114224689
E-mail address akindra@kiu.ac.lk

Signature

2.3. Other investigators

Name Mrs. W. S. T. Wedage
Qualifications Diploma in General Nursing
Designation Registered Nursing Officer
Official Address National Eye Hospital, Colombo 10.
Telephone 094714969392
E-mail address thushariwedage155@gmail.com
Signature
 81

2.4. Other investigators

Name Mrs. M. P. Deepani
Qualifications Diploma in General Nursing
Designation Registered Nursing Officer
Official Address National Eye Hospital, Colombo 10.
Telephone 094711505304
E-mail address pushpikamirihanage@gmail.com
Signature

(If there are any more investigators, please add their details)

Other investigators
Name Mrs. W. P. N. M. Thennakoon
Qualifications Diploma in General Nursing
Designation Registered Nursing Officer
Official address National Eye Hospital Colombo 10
Telephone 094711615732
E- mail address thennakoonnimu@gmaik.com
Signature

Other investigators
Name Mrs. K. N. Sithumini
Qualifications Diploma in General Nursing
Designation Registered Nursing Officer
Official address National Eye Hospital Colombo 10.
Telephone 094765907968
E-mail address Knsithu1994@gmail.com
Signature
 82

Other investigators
Name Ms. C. P. Wickramage
Qualifications Diploma in General Nursing
Designation Registered Nursing Officer
Official address Teaching Hospital,Peradeniya
Telephone 094714042058
E-mail address Chamaliwikramage1992@gmail.com
Signature

2.4. Is the principal investigator affiliated to KIU? YES ☒ NO☐

2.5. Is/are any of the investigator/s affiliated to KIU? YES☒ NO☐

If the answer to 2.6 is NO, please justify submitting your proposal to the Ethics review
committee, KIU Battaramulla

3.3. Other (Specify)

N/A

3.4. Is this a
clinical trial?
YES ☒

NO☐

3.5. If clinical trial – Is it industry sponsored?

 83

YES ☐

NO ☒

4. Planned date of commencement and completion

[From initial recruitment of participants until completion of all data collection]

Date of commencement: 10 October 2023

Date of completion: 25 March 2024

5. Has ethical review for this study been requested earlier from this Ethics Review
Committee?

YES NO
If yes,
Reference number
N/A

Decision*
N/A

Date
N/A

6. Has ethical review for this study been requested from any other Ethics Review
Committee?

YES NO

If yes,
Reference number
N/A

Decision *
N/A
 84

Date
N/A

* Attach documentary evidence

7. Funding

7.1. Is the funding agency within Sri Lanka? YES NO

Name and address of

funding agency
N/A

Amount
N/A

7.2. Do the study subjects have to incur any expenses by being participants in the study?
YES Specify) NO

N/A

8. Collaborative research

8.1. List the collaborating institutes and its role

Institution Recruitment Lab Logistics Intellectual Any

facility other

1.
N/A
 85

2.

3.

* Attach documentary evidence

8.2. Has this study been submitted to an ERC / similar body in the country/ countries of
foreign collaborator/s? YES NO

If yes,
a)
Name and address of the
committee The Ethical Review Committee of KIUN/A

Decision * N/A

Date
N/A

b)
Name and address of the
committee N/A

Decision *
N/A
Date N/A
 86

c)
Name and address of the
committee N/A

Decision *
N/A
Date N/A

If no, give reason/s

N/A

* Attach documentary evidence

8.3. What is the relevance of this study to Sri Lanka?

In this study the assessment of visual impairment and quality of life among older
adults attending to a selected eye clinic at National Eye Hospital, Colombo, Sri Lanka
8.4. Are biological samples to be transferred abroad?
YES NO

If yes,
a) Attach the material transfer agreement.
b) Describe the fate of the biological sample at the conclusion of the study

N/A

9. Intervention study/ to be filled if conducting a clinical trial

9.1. What phase clinical trial/intervention study is being conducted?

 87

9.2. Is the clinical trial registered with a clinical trial registry (CTR)?

In which CTR this will be registered?

Name of the registry N/A

Submit documentary evidence of approval from CTR when you receive registration.

9.3. Is it a multicenter trial? YES NO

If yes, list the other centers.

Country Center ERC Date

N/A

*Has ethical approval obtained from relevant bodies?

9.4. What is the procedure for dealing with adverse events?

Voluntary consent form, Information sheet

9.5. What is the procedure for reporting adverse events?

 88

Voluntary consent form , Information sheet

* Attach documentary evidence

9.6. What is / are the criteria for termination of the trial?

N/A

9.7. Are the participants paid? YES NO

If yes, amount of money per participant?

N/A

9.8. Are the investigators paid? YES NO

If yes, by whom and the amount?

N/A

10. Details of insurance coverage for participants

N/A

11. . If Participant recruitment is not taking place in foreign collaborating institution

explain why.
N/A

12. Potential conflict of interest (if any)

N/A
 89

Part II – Protocol Checklist

Title of the Project: -
Assessment of the visual impairment and quality of life among older adults attending to a
selected eye clinic at Colombo, Sri Lanka.

Page Checked
No.
1 Title 1

2 Summary of the project 2

3 Introduction/ background 4

4 Objectives of the study 7

5 Justification 6

6 Review of literature 8

Methodology
7 Study design 15

8 Place of study 15

9 Duration of the study 22

10 Study population 15

11 Sample size and calculation of sample size 16

12 Inclusion criteria
15
13 Exclusion criteria
15
14 Study instrument/s 16

15 Pilot study
16 Sampling/ recruitment procedure 17
17 Description of procedure
17
18 Data collection 17

19 Data analysis 17
20 Maintenance and fate of data 20
21 Dissemination of results
Ethical issues
22 Assessment of risks/ benefits 51

23 Procedure for obtaining consent

62
24 Informed consent form 62

25 Participants Information sheet 51

26 Justification for including vulnerable population 51

 90

27 Fair participant selection 51

28 Procedures to protect the rights of participants

51
29 Confidentiality/Privacy 51

30 Voluntary participation right to refuse or withdraw without 51

penalty
31 Safety monitoring 51

32 Responsibilities of the researchers 51

33 Provision of medical and psychological support to participants 51
Biological Samples
34 Justification for using biological sample/s
N/A
35 Procedures for collection, storage and disposal of biological N/A

36 Consent for collecting biological sample/s

N/A
37 Protection of the rights of local collaborator
N/A
38 Justification for transfer of data and /or biological/ genetic
N/A
39 Fate of transferred data and biological/ genetic material N/A

Clinical trial
40 Criteria for termination of participants from the trial
N/A
41 Criteria for termination of the trial
N/A
42 Adverse event monitoring, management and reporting N/A

I understand that the application for ethics clearance will not be accepted unless all
necessary documents are submitted. I declare that I am not seeking approval for a study
that has already commenced or has already been completed.

Date: 02/11/2023

Signature of the Principal Investigator: Ms. Nishadhi Dharmarathna

Application submitting investigator: Miss Akindra Kariyawasam

Mrs. W. S. T. Wedage

Mrs. M. P. Deepani

Mrs. W. P. N. M. Thennakoon

Mrs. K. N. Sithumini

Ms. C. P. Wickramage
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THANK YOU