The goal of this clinical trial is to learn whether Health Belief Model (HBM)-based educational interventions can improve knowledge and practices related to Retinopathy of Prematurity (ROP) screening among parents of premature infants attending ROP clinics in Karachi, Pakistan. The main questions it aims to answer are:

• Do HBM-based educational interventions improve parents' knowledge about Retinopathy of Prematurity screening?
• Do HBM-based educational interventions improve parents' screening-related practices and follow-up for Retinopathy of Prematurity?

Researchers will compare different educational approaches, including video-based education, audio-based education, and standard educational material, to see which method is more effective in improving parental understanding and practices regarding ROP screening.

Participants will:

• Complete a questionnaire assessing their knowledge and practices related to Retinopathy of Prematurity screening at baseline
• Receive one of the following educational approaches: video message plus counselling and pamphlet, audio message plus counselling and pamphlet, or counselling and pamphlet only
• Attend a follow-up visit approximately 2 weeks after the initial visit
• Complete a follow-up questionnaire to assess changes in knowledge and practices related to Retinopathy of Prematurity screening

Retinopathy of Prematurity (ROP) is a retinal vascular disorder affecting premature infants and remains a leading preventable cause of childhood blindness worldwide. Premature infants, particularly those born before 37 weeks of gestation and with low birth weight, are at increased risk of developing ROP. Timely screening and follow-up are critical to prevent severe visual impairment; however, delayed presentation and poor adherence to follow-up appointments remain important barriers to effective management, especially in low- and middle-income countries.

Parental awareness and engagement are essential for ensuring timely screening and treatment. Conventional parental education methods, such as routine verbal communication and printed informational materials, may be limited by parental stress, health literacy, language barriers, and inconsistent access to healthcare information. Consequently, there is a need for evidence-based educational strategies that improve parental understanding and encourage timely health-seeking behavior.

The Health Belief Model (HBM) provides a theoretical framework for understanding and promoting preventive health behaviors by addressing perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to action. Applying this framework to parent education may improve awareness regarding the risks of untreated ROP and the importance of screening and follow-up.

This randomized controlled trial will evaluate the effectiveness of Health Belief Model-based educational interventions for parents of premature infants attending Retinopathy of Prematurity clinics at Aga Khan University Hospital, Karachi, Pakistan. The study compares multiple educational delivery methods integrated into routine clinical care to determine whether structured educational approaches can improve parental understanding and engagement in ROP screening.

Educational materials have been developed by the Department of Ophthalmology and Visual Sciences and are available in English and Urdu to improve accessibility and cultural appropriateness. Findings from this study are expected to inform strategies for strengthening parental education and improving neonatal ophthalmic care in resource-limited settings.

Inclusion Criteria:

• Mother or father of a premature infant attending Retinopathy of Prematurity (ROP) clinic
• Parent aged 18 years or older
• Parent of a premature infant who was admitted to the Neonatal Intensive Care Unit (NICU)
• Able to understand English or Urdu
• Willing and able to provide written informed consent

Exclusion Criteria:

• Parents with disability or cognitive impairment affecting participation
• Uncooperative participants
• Parents unwilling or unable to provide informed consent

Individual participant data (IPD) will not be shared due to participant confidentiality considerations and institutional data protection policies. The study involves questionnaire-based data collected from parents of premature infants, and no formal data-sharing agreement or repository is planned as part of the approved study protocol.

Outcome assessors responsible for evaluating study outcomes will remain blinded to participant group assignments. A separate assessment team not involved in intervention delivery and without access to the randomization list will conduct outcome assessments. Investigators delivering educational interventions will not be blinded due to the nature of the intervention.