A population-based cross-sectional study of barriers to uptake of eye care services in South India: the Rapid Assessment of Visual Impairment (RAVI) project

Abstract

ObjectiveTo assess the barriers to uptake of eye care services among those with avoidable impairment in the population aged ≥40 years in the South Indian state of Andhra Pradesh.DesignCross-sectional study.SettingCommunity setting.ParticipantsOf 7800 participants recruited from one urban and two rural locations using a two-stage cluster random sampling methodology, 7378 (95%) were examined. Eye examinations were conducted using a rapid assessment protocol. Visual impairment (VI) was defined as presenting visual acuity <6/18 in the better eye. For the purpose of this study, VI caused due to cataract or uncorrected refractive error was considered avoidable VI. A validated questionnaire was used to collect information on barriers for uptake of services among those who had avoidable VI.Primary outcomeBarriers to uptake of services among those with avoidable VI.ResultsThe prevalence of avoidable VI was 11.8% (95% CI 11.0% to 12.5%; n=868). Among these, 71.1% (n=617) individuals reported ‘person-related’ barriers whereas 28.9% (n=251) individuals reported ‘service-related’ barriers to uptake of services. Among the ‘person-related’ barriers, the leading barrier was ‘lack of perceived need’ (61.1%; n=377) for reasons such as old age, good vision in the other eye. This was followed by ‘no one to accompany’ (20.3%; n=125). Of the 251 individuals who had ‘service-related’ barriers, lack of affordability was the major barrier (76.1%; n=191) followed by lack of accessibility (12.7%; n=32). Over 11% (n=28) of the individuals were advised to wait for cataract surgery.ConclusionsPerson-related barriers are more common than service-related barriers in Andhra Pradesh. As the barriers trend more towards ‘person-related’ phenomenon such as person's attitude and ‘felt need’ to improve vision, newer and much intensive awareness campaigns are needed to bring about an attitudinal/behavioural change among individuals to improve the uptake of services.

Population-based assessment of prevalence and causes of visual impairment in the state of Telangana, India: a cross-sectional study using the Rapid Assessment of Visual Impairment (RAVI) methodology

“…There is some evidence for this from other studies where usage of eye care services is reported. The studies on barriers have shown a decline in the proportion of people who reported accessibility as a barrier for the uptake of eye care services in Andhra Pradesh 16. Studies have also reported a higher prevalence of spectacles among rural women compared with men, suggestive of higher uptake of services 17…”

“…We found that those who were educated had lower odds of having VI. It is possible that those who were educated had better awareness, affordability and access to eye care services compared with their uneducated counterparts 16. This can also partly be attributed to higher visual demands among those who were educated.…”

Barriers to Utilization of Eye Care Services in the Upper East Region, Ghana

“…Dhaliwal and Gupta and Patel et al [16,17] reported person-related (attitude) barriers to be major barriers to utilization of eye care services in Indians. A study in southern India by Marmamula et al [18] reported the lack of perceived need for eye care services to be the leading person-related barrier to utilization of eye care services. Other studies have reported similar findings [10,[19][20][21].…”

Barriers, Costs, and Attitudes Toward Pediatric Cataract Surgery at Two Large Facilities in China and India

“…11 The cost of childhood cataract is far greater than for adult surgery, as specialized surgical centers may lie at a great distance; family members need to travel with the child; inpatient stays are longer; hospital charges are higher due to more prolonged surgery and the need for general anesthesia; regular follow up is essential for optimal visual outcomes; and children may need to change spectacles frequently as the eyes develop. 12,13 Although there are studies showing cost as one of the barriers to uptake of cataract surgery in China and India 14,15 , few have investigated the economic impact of cataract surgery on children and families. We carried out a pilot questionnaire survey in Shanxi Eye Hospital, China and Vivekananda Mission Asram Netra Niramay Niketan, India, to explore the barriers and costs associated with the detection and management of pediatric cataract in India and China.…”