Impact of vision impairment and self-reported barriers to vision care: The views of elders in Nuwara Eliya district, Sri Lanka

Holmes, Wendy; Shajehan, Roshan; Kitnasamy, S.; Abeywickrama, C.; Arsath, Y.; Gnanaraj, F.; Inbaraj, S.; Jayakody, Gamini; Durrant, Kelly; Luchters, Stanley

doi:10.1080/17441692.2016.1241816

Cited by 4 publications

(3 citation statements)

References 29 publications

(36 reference statements)

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“…The difference in time, settings, and methodology could have led to this disparity. Cost, as a leading barrier to cataract surgery reported in our study, was concordant to that reported among elders in the Nuwara Eliya District, Sri Lanka [ 88 ], as a leading barrier to eye care services. Kumar et al [ 89 ] reported that 88.9% of surveyed subjects attending an outpatient unit in Uttar Pradesh, India, complained about the cost of cataract surgery and 59.1% complained about the fear of losing sight.…”

Section: Discussionsupporting

confidence: 90%

Exploring the Reasons for Low Cataract Surgery Uptake Among Patients Detected in a Community Outreach Program in Cameroon: Focused Ethnographic Mixed Methods Study

Mbwogge¹,

Nkumbe²

2022

JMIRx Med

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Background Vision 2020: The Right to Sight, was one potential way to deal with the barriers surrounding cataract surgery and improve access to eye care. To this effect, the Magrabi International Council of Ophthalmology (ICO) Cameroon Eye Institute (MICEI) has performed more than 1000 sight-restoring cataract surgeries among patients referred from outreach camps. However, quite a good number of patients diagnosed with cataracts during community screening camps fail to present for surgery. This study sought to explore some of the challenges to accepting cataract surgery among community-diagnosed patients with cataract, patients operated for cataract, and community members. Objective The study objective was 5-fold: (1) to assess the level of awareness about cataract and available treatment, (2) to explore barriers to cataract surgery uptake, (3) to assess people’s perception about the outcome of cataract surgery, (4) to understand people’s perception about free cataract surgery, and (5) to explore reasons for outright refusal of cataract surgery. Methods This was a focused ethnographic study from December 2018 through February 2019 in 3 different communities of the Center Region of Cameroon, in which patients with cataract were diagnosed. The study sample was composed of patients operated for cataract, those diagnosed with cataract, key informants, and community members. Focus group discussions (FGDs), personalized in-depth interviews, and a short demographic questionnaire were used to collect data. Data were analyzed using a Microsoft Excel spreadsheet and Stata 14 (StataCorp). Data were presented using tabular and graphical methods. Results A total of 29 subjects (19 men) with a mean age of 54.5 (SD 14.5) years took part in the study. The most prominent barriers to cataract surgery were found to be cost (25/29, 86%) and fear of surgery (17/29, 59%). It was also noted by 41% (12/29) of subjects that those who do not take up cataract surgery turn to traditional medicine. Other barriers included the lack of awareness of available treatment (6/29, 21%), no perceived need (5/29, 17%), cultural beliefs and superstition (4/29, 14%), and negligence (4/29, 14%). Conclusions We found cost (25/29, 86%) and fear (17/29, 59%) to be the main barriers. Belief in traditional medicine and superstition were the main drivers of fear. The implementation of a tiered pricing system, counseling training for key informants, incentives for the referral of patients with cataract, mass media engagement, advocacy, training and active involvement of traditional doctors as key informants, acquisition of a 4×4 outreach van, and motorbikes for camp organizers were some of the recommendations based on our results.

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Section: Discussionsupporting

confidence: 90%

Exploring the Reasons for Low Cataract Surgery Uptake Among Patients Detected in a Community Outreach Program in Cameroon: Focused Ethnographic Mixed Methods Study

Mbwogge¹,

Nkumbe²

2022

JMIRx Med

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“…However, lack of time and someone to accompany participants to the facility was an issue, particularly for those with visual impairment. Fear of surgery was not an important barrier unlike in a previous study [14]. The chronic nature of many of the conditions experienced by patients over a long period of time may be one reason why eye care was not sought [21], as demonstrated in this study where persons with acute conditions like foreign body/eye injury, dry eye and pain had higher rate of seeking care.…”

Section: Discussionmentioning

confidence: 64%

“…and extrinsic factors (cost of care, transportation links, perceived efficacy of treatment and past experience with the health system) [13]. In low and middle-income countries (LMICs) patients' demand for eye care is often restricted by the limited number of eye care facilities, particularly those at secondary and tertiary levels, resulting in increased time and transport costs required for access, as was recently reported from Sri Lanka [14].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and determinants of self-reported ocular morbidity and utilization of eye services in Sri Lanka: results from a national population-based survey

et al. 2018

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Introduction Data on ocular morbidity is essential for planning primary and referral eye care services.Objectives Determine the prevalence and causes of selfreported ocular morbidity and eye care service utilization in Sri Lanka among adults 40 years of age.Methods Multistage, stratified, cluster random sampling was used to select a nationally representative sample aged 40 years. All participants were administered a questionnaire to assess ocular morbidity they had experienced in the previous month and the pattern of service utilization for reported eye problems. The interviews were conducted by a team of trained investigators at the clinical examination site before they underwent an eye examination.Results 5779 of those presenting for a clinical examination were interviewed among 6713 enumerated (86.1%). The prevalence of self-reported ocular morbidity was 89.9% [95% Confidence Interval (CI): 89.0-90.6%]. Near vision impairment was the commonest problem reported (72.1%; 95% CI: 70.8-73.3%) followed by distance vision impairment (36.2%; 95% CI: 34.9-37.5%). Among those reporting an eye problem, 31.4% sought treatment. 49.4% of those seeking care utilized private facilities. Financial constraints, perceptions that the condition was not serious or had insufficient impact on day-to-day tasks were the most important reasons for not accessing care.Conclusions Ocular morbidities are common in the Sri Lanka population; however utilization of services is relatively low, particularly for asymptomatic illnesses. It is important that the service planners take into account geographical and social inequalities and focus the services on underserviced areas and disadvantaged social groups.

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Factors associated with social participation amongst elders in rural Sri Lanka: a cross-sectional mixed methods analysis

Marsh

Agius

Jayakody³

et al. 2018

BMC Public Health

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BackgroundPopulations of low and middle-income countries are ageing rapidly; there is a need for policies that support an increase in the duration of old age lived in good health. There is growing evidence that social participation protects against morbidity and mortality, but few studies explore patterns of social participation. Analysis of baseline quantitative and qualitative data from a trial of the impact of Elders’ Clubs on health and well-being in the hill country of Sri Lanka provided an opportunity to better understand the extent of, and influences on, social participation among elders.MethodsWe analysed data from 1028 baseline survey respondents and from 12 focus group discussions. Participants were consenting elders, aged over 60 years, living in Tamil tea plantation communities or Sinhala villages in 40 randomly selected local government divisions. We assessed participation in organised social activities using self-reported attendance during the previous year. Multivariable regression analyses were used to explore associations with community and individual factors. The quantitative findings were complemented by thematic analysis of focus group discussion transcripts.ResultsSocial participation in these poor, geographically isolated communities was low: 63% reported ‘no’ or ‘very low’ engagement with organised activities. Plantation community elders reported significantly less participation than village elders. Attendance at religious activities was common and valued. Individual factors with significant positive association with social participation in multivariable analyses were being younger, male, Sinhala, married, employed, and satisfied with one’s health. Domestic work and cultural constraints often prevented older women from attending organised activities.ConclusionsElders likely to benefit most from greater social contact are those most likely to face barriers, including older women, the oldest old, those living alone and those in poor health. Understanding these barriers can inform strategies to overcome them. This might include opportunities for both informal and formal social contact close to elders’ homes, consulting elders, providing childcare, improving physical access, advocating with elders’ families and religious leaders, and encouraging mutual support and inter-generational activities. Influences on social participation are interrelated and vary with the history, culture and community environment. Further study is required in other low and middle-income country contexts.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5482-x) contains supplementary material, which is available to authorized users.

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Impact of vision impairment and self-reported barriers to vision care: The views of elders in Nuwara Eliya district, Sri Lanka

Abstract: FGDs: focus group discussions; GBD: global burden of disease; NCDs: non-communicable diseases; VI: vision impairment.

Cited by 4 publications

References 29 publications

Exploring the Reasons for Low Cataract Surgery Uptake Among Patients Detected in a Community Outreach Program in Cameroon: Focused Ethnographic Mixed Methods Study

Exploring the Reasons for Low Cataract Surgery Uptake Among Patients Detected in a Community Outreach Program in Cameroon: Focused Ethnographic Mixed Methods Study

Prevalence and determinants of self-reported ocular morbidity and utilization of eye services in Sri Lanka: results from a national population-based survey

Factors associated with social participation amongst elders in rural Sri Lanka: a cross-sectional mixed methods analysis

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