The social and family dynamics behind the uptake of cataract surgery: findings from Kilimanjaro Region, Tanzania

Abstract

Aims: To describe and understand better the barriers that elderly cataract patients in Kilimanjaro region (Tanzania) experience at the family level in order to access surgery. Methods: A phenomenological study carried out in the catchment area of a teaching hospital in Kilimanjaro Region. 60 semi-structured interviews were conducted with patients and ex-cataract patients. Results: The perceived need for sight and for surgery appears partly socially constructed at the family level. It was found that women were less likely to express a need for sight for fear of being seen as a burden. Furthermore, young heads of family are more inclined to support old men than old women. The consensus is that asking children for help can be difficult. Going for cataract surgery must be seen as a social process where elderly patients might have to wait or negotiate support for weeks, months, or even years. Conclusions: Eye programmes must promote the benefits of cataract surgery to all family members, not just to the patient. A changing social climate, changing expectations of vision, and evolving cost sharing systems will have significant, sometimes contradictory, impacts on use of eye care services. Strategies for reaching those without access to financial resources need to be strengthened.

Cataract Surgery in Andhra Pradesh State, India: An Investigation into Uptake Following Outreach Screening Camps

“…The positive or negative effect a hearsay outcome or experience with a service provider or a certain treatment can have on service uptake, has been reported by Geneau et al 12 and described as a domino effect by increasing or decreasing service utilization.…”

“…Described as "social cost" by Geneau et al 12 admittance of a visual handicap, the associated stigma and lowered self and social esteem were other factors involved in the decision making process. Many, especially women, felt that this social cost could be avoided as long as they could cope with daily life or had one "good eye" left.…”

Acceptance of cataract surgery in a cohort of Tanzanians with operable cataract

“…Indeed, some of the factors determining acceptance of surgery which operate within this population have already been described as involving complex family and social processes unfolding over several months or sometimes years. 3 Counselling efforts need to be directed at family members as well as the patients themselves but this is difficult, as family members increasingly do not live in the village. Community social structures are highly variable and may be weak; neither village leaders nor schoolteachers seemed particularly influential in getting patients to surgery in our setting.…”

“…All were advertised ahead of time. In addition, in-depth interviews were undertaken with half of the study population between October 2002 and 2004 (findings published previously 3 ). In September 2003 and January 2005, all enrolees were traced to their residence and re-examined.…”

Are Blind People More Likely to Accept Free Cataract Surgery? A Study of Vision-Related Quality of Life and Visual Acuity in Kenya

“…[5][6][7] The barriers differ depending on the location and availability of cataract surgical services and costs and missing social support are often cited as being main barriers. [8][9][10][11][12][13][14][15] It appears reasonable that the more someone's vision is reduced the more likely he or she would be to seek treatment. However, there is no evidence from the developing world that this assumption is true.…”