Dataset Information

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:

Objective

To 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.

Design

Cross-sectional study.

Setting

Community setting.

Participants

Of 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 outcome

Barriers to uptake of services among those with avoidable VI.

Results

The 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.

Conclusions

Person-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.

SUBMITTER: Marmamula S

PROVIDER: S-EPMC4067889 | biostudies-literature | 2014 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

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.

Marmamula Srinivas S Khanna Rohit C RC Shekhar Konegari K Rao Gullapalli N GN

BMJ open 20140612 6

<h4>Objective</h4>To 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.<h4>Design</h4>Cross-sectional study.<h4>Setting</h4>Community setting.<h4>Participants</h4>Of 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. Vis ...[more]

PMID: 24928590

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Project description:IntroductionUnderstanding barriers to seeking eye care and providing evidence-based theory-informed solutions can improve the uptake of eye care services. Therefore, in this cross-sectional study, we aim to report and analyse barriers to seeking eye care services among individuals with vision impairment in the Akividu region of Andhra Pradesh, India.MethodsOut of the 3000 enumerated participants, a total of 2587 were examined. All participants with vision impairment were asked to report barriers for not seeking eye care despite noticing reduced vision using a validated questionnaire. The reported barriers were mapped to the theoretical domains framework (TDF) to explore potential individual and environmental influences on the uptake of eye care services.ResultsBarriers to seeking eye care services are most frequently mapped to the 'beliefs about capabilities', 'environmental context and resources' and 'social influences' domains of the TDF. The most frequently reported barrier was 'aware of the problem but can manage' (beliefs about capabilities), expressed by 43.4% (n = 156) and 55.7% (n = 337) of participants with distance and near vision impairment, respectively. 'No one to accompany' for an appointment (social influences) was a significant barrier for participants with distance vision impairment (n = 44, 12.2%) in comparison to participants with near vision impairment (n = 19, 3.1%). Additionally, fear of losing eyesight or operation or consultation (emotion) was a major deterrent for seeking eye care services, particularly among participants with distance vision impairment (n = 31, 8.6%) when compared with near vision impairment (n = 17, 2.8%).ConclusionThe uptake of eye care services is influenced by a complex set of interacting factors. Identification of potentially modifiable target behaviours provides an opportunity to develop theory-informed solutions to improve uptake of services and prevent avoidable vision loss.

Project description:BackgroundYoung people face many barriers to accessing appropriate health care services including screening for HIV and tuberculosis (TB). The study aimed to identify perceived barriers to the uptake of health services among young adults entering the tertiary education system in South Africa.MethodsWe conducted a cross-sectional study among first-year students aged 18-25 years, registered at one of three universities in Johannesburg, South Africa, in 2017. Participants completed a self-administered paper-based questionnaire. We describe perceived barriers to accessing health services, stratified by gender and recent engagement in TB or HIV services, together with sources of information about HIV and TB.ResultsSeven hundred and ninety-two (792) students were included in the study of which 54.8% were female. Perceived barriers to accessing services included long waiting time (n = 342,43.2%), attitude of health workers (n = 263,33.2%), lack of sufficient information/poor health literacy (n = 148,18.7%), and inability to leave/stay away from studies (n = 137,17.3%). Among participants who tested for HIV in the past 6 months (n = 400, 50.5%), waiting time and attitude of health care workers were perceived as barriers to accessing services. Compared to males, females were more likely to view attitudes of health workers (40.3% vs. 25.0%; p = 0.001) and inability to leave/stay away from studies (20.5% vs.13.4%; p = 0.025) as potential barriers. While just over half of the students (50.5%; 400/792) in this study had accessed health services in the past 6 months, very few (15.0%) opted to use campus health services, and even less (5%) reported receiving information about HIV and TB from the university itself.ConclusionDespite perceived barriers to accessing HIV and TB services off campus, fewer than one in five students starting out at university opted to use campus health services. Campus health services could address many of the barriers unique to university students.

Project description:PurposeTo analyse the disease burden of pseudoexfoliation (PXF) disease stages from East and South India.DesignProspective hospital based study of patients seen at 4 tertiary centres.Subjects, participants, and/or controlsConsecutive old and new patients of pseudoexfoliation with normal intraocular pressure (IOP), raised IOP (PXF with Ocular hypertension, OHT) and irreversible disc/field changes (pseudoexfoliation glaucoma, PXG) seen from April 2016-March 2017 at a tertiary centre in Odisha, East India and 3 centres in Andhra Pradesh and Telangana, South India, recruited into the prospective study were screened for baseline characteristics.MethodsThe clinical and demographic details including visual acuity, laterality, intraocular pressure (IOP) with details of medical/surgical therapy at presentation were collected from the hospital database at all 4 centres.Intervention or exposureThe World Health Organization WHO visual criteria were used for defining visual impairment/absolute blindness in different disease stages.Outcome measuresThe visual impairment/blindness rates with comorbidities in the anterior/posterior segment in PXF, OHT and PXG at baseline were compared and the influence of age, IOP fluctuations and laterality was analysed using multivariate logistic regression.ResultsOf 6284 PXF eyes (of 3142 patients) included from all centres, OHT and PXG was seen in 2.1% and 29% respectively which included 3676 (>50%) bilateral PXF eyes. Reversible visual impairment rates caused by PXF associated co-morbidities in PXF and OHT were 33% and 26% respectively with cataract being the major cause (67% in PXF and 74% in OHT). Irreversible blindness rate was higher in bilateral PXG eyes (30.5%) compared to bilateral PXF (23.2%) or bilateral OHT (21.6%) with overall absolute blindness rates of 28.2% at presentation. Older age (p<0.001), bilaterality and higher baseline IOP were significantly associated with higher rates of blindness in PXF eyes.Conclusion and relevancePseudoexfoliation is associated with ≥30% visual impairment across all stages and 28% absolute blindness rate which is a huge hidden burden of glaucoma. Adequate disease staging and assessment of comorbidities is required for accurate prognostication at baseline and reducing avoidable pseudoexfoliation blindness.

Dataset Information

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.

Objective

Design

Setting

Participants

Primary outcome

Results

Conclusions

Publications

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.

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