In a collaborative study by LVPEI and the City St. George’s University of London, Vijay Kumar Yelagondula, Dr. Srinivas Marmamula, Prof. John G. Lawrenson, and others evaluated the barriers that keep people in Andhra Pradesh from seeking eye care.
Over a billion people worldwide have vision impairment (VI), more than one-fourth of whom live in India. A person with uncorrected VI faces various challenges in life, including difficulties in daily activities, poor employment opportunities, and social isolation. Luckily, 90% of VI can be corrected, often using simple, affordable interventions like spectacles. Access to eye care in India has improved over the last four decades, especially in South India which has several well-known eye care networks. But it is not enough. Only a third of 100 million Indians with VI have access to spectacles. Moreover, not enough people are seeking eye care.
Access to eye care can have several barriers, such as distance, financial constraints, and lack of awareness. Another major barrier to seeking eye care is patient attitude. A study from LVPEI showed that more than one-fourth of patients with VI did not seek eye care because they did not consider it a serious problem. A structured and evidence-based approach to mapping behavior change in populations is key to understanding change. The theoretical domains framework (TDF), a multi-model method to identify and assess factors that affect behavior, i.e., barriers to seeking eye care.
In a new study published in the journal Ophthalmic & Physiological Optics, Vijay Kumar Yelagondula, Dr. Srinivas Marmamula, and others from LVPEI in collaboration with Prof. John G. Lawrenson from the City St. George’s University of London used TDF to evaluate barriers to eye care uptake in the Akividu region of the Indian state of Andhra Pradesh. The study included 2,587 participants aged 40 years and above, of whom 604 had near vision impairment and 359 had distance vision impairment. The participants with VI were asked what prevents them from accessing eye care despite noticing a decline in vision. The reported barriers were mapped to a TDF category, such as ‘beliefs about capabilities’ (BAC), ‘environmental context and resources’ (ECR), ‘social influences’ (SI), and ‘emotions’.
Patient attitude—which falls in the BAC category—was the biggest barrier to eye care uptake. Over half (55.7%) of participants with near VI and 43.4% of those with distance VI said that they were aware of their sight loss but felt that it was manageable. Other BAC barriers include people who accepted VI as part of their advanced age or people who thought they still had adequate vision. Another major barrier (SI category) was that people with VI, especially those with distance VI, had no one to take them to a hospital or clinic. About 8.6% of those with distance VI were also afraid that an eye surgery may cause them to lose their sight—a barrier that fell in the emotion category. The study underscores how attitude, belief, and emotions can stop people from seeking eye care, even when it is free.
'The study identifies a range of multifaceted barriers, including patient attitudes, social influences, and environmental constraints, highlighting the need for targeted interventions across multiple domains to enhance the uptake of eye care services in South India,' notes Vijay Yelagondula, Registrar, the Bausch & Lomb School of Optometry and the first author of this paper.
Citation
Yelagondula, V. K., Marmamula, S., Varada, R., Subramanian, A., & Lawrenson, J. G. (2024). Uptake of eye care services in South India: Retrospective mapping of self-reported barriers using the Theoretical Domains Framework. Ophthalmic & Physiological Optics. Advance online publication. https://doi.org/10.1111/opo.13424
Photo credit: Sayak Banerjee, ‘Love Your Eyes’ WSD Photo competition, CC BY 2.0.