Understanding patient health-seeking behaviour to optimise the uptake of cataract surgery in rural Kenya, Zambia and Uganda: findings from a multisite qualitative study.
access to eye care
cataract surgery
health system
health-seeking behaviour
sub-Saharan Africa
uptake of services
Journal
International health
ISSN: 1876-3405
Titre abrégé: Int Health
Pays: England
ID NLM: 101517095
Informations de publication
Date de publication:
06 04 2022
06 04 2022
Historique:
received:
27
07
2021
accepted:
14
09
2021
pubmed:
29
9
2021
medline:
9
4
2022
entrez:
28
9
2021
Statut:
ppublish
Résumé
Cataract is a major cause of visual impairment globally, affecting 15.2 million people who are blind, and another 78.8 million who have moderate or severe visual impairment. This study was designed to explore factors that influence the uptake of surgery offered to patients with operable cataract in a free-of-charge, community-based eye health programme. Focus group discussions and in-depth interviews were conducted with patients and healthcare providers in rural Zambia, Kenya and Uganda during 2018-2019. We identified participants using purposive sampling. Thematic analysis was conducted using a combination of an inductive and deductive team-based approach. Participants consisted of 131 healthcare providers and 294 patients. Two-thirds of patients had been operated on for cataract. Two major themes emerged: (1) surgery enablers, including a desire to regain control of their lives, the positive testimonies of others, family support, as well as free surgery, medication and food; and (2) barriers to surgery, including cultural and social factors, as well as the inadequacies of the healthcare delivery system. Cultural, social and health system realities impact decisions made by patients about cataract surgery uptake. This study highlights the importance of demand segmentation and improving the quality of services, based on patients' expectations and needs, as strategies for increasing cataract surgery uptake.
Sections du résumé
BACKGROUND
Cataract is a major cause of visual impairment globally, affecting 15.2 million people who are blind, and another 78.8 million who have moderate or severe visual impairment. This study was designed to explore factors that influence the uptake of surgery offered to patients with operable cataract in a free-of-charge, community-based eye health programme.
METHODS
Focus group discussions and in-depth interviews were conducted with patients and healthcare providers in rural Zambia, Kenya and Uganda during 2018-2019. We identified participants using purposive sampling. Thematic analysis was conducted using a combination of an inductive and deductive team-based approach.
RESULTS
Participants consisted of 131 healthcare providers and 294 patients. Two-thirds of patients had been operated on for cataract. Two major themes emerged: (1) surgery enablers, including a desire to regain control of their lives, the positive testimonies of others, family support, as well as free surgery, medication and food; and (2) barriers to surgery, including cultural and social factors, as well as the inadequacies of the healthcare delivery system.
CONCLUSIONS
Cultural, social and health system realities impact decisions made by patients about cataract surgery uptake. This study highlights the importance of demand segmentation and improving the quality of services, based on patients' expectations and needs, as strategies for increasing cataract surgery uptake.
Identifiants
pubmed: 34581785
pii: 6377320
doi: 10.1093/inthealth/ihab061
pmc: PMC8986356
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
i57-i63Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.
Références
Asia Pac J Ophthalmol (Phila). 2017 May-Jun;6(3):266-272
pubmed: 28379656
Ophthalmic Epidemiol. 2014 Jun;21(3):153-60
pubmed: 24754232
Int J Hypertens. 2018 Apr 26;2018:8307591
pubmed: 29854433
Br J Ophthalmol. 2005 Nov;89(11):1399-402
pubmed: 16234438
Soc Sci Med. 2008 Feb;66(3):558-68
pubmed: 18006201
BMC Geriatr. 2020 Feb 18;20(1):71
pubmed: 32070288
PLoS One. 2012;7(8):e44268
pubmed: 22952945
Afr Health Sci. 2014 Dec;14(4):1046-55
pubmed: 25834516
J West Afr Coll Surg. 2012 Oct;2(4):38-50
pubmed: 25453003
Trop Med Int Health. 2010 May;15(5):534-9
pubmed: 20214758
Ann Ib Postgrad Med. 2018 Jun;16(1):52-60
pubmed: 30254559
Lancet Glob Health. 2021 Feb;9(2):e144-e160
pubmed: 33275949
Ophthalmic Epidemiol. 2014 Jun;21(3):144-52
pubmed: 24742058
Qual Health Res. 2018 Oct;28(12):1969-1977
pubmed: 30024317
BMC Ophthalmol. 2015 Jun 30;15:67
pubmed: 26122748
Curr Gerontol Geriatr Res. 2019 Mar 3;2019:6262456
pubmed: 30941168
Milbank Q. 2010 Dec;88(4):595-615
pubmed: 21166870
PLoS One. 2020 Jul 9;15(7):e0235699
pubmed: 32645065