Rotchford A P, Rotchford K M, Mthethwa L P, Johnson G J
International Centre for Eye Health, Institute of Ophthalmology, London, UK.
Trop Med Int Health. 2002 Mar;7(3):288-92. doi: 10.1046/j.1365-3156.2002.00850.x.
To understand the reasons for poor cataract surgery uptake in people with blindness or severe visual impairment in rural South Africa.
A qualitative analysis of detailed, domiciliary interviews with a community-based random sample of elderly Zulus who were blind or severely visually impaired as a result of operable cataract, who had previously been invited for surgery but had failed to attend.
Fear of surgery and a fatalistic attitude to the inevitability and irreversibility of blindness in old age were the main reasons for failure to attend for surgery. There was a lower level of disability and perceived need than had been assumed for people with such poor visual acuity. Non-surgical western style health care for systemic illness was common but few patients had sought any form of assistance for their poor vision. Issues of cost and accessibility were relatively unimportant.
Provision of affordable and accessible cataract surgery for the blind and severely visually impaired members of a community does not guarantee that it will be taken up. Other barriers to surgery may be revealed when practical issues such as cost and accessibility are addressed. Perceptions of visual disability among subjects with cataract may differ from simple objective clinical standards.
了解南非农村地区失明或严重视力受损者白内障手术接受率低的原因。
对以社区为基础随机抽取的老年祖鲁人进行详细的入户访谈并进行定性分析，这些老年祖鲁人因可手术治疗的白内障而失明或严重视力受损，此前曾被邀请手术但未就诊。
害怕手术以及对老年失明的必然性和不可逆转性持宿命论态度是未就诊手术的主要原因。与视力如此差的人群相比，残疾程度和感知需求较低。针对全身性疾病的非手术西式医疗很常见，但很少有患者因视力差寻求任何形式的帮助。成本和可及性问题相对不太重要。
为社区中失明和严重视力受损者提供负担得起且可及的白内障手术并不能保证他们会接受手术。当解决成本和可及性等实际问题时，可能会发现其他手术障碍。白内障患者对视力残疾的认知可能与简单的客观临床标准不同。
