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

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.