Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
The School of Social Work, Faculty of Arts, McGill University, Montreal, Quebec, Canada.
BMJ Open. 2019 Sep 3;9(9):e029940. doi: 10.1136/bmjopen-2019-029940.
In order to better understand the barriers that limit the social participation of older people with low vision, the aim of this study was to describe and clarify the factors that shape the social participation of older adults with vision loss.
As part of a study on rehabilitation access barriers, six qualitative focus groups were conducted in a private room in a hospital, with 21 individuals with low vision (aged 38-92 years) who had or had not accessed low vision services. During the focus groups, participants often spoke of the challenges they faced when interacting with people with 'normal' vision; this discussion led to a modification of the interview guide in order to capture barriers to social participation. Focus group discussions were audiotaped and transcribed, and content analysis was conducted.
Content analysis revealed that personal as well as environmental factors influenced the social participation of older adults with low vision. Four themes emerged: 1) experiencing the onset of impairment and degenerating ability, 2) the physical environment, 3) attitudes and responses from others and 4) individual internal attitude and responses during social interactions. Lived and perceived stigma from the perspective of the insider (person living with low vision) interacting with an outsider (person with 'normal' vision) and difficult environmental contexts were described as barriers to social participation and optimal functioning.
At a personal level, transitioning from an outsider to an insider influenced self-identity and social participation. Further, insiders experiencing stereotypes associated with older adults who are blind had a negative impact on their social participation. Findings highlight the importance of stigma and stereotyping in the lived experience of older adults with low vision. Stigma is persistent, but strategies to reduce stigma will ultimately facilitate the social participation of older adults with low vision.
为了更好地了解限制低视力老年人社会参与的障碍，本研究旨在描述和阐明影响视力丧失老年人社会参与的因素。
作为康复机会障碍研究的一部分，在医院的一个私人房间里进行了六次定性焦点小组讨论，参与者为 21 名低视力者（年龄 38-92 岁），他们或已经或没有接受过低视力服务。在焦点小组讨论中，参与者经常谈到他们在与“正常”视力者互动时面临的挑战；这一讨论导致了访谈指南的修改，以捕捉社会参与的障碍。焦点小组讨论进行了录音和转录，并进行了内容分析。
内容分析显示，个人因素和环境因素都影响了低视力老年人的社会参与。出现了四个主题：1）经历残疾的发作和能力下降，2）物理环境，3）来自他人的态度和反应，4）个人在社会互动中的内部态度和反应。从与局外人（有“正常”视力的人）互动的局内人的角度（有低视力的人）体验到的污名和感知污名，以及困难的环境背景被描述为社会参与和最佳功能的障碍。
在个人层面上，从局外人到局内人的转变影响了自我认同和社会参与。此外，局内人体验到与盲老年人相关的刻板印象，这对他们的社会参与产生了负面影响。研究结果强调了污名和刻板印象在低视力老年人的生活体验中的重要性。污名是持久的，但减少污名的策略最终将促进低视力老年人的社会参与。
