Barriers for the uptake of cataract surgery: A rural community-based study

Abstract

Background: Cataract is the leading cause of blindness. Various national programmes have been undertaken to reduce its prevalence. Several barriers in the rural community and individuals exist which decreases the uptake of cataract surgery. Knowledge of factors would help in improving surgical uptake in rural patients and a decrease in blindness rate.Aim: This study aimed to evaluate the factors preventing cataract surgery acceptance in rural patients.Setting: An observational cross-sectional study was conducted between June 2019 to December 2019 in eye screening camps in rural areas of south Karnataka, India.Methods: An observational cross-sectional study was conducted between June 2019 and December 2019. A total of 4114 patients were screened at camps, out of which 500 patients above the age of 50 years, diagnosed with cataracts but had refused cataract surgery earlier, were included. Data were collected on demography, visual acuity, cataract or lens status, source of information on cataract surgery in camps, reasons for refusal of cataract surgery previously. Barriers to cataract surgery uptake (CSU) were classified as attitudinal, social, economical and psychological factors and reasons for uptake of cataract surgery in the current visit were recorded in the form of a questionnaire and analysed.Results: The mean age of the participants was 65.8 years. The male to female ratio was 1.1:1. The prevalence of cataract blindness in our study population was 11.5%, which was significant (p = 0.000). Announcements and pamphlets were the most common source of information on cataract surgery in camps. Significant barriers to CSU were attitudinal factors, mainly the ability to manage daily work (66.4%) with cataract; one eye had an adequate vision (57.4%). The next common barrier was an economic factor as they waited for a camp to avail themselves of free service (61.5%). The least common barriers were female gender (13.2%), fear related to surgery (11.8%), old age (9.6%), God’s will/fate (6.2%), lack of transport (5.4%). The critical factors in CSU in the camps were a provision of free surgery, accessible transport, the camp being conducted closer to their home and motivation by the health workers.Conclusion: Although economic barriers were efficiently taken care of by the government through national programmes, attitudinal barriers seem to be the most important barriers to achieve the goal of reducing blindness because of cataract in rural population.