Correcting near vision impairment and women's empowerment: a before-after mixed-methods study among older Zanzibari craftswomen.

Objective: To understand if presbyopia correction could empower older craftswomen entrepreneurs living in Zanzibar.

Design: Mixed-method, before-after intervention study.

Setting: Unguja and Pemba islands, Zanzibar.

Participants: 209 craftswomen (weaving, tailoring and sewing, pottery and producing oil and making soaps) 40 years and older with correctable presbyopia, with no other ocular morbidities.

Intervention: Eye health assessment and near vision spectacle correction for 6 months.

Primary and secondary outcomes: Change in economic, social, psychological and political empowerment (4-point Likert scale responses) before and after correction. Odds ratios were calculated to determine the likelihood of upward movement on the Likert scale. Five focus group interviews were conducted to explore the craftswomen's daily experiences concerning vision correction and empowerment, and subsequently, narrative analysis was conducted.

Results: Of the 209 craftswomen who completed the baseline survey from 4 to 21 April 2022, 157 (75.1%) were successfully followed up from 6 to 27 October 2022. Craftswomen reported significantly greater economic, social, psychological and political empowerment in 14 out of 18 statements (77.8%) (p<0.05). Qualitative responses showed that after correction, craftswomen reported having greater autonomy in running the business and improved income, better decision-making power for their business and children, greater independence and confidence and greater participation in problem-solving for the community and appointing leaders. We did not observe a significant change in the following: ability to make decisions for their family, understanding their capabilities, ability to be elected as a leader and ability to advise government leaders.

Conclusion: The correlation between presbyopia correction and empowerment among older Zanzibari craftswomen is mostly positive. Some aspects of empowerment require further investigation with an extended timeframe.