Access to Eye Care Before and After Vision Loss: A Qualitative Study Investigating Eye Care Among Persons Who Have Become Blind

Zaback, Tosha; Lam, Stephanie; Randall, Joan A.; Field, Teresa; Brinks, Mitchell V.

doi:10.46743/2160-3715/2020.4180

Cited by 3 publications

(3 citation statements)

References 21 publications

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“…Using a constant comparative approach they found that social support structures and personal readiness to change were important factors for some people, alongside familiar themes of geographic access and low trust in providers. 40 Elam and Lee conducted content analysis on data from four focus groups with American community members at risk of not attending eye services. Issues around health insurance, racism, unfriendly service at the clinic, and procrastination supplemented familiar themes of cost, trust, and fear.…”

Section: Introductionmentioning

confidence: 99%

Identifying barriers and potential solutions to improve equitable access to community eye services in Botswana, India, Kenya, and Nepal: a rapid exploratory sequential mixed methods study protocol

Allen,

Karanja,

Gichangi

et al. 2024

Preprint

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Introduction Evidence suggests that certain groups face substantial barriers to accessing eye care services. This study seeks to explore barriers and potential solutions as perceived by members of the population groups who are least able to access care in the context of four national eye screening programmes. We aim to use rapid yet robust mixed methods that allow us to identify generalisable findings and testable service modifications to improve equitable access to care. Methods and analysis This is a multi-phased exploratory sequential mixed methods study. First, we will conduct interviews with people purposively selected from the sociodemographic subgroups with the lowest odds of accessing care within each screening programme. Taking a phenomenological approach, we will explore their perceptions of barriers and potential service modifications that could boost attendance at eye clinics among people from these "left behind" groups. We will use a deductive analytic matrix to facilitate the rapid analysis of qualitative data. Space will be made for the inductive identification of themes that are not necessarily captured in the framework. Sample size will be determined by thematic saturation. Next we will conduct a survey with a representative sample of non-attenders from the same left behind groups, asking them to rank each suggested service modification by likely impact. Finally, we will convene a multistakeholder workshop to asses each service modification based on ranking, likely impact, feasibility, cost, and potential risks. The most promising service modifications will be implemented and evaluated in a follow-on randomised controlled trial, the methods for which will be reported elsewhere. Ethics and dissemination This project has been approved by independent research ethics committees in Botswana, Kenya, India, Nepal and the UK. We will disseminate our findings through local community advisory boards, national eye screening meetings, in peer-reviewed journals, and at conferences.

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Section: Introductionmentioning

confidence: 99%

Identifying barriers and potential solutions to improve equitable access to community eye services in Botswana, India, Kenya, and Nepal: a rapid exploratory sequential mixed methods study protocol

Allen,

Karanja,

Gichangi

et al. 2024

Preprint

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“…SDOH are not negative or positive, and they affect society, whereas social risk factors (SRFs) explain how SDOH affect individuals. SRFs can be unfavorable social conditions associated with poor health and include high area deprivation, low income, lower education levels, and less access to health care . Understanding the SRFs driving health inequities creates the impetus for policy change.…”

Section: Introductionmentioning

confidence: 99%

“…SRFs can be unfavorable social conditions associated with poor health 3 and include high area deprivation, 4 low income, 5,6 lower education levels, [5][6][7] and less access to health care. 5,8 Understanding the SRFs driving health inequities creates the impetus for policy change.…”

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confidence: 99%

Social Risk Factor Associations With Presenting Visual Acuity in Patients With Microbial Keratitis

et al. 2023

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ImportanceNeighborhood-level social risk factors may contribute to health disparities in microbial keratitis (MK) disease presentation. Understanding neighborhood-level factors may identify areas for revised health policies to address inequities that impact eye health.ObjectiveTo investigate if social risk factors were associated with presenting best-corrected visual acuity (BCVA) for patients with MK.Design, Setting, and ParticipantsThis was a cross-sectional study of patients with a diagnosis of MK. Patients presenting to the University of Michigan with a diagnosis of MK between August 1, 2012, and February 28, 2021, were included in the study. Patient data were obtained from the University of Michigan electronic health record.Main Outcomes and MeasuresIndividual-level characteristics (age, self-reported sex, self-reported race and ethnicity), presenting log of the minimum angle of resolution (logMAR) BCVA, and neighborhood-level factors, including measures on deprivation, inequity, housing burden, and transportation at the census block group, were obtained. Univariate associations of presenting BCVA (&lt; 20/40 vs ≥20/40) with individual-level characteristics were assessed with 2-sample t, Wilcoxon, and χ2 tests. Logistic regression was used to test associations of neighborhood-level characteristics with the probability of presenting BCVA worse than 20/40 after adjustment for patient demographics.ResultsA total of 2990 patients with MK were identified and included in the study. Patients had a mean (SD) age of 48.6 (21.3) years, and 1723 were female (57.6%). Patients self-identified with the following race and ethnicity categories: 132 Asian (4.5%), 228 Black (7.8%), 99 Hispanic (3.5%), 2763 non-Hispanic (96.5%), 2463 White (84.4%), and 95 other (3.3%; included any race not previously listed). Presenting BCVA had a median (IQR) value of 0.40 (0.10-1.48) logMAR units (Snellen equivalent, 20/50 [20/25-20/600]), and 1508 of 2798 patients (53.9%) presented with BCVA worse than 20/40. Patients presenting with logMAR BCVA less than 20/40 were older than those who presented with 20/40 or higher (mean difference, 14.7 years; 95% CI, 13.3-16.1; P &lt; .001). Furthermore, a larger percentage of male vs female sex patients presented with logMAR BCVA less than 20/40 (difference, 5.2%; 95% CI, 1.5-8.9; P = .04), as well as Black race (difference, 25.7%; 95% CI, 15.0%-36.5%;P &lt; .001) and White race (difference, 22.6%; 95% CI, 13.9%-31.3%; P &lt; .001) vs Asian race, and non-Hispanic vs Hispanic ethnicity (difference, 14.6%; 95% CI, 4.5%-24.8%; P = .04). After adjusting for age, self-reported sex, and self-reported race and ethnicity, worse Area Deprivation Index (odds ratio [OR], 1.30 per 10-unit increase; 95% CI, 1.25-1.35; P &lt; .001), increased segregation (OR, 1.44 per 0.1-unit increase in Theil H index; 95% CI, 1.30-1.61; P &lt; .001), higher percentage of households with no car (OR, 1.25 per 1 percentage point increase; 95% CI, 1.12-1.40; P = .001), and lower average number of cars per household (OR, 1.56 per 1 less car; 95% CI, 1.21-2.02; P = .003) were associated with increased odds of presenting BCVA worse than 20/40.Conclusion and RelevanceFindings of this cross-sectional study suggest that in a sample of patients with MK, patient characteristics and where they live were associated with disease severity at presentation. These findings may inform future research on social risk factors and patients with MK.

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Access to Eye Care Before and After Vision Loss: A Qualitative Study Investigating Eye Care Among Persons Who Have Become Blind

Zaback¹,

Lam²,

Randall³

et al. 2020

TQR

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Navigating access to eye care requires that patients recognize the need for screening and care, employ limited financial and social resources, manage complex health insurance policies, and access specialty clinical care. We investigated the experience of patients through the progression of vision loss to blindness, utilizing qualitative methods. We conducted structured telephone interviews with 28 persons with blindness throughout Oregon. Utilizing closed and open-ended questions, we explored patient experience on the events preceding avoidable blindness. Coding for emergent themes was conducted independently by two researchers using a constant comparative method. Participants described important barriers to accessing eye care: at the systems level, lack of access to providers and treatment; at the community level, available social support and services; and at the individual level, readiness to act and trust in providers. These findings suggest that important barriers to accessing preventive eye care, early diagnosis and treatment, vocational rehabilitation, and social services often occur at multiple levels. Access to eye care should be prioritized in efforts to reduce preventable visual impairment.

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Access to Eye Care Before and After Vision Loss: A Qualitative Study Investigating Eye Care Among Persons Who Have Become Blind

Cited by 3 publications

References 21 publications

Identifying barriers and potential solutions to improve equitable access to community eye services in Botswana, India, Kenya, and Nepal: a rapid exploratory sequential mixed methods study protocol

Identifying barriers and potential solutions to improve equitable access to community eye services in Botswana, India, Kenya, and Nepal: a rapid exploratory sequential mixed methods study protocol

Social Risk Factor Associations With Presenting Visual Acuity in Patients With Microbial Keratitis

Access to Eye Care Before and After Vision Loss: A Qualitative Study Investigating Eye Care Among Persons Who Have Become Blind

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