Attitudes of Physicians, Patients, and Village Health Workers Toward Glaucoma and Diabetic Retinopathy in Rural China

Abstract

OBJECTIVE To understand the knowledge and attitudes of rural Chinese physicians, patients, and village health workers (VHWs) toward diabetic eye disease and glaucoma. METHODS Focus groups for each of the 3 stakeholders were conducted in 3 counties (9 groups). The focus groups were recorded, transcribed, and coded using specialized software. Responses to questions about barriers to compliance and interventions to remove these barriers were also ranked and scored. RESULTS Among 22 physicians, 23 patients, and 25 VHWs, knowledge about diabetic eye disease was generally good, but physicians and patients understood glaucoma only as an acutely symptomatic disease of relatively low prevalence. Physicians did not favor routine pupillary dilation to detect asymptomatic disease, expressing concerns about workflow and danger and inconvenience to patients. Providers believed that cost was the main barrier to patient compliance, whereas patients ranked poorly trained physicians as more important. All 3 stakeholder groups ranked financial interventions to improve compliance (eg, direct payment, lotteries, and contracts) low and preferred patient education and telephone contact by nurses. All the groups somewhat doubted the ability of VHWs to screen for eye disease accurately, but patients were generally willing to pay for VHW screening. The VHWs were uncertain about the value of eye care training but might accept it if accompanied by equipment. They did not rank payment for screening services as important. CONCLUSIONS Misconceptions about glaucoma's asymptomatic nature and an unwillingness to routinely examine asymptomatic patients must be addressed in training programs. Home contact by nurses and patient education may be the most appropriate interventions to improve compliance.

Interventions to Promote Follow-up After Trabeculectomy Surgery in Rural Southern China

“…Multimedia educational interventions, when used alone, have been unsuccessful in increasing acceptance of low-cost comprehensive eye examinations 24 or cataract surgery 25 or in promoting purchase of children's spectacles. 26 Although a focus group study 27 indicated that patients in rural China may not be comfortable with direct cash payments to encourage medical compliance, Ma et al 28 have reported that the offer of free spectacles doubled spectacle wear at a later unannounced examination, which is consistent with improved adherence observed in the present study. It appears that the offer of free medical goods, such as medication and spectacles, may be particularly effective in this setting in changing behavior and gives the added advantage of direct clinical benefit to patients.…”

“…b Three patients were unavailable for follow-up at 2 weeks and 4 patients were unavailable for follow-up at 1 mo after surgery. The result of the current study, in which adherence was nearly doubled with an intervention costing less than US$25 per patient, may be compared with other reports [24][25][26][27][28] on interventions to enhance uptake of or adherence with eye care in rural China. Multimedia educational interventions, when used alone, have been unsuccessful in increasing acceptance of low-cost comprehensive eye examinations 24 or cataract surgery 25 or in promoting purchase of children's spectacles.…”

Preoperative characteristics and compliance with follow-up after trabeculectomy surgery in rural southern China

“…However, our finding that low income and lack of an accompanying person were important risk factors for failure to return to clinic as directed suggests that financial incentives to patients, family members and other potential escorts could also be of value, and might be combined with educational interventions. Financial incentives might include free medications or cell phone top-ups, as previous focus group studies have indicated that patients in rural China are uncomfortable with direct cash payments to encourage medical compliance 28. Shortening waiting times in the clinic might also decrease escorts' burden of time spent and wages lost.…”

Accuracy of trained rural ophthalmologists versus non-medical image graders in the diagnosis of diabetic retinopathy in rural China

“…The CREST programme aims to create a rural model of comprehensive eye care, including the specific goal of developing capacity to diagnose and treat DR, including DMO. From the outset, the project was designed to compare the accuracy and efficiency of two screening methods in the assessment of DR,12 trained rural ophthalmologists and non-medical graders using digital images.…”