Factors Influencing Disability Inclusion in General Eye Health Services in Bandung, Indonesia: A Qualitative Study

Abstract

The Inclusive System for Effective Eye-care (I-SEE) is a pilot project for disability inclusion in eye health in Bandung district of Indonesia. The aim of this research was to investigate factors influencing the introduction, i.e., adoption, implementation and continuation of I-SEE. A qualitative exploratory study was conducted by interviewing relevant stakeholders (n = 27) and users with disabilities (n = 12). A theoretical framework on the introduction of innovations in health care was used to guide data collection and thematic analysis. Factors related to the characteristics of the innovation (I-SEE) (e.g., infrastructure, equipment, engagement of people with disabilities, inclusive communication), service provider characteristics (e.g., motivation, attitudes, training), organizational characteristics (e.g., supervision, indicators, data), and the socio-political context of I-SEE (policy, motivation of users, family support, costs, transport) were essential for supporting the introduction process. Additionally, stakeholders proposed strategies for enhancing the introduction of I-SEE (e.g., awareness, collaborations). While there are specific disability related factors, most factors influencing the introduction of disability inclusive eye health were similar to introducing any innovation in general health care. Strategies for disability inclusion should be included from the planning phase of an eye health program and are reasonably simple to adapt.

Barriers to accessing primary healthcare services for people with disabilities in low and middle-income countries, a Meta-synthesis of qualitative studies

“…The real and perceived level of dependence can have both positive and negative impact on both people with disabilities and their caregivers, and may further influence their decision making and prioritization for seeking healthcare services. For instance, a number of the studies indicated that people with disabilities feel less valued by their family members and that they are left to fend for themselves in finding the resources to access services, including health [41,44,[48][49][50][51]. This concern is described in the following quote by a person with visual impairment in Cameroon:…”

“…I cannot hear so they should communicate with me in writing … I need my husband to accompany me as they (doctors) speak with him directly. [50] Communication barriers often arise from lack of knowledge about different styles and alternative modes of communication (e.g., verbal, written, picture, or sign). In addition, use of complex technical health-related terminology can lead to difficulties in comprehension, particularly for people with cognitive difficulties.…”

“…For instance, the ramp was covered by motorbikes or the flower pots. [50] The examples above are only a small sample of practical and logistical barriers faced by people with disabilities when accessing primary healthcare services. These barriers tend to cluster in the middle of the conceptual framework of access to healthcare by Levesque et al, focusing on availability and accommodation, affordability, and appropriateness from the supply side determinants and ability to reach and ability to pay from the demand side determinants [28].…”

Participation in community-based healthcare interventions and non-communicable diseases early detection of general population in Indonesia

“…One of the plausible explanations is that the eye care infrastructure and human resource availability vary significantly across the Primary Health Care Centres ( Puskesmas ). A qualitative study in West Java found that the availability of necessary equipment and resources are among the barriers to getting eye care ( Marella et al, 2019 ). More than half (54%) of ophthalmologists in Indonesia are concentrated on Java island, leaving the rest of the islands with low access to eye care ( Kusnawan et al, 2015 ).…”

Eye Health Service Uptake among People with Visual Impairment and Other Functional Difficulties in Bangladesh: A Cross-Sectional Study with Short-Term Follow Up

“…A 2017 systematic review of poverty and disability in low-and middle-income countries found strong evidence to support the link between disability and economic poverty, with 122 of 150 (81%) of included studies reporting a positive relationship between the two variables [2]. In relation to eye health service provision, the combination of direct costs, such as the cost of spectacles or cost of surgery, and indirect costs, such as transport, accommodation, and food, are known to act as a significant deterrent for people with disabilities [23]. Although the project in this study heavily subsidized cataract surgeries, it did not address the cost of spectacles.…”