Understanding patient health-seeking behaviour to optimise the uptake of cataract surgery in rural Kenya, Zambia and Uganda: findings from a multisite qualitative study

Abstract

Background Cataract is a major cause of visual impairment globally, affecting 15.2 million people who are blind, and another 78.8 million who have moderate or severe visual impairment. This study was designed to explore factors that influence the uptake of surgery offered to patients with operable cataract in a free-of-charge, community-based eye health programme. Methods Focus group discussions and in-depth interviews were conducted with patients and healthcare providers in rural Zambia, Kenya and Uganda during 2018–2019. We identified participants using purposive sampling. Thematic analysis was conducted using a combination of an inductive and deductive team-based approach. Results Participants consisted of 131 healthcare providers and 294 patients. Two-thirds of patients had been operated on for cataract. Two major themes emerged: (1) surgery enablers, including a desire to regain control of their lives, the positive testimonies of others, family support, as well as free surgery, medication and food; and (2) barriers to surgery, including cultural and social factors, as well as the inadequacies of the healthcare delivery system. Conclusions Cultural, social and health system realities impact decisions made by patients about cataract surgery uptake. This study highlights the importance of demand segmentation and improving the quality of services, based on patients’ expectations and needs, as strategies for increasing cataract surgery uptake.

Childhood vision impairment and blindness in West Africa: public health measures and implications for systemic health

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Eye Health Seeking Behavior and Its Associated Factors among Adult Population in Mangu LGA, Plateau State, Nigeria

“…Eye Health-Seeking behavior (HSB) can be defined as willful action taken by individuals who have eye problems with the intention of finding a possible solution [1,2]. Behavior being a pattern or way of life could be obvious or hidden traits, that influence a man's attitude toward seeking eye health care through various factors such as socioeconomic factors, psychological behavior of patient is a complex decision-making especially when it comes to the uptake of healthcare interventions, being influenced by the patients' overall engagement with health and healthcare, patient-healthcare provider relationships and previous experiences; and the socio-economic context of decision-making [3][4][5]. Studies in sub-Saharan Africa identified barriers to HSB among adults to include socioeconomic status, masculinity, lack of awareness of the need for primary eye care, cultural beliefs, peer influences, distance and cost, health and illness values, social support, residence and access to health resources, as well as lack of availability of eye care services, lack of awareness about the need and availability of services, financial constraints, utilization of time to receive such services, improper referral by general practitioners and belief in traditional medicine and taboos [6][7][8][9][10][11].…”

Responsive neglected tropical disease programme delivery: listening and responding to the views and perceptions of beneficiaries

“…Valuing the voices of those receiving support deserves a greater emphasis within programmes 7 as it can strengthen adaptive programming and improve the quality of services. 8 …”