35 research outputs found
Sight restoration after congenital blindness does not reinstate alpha oscillatory activity in humans
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Barriers to childhood cataract services across India. A mixed methods study using the Theoretical Domains Framework (TDF) of behaviour change
Purpose : Early identification and presentation for childhood cataract surgery remains a major challenge in developing countries. The main aim of this study was to identify potential barriers to childhood cataract services from the perspective of parentsâ and carersâ, as a critical step towards achieving the timely uptake of cataract services.
Methods : We used a mixed methods explanatory sequential study and interviewed 572 parents/carers attending tertiary hospitals in 8 states across India for their child's cataract surgery. We collected information on barriers to accessing services using a 12-item questionnaire and for each reported barrier, responses recorded on a 5 point scale ranging from âlow to high importanceâ. Based on the quantitative data, in-depth interview questions were prepared and 35 interviews were conducted with randomly selected parents/ carers. Majority of these interviews were conducted at the hospital and /at home for those who did not undergo the surgery. Quantitative questionnaires were completed by the trained interviewer and responses were recorded in a pre-designed format. In-depth interviews were audio taped and transcribed for analysis. Quantitative data were analysed using SPSS 22 while qualitative data were organised with NVivo 11 and a thematic analysis was conducted utilising TDF, an integrative framework of theories.
Results : From the 831 responses the 5 most important barriers were: economic (40%; n=222); child too young for surgery (17%; n=97); the problem was not felt as severe (16%; n=90); distance (14.5%; n=83) and no one to accompany to the hospital (9.5%; n=54). In addition, being advised by a local ophthalmologist to delay the surgery was also reported (n=16). Domains identified by the TDF included âKnowledgeâ, âBeliefs about consequencesâ, âIntentionsâ, âGoalsâ, âDecision processesâ, âEnvironmental context and resourcesâ, âSocial influences and emotionâ. This comprehensive TDF approach enabled us to understand the parents perceived barriers to access services for the children.
Conclusions : Barriers to accessing childhood cataract services include both practical concerns relating to the familyâs socio economic status as well as obstacles from the providers. Mapping out the barriers is necessary to design appropriate intervention for achieving positive behaviour change that can have potential social and economic impact
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Delay in presentation to hospital for childhood cataract surgery in India
Purpose
Cataract is one of the major causes of avoidable visual disability in children and the aim of this study was to investigate the age at which children with cataract present for surgery at tertiary hospitals across India.
Methods:
A prospective multicenter study collected data from 9 eye hospitals in 8 states in India. All children admitted for cataract surgery between Nov 2015 and March 2016 were considered eligible. Parents were interviewed at the hospital by trained personnel and socio demographic information, age at diagnosis and at surgery and the relevant clinical data were obtained from the medical records. Mean age, age range at surgery were used and performed logistic regression analyses.
Results
Parents of 751 consecutive cases were interviewed, of which 469(63%) were boys and 548(73%) were from rural areas. Cataract was bilateral in 493 (66%) and unilateral in 258 (34%); of the unilateral cases, 179 (69%) were due to trauma. The mean age at surgery for âcongenitalâ and âdevelopmentalâ cataract was 48.2±50.9 and 99.7±46.42 months respectively and the mean age was lower in the southern region compared to other regions. Children with 2 or more siblings at home were five times more likely to undergo surgery within 12 months (OR, 4.69; 95% CI: 2.04 â 10.79; p = <0.001).
Conclusions
Late surgery for childhood cataract remains a major challenge and the factors determining this issue in India are pertinent also to several other countries and need to be addressed for every child with cataract to achieve full visual potential
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Barriers and enablers to access childhood cataract services across India. A qualitative study using the Theoretical Domains Framework (TDF) of behaviour change
Early presentation for childhood cataract surgery is an important first step in preventing related visual impairment and blindness. In the absence of neonatal eye screening programmes in developing countries, the early identification of childhood cataract remains a major challenge. The primary aim of this study was to identify potential barriers to accessing childhood cataract services from the perspective of parents and carers, as a critical step towards increasing the timely uptake of cataract surgery. In-depth interviews were conducted using a pre-designed topic guide developed for this study to seek the views of parents and carers in nine geographic locations across eight states in India regarding their perceived barriers and enablers to accessing childhood cataract services. A total of 35 in-depth interviews were conducted including 30 at the hospital premises and 5 in the participants' homes. All interviews were conducted in the local language and audio taped for further transcription and analysis. Data were organised using NVivo 11 and a thematic analysis was conducted utilising the Theoretical Domains Framework (TDF), an integrative framework of behavioural theories. The themes identified from interviews related to 11 out of 12 TDF domains. TDF domains associated with barriers included: 'Environmental context and resources', 'Beliefs about consequences' and 'Social influences'. Reported enablers were identified in three theoretical domains: 'Social influences', 'Beliefs about consequences' and 'Motivations and goals'. This comprehensive TDF approach enabled us to understand parents' perceived barriers and enablers to accessing childhood cataract services, which could be targeted in future interventions to improve timely uptake