Key factors determining success of primary eye care through vision centres in rural India: Patients′ perspectives

Aim : This paper intends to discuss the patients′ perspective on the determinants of primary eye care services from vision centers (VC) in rural India. Materials and Methods : A retrospective study design and interview method was used on 127 randomly selected patients who accessed the 4 VCs in 2007. Factor analyses and linear regression models were used to predict the associations with patient satisfaction. Results : The three factors derived from factor analyses were: (1)-vision technician (VT), (2)-location of VC, and (3)-access to VC; explaining 60% of the variance in total patients′ satisfaction with VC. The first model (R2 : 0.61; F 1,124=144.36, P <0.001), indicated that respondents who had ′difficulty to travel to the place of VC′ and those who can afford to pay had less satisfaction with VT services. The second model (R2 =0.18; F 1,124=29.5, P <0.001) explained that respondents′ difficulty to identify the building of VC had decreased patients′ satisfaction and the third model (R2 =0.36; F 1,124=45.6, P <0.001) indicated that those who had to travel<5 km to the VC and had 0.38 units of increased satisfaction level with the services of VC. Conclusion : A good VT can enhance patient satisfaction. However, patient expectations are not only confined to the provider but also other factors such as ability to pay and convenient transportation that helps patients reach the location of the VC with ease

Patient reported critical factors in community delivery of vision care: the vision centre model

The existing models of eye care in India have so far not adequately addressed the issues of access, affordability and community involvement, therefore making little impact on avoidable blindness.To this end, The LV Prasad Eye Institute, located in Hyderabad, India has developed a novel approach to reach underserved population in remote rural areas of Andhra Pradesh State in Southern India through a network of tertiary and Secondary Centres integrated with Primary Care facilities known as &#147;Vision Centres&#148;. The objective of the Vision Centre approach was to enhance the access of underserved communities to affordable basic eye care services through a permanent infrastructure and well-trained, community based Vision technician. While the Vision Centre model per se has been successful, it is also apparent that the individual centres vary in terms of success and impact. While many factors are no doubt responsible, the perceptions of the targeted communities in terms of benefit and ease of access may play an important role, little or no work has been carried out in developing countries to understand the underlying factors that determine patients&#146; satisfaction with health services at the primary level, and issues such as cost versus benefit, and how these might relate to uptake of services. A combination of qualitative and quantitative methods was used in this study. Participants included a randomly selected 136 patients (of the 136 selected, 4 patients of &#147;Better of Rural Locations&#148; (BRLs) were rejected and 5 patents of &#147;Poor Rural Locations&#148; (PRLs) were not available) who accessed the 4 selected Vision Centres (of the 8 Vision Centres initially selected, 4 were included in this study). Analyses applied included: a) factor analyses of patients&#146; satisfaction with two Vision Centres in BRLs and two in PRLs; b) regression analysis to determine the associations with patients&#146; characteristics and patient with patients&#146; satisfaction; c) chi-square to explore differences in satisfaction of patients with Vision Centre services; d) Paired sample t &#150; test to check if the costs to access Vision Centre and town based clinic were significantly different. A p-value of <0.05 was considered significant in each instance. Three factors were obtained from factor analysis: Vision Technician (Factor-1), Access to the location of Vision Centre (Factor-2) and Vision Centre services (Factor-3). These three factors of patients&#146; satisfaction can explain 50.0 % cumulative variance of patient satisfaction. Patients&#146; ease to travel to the Vision Centre facility (&#61538; = -0.47; P <0.001), perceived the severity of eye problem (&#61538; = -0.19, P <0.002), level of affordability (&#61538; = -0.27; P = 0.004), ease to identify the Vision Centre building (&#61538; = -0.24; P <0.001), and geographical setting of patients (&#61538; = 0.38; P = 0.001) were significant variables associated with patient satisfaction, which was higher among the patients of BRLs Vision Centres. The total costs were significantly lower for patients who accessed the Vision Centres compared to the patients&#146; costs of town - based facilities (mean INR 178.4 &#61617; 48.3, (SE mean: 4.2) and INR 366.2&#61617; 48.2, (SE mean: 4.2) respectively, t-test p- value <0.001). Conclusions: Three factors are accountable for patients&#146; satisfaction with the Vision Centre facility. Vision Centres, besides providing quality eye care services, offer substantial cost savings to rural population compared with town-based optical clinics. These findings call for greater attention to decentralized eye care services closer to the communities. However, effective service delivery through Vision Centres should also take into account patients&#146; perceptions in order to build a Primary Eye Care System which is truly sustainable and serves the needs of population optimally

Awareness of glaucoma in the rural population of Southern India

PURPOSE: To explore the awareness of glaucoma amongst the rural population of Andhra Pradesh, India. MATERIALS AND METHODS: A total of 7775 subjects of all ages, representative of the rural population of Andhra Pradesh, participated in the Andhra Pradesh Eye Disease Study. The responses of subjects older than 15 years (n = 5573) who completed a structured questionnaire regarding awareness (heard of glaucoma) and knowledge (understanding of disease) of glaucoma formed the basis of this study. RESULTS: Awareness of glaucoma (n = 18; 0.32&#x0025;) was very poor in this rural population, and females were significantly less aware (p = 0.007). Awareness of glaucoma was also significantly less among illiterate persons (p &lt; 0.0001), and socially backward population (p &lt; 0.0001). Majority of the respondents who were aware of glaucoma (n = 10; 55.6&#x0025;) did not know if visual loss due to glaucoma was permanent or reversible. The major source of awareness of glaucoma in this population was TV/magazines and other media followed by information from a relative or acquaintance suffering from the disease. CONCLUSION: Awareness of glaucoma is very poor in the rural areas of southern India. The data suggest the need for community-based health education programmes to increase the level of awareness and knowledge about glaucoma

Barriers to accessing eye care services among visually impaired populations in rural Andhra Pradesh, South India

<b>Purpose:</b> To understand the reasons why people in rural south India with visual impairment arising from various ocular diseases do not seek eye care. <b> Materials and Methods:</b> A total of 5,573 persons above the age of 15 were interviewed and examined in the South Indian state of Andhra Pradesh covering the districts of Adilabad, West Godavari and Mahaboobnagar. A pre-tested structured questionnaire on barriers to eye care was administered by trained field investigators. <b> Results:</b> Of the eligible subjects, 1234 (22.1&#x0025;, N=5573)) presented with distant visual acuity &#60; 20/60 or equivalent visual field loss in the better eye. Of these, 898 (72.7&#x0025;, N=1234) subjects had not sought treatment despite noticing a decrease in vision citing personal, economic and social reasons. The analysis also showed that the odds of seeking treatment was significantly higher for literates [odds ratio (OR) 1.91, 95&#x0025; confidence interval (CI) 1.38 to 2.65], for those who would be defined as blind by visual acuity category (OR 1.35, 95&#x0025; CI 0.96 to 1.90) and for those with cataract and other causes of visual impairment (OR 1.50, 95&#x0025; CI 1.11 to 2.03). Barriers to seeking treatment among those who had not sought treatment despite noticing a decrease in vision over the past five years were personal in 52&#x0025; of the respondents, economic in 37&#x0025; and social in 21&#x0025;. <b> Conclusion:</b> Routine planning for eye care services in rural areas of India must address the barriers to eye care perceived by communities to increase the utilization of services

Awareness of eye donation in the rural population of India

Purpose: To determine the "awareness of eye donation" and "willingness to pledge eyes for donation" in the rural population of Andhra Pradesh, southern India. Methods: A total of 7,775 subjects of all ages, representative of the rural population of Andhra Pradesh, participated in the Andhra Pradesh Eye Disease Study (APEDS). Subjects older than 15 years were interviewed regarding awareness of eye donation and willingness to pledge eyes for donation. Results: Age-gender adjusted prevalence of awareness of eye donation in this population was 30.7&#x0025; (95&#x0025; CI: 29.5 - 31.9) but only 0.1&#x0025; (age-gender adjusted prevalence) (95&#x0025; CI: 0.05 - 0.25) had pledged eyes. On multivariate analysis the awareness of eye donation was significantly less in those subjects 70 years old (OR 0.7; 95&#x0025; CI: 0.6-0.8), illiterates (OR 0.2; 95&#x0025; CI: 0.1-0.2), females (OR 0.8; 95&#x0025; CI: 0.7-0.9), lower socioeconomic status group (OR 0.4; 95&#x0025; CI: 0.4-0.5) and Christians (OR 0.2; 95&#x0025; CI: 0.1-0.6). Media comprised the major source of information about eye donation. Of those aware of eye donation, 32.9&#x0025; were willing to pledge eyes, and 50.6&#x0025; needed more information to decide whether or not to pledge their eyes. Conclusions: There needs to be more transfer of knowledge if more eyes are to be pledged. One-third of those aware of eye donation have not pledged their eyes, and an additional 50.6&#x0025; needed more information to decide. This means only about one-fifth of those aware of eye donations have pledged their eyes

Population-based study of spectacles use in Southern India

This study assessed the use of spectacles and its demographic associations in a sample representative of the population of the Indian state of Andhra Pradesh. A total of 11,786 subjects of all ages were sampled from 94 clusters in one urban and three rural study areas of Andhra Pradesh using stratified, random, cluster, systematic sampling. The eligible subjects underwent detailed interview and eye examination including dilated examination of the posterior segment. The data on the use of spectacles were analysed for subjects> 15 years of age. A total of 7,432 subjects> 15 years of age participated in the study of whom 1,030 (13.8&#x0025;) had a refractive error of spherical equivalent &#x002B; 3.00 Diopter or worse. The prevalence of current use of spectacles in those with spherical equivalent &#x002B; 3.00 Diopter or worse, who were likely to be visually impaired without refractive correction, was 34.2&#x0025; (95&#x0025; confidence interval 30.3-38&#x0025;) and of previous use of spectacles was 12.3&#x0025; (95&#x0025; confidence interval 10.3-14.3&#x0025;). The odds of using spectacles currently were significantly higher for those with any level of education, those living in the urban area, and for those with aphakia or psuedophakia as compared with natural refractive error. Among those who had used spectacles previously, 43.8&#x0025; had discontinued because they felt that either the prescription was incorrect or that the spectacles were uncomfortable, suggesting poor quality of refractive services, and another 19.6&#x0025; had lost the pair and could not afford to buy another pair. These data suggest that the use of spectacles in this population by those with refractive error was not optimal. Two-thirds of those with spherical equivalent &#x002B; 3.00 Diopter or worse were not using spectacles. Of those who had discontinued the use of spectacles, a significant proportion did so for reasons related to poor quality of refractive services. Strategies such as vision screening programmes and eye health promotion need to be implemented, the quality of refractive services monitored and the cost of spectacles regulated, if the substantial burden of visual impairment due to refractive error in this population is to be reduce