A population-based cross-sectional study of barriers to uptake of eye care services in South India: the Rapid Assessment of Visual Impairment (RAVI) project

OBJECTIVE: To assess the barriers to uptake of eye care services among those with avoidable impairment in the population aged ≥40 years in the South Indian state of Andhra Pradesh. DESIGN: Cross-sectional study. SETTING: Community setting. PARTICIPANTS: Of 7800 participants recruited from one urban and two rural locations using a two-stage cluster random sampling methodology, 7378 (95%) were examined. Eye examinations were conducted using a rapid assessment protocol. Visual impairment (VI) was defined as presenting visual acuity <6/18 in the better eye. For the purpose of this study, VI caused due to cataract or uncorrected refractive error was considered avoidable VI. A validated questionnaire was used to collect information on barriers for uptake of services among those who had avoidable VI. PRIMARY OUTCOME: Barriers to uptake of services among those with avoidable VI. RESULTS: The prevalence of avoidable VI was 11.8% (95% CI 11.0% to 12.5%; n=868). Among these, 71.1% (n=617) individuals reported ‘person-related’ barriers whereas 28.9% (n=251) individuals reported ‘service-related’ barriers to uptake of services. Among the ‘person-related’ barriers, the leading barrier was ‘lack of perceived need’ (61.1%; n=377) for reasons such as old age, good vision in the other eye. This was followed by ‘no one to accompany’ (20.3%; n=125). Of the 251 individuals who had ‘service-related’ barriers, lack of affordability was the major barrier (76.1%; n=191) followed by lack of accessibility (12.7%; n=32). Over 11% (n=28) of the individuals were advised to wait for cataract surgery. CONCLUSIONS: Person-related barriers are more common than service-related barriers in Andhra Pradesh. As the barriers trend more towards ‘person-related’ phenomenon such as person's attitude and ‘felt need’ to improve vision, newer and much intensive awareness campaigns are needed to bring about an attitudinal/behavioural change among individuals to improve the uptake of services.