Cataract surgery in Andhra Pradesh state, India: An investigation into uptake following outreach screening camps

Purpose: Prevalence of cataract related blindness and visual impairment is extremely high in India. Service utilization, on the contrary, is sub-optimal. Services offered through outreach screening are often not taken up. Against this background, the decision making processes leading to the uptake of cataract surgery services offered during outreach screening camps were investigated in people with cataract in India. Methods: The study used an exploratory, qualitative approach. Sixty one cataract patients from two eye hospitals in Hyderabad, India, were interviewed using convenience sampling. Two focus group discussions with cataract patients and interviews with seven key informants helped triangulate the information. Results: Lack of access to personal funds limited and delayed the utilization of offered services by patients who had been advised of surgery at outreach screening camps or eye hospitals. Stigma, fatalism and ageism were other limiting factors. The majority of patients did not make the decision regarding uptake of services themselves. Hearsay reports of the outcome of surgery and quality of services had a strong influence on service uptake. Women, particularly widows and those from rural areas, were least likely to use cataract surgery services. Conclusion: Provision of affordable and accessible eye care does not guarantee that the care or service will be utilized. Within the decision making process about cataract surgery, dependency on and importance of the wider family was found to be an often cited context of patients' decisions. Future research and programming activities need to put an emphasis on underserved groups, especially those who may be marginalized or disempowered.