Barriers to Acceptance of Intervention among Patients with Trachomatous Trichiasis or Entropion Presenting to a Teaching Hospital

Abstract

Purpose: To determine the barriers to therapeutic intervention in patients with trachomatous trichiasis or entropion. Methods: Prospective study over one year in 60 patients with trachomatous trichiasis or entropion presenting to a teaching hospital. The outcome measure was reported barriers to uptake of intervention using a questionnaire. The data were analysed using chi-square and Fisher's exact tests. Patient characteristics were correlated with barriers using univariate and multivariate analysis. Results: The major barriers (operative in > 60% of patients) were illiteracy (66.7%), ignorance regarding treatment (65.0%), and fear of surgery (63.3%). Duration of symptoms in 43 females and 17 males ranged from 0.5 to 240 months (mean 30.2 ± 45.82). Females reported significantly more barriers (average 5.8 ± 1.88) than males (average 4.6 ± 1.97; p = 0.03). Shorter duration was significantly related to perceived expense (p = 0.008). Patients aged ≤55 years more often cited young children as a barrier (p = 0.02). Conclusions: Encouraging patients who have undergone intervention to share their experiences with community members, providing intervention in patients' villages, community involvement with patients who live alone and making gender-sensitive medical programmes might be useful in reducing the fear of surgery and enhancing awareness and uptake of intervention. Future studies must identify barriers in their regions so that attempts can be directed to overcoming them so as to reduce the blinding and non-blinding burden of trachoma.

KEYWORDS:

• Entropion
• ocular surgery
• trachoma
• trichiasis
• healthcare utilization
• underdeveloped countries
• India