Understanding Barriers to Cataract Surgery Among Older Persons in Rural China Through Focus Groups

Abstract

Purpose: To utilize focus groups (FGs) to identify barriers to cataract surgery specific to older persons in rural Guangdong, China.

Methods: Three focus groups in separate locations were carried out for persons aged 60 years and above with best-corrected vision <= 6/18 due to cataract, either accepting or refusing surgery. Participants also ranked responses to questions about acceptance of surgery among the elderly. FG transcripts were coded independently by two investigators using qualitative data management software.

Results: Twenty participants had a mean age of 72.7 ± 6.1 years, 14 (70.0%) were women and 17 (85.0%) were blind (best-corrected vision <= 6/60) in at least one eye. Cost was ranked by two of three groups as the main barrier to surgery, and all groups listed reducing cost as the best strategy to increase surgical uptake. Many respondents planned to use China’s New Cooperative Medical Scheme (NCMS) health insurance to pay for surgery. Participants showed poor understanding of cataract, but ranked educational interventions low as methods of increasing uptake. Though opinions of local service quality were poor, respondents did not see quality as an important barrier to accepting service. Participants frequently depended on family members to pay for surgery.

Conclusions: Contrary to some previous reports, cost may be an important barrier to cataract surgery in rural China, which NCMS may help to alleviate. Educational interventions to increase knowledge about cataract are needed, but may face skepticism among patients. Strategies to promote cataract surgery should target the entire family.

Keywords::

• Cataract
• Barriers
• Aging
• Rural
• China
• Focus group
• New Cooperative Medical Scheme

ACKNOWLEDGMENTS

Dr Nathan Congdon, the Principal Investigator, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Financial support: This work is supported by a grant from the Li Ka Shing Foundation, Hong Kong SAR.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

APPENDIX

TABLE 1.  Qualitative data: Nodes created by two independent examiners from transcript of one of three focus groups on the topic of acceptance of cataract surgery among persons aged 60 years and above with visually significant cataract in at least one eye in rural Guangdong province.