title: Reasons for poor cataract surgery uptake - a qualitative study in rural South Africa.
abstract: OBJECTIVE
  To understand the reasons for poor cataract surgery uptake in people with blindness or severe visual impairment in rural South Africa.
  
  
  METHODS
  A qualitative analysis of detailed, domiciliary interviews with a community-based random sample of elderly Zulus who were blind or severely visually impaired as a result of operable cataract, who had previously been invited for surgery but had failed to attend.
  
  
  RESULTS
  Fear of surgery and a fatalistic attitude to the inevitability and irreversibility of blindness in old age were the main reasons for failure to attend for surgery. There was a lower level of disability and perceived need than had been assumed for people with such poor visual acuity. Non-surgical western style health care for systemic illness was common but few patients had sought any form of assistance for their poor vision. Issues of cost and accessibility were relatively unimportant.
  
  
  CONCLUSIONS
  Provision of affordable and accessible cataract surgery for the blind and severely visually impaired members of a community does not guarantee that it will be taken up. Other barriers to surgery may be revealed when practical issues such as cost and accessibility are addressed. Perceptions of visual disability among subjects with cataract may differ from simple objective clinical standards.
authors.affiliation: International Centre for Eye Health, Institute of Ophthalmology, London, UK. rothford@supanet.com
authors.forename: A P
authors.initials: AP
authors.lastname: Rotchford
authors.forename: K M
authors.initials: KM
authors.lastname: Rotchford
authors.forename: L P
authors.initials: LP
authors.lastname: Mthethwa
authors.forename: G J
authors.initials: GJ
authors.lastname: Johnson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D001766:Blindness / Q000523:psychology* / Q000601:surgery; D002387:Cataract Extraction / Q000191:economics / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D013019:South Africa; D011795:Surveys and Questionnaires; D016312:Treatment Refusal / Q000523:psychology*