title: Understanding barriers to cataract surgery among older persons in rural China through focus groups.
abstract: OBJECTIVE
  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.
authors.affiliation: Joint Shantou International Eye Center of Shantou University and Chinese University of Hong Kong, Shantou, PRC. zmz@jsiec.org
authors.forename: Mingzhi
authors.initials: M
authors.lastname: Zhang
authors.forename: Xuefen
authors.initials: X
authors.lastname: Wu
authors.forename: Liping
authors.initials: L
authors.lastname: Li
authors.forename: Yuqiang
authors.initials: Y
authors.lastname: Huang
authors.forename: Geng
authors.initials: G
authors.lastname: Wang
authors.forename: Jasmine
authors.initials: J
authors.lastname: Lam
authors.forename: Dennis S C
authors.initials: DS
authors.lastname: Lam
authors.forename: Yang
authors.initials: Y
authors.lastname: Gao
authors.forename: Sian
authors.initials: S
authors.lastname: Griffiths
authors.forename: Nathan
authors.initials: N
authors.lastname: Congdon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000453:epidemiology*; D002386:Cataract / Q000453:epidemiology*; D002387:Cataract Extraction / Q000191:economics / Q000706:statistics & numerical data*; D002681:China / Q000453:epidemiology; D005260:Female; D017144:Focus Groups; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population / Q000706:statistics & numerical data*