title: Implementation of a free cataract surgery program in rural China: a community-based randomized interventional study.
abstract: OBJECTIVE
  To identify effective methods to increase the number of cataract surgeries in a rural setting in Pucheng County of Shaanxi Province, northwestern China.
  
  
  METHODS
  Community-based randomized interventional study.
  
  
  METHODS
  Four hundred thirty-two patients 50 years of age or older with operable cataract who had not undergone surgery 3 months after participation in a cataract outreach screening program.
  
  
  METHODS
  Three hundred fifty-five (82.2%) patients eligible for surgery, but not scheduling it on their own, were contacted and were assigned randomly into 4 groups. Participants in group 1 (n = 86) were given informative reminders by telephone or in person by a trained facilitator about undergoing low-cost cataract surgery. Group 2 (n = 86) was offered free cataract surgery. Group 3 (n = 90) was offered free surgery and reimbursement of transportation expenses. Group 4 (n = 93) was provided with free rides from home to hospital in addition to the reminder and free surgery.
  
  
  METHODS
  Number of participants undergoing cataract surgery after interventions.
  
  
  RESULTS
  In total, 94 patients (26.5%) underwent cataract surgery after interventions. In group 1, 13 patients (14.4%) underwent surgery, which was significantly lower than the number in group 2 (n = 25 [27.8%]; P = 0.027), group 3 (n = 28 [31.1%]; P = 0.012), and group 4 (n = 26 [28%]; P = 0.038). There were no significant differences between groups 2 and 3 (P = 0.768) or between groups 2 and 4 (P = 0.869).
  
  
  CONCLUSIONS
  Provision of free cataract surgery was twice as effective as giving patients an informative reminder when it came to increasing the uptake of cataract surgery. However, offering reimbursement of transportation expenses or provision of free rides had minimal added impact on the response rate of participants to undergo cataract surgery.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Xiu Juan
authors.initials: XJ
authors.lastname: Zhang
authors.forename: Yuan Bo
authors.initials: YB
authors.lastname: Liang
authors.forename: Ying Peng
authors.initials: YP
authors.lastname: Liu
authors.forename: Vishal
authors.initials: V
authors.lastname: Jhanji
authors.forename: David C
authors.initials: DC
authors.lastname: Musch
authors.forename: Yi
authors.initials: Y
authors.lastname: Peng
authors.forename: Chong Ren
authors.initials: CR
authors.lastname: Zheng
authors.forename: Hui Xi
authors.initials: HX
authors.lastname: Zhang
authors.forename: Ping
authors.initials: P
authors.lastname: Chen
authors.forename: Xin
authors.initials: X
authors.lastname: Tang
authors.forename: Dennis S C
authors.initials: DS
authors.lastname: Lam
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000453:epidemiology*; D002387:Cataract Extraction / Q000191:economics*; D002681:China / Q000453:epidemiology; D018672:Community Health Planning / Q000458:organization & administration; D003695:Delivery of Health Care / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006284:Health Plan Implementation / Q000458:organization & administration*; D006293:Health Promotion; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011446:Prospective Studies; D012424:Rural Population / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D015351:Vision Screening; D014792:Visual Acuity / Q000502:physiology