title: Reasons for refusing cataract surgery in illiterate individuals in a tribal area of Andhra Pradesh, India.
abstract: OBJECTIVE
  To assess the reasons for refusing cataract surgery in illiterate individuals in a tribal area of India.
  
  
  METHODS
  A prospective study evaluated 1046 subjects who had undergone screening in eye camps and included 398 of 492 referred subjects with cataract who refused to seek cataract surgery. Subjects were assessed to elicit general and specific reasons for non-compliance. Multiple logistic regression analysis was applied to determine the associations; p < 0.05 was considered significant.
  
  
  RESULTS
  Overall, 83% (329/398) of subjects reported that they could manage with their current vision. The five most common reasons they did not proceed with cataract surgery were: fear of losing current vision, work priority, lack of support systems, a dependency due to old age, and expenses required after surgery. Odds of seeking treatment were lower among unemployed subjects (odds ratio, OR, 0.4, 95% confidence interval, CI, 0.19-0.86; p = 0.01) and in patients with family income <1000 Indian rupees per month (OR 0.5, 95% CI 0.34-0.94; p = 0.02), and higher among those unilaterally blind (OR 10.8, 95% CI 3.3-35.6; p ≤ 0.01).
  
  
  CONCLUSIONS
  In a tribal setting, 83% of individuals referred for cataract surgery did not proceed with surgery. Reasons given for non-compliance were not directly related to the surgery but focused on valid day-to-day difficulties anticipated to increase following surgery. Beyond accessibility and cost of surgery, other social and infrastructural factors need to be addressed to increase the uptake of cataract surgery.
authors.affiliation: Public Health Division, Brien Holden Vision Institute , Sydney , Australia .
authors.forename: Vilas
authors.initials: V
authors.lastname: Kovai
authors.forename: B V M
authors.initials: BV
authors.lastname: Prasadarao
authors.forename: Prakash
authors.initials: P
authors.lastname: Paudel
authors.forename: Fiona
authors.initials: F
authors.lastname: Stapleton
authors.forename: David
authors.initials: D
authors.lastname: Wilson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000453:epidemiology / Q000534:rehabilitation; D002387:Cataract Extraction / Q000523:psychology* / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010361:Patients / Q000523:psychology*; D044382:Population Groups / Q000706:statistics & numerical data*; D011446:Prospective Studies; D014786:Vision Disorders / Q000453:epidemiology / Q000534:rehabilitation; D019987:Persons with Visual Disabilities / Q000523:psychology*
keywords: Barriers; blindness; cataract; treatment seeking behavior; tribal