title: A population-based cross-sectional study of barriers to uptake of eye care services in South India: the Rapid Assessment of Visual Impairment (RAVI) project.
abstract: OBJECTIVE
  To assess the barriers to uptake of eye care services among those with avoidable impairment in the population aged ≥40 years in the South Indian state of Andhra Pradesh.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Community setting.
  
  
  METHODS
  Of 7800 participants recruited from one urban and two rural locations using a two-stage cluster random sampling methodology, 7378 (95%) were examined. Eye examinations were conducted using a rapid assessment protocol. Visual impairment (VI) was defined as presenting visual acuity <6/18 in the better eye. For the purpose of this study, VI caused due to cataract or uncorrected refractive error was considered avoidable VI. A validated questionnaire was used to collect information on barriers for uptake of services among those who had avoidable VI.
  
  
  METHODS
  Barriers to uptake of services among those with avoidable VI.
  
  
  RESULTS
  The prevalence of avoidable VI was 11.8% (95% CI 11.0% to 12.5%; n=868). Among these, 71.1% (n=617) individuals reported 'person-related' barriers whereas 28.9% (n=251) individuals reported 'service-related' barriers to uptake of services. Among the 'person-related' barriers, the leading barrier was 'lack of perceived need' (61.1%; n=377) for reasons such as old age, good vision in the other eye. This was followed by 'no one to accompany' (20.3%; n=125). Of the 251 individuals who had 'service-related' barriers, lack of affordability was the major barrier (76.1%; n=191) followed by lack of accessibility (12.7%; n=32). Over 11% (n=28) of the individuals were advised to wait for cataract surgery.
  
  
  CONCLUSIONS
  Person-related barriers are more common than service-related barriers in Andhra Pradesh. As the barriers trend more towards 'person-related' phenomenon such as person's attitude and 'felt need' to improve vision, newer and much intensive awareness campaigns are needed to bring about an attitudinal/behavioural change among individuals to improve the uptake of services.
authors.affiliation: Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India Bausch & Lomb School of Optometry, L V Prasad Eye Institute, Hyderabad, India.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Marmamula
authors.affiliation: Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India.
authors.forename: Rohit C
authors.initials: RC
authors.lastname: Khanna
authors.affiliation: Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India.
authors.forename: Konegari
authors.initials: K
authors.lastname: Shekhar
authors.affiliation: Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India Bausch & Lomb School of Optometry, L V Prasad Eye Institute, Hyderabad, India.
authors.forename: Gullapalli N
authors.initials: GN
authors.lastname: Rao
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D013997:Time Factors; D014786:Vision Disorders / Q000628:therapy
keywords: EPIDEMIOLOGY; PUBLIC HEALTH