Methodological quality of the review: Low confidence
Author: Finger RP.
Sub-sector: Access to surgery and barriers to services
Type of cataract: Age-related cataract
Equity focus: None specified
Review type: Effectiveness review
Quantitative synthesis method: Narrative synthesis
Qualitative synthesis methods: Not applicable
Blindness caused by cataracts poses a major challenge all over the world. In India, although there are services available for the treatment of cataract, the number of blind people has risen. The implementation of outreach initiatives and activities to treat cataract and a general increase in cataract services have not translated into take-up of those services, even if many of these are free of charge. Authors note that existing facilities are underutilized and ‘even outreach programmes are faced with a certain proportion of people identified for cataract surgery who do not accept the services offered’.
To perform a systematic review of the literature related to barriers to cataract surgery services in India and to identify research needs.
Authors included studies that made reference to or evaluated barriers to accessing cataract surgery, however, the number and types of studies included in the review were not clearly described.
Authors identified numerous barriers to accessing cataract services including: lack of funding to access to the service, distance, fear, distrust of offered services, lack of awareness that the service exists, lack of support or time and, inability to free oneself from work obligations or family responsibility to have the treatment. However, these have not been put into the wider context of health-seeking behaviour. Authors also found that financial barriers continue to be a major reason for the underutilization of cataract surgery services.
Authors noted that more in-depth research is required to fully understand why people do not take up available cataract services and to encourage and increase self-motivated uptake of cataract surgery services.
Authors included studies that made reference to or evaluated barriers to accessing cataract surgery.
Authors conducted a search of Medline and PUBMED to identify relevant studies and searched reference lists of included studies but did not report if there were any date or language restrictions.
Data synthesis consisted of a narrative analysis of included studies.
Authors did not fully report how generalizable the results are but do recognize that nearly all cited articles were based on findings from the Indian States: Tamil Nadu, Andhra Pradesh, Karnataka and New Delhi and is therefore specific to certain regions in India.
The review focused specifically on India, with passing reference to studies from Kenya and Nepal. Therefore, the review identified certain barriers to access to cataract surgery within certain low-income settings.
This review was based on two databases search (MEDLINE and PUBMED) and on reference lists searches. However, it is not clear whether language and or date restrictions were applied; as such we could not be confident that relevant literature was not omitted. In addition, it is unclear whether two researchers independently participated in the screening and data extraction processes, to reduce potential biases in study selection and analysis.
In relation to the included studies, sufficient details were not provided within the review including, participant characteristics, interventions, and outcomes. Furthermore, no assessment of quality and risk of bias were reported in the review and, therefore, the robustness of the included studies could not be evaluated. The review aimed to identify barriers to cataract surgery services and identify further research needs, making a qualitative synthesis is appropriate, although methods behind the data synthesis are not fully reported. Based on the information provided on the review, overall, low confidence was attributed in the conclusions about the effects of this study.
Finger RP. Cataracts in India: Current Situation, Access, and Barriers to Services Over Time. Ophthalmic Epidemiology. 2007;14:112-8.